Schistosomiasis

(Bilharziasis/Snail Fever)
Definition

This is a slowly progressive disease caused by blood flukes of class

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

This is not a public health concern but also a socio-economic problem

because by causing ill-health. It reduces agricultural productivity (DOH,
1988).

Etiologic Agent

The cause of disease is a parasitic worm, Schistosoma Japonicum.

There are three major types of organism:

1. Schistosoma Japonica

a. This agent infects the intestinal tract (Katayama Disease)

b. It is found to be the only type that is endemic in the Philippines.

c. This is also known as “Oriental Schistosomiasis”

2. Schistosoma Mansoni

a. It also affects the intestinal tract.

b. It is common in some parts of Africa.

3. Schistosoma Haematobium

a. It affects the urinary tract.

b. It can be found in some parts of Middle East, like Iraq and Iran.

Incubation Period

The incubation period is at least 2 months.

Mode of Transmission

1. The disease is transmitted through ingestion of contaminated water.

2. The disease is transmitted through skin pores.

3. The disease is transmitted through intermediary host, a tiny snail

called Oncomelania Quadrasi.

Epidemiology
 Schistosomiasis currently affects >200 million people worldwide, yet
the burden of this chronic disease has long been underestimated (1,2).
Serious health consequences such as undernutrition and anemia are now
recognized as major contributors to the disability adjusted life year estimate
for schistosomiasis. This estimate, which is an attempt to quantify the
burden of disease, was recently upgraded by a factor of 4 to 30 compared
with earlier WHO estimates (1).Schistosoma japonicum is a major public
health problem in the Philippines, with an estimated national prevalence of
3%, i.e., ∼200,000 infected individuals. Because this prevalence is based on
1 stool sample, it is likely underestimated (personal communication, Dr. R.
Olveda, Director, Research Institute of Tropical Medicine, Manila, the
Philippines). Children have the highest prevalence and intensity of infection,
but the consequences of chronic schistosomiasis, such as growth stunting,
anemia, hepatic fibrosis, and impaired cognitive development, continue to
have an effect throughout adulthood (3–6).

Pathophysiology

1. The larvae penetrate the skin or mucous membranes and eventually

work their way to the liver’s venous portal circulation.

2. In the portal vessels, they mature in one to three months.

3. The mature worms live in copula in the portal vessels and migrate to
some parts in the body.

4. The female cercaria lay eggs in blood vessels surrounding the large
intestine or bladder.

5. Ulceration in the mucosa occurs and the eggs are able to escape into
the lumen of the intestine and are excreted with the feces

6. Some of the eggs are carried by the portal circulation and filtered in
the liver where small lesions or granulomas are formed.

7. These granulomas are resolved and are replaced by fibrous tissue.

8. Likewise, the ulcerations in th intestines are healed and scar formation

occurs.

9. As the disease progresses, the liver enlarges due to increasing fibrosis.

10. The flow of blood is interrupted in the intrahepatic portion

thereby resulting to portal hypertension.

11. Fluid accumulates in the patent’s bell that makes it bulging.

Life Cycle of Schistosoma