Schistosomiasis (Bilharziasis ; Snail Fever)

A slowly progressive disease caused by blood flukes of class trematoda. A chronic wasting disease common among farmers and their families in certain parts of the Philippines.

Causative agent
TYPES:

y y y

Schistosoma Japonicum (Oriental Schistosomiasis) - infects the intestinal tract or Katayama disease. Found to be only type that is endemic in the Philippines. Schistosoma Mansoni- infects intestinal tract and common in some parts of Africa. Schistosoma Haematobium- infects urinary tract and can be found in some part of the Middle East.

Incubation period
y 2 months

Modes of transmission
y y y Through ingestion of contaminated water. Through the skin. The disease is transmitted through an intermediary host Oncomelania Quadrasi

Clinical Manifestation
y y y y y y Swimmer s itch- pruritic rash develops at the site of penetration. Low grade fever, myalgia and cough. Hepatomegaly and spleenomegaly. Bloody mucoid stools, dysentery like that comes on and off for 2 weeks. Jaundice. Abdominal enlargement.

Diagnostic Exam
y y Serology Stool and urine analysis

Pathophysiology
Eggs are eliminated with feces and urine

Egg hatch release miracidia swim/ penetrate snails (Oncomelania Quadrasi)

Sporocysts and production of cercariae

Snail inefective cercariae swim penetrate human host schistosomulae

shed their forked tail -

Migrates to several tissues and stage s to their residence in veins

Adult worms resides in the mesenteric

The females deposits eggs in the small venules of the portal and perivesical systems.

The eggs are move progressively toward the lumen of intestine, bladder or ureter and are eliminated

Prevention and Control

PREVENTIVE MEASURES:

y Educate the public in endemic areas regarding mode of transmission and methods of protection. y Dispose of feces and urine so that viable eggs will not reach bodies of fresh water containing intermediate snail host. Control of animals infected with s. Japonicum is desirable but usually not practiced. y Improved irrigation and agriculture practices: reduce snail habitats by removing vegetation or by draining and filling. y Treat snail breeding sites with molluscides. y Prevent exposure to contaminated water (use rubber boots). To minimize cercarial penetration after brief or accidental water exposure, towel dry, vigorously and completely, skin surface those are wet with suspected water. Apply 70% alcohol immediately to the skin to kill surface cercariae. y Provide water for drinking, bathing and washing clothes from sou rces free of cercariae include water treatment with iodine or chlorine, or use of paper filters. Allowing water to stand 48-72 hours before use is also effective. y Treat patients in endemic areas to prevent disease progression and to reduce transmission by reducing egg passage. y Travelers visiting endemic areas should be advised of the risks and informed about preventive measures. FILARIASIS (ELEPHANTIASIS; BARBADOS LEG; ELEPHANT LEG; MORBUS HERCULUS)
An extremely debilitating and stigmatizing disease cau sed by parasitic worm affecting men, women and children. The adult worm can only live in the lymphatic system. Rarely fatal, it causes extensive disability, gross disfigurement and untold suffering for millions of men, women and children.

Causative Agent
Wuchereria Bancrofti: A 4-5 cm long thread like worms that affected the body s lymph nodes and vessels.

Incubation Period
The incubation period which starts from the entry of the infective larvae to the development of the clinical manifestation is variable; nevertheless, it ranges from 816 months. (worms can live for 4 to 6 yrs.)

Modes of Transmission
The disease is transferred from person to person by mosquito bites: Anopheles and Aedes Aegypti.

Pathophysiology
Parasitic filiarae worms lives almost exclusively in humans

Mosquito bites

infected human pick up microfilarae in the blood

Larvae migrate to the mosquitoes biting mouth part ready to enter the punctured skin

The worm lodge in lymphatic system

produce millions immature microfilarea

Acute episode local inflammation of the skin, lymph nodes accompanied by recurrent attack

of fever, pain, head ache and edema, nausea and vomiting.

Chronic stage massively swollen legs, arms, genitals, scrotum, kidney and liver

Complication

tissue necrosis

Clinical Manifestation
ASYMPTOMATIC STAGE:

No clinical signs and symptoms of the disease. Presence of microfilariae in the peripheral blood. Microfilariae rate increases with age and then levels off Some remain asymptomatic for years.

ACCUTE STAGE

Lymphadenitis (inflammation of the lymph nodes). Lymphangitis (inflammation of the lymph vessels). In some cases, the male genitalia are affected leading to funiculitis, Epidydimitis, or orchitis (redness, painful and tender scrotum).

CHRONIC STAGE

Hydrocoele (swelling of the scrotum). Lymphedema (temporary swelling of the upper and lower extremities). Elephantiasis (enlargement and thickening of the skin of the lower and upper extremities, breast and genitals).

Diagnostic Exam
y Serology

Prevention and Control

y y Environmental sanitation such as proper drainage and cleanliness of surrounding. Spraying with insecticides.