5-47
Plates Picture 34)
Assessment:
Differential Diagnosis:
Fever and lymphadenopathy - many possible etiologies to include secondary syphilis, mononucleosis and HIV.
Enlargement of liver - chronic liver diseases (Hepatitis B, hepatitis C and others)
Hematuria - kidney stones, urinary tract infections, bladder cancer and others
Plan:
Treatment: Praziquantel: 20 mg/kg bid po x 1 day for S. mansoni and S. haematobium, 20 mg/kg tid x
1 day for S. japonica. If Katayama fever is present, treatment may result in initial clinical deterioration. Use
steroids for 5 days in conjunction with the praziquantel to prevent this. All infections should be treated to avoid
the chronic complications of this parasitic illness.
Patient Education
General: Avoid contact with fresh water in endemic areas.
Activity: As tolerated
Diet: As tolerated
Medications: Praziquantel is usually very well tolerated
Prevention and Hygiene: Avoid contact with fresh water in endemic areas.
No Improvement/Deterioration: Refer to higher level of care.
Follow-up Actions
Return evaluation: Refer to higher level of care as needed.
Consultation Criteria: Failure to improve
Zoonotic Disease Considerations
Agent: Schistosoma spp., Schistosome cercariae (swimmer’s itch)
Principal Animal Hosts: Cattle, buffalo, swine, dogs, cats, sheep, goats (depending on species and location)
Clinical Disease in Animals: Ruminants - hemorrhagic enteritis, anemia, emaciation
Probable Mode of Transmission: Penetration of unbroken skin by cercariae from infected snails in water
Known Distribution: Worldwide, depending on species and location
ID: Strongyloidiasis (Cutaneous Larva Currens)
LTC Glenn Wortmann, MC, USA & MAJ Joseph Wilde, MC, USARIntroduction: Strongyloides stercoralis is found worldwide in the warm, damp soil of the tropics and
subtropics, especially in Southeast Asia. Larvae penetrate the skin and travel to the lungs, then are coughed
up and swallowed where they pass into the small intestine and mature into adults. Incubation period is 2-4
weeks, but because of an autoinoculation cycle the parasite can be reactivated many years later when host
is immunocompromised (steroids, chemotherapy, AIDS, advanced age). This may result in a hyperinfection
syndrome that can result in overwhelming infection and death.
Subjective: Symptoms
Diarrhea, abdominal pain, nausea, cough, wheezing, SOB. Characteristic rash of cutaneous larvae currens
(CLC)- migrating, thread-like, erythematous, pruritic, maculopapular, rapidly moving rash (several cm per hour)
at the site of larval penetration, often occurs on the buttocks region from external autoinfection.
Focused History: Have you noticed a rash around your anus or trunk? (CLC) Is the rash migrating? (CLC
migrates) How long have you been having symptoms? (can last for years)