Transcript Vaginal Schistosomiasis: A Case That Will Make You Squirm

Vaginal Schistosomiasis:
A Case That Will Make You Squirm
LT Laura Mace, DO
LCDR Kristina St.Clair, DO, MTM&H
Naval Medical Center Portsmouth
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Disclaimer
• 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
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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
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Case
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Case
• 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
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The Missing Link
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The Missing Link
• 23 year old Active Duty boyfriend
– Evaluation in the Infectious Disease Clinic
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The Missing Link
• 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
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The Missing Link
• 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
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Case
• 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
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Schistosomiasis Epidemiology
• 200 million people infected worldwide
• Third most devastating tropical disease
worldwide
– Greater than 200,000 deaths annually
• 5 species:
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S. mansoni
S. haematobium
S. japonicum
S. intercalatum
S. mekongi
CDC
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Schistosomiasis Epidemiology
S. mansoni
S. hematobium
S. mekongi
S. mansoni
S. mansoni
S. hematobium
S. intercalatum
CDC
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S. japonicum
A Complex Lifecycle
CDC
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A Complex Lifecycle
Biomphalaria
CDC
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Clinical Presentation
• “Swimmer’s itch”
– Minutes to days
• Katayama Fever:
– 14 to 84 days
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Fever
General malaise
Headache
Cough
Lymphadenopathy
Hepatosplenomegaly
Urticaria
Arthralgias & myalgias
Diarrhea
Eosinophilia
Manson’s Tropical Disease
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Morbidity & Mortality:
– Urinary obstruction
– Squamous cell carcinoma
– Liver fibrosis
– Portal hypertension
– Ectopic eggs
• CNS
• Infertility
Manson’s Tropical Disease
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tmrc.usu.edu
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Infertility
• Well described with S. hematobium
• S. mansoni
– Migration of eggs through venous channels between the internal
spermatic and mesenteric veins
• Inflammation
• Direct gonadotoxic effects
WHO.com
Research Journal of Medical Sciences. 2010.
African Health Sciences. 2012.
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Key Points
• 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?
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navyseals.com
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Thank You
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Questions?
helenrigden.wordpress.com
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