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Intestinal Schistosomiasis

Disease Details

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Description: Intestinal schistosomiasis is a parasitic infection caused by the Schistosoma mansoni or Schistosoma japonicum worms, characterized by abdominal pain, diarrhea, and blood in the stool.
Type: Intestinal schistosomiasis is an infectious parasitic disease. It is not transmitted genetically; instead, it is acquired through exposure to freshwater contaminated with the larval forms of parasitic worms called Schistosoma.
Signs And Symptoms: Intestinal schistosomiasis is caused by parasitic worms of the Schistosoma genus.

**Signs and Symptoms:**
- Abdominal pain
- Diarrhea, sometimes bloody
- Anemia
- Malnutrition
- Fatigue
- Hepatomegaly (enlarged liver)
- Splenomegaly (enlarged spleen)
- Presence of blood in the stool

Intestinal schistosomiasis can lead to chronic health issues if not treated properly. Early diagnosis and treatment are vital to prevent complications.
Prognosis: Prognosis for intestinal schistosomiasis varies depending on the stage of the disease and the timely initiation of effective treatment. Early detection and proper treatment with antiparasitic medication, such as praziquantel, can lead to a good prognosis with full recovery. However, if left untreated, chronic infection can cause significant complications, including liver and spleen enlargement, intestinal bleeding, and increased risk of liver fibrosis, which can negatively impact the overall prognosis. Regular medical follow-up is crucial for managing and monitoring potential long-term effects.
Onset: The onset of intestinal schistosomiasis typically occurs weeks to months after the initial infection with Schistosoma mansoni or Schistosoma japonicum parasites. Symptoms may include abdominal pain, diarrhea, blood in the stool, and hepatosplenomegaly (enlarged liver and spleen) in chronic cases.
Prevalence: The prevalence of intestinal schistosomiasis varies by region but is especially high in sub-Saharan Africa, parts of the Middle East, Southeast Asia, and the Caribbean. It is estimated that over 200 million people worldwide are affected by schistosomiasis, with a significant portion suffering from the intestinal form of the disease. Some highly endemic areas can see prevalences exceeding 50% within specific communities.
Epidemiology: As of 2021, 251.4 million people worldwide are having schistosomiasis due to different species of Schistosoma. More than 75 million people were given medical treatment. S. mansoni is the major species causing an annual death of about 130,000. It is endemic in 55 countries and most prevalent in Africa, the Middle East, the Caribbean, Brazil, Venezuela and Suriname. About 80-85% of schistosomiasis is found in sub-Saharan Africa, where S. haematobium, S. intercalatum and S. mansoni are endemic. Approximately 393 million Africans are at risk of infection from S. mansoni, of which about 55 million are infected at any moment. Annual death due to S. mansoni is about 130,000. The prevalence rate in different countries of Africa are: 73.9% in northern Ethiopia, 37.9% in western Ethiopia, 56% in Nigeria, 60.5% in Kenya, 64.3% in Tanzania, 19.8% in Ghana, and 53.8% in Côte d'Ivoire. In Egypt, 60% of the population in the Northern and Eastern parts of the Nile Delta and only 6% in the Southern part are infected.S. mansoni is commonly found in places with poor sanitation. Because of the parasite's fecal-oral transmission, bodies of water that contain human waste can be infectious. Water that contains large populations of the intermediate host snail species is more likely to cause infection. Young children living in these areas are at greatest risk because of their tendency to swim and bathe in cercaria-infected waters longer than adults
. Anyone travelling to the areas described above, and who is exposed to contaminated water, is at risk of schistosomiasis.
Intractability: Intestinal schistosomiasis can be challenging to treat, but it is not generally considered intractable. The primary treatment involves the use of antiparasitic medication, particularly praziquantel, which is effective in killing the adult worms. Successful treatment often requires addressing reinfection risks and implementing preventive measures such as improving sanitation and controlling the snail population that serves as an intermediate host. While complications can arise if the infection is not treated promptly, particularly with chronic or severe cases, the disease is typically manageable with appropriate medical intervention.
Disease Severity: Intestinal schistosomiasis, caused primarily by the parasite Schistosoma mansoni, can vary in severity.

- **Acute Stage:** Often manifests with mild symptoms such as rash, fever, chills, and muscle aches. Some individuals may experience no symptoms initially.
- **Chronic Stage:** Long-term infection can lead to more serious complications like intestinal bleeding, liver enlargement, fibrosis, and eventually organ damage if left untreated.

Severity depends on factors such as the level of parasitic infection, duration of the disease, and the individual's immune response. Early diagnosis and treatment are crucial to prevent severe complications.
Healthcare Professionals: Disease Ontology ID - DOID:0050597
Pathophysiology: Intestinal schistosomiasis is caused by the parasitic worms Schistosoma mansoni and Schistosoma japonicum. The pathophysiology involves the following steps:

1. **Infection**: Larvae, known as cercariae, are released by freshwater snails and penetrate human skin upon contact with contaminated water.

2. **Maturation**: The cercariae transform into schistosomula, enter the bloodstream, and migrate to the liver, where they mature into adult worms.

3. **Migration and Egg Production**: Mature worms migrate to the mesenteric veins of the intestines where they mate and produce eggs.

4. **Tissue Response**: Some eggs penetrate the intestinal wall and are excreted in feces. However, many become trapped in tissues, leading to an immune response.

5. **Inflammation and Fibrosis**: The trapped eggs cause granuloma formation, chronic inflammation, and fibrosis in the intestines and liver.

6. **Symptoms**: This can lead to symptoms such as abdominal pain, diarrhea, blood in the stool, and sometimes hepatosplenomegaly (enlarged liver and spleen) due to portal hypertension.

The chronic immune response to the trapped eggs and the resultant tissue damage are central to the disease's pathophysiology.
Carrier Status: Carrier status for intestinal schistosomiasis does not typically apply in the same way as it does for certain viral infections. Instead, humans can be infected by parasitic worms called Schistosoma mansoni. Infected individuals are considered hosts rather than carriers and can exhibit a range of symptoms, depending on the intensity of the infection. If you need further details or have additional questions, feel free to ask!
Mechanism: Intestinal schistosomiasis is caused by parasitic worms of the genus Schistosoma, primarily Schistosoma mansoni.

**Mechanism:**
1. **Infection:** Humans become infected when larvae (cercariae) in contaminated freshwater penetrate the skin.
2. **Migration:** These larvae transform into schistosomula, which enter the bloodstream and migrate to the liver where they mature into adult worms.
3. **Reproduction:** Adult worms migrate to the mesenteric blood vessels of the intestines where they mate and produce eggs.
4. **Egg Deposition:** Some eggs are excreted in the feces, while others become trapped in intestinal tissues, causing localized immune responses.

**Molecular Mechanisms:**
1. **Host Immune Evasion:** Schistosomes can evade the host's immune system by mimicking host antigens and producing immunomodulatory molecules.
2. **Granuloma Formation:** Eggs that become trapped in tissues stimulate a vigorous immune response, leading to granuloma formation. This is mediated by cytokines such as TNF-α, IL-1, IL-4, IL-13, and others, recruiting immune cells (e.g., macrophages, eosinophils) around the eggs.
3. **Tissue Damage and Fibrosis:** The chronic immune response and granuloma formation result in tissue damage and fibrosis, principally driven by T-helper 2 (Th2) type responses and associated cytokine signaling pathways.
4. **Signal Transduction:** Schistosome proteins interact with host receptors to facilitate immune evasion and modulate host signaling pathways important for worm survival and reproduction.

Understanding these mechanisms is crucial for developing targeted treatments and interventions for schistosomiasis.
Treatment: The standard drug for S. mansoni infection is praziquantel at a dose of 40 mg/kg. Oxamniquine is also used.
Compassionate Use Treatment: Intestinal schistosomiasis is primarily treated with praziquantel, which is the standard and most effective medication. However, in cases where standard treatment is not effective or available, there are some off-label or experimental treatments being explored.

1. **Oxamniquine:** Although primarily used for Schistosoma mansoni infections, it can be considered as an alternative treatment option in some settings.
2. **Artemisinin-derivatives:** These are primarily antimalarial drugs but have shown some efficacy against schistosomal infections in experimental settings.
3. **Mefloquine:** Another antimalarial drug, mefloquine has shown some potential in treating schistosomiasis in preliminary studies, though more research is needed.

Compassionate use of these drugs may be considered in severe or refractory cases where conventional treatment has failed or is not available. Note that these treatments should be administrated under close medical supervision, and their use must comply with local medical regulations and guidelines.
Lifestyle Recommendations: For intestinal schistosomiasis, some lifestyle recommendations include:

1. **Avoid Contact with Contaminated Water**: Refrain from swimming, bathing, or wading in freshwater bodies in endemic areas as these waters may harbor parasitic larvae.

2. **Safe Water Practices**: Use boiled or filtered water for drinking, cooking, and washing to prevent infection.

3. **Personal Hygiene**: Maintain good personal hygiene by regularly washing hands with soap and water, especially after using the toilet and before eating.

4. **Protective Clothing**: Wear protective clothing, such as rubber boots, when working in or near contaminated water sources.

5. **Health Screening**: Regularly get screened for schistosomiasis if you live in or frequently visit endemic areas, as early detection and treatment are crucial.

6. **Vector Control**: Support community initiatives that aim to reduce the snail populations which act as intermediate hosts for the parasite.

7. **Education and Awareness**: Stay informed about the risks and transmission of schistosomiasis, and educate others in your community.

Implementing these recommendations can help reduce the risk of contracting intestinal schistosomiasis.
Medication: The primary medications used to treat intestinal schistosomiasis are praziquantel and oxamniquine. Praziquantel is typically the first-line treatment and is highly effective against adult schistosomes.
Repurposable Drugs: For intestinal schistosomiasis, research has indicated potential repurposable drugs such as praziquantel, which is the current standard treatment. Additionally, studies have explored the potential of other drugs, including oxamniquine and artemisinin derivatives, though they are not yet approved for widespread use in treating this condition.
Metabolites: Intestinal schistosomiasis, caused by Schistosoma mansoni, results in the production of various metabolites. Some notable metabolites include:

1. Schistosoma-derived antigens: These are proteins released by the parasite that can cause a measurable immune response in the host.
2. Eosinophil cationic protein: Elevated levels often indicate an immune response to the parasite.
3. Kato-Katz technique can be used for identifying parasite eggs in stool samples, which are indirectly indicative metabolites.
4. Biomarkers such as IP-10 (Interferon gamma-induced protein 10) and other cytokines/chemokines are elevated.
5. Lipid profiles and lactate may also be altered in infected individuals.

These metabolites play critical roles in the diagnosis and understanding the pathophysiology of the disease.
Nutraceuticals: There is limited evidence directly linking nutraceuticals to the treatment of intestinal schistosomiasis specifically. However, nutraceuticals with anti-inflammatory, antioxidant, and immune-boosting properties may support overall health and assist in managing symptoms. Examples include:

1. **Curcumin** (from turmeric): Known for its anti-inflammatory properties.
2. **Omega-3 fatty acids**: Found in fish oil, they possess anti-inflammatory effects.
3. **Probiotics**: May help maintain gut health.

It's important to note that these should not replace conventional treatments, such as praziquantel, which is the primary antiparasitic medication used for schistosomiasis. Always consult healthcare providers for appropriate diagnosis and treatment.
Peptides: Intestinal schistosomiasis is primarily treated using anthelmintic medications like praziquantel. Research into peptides has shown potential for developing vaccines and diagnostic tools, as well as elucidating immune responses. Nanotechnology is being explored to enhance drug delivery systems, improve diagnostics, and create targeted treatments, potentially increasing the efficacy and reducing side effects of current therapies.