Internal Medicine

0521779407-19 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:21

1324 Scabies Schistosomiasis

➣apply nightly for 3 consecutive nights

➣wash off 24 hours after last application

➣messy, odor, not as effective

■crotamiton cream and lotion

➣two daily applications

➣not very effective

■ivermectin tablets

➣repeat 1 week

follow-up

Routine

■if symptomatic, microscopic re-examination

■re-assess symptoms in 6 weeks

complications and prognosis

■secondary bacterial infection

■eczematous symptoms even after scabies eradicated

■prognosis is excellent

SCHISTOSOMIASIS

J. GORDON FRIERSON, MD

history & physical

History

■Causative agents are Schistosoma mansoni, Schistosoma hemato-

bium, Schistosoma japonicum.

➣Life cycle:S hematobiumadults live in venules around the blad-

der,S mansoniin venules around lower colon and rectum (infe-

rior mesenteric plexus), andS japonicumin venules around the

superior and inferior mesenteric plexus. Eggs pass out in either

the urine or stool, depending on worm location, and hatch in

fresh water into miracidia, which penetrate snails. Multiplica-

tion occurs and cercariae emerge as infective larval form. These

penetrate skin and go via the circulation to the lungs, then to the

portal circulation. After mating, the females move to the vesical,

superior or inferior mesenteric plexus (dependant on species),

where they lay eggs and start a new cycle.S hematobiumfound

in tropical Africa and Egypt, S mansoni in tropical Africa, Egypt

and parts of middle East, and South America, andS japonicumin