Schistosomiasis Schistosomiasis (also known

as bilharzia, bilharziosis or snail fever) is a parasitic disease caused by several species of trematodes (platyhelminth infection, or "flukes"), a parasitic worm of the genus Schistosoma

Endemic in 10 regions in the Philippines, 24 provinces, 183 municipalities 1,212 barangays,

High prevalence in Region 5 (Bicol),Region 8 (Samar & Leyte), Region 11 (Davao)

It is a chronic wasting disease common among farmers and their families in certain parts of the Philippines.

This is not only a public health concern but also a socio-economic problem because by causing ill-health, it reduces agricultural productivity (DOH, 1988).

Incubation Period

The incubation period is at least 2 months.

Infectious agent:

- S. mansoni affects intestinal tract, found in Africa

- S. haematobium affects urinary tract, found in the M.E.

- S. japonicum endemic in the Philippines

infects the intestinal tract

- a.k.a. “Oriental Schistosomiasis”

Sources of Infection

Feces of infected persons

Dogs, pigs, carabaos, cows, monkeys, and wild rats have been found to be infected and therefore,they also serve as host

Mode of Transmission

The disease is transmitted through ingestion of contaminated water.

The disease is transmitted through the skin pores.

The disease is transmitted through an intermediary host, a tiny snail called Oncomelania Quadrasi.

Mode of TransmissionSkin comes in contact with or ingestion of

contaminated fresh water

↓

Larva forms that penetrate the skin

↓

Fresh water were infected when infectedpeople urinate or defecate in the water

↓

Eggs hatch, enters the snail grow &develop

↓

Parasite leaves the snail goes to the waterwhere they can

survive for 48 hrs.

↓

w/n several weeks parasites grow insideblood vessels & produce eggs

Risk Factors

Risk factors for Schistosomiasis are factors that do not seem to be a direct cause of the disease, but seem to be associated in some way.

Water snails

Drinking contaminated water

Bathing in contaminated water

Swimming in contaminated water

Urine

Feces

Sewage

Middle East

Africa

Asia

Central America

South America

Signs & Symptoms

Diarrhea

Abdominal discomfort due to enlargement, spleenomegaly, lymphadenopathy

Anemia

Inflamed liver – later stage (accumulation of eggs)

Pruritic rash at site of penetration– “swimmer’s itch”

Low grade fever, myalgia, cough

Bloody mucoid stool – on and off for weeks

Patient becomes pale, weak, marked muscle wasting

Severe HA, dizziness, convulsion when parasites reach the CNS

Icteric and jaundice

Complications Liver cirrhosis (portal HPN)

Cor pulmonale (pulmonary HPN)

Heart failure

Ascitis

Hematemesis (rupture of eosophageal varices)

Renal failure

Diagnosis Procedures Fecalysis or direct stool exam

Kato Katz technique

- a laboratory method for preparing human stool samples prior to searching for parasite eggs.

Liver and rectal biopsy

Enzyme Link Immunusorbent Assay (ELISA)

- a test that uses antibodies and color change to identify a substance.

Cercum Ova Precipitin Test (COPT) - confirmatory diagnostictest

Treatment

Praziquantel : 40 - 60 mg/kg Mode of action : calcium

permeation

Other drugs: oxamniquine and metrifonate (WHO)

If the infection is severe or involves the brain, corticosteroidsmay be given.

Frequency :

once a year in high risks communities

once every 2 years in moderate-risk communities

twice during period of primary schooling

Methods of ControlA/ Preventive measures:

educate the public in endemic areasre: M.O.T.

dispose of feces & urine so that viable eggs will not reach body of fresh water containing snail host

improve irrigation & agricultural practices: snail habitats by ↓draining & removing vegetation

Treat snail-breeding sites w/ molluscicides

Use rubber boots

Towel dry the skin vigorously and completely

Apply 70% alcohol immediately to the skin

Use paper filters, get water from sources free of cercariae or treatment to kill them

Treat water with chlorine or iodine

Allowing water to stand 48-72 hrs before use is also effective

B/ Control of Patients

- report to local health authority

- isolation: none

- concurrent disinfection: sanitary disposal of feces and urine

- quarantine: none

- immunization of contacts: none

C/ Investigation of contacts & source of infection

- the search for the source is a community effort

- specific tx: Praziquantel (Biltricide) –drug of choice against all species

- pay attention to infected children

- motivate people in these areas to have annual stool examination

- PHN in endemic areas participates actively

Nursing Diagnosis andInterventions

1.) Dehydration Provide extra fluid with

meals, including juice, soup, ice cream and sherbet, gelatin, water on trays.

Offer Popsicles between meals.

Assess vital signs, noting peripheral pulses.

Monitor blood pressure and invasive hemodynamic parameters.

Strictly monitor intake and output. Observe the physical properties of the urine.

Correctly infuse the right amount of IVF.

Encourage small, frequent feedings.

Provide frequent, oral care.

Administer medications as prescribe

2.) Abdominal pain Maintain bed rest in a

comfortable position, do not support the knee.

Assess the location, weight and type of pain

Assess effectiveness and monitor side effects of analgesic; avoid morphine

Provide a planned rest period.

Change positions frequently and give her back rubbing and skin care.

Auscultation bowel sounds; kekauan or notice increasing pain; give enema slowly whenordered.

Give and recommend alternative pain relief measures.

Give IV Fluids as order

Decreased anxiety with increased knowledge of disease,

Monitor client’s laboratory tests results for abnormal values.

Provide emotional support to client

3.) Activity intolerance related to weakness

Give IV Fluids as order Decreased anxiety with

increased knowledge of disease,

Monitor client’s laboratory tests results for abnormal values.

Provide emotional support to client

Determine patient's perception of causes of fatigue or activity intolerance. These may be temporary or permanent, physical or psychological.

Monitor patient's sleep pattern and amount of sleep achieved over past few days. Difficulties sleeping need to be addressed before activity progression can be achieved.