B65.0/B65.1
DESCRIPTION
- Disease manifestations caused by infestation by species of the genus Schistosoma.
- Infestations with S. haematobium and S. mansoni are endemic in certain areas of South Africa.
- Nematodes reside in venous plexus draining bladder wall (haematobium ) or intestine (mansoni ).
Complications include:
- haematuria,
- strictures,
- dysuria,
- hepatosplenomegaly,
- cystitis,
- portal hypertension,
- calcifications in the bladder wall,
- cirrhosis,
- obstructive uropathy,
- ascites,
- bladder stones,
- pulmonary hypertension,
- intestinal perforation,
- bladder cancer,
- fistulas,
- spinal cord granulomas with pressure effects.
DIAGNOSTIC CRITERIA
Clinical
- Transient pruritic papular rash (swimmers itch) after exposure to cercariae in the water.
- A few weeks after exposure:
- fever,
- wheezing,
- chills,
- hepatosplenomegaly,
- headache,
- arthralgia,
- urticaria,
- lymphadenopathy,
- cough, and
- eosinophilia.
- Haematuria and dysuria.
- Abdominal pain and diarrhoea often after ingestion of food.
Investigations:
- Serology for schistosomiasis.
- Urine and stools microscopy for viable eggs or rectal biopsy specimens.
GENERAL AND SUPPORTIVE MEASURES
- Educate patient/caregiver on preventative measures.
- Symptomatic and supportive treatment.
- Avoid exposure to water contaminated by schistosoma.
- Surgical intervention to correct or prevent complications.
MEDICINE TREATMENT
Acute Schistosomiasis
- Prednisone, oral, 0.5 – 1 mg/kg daily for 5 days.
Start antihelmintic once acute symptoms have resolved:
- Praziquantel, oral, 40 mg/kg as a single dose or in 2 divided doses on the same day.
Chronic Schistosomiasis
- Praziquantel, oral, 40 mg/kg as a single dose or in 2 divided doses on the same day.
- If given within 6 weeks of exposure, to be repeated in 4-6 weeks.
REFERRAL
- Schistosomiasis with suspected complications following adequate therapy.