Vaginal Schistosomiasis : A Case That Will Make You Squirm
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Transcript of Vaginal Schistosomiasis : A Case That Will Make You Squirm
”FIRST AND FINEST”
Vaginal Schistosomiasis:A Case That Will Make You Squirm
LT Laura Mace, DO
LCDR Kristina St.Clair, DO, MTM&H
Naval Medical Center Portsmouth
”FIRST AND FINEST”
• Nothing to disclose
• The views and opinions expressed herein do not necessarily state or reflect those of the Naval Medical Center Portsmouth, DoD, or the United States Government
Disclaimer
”FIRST AND FINEST”
Case• 22-year-old active duty female routine
pap smear – Incidental schistosomiasis eggs
• Patient born in the United States• No travel history outside of the
country• Asymptomatic and normal exam
”FIRST AND FINEST”
Case
”FIRST AND FINEST”
Case
”FIRST AND FINEST”
• Schistosoma egg – Confirmed by Parasitologists:
• Uniformed Services University• Brown University
• Schistosoma mansoni Falcon Assay – 0 units/l serum (>10 units/l positive test)
• One stool for ova and parasite – Negative
Case
”FIRST AND FINEST”
The Missing Link
”FIRST AND FINEST”
• 23 year old Active Duty boyfriend– Evaluation in the Infectious Disease Clinic
The Missing Link
”FIRST AND FINEST”
• 23 year old Active Duty boyfriend– Evaluation in the Infectious Disease Clinic
• Travel History:– South Korea
• Age 10 for two weeks
– Dominican Republic• Age 17 for two weeks
– Iraq • 6 months in 2011
The Missing Link
”FIRST AND FINEST”
• 23 year old Active Duty boyfriend– Evaluation in the Infectious Disease Clinic
• Travel History:– South Korea
• Age 10 for two weeks
– Dominican Republic• Age 17 for two weeks
– Iraq • 6 months in 2011
The Missing Link
”FIRST AND FINEST”
• One stool ova and parasites – Negative
• A CT abdomen and pelvis
• Schistosoma mansoni Falcon Assay– 7 units/l serum
• Permanent change of station soon after evaluation– Contacted for treatment
Case
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• 200 million people infected worldwide• Third most devastating tropical disease
worldwide – Greater than 200,000 deaths annually
• 5 species: – S. mansoni– S. haematobium– S. japonicum – S. intercalatum– S. mekongi
Schistosomiasis Epidemiology
CDC
”FIRST AND FINEST”
CDC
S. mansoni
S. hematobium
S. japonicum
S. mekongi
S. mansoni
S. mansoniS. hematobiumS. intercalatum
Schistosomiasis Epidemiology
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A Complex Lifecycle
CDC
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A Complex Lifecycle
Biomphalaria CDC
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• “Swimmer’s itch” – Minutes to days
• Katayama Fever:– 14 to 84 days
• Fever• General malaise• Headache• Cough• Lymphadenopathy• Hepatosplenomegaly• Urticaria• Arthralgias & myalgias• Diarrhea • Eosinophilia
Clinical Presentation
Manson’s Tropical Disease
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– Urinary obstruction
– Squamous cell carcinoma
– Liver fibrosis
– Portal hypertension
– Ectopic eggs• CNS• Infertility
Morbidity & Mortality:
Manson’s Tropical Disease
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tmrc.usu.edu
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• Well described with S. hematobium• S. mansoni
– Migration of eggs through venous channels between the internal spermatic and mesenteric veins
• Inflammation• Direct gonadotoxic effects
Infertility
WHO.comResearch Journal of Medical Sciences. 2010.African Health Sciences. 2012.
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• Parasite lifecycle – Real patient
• Travel history• Praziquantel - drug of choice• Active Duty male patient treated to avoid
potential infertility• Question: should certain high risk Active Duty
populations be intermittently screened?
Key Points
”FIRST AND FINEST”
navyseals.com
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Thank You
”FIRST AND FINEST”
Questions?
helenrigden.wordpress.com