Schistosomiasis Treatment Overview
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Which of the following is NOT a primary goal of treatment for schistosomiasis?

  • Eradicating the parasite completely (correct)
  • Reversing acute disease
  • Preventing neuroschistosomiasis
  • Preventing complications of chronic infection

    • What is the primary mechanism by which treatment of schistosomiasis aims to reduce the severity of the disease?

  • Neutralizing circulating immune complexes
  • Reducing the production of eggs (correct)
  • Repairing damaged organs
  • Directly killing the adult worms

    • Which of the following is typically the cause of swimmer's itch?

  • Prolonged exposure to contaminated water
  • Infection by human schistosome species
  • Exposure to nonhuman schistosome species (correct)
  • A systemic hypersensitivity reaction

    • What is the nature of 'Katayama fever' in the context of schistosomiasis?

    <p>A systemic hypersensitivity reaction (A)</p> Signup and view all the answers

    What is the usual course of treatment for the acute schistosomiasis syndrome?

    <p>Corticosteroids to reduce inflammation (C)</p> Signup and view all the answers

    What is the main reason why complete eradication of worms is not the primary focus of treatment for schistosomiasis?

    <p>Reducing the worm load is sufficient to lessen disease impact (C)</p> Signup and view all the answers

    In what geographical regions are Schistosoma japonicum infections primarily found?

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

    Which of the following clinical conditions is least likely to be reversed by anthelmintic treatment for schistosomiasis?

    <p>Late-stage hepatic fibrosis (B)</p> Signup and view all the answers

    What is the primary characteristic of praziquantel resistance in schistosomiasis, as described?

    <p>It remains exceptionally rare despite widespread use. (C)</p> Signup and view all the answers

    Which of the following best describes praziquantel's mechanism of action against schistosomes?

    <p>Exerts a combined effect on multiple pharmacologically relevant targets. (B)</p> Signup and view all the answers

    What is a significant challenge in interpreting reports of reduced praziquantel sensitivity?

    <p>Distinguishing between resistance and reinfection. (B)</p> Signup and view all the answers

    Why might praziquantel be less effective in areas with high S. mansoni transmission?

    <p>It is due to rapid reinfection and a high parasite burden. (B)</p> Signup and view all the answers

    Which of the following is a limitation of using oxamniquine as an alternative to praziquantel?

    <p>It is not as effective and contraindicated during pregnancy. (A)</p> Signup and view all the answers

    How do artemisinin derivatives potentially assist in treating schistosomiasis?

    <p>By acting on the glucose metabolism of immature schistosomes. (D)</p> Signup and view all the answers

    What has been observed when dihydroartemisinin-piperaquine is co-administered with praziquantel?

    <p>Increased effectiveness of praziquantel. (D)</p> Signup and view all the answers

    What is the primary approach advocated by the WHO for controlling schistosomiasis in endemic areas?

    <p>Periodic mass drug administration using praziquantel. (C)</p> Signup and view all the answers

    Why is mass treatment particularly beneficial among school-age children?

    <p>They typically carry the highest burden of parasites. (C)</p> Signup and view all the answers

    What is the typical dosage and method of praziquantel administration in mass treatment programs?

    <p>Single dose of 40 mg/kg orally. (D)</p> Signup and view all the answers

    What is the primary mechanism by which praziquantel affects adult schistosomes?

    <p>Disruption of tegument and increased calcium influx, leading to paralysis (D)</p> Signup and view all the answers

    Which of the following is a common complication of hepatosplenic schistosomiasis in adults?

    <p>Variceal bleeding due to portal hypertension (B)</p> Signup and view all the answers

    Why is corticosteroid treatment essential in neuroschistosomiasis?

    <p>To limit irreversible tissue damage caused by the inflammatory response to embolized eggs (C)</p> Signup and view all the answers

    In the treatment of neuroschistosomiasis, when should praziquantel be administered in relation to corticosteroid treatment?

    <p>A few days after initiation of corticosteroid treatment (D)</p> Signup and view all the answers

    Which of the following is a common adverse effect of praziquantel?

    <p>Dizziness, headache, vomiting and diarrhea (C)</p> Signup and view all the answers

    What is the primary reason for the long-term use of corticosteroids in the treatment of neuroschistosomiasis?

    <p>To manage the inflammatory response to eggs located at ectopic sites (C)</p> Signup and view all the answers

    Which of the following best describes a reason for annual screening for glomerular disease in patients with hepatosplenic schistosomiasis in endemic regions?

    <p>Hepatosplenic schistosomiasis is associated with glomerular dysfunction. (B)</p> Signup and view all the answers

    What is the recommended method for initial evaluation of potential glomerular dysfunction related to schistosomiasis?

    <p>Measurement of serum creatinine and urine dipstick testing (B)</p> Signup and view all the answers

    What is the typical duration of corticosteroid therapy in patients with neuroschistosomiasis?

    <p>At least two months, but could be longer, tailored to individual circumstances (C)</p> Signup and view all the answers

    In someone with neuroschistosomiasis, what can happen if corticosteroid therapy is discontinued or tapered too quickly

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

    What is the typical dosage of praziquantel for an adult in the treatment of regular schistosomiasis

    <p>40 mg/kg single dose (D)</p> Signup and view all the answers

    What is the most common clinical manifestation of neuroschistosomiasis

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

    What is the potential issue with praziquantel in the setting of Strongyloides infection?

    <p>It can cause the syndrome of strongyloidiasis hyperinfection in patients on corticosteroids. (A)</p> Signup and view all the answers

    What is the most common manifestation of Genital Schistosomiasis in adults?

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

    What is a common medical treatment for variceal bleeding associated with hepatosplenic schistosomiasis?

    <p>Beta-blockers (A)</p> Signup and view all the answers

    What is the typical initial treatment duration with prednisolone for schistosomiasis, based on the provided information?

    <p>Until symptoms subside and for 48 hours thereafter (B)</p> Signup and view all the answers

    Why is praziquantel typically administered 8 to 12 weeks after initial infection, alongside with corticosteroids

    <p>To allow the worms to fully mature and become susceptible to the drug, and to prevent symptom aggravation. (B)</p> Signup and view all the answers

    According to the content, what is the recommended second dose timing for Praziquantel, assuming the first dose was administered successfully?

    <p>4 to 6 weeks after the first dose, if not previously given with corticosteroids (B)</p> Signup and view all the answers

    In non-endemic areas, when should follow-up microscopy be performed post-treatment for schistosomiasis?

    <p>Three to six months after treatment (B)</p> Signup and view all the answers

    What is the primary goal of schistosomiasis treatment for individuals in endemic areas?

    <p>To reduce parasite burden and morbidity (B)</p> Signup and view all the answers

    What is the recommended dosage of praziquantel for S. japonicum infection, based on the provided text?

    <p>60 mg/kg in two divided doses (C)</p> Signup and view all the answers

    When is additional treatment with praziquantel warranted after the initial dose?

    <p>If viable eggs are present 6 to 12 weeks after initial therapy (D)</p> Signup and view all the answers

    In the context of schistosomiasis treatment, what is indicated by persistent eosinophilia for more than three months after treatment?

    <p>Insufficient reduction of parasite burden or presence of another helminth infection (B)</p> Signup and view all the answers

    Which of the following is NOT considered a suitable method for monitoring schistosomiasis treatment?

    <p>Serum polymerase chain reaction tests (D)</p> Signup and view all the answers

    Why is it crucial to defer treatment for patients with recent exposure to schistosomiasis?

    <p>To allow diagnostic serology or microscopy to confirm the infection, and for acute symptoms to subside first (C)</p> Signup and view all the answers

    What is the effect of corticosteroids on praziquantel plasma levels?

    <p>Corticosteroids reduce praziquantel plasma levels (C)</p> Signup and view all the answers

    What is one of the potential adverse effects of genitourinary schistosomiasis in adult women?

    <p>Increased vaginal mucosal fragility and bleeding (B)</p> Signup and view all the answers

    What is the primary purpose of administering corticosteroids along with praziquantel during the initial stages of schistosomiasis treatment?

    <p>To prevent potential increases in symptoms associated with praziquantel administration within 12 weeks of infection (B)</p> Signup and view all the answers

    Which of the following statements accurately describes treatment outcomes in endemic areas?

    <p>Single-dose praziquantel is curative in 20 to 100 percent of cases, and can reduce parasite burden by 30 to 90%. (C)</p> Signup and view all the answers

    When is praziquantel most effective, based on the parasite's life cycle?

    <p>When the worms have fully matured, at least 4 to 8 weeks post infection (C)</p> Signup and view all the answers

    Study Notes

    Schistosomiasis Treatment

    • Schistosomiasis is a parasitic disease caused by blood flukes (Schistosoma species).
    • Major species: Schistosoma mansoni (Africa, South America), Schistosoma japonicum (East Asia), Schistosoma haematobium (Africa, Middle East).
    • Minor species: Schistosoma mekongi, Schistosoma malayi, Schistosoma intercalatum, Schistosoma guineensis.
    • Treatment aims to reduce egg production, thereby reducing morbidity and mortality, even without total worm eradication.
    • Repeated treatment is crucial in endemic areas for elimination.
    • Benefits: Reversal of early hydronephrosis and periportal fibrosis. Limited effect on extensive fibrosis or secondary complications (portal hypertension, cor pulmonale).

    Acute Schistosomiasis

    • Swimmer's itch: Caused by nonhuman schistosome species; skin rash resolves within days. Treatment is symptomatic.
    • Acute schistosomiasis syndrome (Katayama fever): Systemic hypersensitivity reaction occurring 3-8 weeks post-infection.
    • Management: Initial treatment with corticosteroids (prednisolone 1 mg/kg/day) to reduce inflammation, typically for 3-10 days.
    • Subsequent treatment with praziquantel (40 mg/kg) 8-12 weeks after infection (after initial corticosteroid resolution). Praziquantel dosage depends on parasite species (S. haematobium/S. mansoni/S. intercalatum=40 mg/kg, S. japonicum/S. mekongi=60 mg/kg).
    • Additional praziquantel dose 4-6 weeks later (3 months after initial infection).

    Chronic Schistosomiasis

    • Treatment Goal: Reduce parasite load and morbidity in endemic areas; definitive cure outside endemic areas.

    • Treatment Timing: Delay therapy until diagnostic confirmation (6-12 weeks after suspected exposure) and resolution of acute symptoms (if present).

    • Endemic Areas: Single praziquantel dose is curative in 20-100% of cases; Reduces worm load by 30-90% (depending on diagnostic method). Retreatment offers minimal additional benefit for residual infection.

    • Travelers/Expatriates: Single praziquantel dose generally sufficient to significantly reduce worm load.

    Follow-up After Treatment

    • Monitor symptoms, eosinophil counts (if eosinophilia present), stool/urine microscopy (for eggs).
    • Antibody tests (serology), PCR are not reliable monitoring tools (remain positive for a while after treatment).
    • Eosinophilia may increase initially, then gradually decline over several weeks. Persistent eosinophilia (> 3 months post-treatment) may indicate insufficient worm load reduction or another helminth infection.
    • Endemic areas: Follow-up microscopy 6 weeks post-treatment. Non-endemic areas: 3-6 months post-treatment.

    Treatment Failure (and Retreatment)

    • Presence of viable eggs 6-12 weeks after initial therapy warrants repeat praziquantel treatment.

    • Radiographic imaging (e.g., ultrasound, MRI) may be needed in high-burden areas for long-term assessment of urinary tract/liver lesions after repeated treatment.

    Genitourinary & Hepatosplenic Schistosomiasis

    • Repeated praziquantel treatment may reverse genital lesions (more likely in younger patients). Genital schistosomiasis is associated with increased vaginal fragility/bleeding in adult women. and HIV risk.
    • Hepatosplenic schistosomiasis (associated with intestinal schistosomiasis) causes portal hypertension, often needing surgical intervention (portal shunt, devascularization, splenectomy) or medical treatment (ß-blockers).
    • Annual screening/monitoring for glomerular disease & renal dysfunction (serum creatinine, urinalysis) is recommended in patients with hepatosplenic schistosomiasis living in endemic areas.

    Neuroschistosomiasis

    • Caused by embolised adult worms in spinal cord or brain/microcirculation.
    • Severe inflammatory response leads to tissue damage and scarring which can cause cerebral disease or myelopathy.
    • Prompt corticosteroid treatment (prednisone 1-2 mg/kg/day) is essential.
    • Praziquantel may induce inflammatory reaction, and thus administered post-corticosteroid therapy.
    • Treatment duration is individualized and may last several months. Early cessation can lead to relapse.

    Anthelminthic Therapy: Praziquantel

    • Mechanism: Alters worm tegument structure, increasing calcium permeability in the worm, leading to paralysis.
    • Absorption: Oral, with food; short plasma half-life.
    • Side Effects: Dizziness, headache, vomiting, abdominal pain, diarrhoea, pruritus (often mild). High worm burden may increase adverse effects. Paradoxical hypersensitivity reactions possible in patients with acute infection or early chronic disease.
    • Pregnancy and Lactation: Praziquantel is safe for pregnancy. Excreted in breast milk; discontinue breastfeeding during and for 72 hours after treatment, or delay treatment until after breastfeeding is completed.

    Drug Resistance

    • True resistance to praziquantel is rare. Reduced sensitivity in some schistosome species has been observed, possibly linked to reinfection rather than true resistance.
    • High parasite burden and rapid reinfection may contribute to therapeutic failure (e.g., S. mansoni in Senegal)

    Alternative Therapies

    • Oxamniquine (used for refractory S. mansoni; contraindicated in pregnancy, less effective than praziquantel).
    • Artemisinin derivatives.
    • Mefloquine.

    Control and Prevention

    • Control strategies in endemic areas: Periodic mass treatment, water sanitation, vaccine development.
    • Mass drug administration (praziquantel 40 mg/kg orally) is the main WHO-recommended strategy, especially for school-age children.

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    Description

    This quiz explores the treatment of schistosomiasis, a parasitic disease caused by blood flukes. It covers key species involved, the goals of treatment, and benefits of effective management strategies. Additionally, it touches on acute schistosomiasis and related conditions.

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