5-46
Objective: Signs
Using Basic Tools: Cough, hemoptysis, tender chest, rales and decreased breath sounds.
Using Advanced Tools: Lab: Eggs in O&P of sputum (particularly in colored flecks) or feces.
CXR: Increased markings and atelectasis on effected side (consolidation).
Assessment: Diagnose empirically by history of bloody cough in an endemic area.
Differential Diagnosis - chronic cough: pneumonia, tuberculosis, lung cancer and chronic bronchitis.
Plan:
Treatment: Praziquantel 25 mg/kg tid x 3 days.
Patient Education
General/ Diet/ Prevention and Hygiene: Avoid improperly cooked freshwater crabs, crayfish and shrimp.
Activity: As tolerated
Medications: Occasional gastrointestinal side effects.
No Improvement/Deterioration: Return for evaluation.
Follow-up Actions
Return evaluation: As needed
Consultation Criteria: Failure to improve.
Zoonotic Disease Considerations
Principal Animal Hosts: Dogs, cats, swine
Clinical Disease in Animals: Can migrate aberrantly and produce cysts in brain and spinal cord; may have
neurological signs based on location of lesion.
ID: Schistosomiasis
LTC Glenn Wortmann, MC, USAIntroduction: A blood fluke (trematode) infection found in most tropical areas, particularly Asia, characterized
by adult male and female worms living in the veins of a human host. Three major disease syndromes occur in
schistosomiasis: dermatitis, Katayama fever and chronic infection. Infection occurs while swimming, wading,
rafting, washing etc. in contaminated fresh water. Penetration of the skin by worm larvae causes dermatitis
in the first 24 hours, but the clinical symptoms of acute schistosomiasis develop 2 weeks - 3 months after
exposure. Chronic schistosomiasis can result in abdominal pain or liver failure (Schistosoma mansoni, S.
japonicum) or hematuria or kidney problems (S. hematobium).
Subjective: Symptoms
Dermatitis: A pruritic rash known as swimmer’s itch.
Katayama fever: Occurs 4-8 weeks after infection and presents with acute fever, chills, headache, sweating
and cough.
Chronic infection: Can result in abdominal pain with diarrhea or hematuria.
Focused History: Have you been exposed to fresh water (e.g., swimming in a lake or pond)? (typical
exposure in endemic areas) Did you notice a rash after swimming? (rash is caused by the organism invading
the skin) How long ago were you exposed to fresh water? (Fever and lymphadenopathy from schistosomiasis
occur 4-8 weeks after exposure.)
Objective: Signs
Using Basic Tools: Dermatitis: A papular rash; Katayama fever: fever and lymphadenopathy; chronic
infection; enlargement of the liver and spleen may be noted, weight loss is common; hematuria may occur
Using Advanced Tools: Lab: Diagnose by finding schistosome eggs in O&P of feces or urine. (see Color