Indiana University Infectious Diseases Fellowship
5 Mar,
14 tweets, 6 min read
#idboardreview 25 M from Madagascar 🇲🇬 swam all life in freshwater lakes presents w/ 1wk fever, pleuritic chest pain, hemoptysis, hypoxia. CT chest shown s/p lobectomy +tissue necrosis. CT pelvis:bladder wall calcification. Diagnosis? #medEd #idmedEd #IDTwitter 
#Schistosomiasis #haematobium helminthic infect 235 million people globally w/ 200k deaths annually
2 major #Schistosoma species in Africa S. mansoni (GI) & S. haematobium (GU). Both species are endemic to Madagascar, where S. mansoni in eastern, central, southern regions & S. haematobium predominant in northwest & west coast. Both species coexist in certain irrigated regions
#schistosomiasis cercarial larvae penetrate skin of human hosts➡️migrate through circulatory system➡️liver: transform into young worms & mature into adults in portal vein. Adult worms migrate to mesenteric (S. mansoni) or perivesical venous plexus (S. haematobium)➡️eggs
eggs can embolize to other organs or become entrapped in tissues while en route to bladder or intestine. Once deposited, eggs secrete proteolytic enzymes➡️granulomatous reactions&fibrosis in tissues➡️portal/pulmonary HTN. host immune response to #schistosome eggs➡️clinical dz
gold standard dx #schistosomiasis imicroscopic exam of urine, stool, or tissues for ova. Ab assays are sensitive, though do not distinguish b/w active & chronic dz. PCR for species identification. Radiology for pathognomonic signs as bladder calcification in S. haematobium
S haematobium: urinary #schistosomiasis hematuria, later bladder calcification, hydronephrosis, renal failure & bladder cancer
S mansoni egg deposition in liver can cause periportal fibrosis leading to portal HTN & GI varices
S mansoni egg deposition in liver can cause periportal fibrosis leading to portal HTN & GI varices
pulmonary #schistosomiasis ova embolize to lung via portosystemic collateral blood vessels (Smansoni) or rarely direct via IVC (Shaematobium) Granuloma in rx to ova in pulmonary arterioles➡️fibrosis➡️granulomatous endarteritis complication:thrombus, cor pulmonale, AVfistula
Treatment praziquantel #schistosomiasis
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