vaginal schistosomiasis : a case that will make you squirm
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”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
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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
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Case
”FIRST AND FINEST”
Case
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• 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
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The Missing Link
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• 23 year old Active Duty boyfriend– Evaluation in the Infectious Disease Clinic
The Missing Link
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• 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
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• 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
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• 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
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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
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navyseals.com
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Thank You
”FIRST AND FINEST”
Questions?
helenrigden.wordpress.com
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