Schistosomiasis

Question 1

Schistosomiasis is an acute and chronic parasitic disease caused by blood flukes (trematode worms) of the genus Schistosoma. Is this a:

1 - virus
2 - bacteria
3 - parasite

Answer 1

3 - parasite

Basically worms
251.4 million people required preventive treatment in 2021.

Question 2

Where is Schistosomiasis most common?

1 - North America
2 - Sub-Sahara Africa
3 - South East Asia
4 - South America

Answer 2

2 - Sub-Sahara Africa

Question 3

What is the typical incubation period for Schistosomiasis?

1 - <7 days
2 - <11 days
3 - <21 days
4 - 18-84 days

Answer 3

4 - 18-84 days

Question 4

Is Schistosomiasis most common in men or women?

Answer 4

• Men

Transmitted by swimming through the urethra or broken skin when men urinate in fresh water

Question 5

Which 2 of the following are risk factors for Schistosomiasis?

1 - fresh water exposure in endemic areas
2 - female
3 - male
4 - immunocompromised

Answer 5

1 - fresh water exposure in endemic areas
3 - male

Question 6

Once infected, where do Schistosomiasis migrate to?

1 - liver
2 - spleen
3 - kidneys
4 - heart

Answer 6

1 - liver

Question 7

Once mature, Schistosomiasis leave the liver and migrate where?

1 - kidneys
2 - payers patches of the kidneys
3 - venous plexus
4 - lungs

Answer 7

3 - venous plexus

Targeting eggs and sperm, leading to inflammation and fibrosis and form granulomas

Can cause infertility

Question 8

Which of the following is the most common acute presentation of Schistosomiasis?

1 - strawberry tongue
2 - swimmers itch
3 - rose/salmon sports
4 - erythema migrans

Answer 8

2 - swimmers itch

Pruritic (itchy) papular, urticarial (hives) rash, especially on legs and feet

Strawberry tongue = Kawasaki disease or Scarlet fever
Rose/salmon sports = Enteric Fever
Erythema migrans = Lyme disease

Question 9

In addition to swimmers itch, which of the following are part of the Schistosomiasis syndrome?

1 - flu like symptoms (headache, myalgia, chills)
2 - angioedema
3 - cough
4 - abdo pain
5 - diarrhoea
6 - all of the above

Answer 9

6 - all of the above

Can also lead to eosinophilia (high number)

Angioedema = this is excessive swelling of parts of the body

Question 10

If the Schistosomiasis infection becomes chronic, which of the following can occur?

1 - hepatosplenomegaly
2 - portal/pulmonary hypertension
3 - haematuria
4 - neuroschistosomiasis
5 - all of the above

Answer 10

5 - all of the above

Neuroschistosomiasis = acute myelopathy (spinal cord damage)

Ultrasound, CT and MRI can be used to confirm diagnoses of organ damage

Question 11

Which cancer is most commonly associated with Schistosomiasis?

1 - lung cancer
2 - bladder cancer
3 - liver cancer
4 - splenic cancer

Answer 11

2 - bladder cancer

If genitourinary system becomes infected.
Leads to dysuria, haematuria, obstruction and bladder cancer (squamous cell)

Question 12

When diagnosing Schistosomiasis, there is typically a rise in which cell during acute infection?

1 - B cells
2 - macrophages
3 - RBCs
4 - neutrophils

Answer 12

4 - neutrophils

Chronic infection leads to anaemia

Question 13

Stool and urine samples are the gold standard for diagnosing Schistosomiasis. Microscopy urine and stool and tissue samples and biopsy from bladder and/or rectum in a patient with suspected Schistosomiasis will demonstrate what that can aid in diagnosis?

1 - inflammation and fibrosis
2 - Schistosomiasis eggs
3 - high macrophage count
4 - active bleeding

Answer 13

2 - Schistosomiasis eggs

Also be present in stool and urine

Question 14

Which of the following is the 1st line treatment for a patient with a confirmed diagnosis of Schistosomiasis?

1 - doxycycline
2 - praziquantel
3 - aciclovir
4 - amoxicillin

Answer 14

2 - praziquantel

Medication that targets parasites including worms

Typically 1 dose, but can be repeated if infection is persistent or reinfection

Question 15

18 yr old 6th former returned from a 6/52 trip in Uganda on school expedition. 1/52 after returning, he had self-limiting febrile diarrhoeal illness. He was referred to rapid access ID clinic, confirming he had all his travel vaccines and went white water rafting. Examination entirely unremarkable. Tests showed:

• Eosinophilia 4.2 x109/L
• Evanescent urticarial rash
• Mild wheezeStool
• ova, cysts and parasite x 3 NEG
• Terminal urines – NEG

Which parts of the history suggest a Schistosomiasis infection?

Answer 15

• trip to Uganda
• white water rafting
• high neutrophils

Question 16

If Lake Milawi comes up in a question then the answer is Schistosomiasis