0521779407-19 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:21
1326 Schistosomiasissigmoidoscope can show eggs. Chest X-ray in Katayama syndrome
may show scattered infiltrates, and in late stage of all 3 types may
show fibrosis and pulmonary hypertension.
➣Ultrasound shows signs of portal hypertension and periportal
fibrosis. Liver biopsy can show eggs in all 3 types.
➣Blood assay for schistosoma antigen available as research tool.
differential diagnosis
■Cercarial dermatitis resembles other irritative and allergic der-
matoses. Sharp delimitation at borders of water exposure charac-
terize it.
■Katayama syndrome confused with invasive stage of roundworms
(hookworm, ascaris, strongyloides) and serum sickness.
■Chronic stage:S hematobiumconfused with other bladder patholo-
gies, including cancer.S mansoniandjaponicumconfused with
other helminthic infections, amebiasis, ulcerative colitis, carcinoma
of colon. Hepatosplenic stage confused with other causes of portal
hypertension: chronic hepatitis B or C, cirrhosis of any type. These
conditions can co-exist.
management
What to Do First
■Cercarial dermatitis: assess severity.
■Katayama syndrome: assess need for hospitalization, fluids.
■Chronic stage: assess for signs of portal hypertension and possible
hemorrhage. InS hematobiumassess for secondary urine infection.General Measures
■Fluids, transfusions as needed
specific therapy
Indications
■Probably all patients should be treated.
Treatment Options
■Praziquantel for 1 day. This is drug of choice.
■Oxamniquine once; give after a meal (less efficacious treatment, dif-
ficult to obtain)
Side Effects & Complications
■Praziquantel: nausea, vomiting, abdominal pain, diarrhea may
occur, usually in heavily infected patients, seldom in lightly infected.
Headache, dizziness of mild degree, sometimes.