0521779407-19 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:21
Schistosomiasis 1327■Oxamniquine: drowsiness and dizziness (in up to 15%), and mild
fever on day 3–4 after administration (probably due to worm death)
■Contraindications to treatment: absolute: first-trimester pregnancy,
patients clinically unstable (such as hemorrhage, sepsis, etc.)
■Contraindications to treatment: relative: lesser degrees of instability
(such as recent surgery, etc.)
follow-up
During Treatment
■Katayama syndrome: Observation, stabilization
➣Chronic phase: little needed
Routine
■Chronic phase: Check urine or stool for O&P 3 months or more after
treatment, and request assessment for viability of eggs found. In later
stages, reassessment of portal fibrosis with ultrasound.
complications and prognosis
■Portal hypertension: low degree of reversibility with chemotherapy.
May require shunting procedure to prevent recurrent bleeding.
■Genitourinary disease: Ureteral obstruction often reverses with
chemotherapy, and bacteriuria responds better after worm therapy.
Calcification and carcinoma of bladder occur in chronic hemato-
bium. Granulomas, fibrotic lesions common in female genitalia, less
in male, generally treated with excision.
■Pulmonary disease: presents as cor pulmonale, and some fibrosis,
mainly around arterioles. Not usually reversible.
■CNS disease:S japonicum(2–4% of cases) orhematobium(infre-
quent) eggs may be in brain, causing seizures or mass effect. Diag-
nosed on CT or MRI in appropriate patient. Treated with praziquantel
and often steroids.
■S mansonieggs may occur in spinal cord, usually low, causing para-
plegia, usually seen early in infection. Diagnosed by seeing swelling
on MRI in patient with known disease, or at surgery. Treated with
steroids and praziquantel.
■Salmonella-schistosome syndrome: chronic salmonella bacteremia
can occur in all 3 schistosome infections, apparently due to
salmonella attached to cuticle of adult worms. Presents as chronic
fatigue, fever, weight loss, seldom acutely ill. Chronic salmonella uri-
nary infection may co-exist inS hematobium. Responds to treatment
of schistosomiasis and antibiotics.
■Ectopic eggs and worms can be found almost anywhere, responding
to local excision or chemotherapy.