Schistosomiasis Quiz

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Questions and Answers

What is the initial stage of schistosomiasis after cercarial penetration?

  • Stage of egg deposition
  • Stage of chronic infection
  • Stage of established infection
  • Stage of invasion (correct)

What characteristic is true of mature eggs extruded by female worms?

  • They are larger than those of male worms
  • They contain a fully developed miracidium (correct)
  • They have an operculated shape
  • They are immature and lack a miracidium

Which symptom is associated with the schistosomular migration stage of schistosomiasis?

  • Hepatosplenomegaly
  • Pruritus and rash
  • Eosinophilia (correct)
  • Abdominal pain

What typically triggers the symptoms of Katayama fever?

<p>Schistosome migration and antigen release (C)</p> Signup and view all the answers

Which animal is considered a reservoir of schistosomiasis infection?

<p>Monkeys (C)</p> Signup and view all the answers

During which time frame does the acute schistosomiasis typically present symptoms after the initial infection?

<p>2-3 weeks (A)</p> Signup and view all the answers

In which location do immature eggs first get laid by female worms?

<p>Inferior mesenteric veins (D)</p> Signup and view all the answers

Which of the following statements about female and male worms is true?

<p>Female worms lie in the gynaecophoric canal of males. (A)</p> Signup and view all the answers

What is the primary immune response triggered by the miracidial antigens in schistosomiasis?

<p>Stimulation of both humoral and cellular immunity (A)</p> Signup and view all the answers

Which of the following conditions should be differentiated from intestinal schistosomiasis due to similar symptoms?

<p>Amoebic colitis (B)</p> Signup and view all the answers

What complication may arise from long-standing polyps in schistosomiasis?

<p>Complete intestinal obstruction (B)</p> Signup and view all the answers

What is bilharzial cor pulmonale primarily associated with in schistosomiasis?

<p>Fibrosis of pulmonary arteries (B)</p> Signup and view all the answers

Which symptom is NOT typically associated with the stage of late infection in schistosomiasis?

<p>Severe headaches (C)</p> Signup and view all the answers

What is one potential outcome of protein losing enteropathy in schistosomiasis?

<p>Decreased iron metabolism (B)</p> Signup and view all the answers

How do ectopic ova access the central nervous system in cases of neuroschistosomiasis?

<p>Through lumbar veins and the internal vertebral venous plexus (C)</p> Signup and view all the answers

What underlying issue contributes significantly to the anemia observed in schistosomiasis patients?

<p>High levels of blood loss due to inflammation (C)</p> Signup and view all the answers

Which schistosomiasis species is primarily associated with cerebral schistosomiasis?

<p>Schistosoma japonicum (C)</p> Signup and view all the answers

What clinical sign can indicate increased intracranial pressure in neuroschistosomiasis?

<p>Weakness (B)</p> Signup and view all the answers

What is a common consequence of chronic hepatic schistosomiasis?

<p>Symmer's pipe-stem fibrosis (C)</p> Signup and view all the answers

Which clinical stage of hepatosplenic schistosomiasis is characterized by tender hepatomegaly?

<p>Hepatomegaly (A)</p> Signup and view all the answers

What complication can arise from portal hypertension in patients with hepatosplenic schistosomiasis?

<p>Hematemesis (D)</p> Signup and view all the answers

Which symptom is indicative of splenomegaly in patients with hepatosplenic schistosomiasis?

<p>Spleen enlargement reaching iliac fossa (D)</p> Signup and view all the answers

Which symptom is NOT typically associated with hepatosplenic schistosomiasis in its advanced stages?

<p>Increased appetite (D)</p> Signup and view all the answers

What can lead to neuropsychiatric manifestations in patients with portal hypertension?

<p>Increased intracranial pressure (D)</p> Signup and view all the answers

What is a characteristic symptom of the acute stage of fascioliasis?

<p>Upper right abdominal pain (B)</p> Signup and view all the answers

Which sign is closely associated with the chronic stage of fascioliasis?

<p>Moderate eosinophilia (A)</p> Signup and view all the answers

What severe complication can arise from chronic fascioliasis?

<p>Hemobilia (C)</p> Signup and view all the answers

Which clinical sign indicates advanced chronic fascioliasis?

<p>Severe anemia (D)</p> Signup and view all the answers

Which condition is associated with Hazloun syndrome?

<p>Pharyngeal blockage (C)</p> Signup and view all the answers

What is a common symptom of ectopic fascioliasis?

<p>Subcutaneous edema (C)</p> Signup and view all the answers

What type of anemia is commonly observed in chronic fascioliasis?

<p>Microcytic hypochromic anemia (D)</p> Signup and view all the answers

Which of the following is an indication for clinical diagnosis of fascioliasis?

<p>High eosinophilia with liver function tests (B)</p> Signup and view all the answers

Which antigen detection methods are primarily used for diagnosing schistosomiasis?

<p>Monoclonal antibodies (D)</p> Signup and view all the answers

What is the recommended treatment for acute schistosomiasis after managing Katayama fever?

<p>Prednisolone followed by praziquantel (A)</p> Signup and view all the answers

What is the standard dose of praziquantel for treating S.haematobium and S.mansoni in adults?

<p>40 mg/kg (C)</p> Signup and view all the answers

Which measure contributes to the prevention and control of schistosomiasis?

<p>Sanitary sewage disposal (B)</p> Signup and view all the answers

Which of the following is a recommended action to minimize cercarial penetration after water exposure?

<p>Applying 70% alcohol to the wet skin (B)</p> Signup and view all the answers

For which species of schistosoma is the recommended praziquantel dose higher than 40 mg/kg?

<p>S.japonicum (D)</p> Signup and view all the answers

Which preventive strategy is NOT listed for schistosomiasis control?

<p>Refusing to drink water (A)</p> Signup and view all the answers

What is one method for effective inactivation of cercariae in water?

<p>Chemical treatment with iodine or chlorine (C)</p> Signup and view all the answers

What is the primary effect of effective treatment for schistosomiasis in relation to Salmonella infections?

<p>It deprives Salmonella of favorable conditions for growth. (D)</p> Signup and view all the answers

Which of the following diseases is associated with chronic salmonellosis in patients infected with schistosomiasis?

<p>Exudative glomerulonephritis (B)</p> Signup and view all the answers

Where does Schistosoma mansoni typically inhabit within the human body?

<p>The intestines and mesenteric veins (D)</p> Signup and view all the answers

Which species of Salmonella is mentioned in relation to schistosomiasis in chronic infections?

<p>Salmonella typhi (B)</p> Signup and view all the answers

What characteristic infections are observed in individuals with chronic salmonellosis and schistosomiasis?

<p>Chronic active schistosomiasis with indolent febrile disease (D)</p> Signup and view all the answers

In which regions is Schistosoma mansoni commonly found?

<p>Southern and sub-Saharan Africa (A)</p> Signup and view all the answers

What is the morphology of adult Schistosoma mansoni worms?

<p>Small, separate sexes with a gynaecophoric canal (B)</p> Signup and view all the answers

What role has been suggested for schistosomes concerning Salmonella infection?

<p>Schistosomes act as carriers of Salmonella infection. (C)</p> Signup and view all the answers

Flashcards

Acute Fascioliasis

The initial stage of fascioliasis characterized by high eosinophilia (up to 80%), fever, tender hepatomegaly, and jaundice.

Chronic Fascioliasis

The chronic stage of fascioliasis, marked by adult flukes in the bile ducts, leading to intermittent biliary obstruction, inflammation, and symptoms like nausea, vomiting, and pruritus.

Hemobilia

A rare complication of chronic fascioliasis where bleeding occurs in the bile duct, potentially leading to fatigue, hematemesis, melena, and anemia.

Hazloun

A type of fascioliasis where the worms settle in the pharynx, causing pain, edema, and bleeding that may affect breathing.

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Eosinophilia

A common diagnostic clue for fascioliasis, especially in the acute stage.

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Fever

A significant symptom of fascioliasis, often experienced in the acute stage.

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Hepatomegaly

A distinct sign of fascioliasis, often present in the acute and chronic stages, resulting from the parasite's impact on the liver.

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Jaundice

A key sign that indicates the presence of fascioliasis, often seen in both the acute and chronic phases.

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Chronic Salmonellosis Associated with Schistosomiasis

A parasitic infection caused by the trematode worm Schistosoma mansoni. It's characterized by chronic persistent Salmonella bacteremia, often with an indolent febrile disease lasting weeks to years, and active schistosomiasis.

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Salmonellosis

The primary cause of Chronic Salmonellosis associated with Schistosomiasis, it's a bacterial infection that can coexist with Schistosoma infections.

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Pathogenesis of Chronic Salmonellosis in Schistosomiasis

A possible mechanism by which Salmonella can persist in Schistosomiasis: Bacteria can be found in the tegument of Schistosoma worms or in the infected individual's intestinal tract.

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Indolent febrile disease

A common sign of Chronic Salmonellosis associated with Schistosomiasis, it's characterized by fever that comes and goes over an extended period.

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Salmonella bacteremia

A serious complication of Schistosomiasis, it's characterized by the presence of Salmonella bacteria in the blood.

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Intestinal Schistosomiasis

The presence of adult Schistosoma worms in the veins draining the large intestine and lower ileum.

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Occurrence of Intestinal Schistosomiasis

The geographic distribution of the Schistosoma mansoni parasite, responsible for Intestinal Schistosomiasis.

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Cycle of Infection for Intestinal Schistosomiasis

The life cycle of the Schistosoma mansoni parasite, including its habitat within the human body.

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Cercarial Penetration

Invasive stage of schistosomiasis characterized by cercariae penetration of the skin, resulting in pruritus and maculo-papular rash.

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Schistosomular Migration

The migratory phase of schistosomules through the body, leading to inflammation and immune responses, particularly affecting the lungs and liver.

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Katayama Fever

A severe allergic reaction that occurs during the migratory phase of schistosomiasis, characterized by fever, malaise, myalgia, headache, eosinophilia, fatigue, dry cough, hepatosplenomegaly, and abdominal pain.

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Chronic Schistosomiasis

The stage of schistosomiasis where adult worms release eggs into the host's body, leading to chronic inflammation and tissue damage.

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Egg Extrusion

The process by which schistosomiasis eggs leave the body through feces or urine.

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Oviposition

The presence of Schistosoma eggs in the body's tissues, leading to granulomas and chronic inflammation.

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Prepatent Stage

The stage of Schistosoma infection where symptoms are absent or mild.

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Incubation Period

The period before the clinical symptoms of schistosomiasis become apparent. It occurs during the migratory phase.

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Schistosomiasis Egg Deposition

The stage where Schistosoma eggs are deposited in the large intestine, causing a local inflammatory response known as the "bilharzial granuloma".

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Schistosomiasis Egg Pathogenicity

The main cause of serious health problems in schistosomiasis, resulting from the body reacting to the parasite's eggs.

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Fibrosis in Schistosomiasis

A complication of schistosomiasis where the accumulation of fibrous tissue prevents egg expulsion, leading to various health issues.

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Intestinal Polyposis

The development of polyps in the intestines, a common complication of schistosomiasis.

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Bilharzial Cor Pulmonale

The condition of right-sided heart failure occurring due to fibrosis and sclerosis of the pulmonary arteries, specifically in Schistosoma mansoni infections.

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Schistosomiasis and Anemia

Anemia, malnutrition, and developmental problems in children caused by Schistosoma infections.

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Neuroschistosomiasis

A rare but serious complication of schistosomiasis, where the eggs reach the central nervous system through vein connections.

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Immune Response to Schistosomiasis

The release of miracidial antigens triggers both humoral and cellular immune responses in the body.

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Neurological Complications of Schistosomiasis

Eggs deposited by Schistosoma worms in the spinal cord or brain can cause inflammation and granulomas.

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Cerebral Schistosomiasis

Schistosomiasis japonicum, with its smaller eggs, is more likely to cause brain infection than other types of schistosomiasis.

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Lumbosacral Myelopathy

Caused by Schistosoma mansoni or S. haematobium, this condition involves inflammation and damage to the spinal cord in the lower back.

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Proliferative Glomerulonephritis

The most common type of glomerulonephritis associated with hepatosplenic schistosomiasis, caused by the deposition of immune complexes.

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Hepatomegaly (Early Stage)

An early stage of hepatosplenic schistosomiasis characterized by a swollen and tender liver, often accompanied by a moderately enlarged spleen.

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Hepatosplenomegaly

A later stage of hepatosplenic schistosomiasis, marked by a liver that's enlarged but not tender, along with significant spleen enlargement due to blood congestion.

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Splenomegaly (Final Stage)

The final stage of hepatosplenic schistosomiasis, where the liver shrinks due to fibrosis, while the spleen becomes extremely enlarged, potentially reaching the iliac fossa.

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Praziquantel

The most common treatment for schistosomiasis, this drug effectively eliminates adult schistosomes in the body. It's especially effective for S. haematobium and S. mansoni, with a standard dose of 40 mg/kg.

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Antigen Detection Methods

This method involves using monoclonal antibodies to detect circulating antigens in blood, stool, urine, and other body fluids, which can be useful for diagnosing schistosomiasis.

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Mass Chemotherapy

Involves treating high-risk groups like school-age children, women of childbearing age, or people working in endemic areas with praziquantel to prevent disease development and suffering.

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Snail Control

This method uses molluscicides, predators, biological control, water management, and engineering to target and control snail populations, which are crucial for the parasite's life cycle.

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Individual Protection

This involves individual measures to protect from exposure to infected water. Examples include wearing rubber boots and drying exposed skin thoroughly after potential contact.

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Study Notes

FASCIOLIASIS

  • A disease caused by a large parasite (Fasciola), belonging to the phylum Platyhelminthes, class Trematoda
  • Affects sheep, cattle, and occasionally humans
  • A zoonotic disease—transmissible from animals to humans
  • Two species cause the disease: Fasciola hepatica and Fasciola gigantica
  • Global disease, reported from over 75 countries

OCCURRENCE

  • Common in sheep and cattle-raising areas worldwide
  • High prevalence in Egypt, particularly in the Delta region, Alexandria, Upper Egypt and the reclaimed desert areas
  • Prevalence tends to peak in children in rural areas
  • Infection can occur anywhere, following trade routes of plants (which are part of the diet in many areas)

CYCLE OF INFECTION

  • Causative agent: Fasciola species
  • Parasite lives in the bile ducts of sheep, goats, and buffaloes
  • Human infection is rare
  • Fasciola hepatica: Leaf-like, pale grey trematode, with diverging margins and spiny cuticle; 2.5-3 cm long, 1 cm wide
  • Has oral and ventral suckers
  • Hermaphrodite, with branched digestive and genital systems

PATHOLOGY & PATHOGENESIS

  • Encysted metacercariae migrate through intestinal walls, peritoneal cavity, and Glisson's capsule, often causing little damage
  • Migration in the liver parenchyma leads to trauma and necrosis.
  • Larvae cause inflammation and adenomatous response in biliary epithelium when mature.

CLINICAL PRESENTATION

  • Acute stage:
    • Upper right abdominal pain, cough, vomiting, fever, diarrhoea, weight loss, and headache
    • Main symptom is eosinophilia (up to 80%)
  • Chronic stage:
    • Cholestatic jaundice, hepatomegaly, fever, and cholangitis
  • Ectopic fascioliasis: Can affect various tissues (e.g., subcutaneous tissues, brain, lungs, lymph nodes)
  • Eosinophilia in chronic stage (up to 40%).

DIAGNOSIS

  • Microscopic identification of eggs in stool or duodenal samples (direct methods)
  • Serological tests for detection of antibodies (immunological methods)

TREATMENT

  • Triclabendazole (10 mg/kg) is the recommended treatment.

PREVENTION & CONTROL

  • Proper washing of raw vegetables
  • Avoidance of contaminated water
  • Treating domestic animals to eliminate snails

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