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Diagnosis and Management of Schistosomiasis


Diagnosis and Management of Schistosomiasis

Darren J Gray et al. BMJ.

Conflict of interest statement

Competing interests: All authors have completed the Unified Competing Interest form at (available on request from the corresponding author) and declare: all authors had financial support from the National Health and Medical Research Council of Australia for the submitted work, no financial relationships with any organisations that might have an interest in the submitted work in the previous three years, and no other relationships or activities that could appear to have influenced the submitted work.


Fig 1 Proposed pathways of schistosomiasis associated disease and disability. Adapted from King et al with permission from Elsevier
Fig 2 Global distribution of schistosomiasis. Adapted from Gryseels et al with permission from Elsevier.
Fig 3 Schistosome lifecycle. Freshwater molluscs act as intermediate hosts and higher order vertebrates as definitive hosts. Adult male and female worm pairs (slender female schistosome lies within the ventral gynaecophoric canal of the male) produce numerous eggs, most of which are deposited in the capillaries and tissues of the parasitised target organ and some of which are excreted via the urine or faeces. The shape of the eggs and the location of their excretion differentiate the various species. S haematobium inhabits the urinary system and the sacral and pelvic vessels, while intestinal schistosomes inhabit the intestinal mucosa. Some eggs are carried downstream in the portal circulation and, in the case of an S mansoni or S japonicum infection, are trapped in the liver. Once excreted, an ovum hatches in contact with fresh water and a free living motile miracidium is released to infect the specific freshwater snail intermediate host—with S mansoni this is generally Biomphalaria glabrata (Americas) or B pfeifferi (Africa). After about 30 days infected snails release free swimming cercariae in response to sunlight. These can penetrate the skin of the mammalian host within 12-24 hours, invade the lymphatic system, and enter the circulation via the lungs as maturing schistosomula.
Fig 4 Clinical manifestations of acute schistosomiasis. Left: maculopapular rash ( Right: chest radiograph showing pulmonary infiltrates. Reproduced from McManus et al with permission from the American Society for Microbiology.
Fig 5 Chronic/advanced schistosomiasis pathology. (A) Characteristic perioval granuloma formed around S japonicum egg in mouse liver. (B) Granuloma formed around an S mansoni egg in human lung tissue. (C) Retrograde pyelogram showing right sided ureteric stricture due to infection with S haematobium. (D) Double contrast barium enema of a patient infected with S mansoni. The right side of the transverse colon (left of image) has a normal smooth mucosal lining. The left transverse colon, splenic flexure, and descending colon have a fine irregular granular mucosal surface, owing to numerous small lesions caused by deposition of schistosome eggs. The lesions result in inflammation and erosion of the mucosa. Reprinted from McManus et alwith permission from the American Society for Microbiology. Courtesy of the Wellcome Trust.
Fig 6 Pathology in neuroschistosomiasis. (A) Unenhanced axial CT scan shows small, oval, hyperdense lesion (black arrow) in the paraventricular zone, dorsal of the right posterior horn. (B) Axial T2-weighted (2437/90/1 [repetition time/echo time/excitations]) MRI shows hypointense lesion (white arrow) with small centrally located area of intermediate signal (black arrow). (C) Coronal contrast-enhanced T1-weighted (600/15/2) MRI shows oval lesion of intermediate signal (arrow) with ring-like and septum-like contrast enhancement. Reprinted from McManus et alwith permission from the American Society for Microbiology. Courtesy of the Wellcome Trust.
Fig 7 Diagnostic and treatment algorithm. M/C/S=microscopy/culture/sensitivity; O/C/P=ova/cysts/parasites; FBC=full blood count; UE/LFT=urea, electrolytes, and liver function test; ESR=erythrocyte sedimentation rate; CRP=C-reactive protein; ID doctor=infectious diseases doctor; KUB=kidney, ureter, and bladder; SCC=squamous cell carcinoma.
Fig 8 Schistosome eggs from species (A) S japonicum, (B) S mekongi, (C) S mansoni, (D) S haematobium,(E)S intercalatum. Courtesy of the Centers for Disease Control and Prevention, (A, C, D, and E) and (B). Reproduced from Ross et al with permission from Elsevier.

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