Schistosomiasis: A Deep Look into Clinical Features and Laboratory Dianosis.
Schistosomiasis is a chronic disease. Many infections are such clinically sympathetic, with the anaemia and malnutrition been common in endemic areas. Acute schistosomiasis (Kafayama’s fever) many occur weeks after the initial infection, especially by S. mansomi and S. japomicum.
Symptoms vary with species of worm and the phase of infectious. Initial invasion of the skin may cause itching and a rash (swimmiers and aposis itch). Heavy intestation (a long number of parasites) may cause fever, Chills, lymph node enlargement, lever and spleen enlargement.
Urinary symptoms may include frequent urination, painful urination (dysuria) and blood in urine (hematuria). Intestinal symptoms include abdominal pain and diarrhea (which may by bloody), Eosinophilia-extreemly high esocinophil granulocyte count. (Cheesbrough, 2000).
Occasionally central nervous system lesions occur, cerebral granulomatious disease may be caused by ectopic S. japrocum eggs in the brain and granulomatious lesion around ectopic eggs in the spinal cord from S. manson myelitis with flaccid paraplegia.
Continuing infection may cause granulomatious reaction and fibrosis is the affected organs which may result in manifestation that includes.
- Colomic polyposis with bloody diarrhea. (S. mansom mostly).
- Portal hypertension with hematemesis and spleenomegaly caused by S. mansom and S. japoncum.
- Glomerulonephritis and central nervous system lesions
- Repeated secondary blood infection can occur, because bacteria can enter the blood stream through the colon if it has become irritated. Bladder cancer diagnosis and mortality are generally elevated in affected areas (CDC 2004). Hepatic schistosomiasis, in early stage causes dyspespsia, flatulence and pain are present in the lefe hypochondium due to spleen enlargement. Anaemia or corpulence may cause generalized pain, weakness and shortness of breath, in the later stages, abdominal distension, lower limb oedema hematemosis and melena can occur. Symptoms of liver failure are rare unless other infectious, toxic of malignant causes of hepatitis are present latif, (Strickland GT 2006).
Cardiopulmonary schistosomiasis may cause larval pneumonirs with a cough, mild wheezing and a cow grade fever. In schistosomal or corpulmonale, easy fatigability palpitations occurs, CNS schistosomiasis involves focal and generalized seizures, headache and myeloradiculopathy with lower limb and back pain, bladder dysfunction, parestheesia and lower limb.
Weakness female gential schistosomiasis (FGS): include postcoital bleeding, genital ulceration irregular menstruation and picric pain. (Parslow, T.N, 2001)
Methods of diagnosis include:
- Antibody detection
- Morphologic comparison with other intestinal parasites.
Microscopic identification of eggs in urine is the most practical method for diagnosis. Eggs can be found in the urine infected with S. haematobium (recommended time of collection is between 10am and 3pm) and with S. japnicum. Dedication was enhanced by centrifugation and examination of the sediment. Quantitation is possible by using filtration through nucleopore membrane of a standard volume of urine followed by egg count on the membrane (Cheesbrough M. 2000
Tissue biopsy (rectal biopsy for all species and biopsy of the bladder for S. haematobium) may demonstrate egg when stool or urine examinations are negative. Investigation of S. haematobium should also include a picric x-ray as bladder will calcification is highly characteristic of chronic infection (CDC, 2006).
Antibody defection can be useful in both clinical management (e.g. recent infection) and for epidemiologic surveys. Hence upon return from foreign travel, those who may have been exposed to schistosome infected freshwater should be advised to undergo screening tests.
Because serologic test are more sensitive than microscopic examination of stool, and urine for eggs, previously uninfected but potentially exposed travelers should be tested for antibodies to schistosome if microscopic examination of stools and urine for eggs is negative or not available (CDC,2006).
Detecting antibodies specific to S. haematobium and S. japonicum adult worm microsomal antigens (i.e mansom adult worm microsomal antigen (MAMA), haematobium adult worm microsomal antigen (HAMA), japonicum adult worm microsomal antigen (JAMA) have been reported to be highly specific for all three (3) species when used in the falcon assay screening test (FAST), enzyme liked immune assay (ELISA), and test immunoblot assays.
In CDC 2006 ELISA screening performed showed 99%, 9%and 50% sensitive for S. manson, S. hacmabium and S. japonicum respectively, and a confirmatory, S. specie specific immunoblot that is at least 95% sensitive and 99% specific for all the three species.
Though serologic test performed in commercial laboratories may not be as sensitive and specific. Antibody detection can be useful in both clinical management and for epidemiologic surveys but cannot be used to differentiate active and past illness, (CDC,2006).