Leukemia (Blood Cancer)

 

Schistosomiasis the disease caused by the parasite Schistosoma we're gonna talk about what are some of the symptoms of schizophrenia and finally we're gonna talk about how it’s treated so I begin with what is Schistosomiasis, well again it is a disease caused by an infection of a parasitic blood fluke or schistosome and this disease is also known as bilharziasis and it is estimated that more than 200 million people worldwide are infected with schistosomiasis and about 200,000 deaths are attributed to schistosomiasis per year and most infected individuals are actually symptomatic now here's a picture of the schistosome parasitic blood fluke and individuals are infected with the blood fluke in contaminated water so when individuals such as children adults wade through the waters they can be infected by the schistosome blood flukes.

There are five different species of Schistosoma blood fluke that can cause Schistosomiasis and each has a different geographical range.

The first one is Schistosoma mansoni and Schistosoma mansoni is located in Africa, Middle East Caribbean, and South America the next one is Schistosoma japonicum and Schistosoma japonicum is located in China Indonesia and the Philippines another species is known as Schistosoma Mekongi and this species is found in Cambodia another species is Schistosoma haematobium in this species is found in Africa in the Middle East and this one, in particular, is involved in genital urinary infection and the last one is Schistosoma intercalated in Schistosoma intercalated is found in the Congo Gabon and Cameroon so here is a diagram from the CDC on the lifecycle of Schistosoma.

So if we start at the egg stage the eggs can be carried in the feces and urine of infected individuals and these eggs can be released into the water and hatched into what we call miracidia. Miracidia can then penetrate into snail tissue so the miracidia can then penetrate into its intermediate host the snail eventually what we call sporocysts to begin to accumulate in the snail and then cercariae are released from the snail and into the water and these cercariae are free swimming and these are what can actually penetrate and they can penetrate into the skin so when the person is walking through the water the Sarkari can enter and penetrate into the skin when the circular to penetrate into the skin they lose their tail and become a Schistosoma lay the Schistosoma we can then enter the circulation of the infected individual migrate to the portal blood in the liver and then mature into adults whereby they.

The adult worms can then migrate into the mesenteric venules of the bowel and rectum they lay eggs and then these eggs can be shed in the stool and then into some water source and then the cycle can begin again and that completes the life cycle of the Schistosoma parasitic blood fluke so when an individual is infected with a Schistosoma parasite what are some of the symptoms well in an acute infection which typically occurs in travelers going to some of these affected regions. The individuals can get what we call swimmers to itch or an itchy rash from the penetration of sir Kerry into the skin and it can look something like this so you get this rash if you've been in contaminated waters and during the acute period of infection we can see this syndrome known as acute schizophrenia fever and this we'll talk about this in another lesson but this is due to an immune reaction to these parasites and can lead to a different subset of symptoms.

Now most of the symptoms we talked about in schistosomiasis are due to a chronic infection the chronic infection is due to ongoing exposure to the parasites and they've produced eggs and the disease severity itself is related to the number of eggs and tissue distribution of the parasites and the eggs now depending on how many eggs are in the intestinal tract, we can see different types of symptoms within the intestinal tract some of them include a chronic or intermittent abdominal pain. These individuals can also experience poor appetite they can have diarrhea can have intestinal bleeding and diarrhea and intestinal bleeding can lead to an iron deficiency anemia some of the other symptoms of schizophrenia system so we've talked about how the worms can migrate to the portal system of the liver and this can lead to several important symptoms.

In these patients one is hepatomegaly so the liver enlarges in some of these patients there can be periportal fibrosis there can be portal hypertension, the portal hypertension is due to just an accumulation of these parasites within the portal system leading to an increase or buildup in the portal pressure and portal hypertension from the parasite burden can lead to splenomegaly due to a backup of venous return back into the spleen leading to splenomegaly so we call this a Patou splenic Schistosomiasis.

Another system that can be infected is the genitourinary system and this can lead to genitourinary schistosomiasis this genital urinary symptoms can be usually related to an infection with Schistosoma haematobium and this can lead to infertility in some patients it can lead to an increased risk for HIV infection, hematuria and it's essential to realize that in these cases eggs can be also excreted in the urine so the eggs can be released leading to lesions and this is can be a reason why we see blood in the air in hematuria and can also lead to increased risk of HIV infection.

Another system that can be infected is the pulmonary system and the parasite burden if they are located within the pulmonary system it can lead to an increase in pressure in the system leading to pulmonary hypertension it can lead to a core pulmonale can lead to disme a can lead to cardiac enlargement and it can lead to pulmonary arterial dilatation which is typically seen in the end stage.  

Another system that can be affected is the nervous system and it can lead to what we call neuro schistosomiasis and this is again due to the parasite burden. It can lead to spinal cord lesions and it typically causes myelopathy more so than the cerebral disease but you can still see symptoms of the cerebral disease as well. Other symptoms include anemia malnutrition growth retardation and general disability. We've talked about some of the reasons why these symptoms can occur as well so now that we know some of the symptoms of schistosomiasis how can we definitively determine if it is schistosomiasis or not. That comes down to diagnosis of the schistosomiasis and it is so important to ask travelers in particular what countries they've traveled to if they've been into any of these affected regions and it's also important to ask individuals from these countries if they've been wading through any open waters and if they've had any rash or any of the other symptoms that can fit with schistosomiasis but with diagnosis, it's important to check serology so look for antibodies that's particularly important in travelers it's important to do a urine analysis. we've talked about how some species can release their eggs in the urine and it's important to do a PCR to check for parasite genetics so it's important to check these for diagnostic criteria to see if these individuals are in fact infected with Schism parasites and once we have determined if it is a Schistosoma infection what are some of the treatments.

Well, the treatment for schizophrenia or built reside so praziquantel is actually anthelmintic or an antihelminthic anti against helminthic it's against these parasitic worms so it is a drug that can kill these parasitic worms and a dose of typically 20mg/kg is needed three times daily four to six-hour intervals for one day would be the treatment for these individuals so again the treatment for schistosomiasis and antihelminthic and we give it to the patient at a 20mg/kg dose and we give this dose three times a day in about four to six-hour intervals for one day and that is the treatment for schistosomiasis. 

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