OVERVIEW
Overview
Schistosomiasis is an immune disease caused by infection with Schistosoma japonicum after eating uncooked stone crabs or mayflies containing cysts. The cysts of Schistosoma japonicum enter the abdominal cavity, lungs and central nervous system through the intestinal tract and grow in the tissues and organs, and antigens of the worms at different stages of development induce the body to produce the corresponding immune response and immunopathological changes.
Whether medical insurance
Yes, it is
Department
Gastroenterology, Basic General Surgery, Infection Medicine
Clinical symptoms
Diarrhea, constipation, and urgency, cough, rust-colored sputum, and abdominal mass.
Harmful effects
It leads to gastrointestinal dysfunction, abdominal adhesions, etc., affecting work and life.
Complications
Adhesion of abdominal organs, adhesive intestinal obstruction
Examination
Blood routine, blood sedimentation, sputum smear, fecal smear, cerebrospinal fluid, X-ray, fiberoptic bronchoscopy, fiberoptic colonoscopy, measurement of circulating antibody of Schistosoma pneumoniae serum, intradermal test.
Diagnosis
Diagnosis can be made on the basis of history, clinical manifestations and relevant examinations.
Treatment principle
First choice of praziquantel deworming, symptomatic treatment, surgery if necessary.
Curability
Generally curable after active treatment.
Dietary advice
Avoid eating uncooked freshwater crabs contaminated with cysticercus and freshwater crabs of freshwater crabs, freshwater crayfish, marsh shrimp, and wild animal meat.
Etiology
Causes
Transmission
Foodborne.
Symptoms and Diagnosis
Typical symptoms
According to the different major organs invaded, it can be clinically categorized into 4 types.
1. Lung type
Lung is the most common parasitic site of Schistosoma welchii, symptoms include cough, bloody sputum, chest pain, typical sputum is jam-like sticky sputum, if accompanied by necrotic tissue in the lungs, then it is peach-like bloody sputum. 90% of the patients can suffer from recurrent hemoptysis, which may last for years, and the eggs of worms may be found in the sputum. When Schistosoma japonicum migrates into the chest cavity, it often causes chest pain, exudative pleural effusion or pleural hypertrophy and other changes.
2. Abdominal type
Abdominal pain, especially in the right lower abdomen, varies in severity, and there may be diarrhea, hepatomegaly, bloody stools or sesame seed paste-like stools, with an obvious sense of urgency and heaviness. Abdominal tenderness, occasional liver, spleen, lymph node enlargement and abdominal nodules, masses or abdominal fluid. Abdominal masses seem to have cystic sensation, the number of which varies from 1 to 4 cm in diameter, and Schistosoma sichuanensis often forms eosinophilic abscesses in the liver, resulting in hepatomegaly and liver function abnormalities.
3. Cerebral type
Most common in children and young adults.
(1) Symptoms of increased intracranial pressure, such as headache, vomiting, delayed consciousness, optic disk edema, etc., mostly seen in early patients.
(2) Symptoms of destructive brain tissue: such as paralysis, aphasia, hemianopsia, ataxia, etc., which usually appear in the late stage.
(3)Irritative symptoms: such as seizures, visual hallucinations, abnormal sensations in limbs, etc., which are caused by the lesion close to the cortex.
(4) Inflammatory symptoms: such as chills, fever, headache, meningeal irritation signs, etc., mostly seen in the early stage of the disease.
4. Nodular type
It is caused by Schistosoma sichuanensis, and its incidence is 50%～80%, which can occur in the abdomen, chest, back, groin, thighs, scrotum, head and neck, orbits and other parts of the body, and it is as big as a soybean to a duck’s egg. The nodules are typical eosinophilic granulomas, 1-6 cm in size, isolated or present in bunches, with Charcot crystals, worm bodies or eggs within the nodules.
Diagnostic basis
Growing up in or visiting an endemic area for Schistosoma japonicum, history of eating raw or semi-raw stream crabs or mayflies, or drinking raw stream water. Early diarrhea and abdominal pain, followed by cough, fever, rust-colored sputum with pleural cavity effusion, or wandering subcutaneous nodules or masses. Eggs were found in sputum, feces and various body fluids. Biopsy of the subcutaneous nodules or masses reveals eggs, or child or adult worms.
Treatment
Treatment guidelines
Deworming with praziquantel, surgery if necessary
Medication
Praziquantel Praziquantel is the drug of choice for the treatment of Schistosoma japonicum and is suitable for all stages of the disease. It is effective against adult worms, child worms, and eggs, and is rapidly absorbed orally. Side effects are dizziness, malaise, palpitations and preterm contractions, but they are mild. Thiocolchicol (Thiobisdichlorophenol) has a recent cure rate of 84% to 100%. The side effects of this product are mainly diarrhea, abdominal pain, nausea, vomiting and anal irritation. Cough and chest pain can be applied to cough and analgesic. For epileptic seizures, oral prophylaxis with phenytoin sodium, phenobarbital (luminal) and diazepam (Valium) can be used. Those with increased intracranial pressure can apply dehydration agents, such as hypertonic glucose solution, 20% mannitol, etc.
Surgical treatment
Adhesive intestinal obstruction, abdominal mass of unknown nature can be operated.
Prognosis
Prognosis is good in general cases. Those with cerebral type have poor prognosis and may lead to disability.
Nursing care
Daily care
Do not spit or defecate, and avoid contaminating water sources by washing eggs with rainwater into streams.
Diet
Avoid eating raw or half-cooked stone crabs, mayflies and raw water to prevent infection.