Greater Washington Infectious Greater Washington Infectious Diseases Society Conference Diseases Society Conference October 20, 2008 October 20, 2008 Temujin T. Chavez, MD Temujin T. Chavez, MD LCDR MC USN LCDR MC USN National Capitol Consortium National Capitol Consortium
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
Greater Washington Infectious Greater Washington Infectious Diseases Society ConferenceDiseases Society Conference
October 20, 2008October 20, 2008
Temujin T. Chavez, MDTemujin T. Chavez, MDLCDR MC USNLCDR MC USN
National Capitol ConsortiumNational Capitol Consortium
CaseCase CCCC
• Diarrhea and abdominal painDiarrhea and abdominal pain HPI HPI
• Insidious onset of intermittent, sharp, crescendo-Insidious onset of intermittent, sharp, crescendo-decrescendo, non-radiating right flank pain since Spring decrescendo, non-radiating right flank pain since Spring 20052005
• Melena June 2005Melena June 2005 EGD with EGD with Helicobacter pylori Helicobacter pylori gastritisgastritis
• CT A/P October 2006CT A/P October 2006 NormalNormal
• Fall 2007, pain worsensFall 2007, pain worsens• Diarrhea with occasional rectal bleedingDiarrhea with occasional rectal bleeding• Gastroenterology evaluation February 2008Gastroenterology evaluation February 2008
Large bowelLarge bowel• Chronic or intermittent abdominal painChronic or intermittent abdominal pain• Diarrhea in 3-55%Diarrhea in 3-55%• Bloody diarrhea in 11-50%Bloody diarrhea in 11-50%
Am J Trop Med Hyg 1995;53(6):660-667Am J Trop Med Hyg 1995;53(6):660-667
Intestinal schistosomiasis –Intestinal schistosomiasis –Clinical featuresClinical features
Area 5-9 10-19 >/=20 All
Bloody diarrheaBloody diarrhea Cohoha Lake 4.1 5.0 1.1 2.2
Rusizi Plain 3.4 2.8 2.0 2.3
Left liver enlargementLeft liver enlargement Cohoha Lake 1.2 6.4 1.0 1.9
Rusizi Plain 1.1 1.6 0.8 0.9
Spleen enlargementSpleen enlargement Cohoha Lake 0 3.4 0.4 0.9
Rusizi Plain 0.9 1.3 1.8 1.5
DiarrheaDiarrhea Cohoha Lake 5.1 5.7 0.8 2.5
Rusizi Plain 3.1 2.9 1.9 2.0
Prevalence (%) of morbidity attributable to Prevalence (%) of morbidity attributable to S. mansoni S. mansoni in two in two areas of Burundiareas of Burundi
Management
Intestinal Intestinal Schistosomiasis mansoniSchistosomiasis mansoni• Praziquantel 40 mg/kg poPraziquantel 40 mg/kg po• Repeat treatment in 4 to 6 weeksRepeat treatment in 4 to 6 weeks• Review CT A/PReview CT A/P• CounselingCounseling
Avoid fresh waterAvoid fresh water Water used for washing heated to 50 Water used for washing heated to 50
degrees Celsius or let stand 2 daysdegrees Celsius or let stand 2 days
DiscussionDiscussion
Schistosomiasis has a high global prevalence and a large burden of disease in sub-Saharan Africa
S. mansoni should be suspected in immigrants of endemic areas who present with lower GI symptoms
Visualization of S. mansoni eggs on microscopy or histopathology is important diagnostically
Two physicians performed abdominal palpationTwo physicians performed abdominal palpation All aged > 5 yo examined by USAll aged > 5 yo examined by US Exam and eggs in stools unable to adequately detect in Exam and eggs in stools unable to adequately detect in
endemic communityendemic community• Severe peri-portal thickening, portal hypertension and spleen not Severe peri-portal thickening, portal hypertension and spleen not
palpablepalpable• Normal liver with palpable spleenNormal liver with palpable spleen
Two distinct syndromes of early inflammation and Two distinct syndromes of early inflammation and late fibrotic diseaselate fibrotic disease
Inflammatory hepatic schistosomiasis is an early Inflammatory hepatic schistosomiasis is an early rxn to trapped ova in pre-sinusoidal periportal rxn to trapped ova in pre-sinusoidal periportal spacesspaces• Left lobe enlargement and nodular Left lobe enlargement and nodular
splenomegalysplenomegaly• Most cases w/o signs of functional diseaseMost cases w/o signs of functional disease
Fibrotic or chronic hepatic schistosomiasis Fibrotic or chronic hepatic schistosomiasis develops in long-standing intense infectiondevelops in long-standing intense infection• Periportal pipestem fibrosisPeriportal pipestem fibrosis• Gastro-esophageal variceal bleedingGastro-esophageal variceal bleeding
Intestinal schistosomiasis –Intestinal schistosomiasis –Clinical featuresClinical features
Individuals with Individuals with higher infection higher infection intensity at greater intensity at greater risk of morbidity risk of morbidity (right)(right)