SCHISTOSOMA JAPONICUM

Prepared by:

MOHD KHAIRUL AMRAN BIN MOHAMMAD

KAMALRU AZMAN BIN DAUD Bsc. In Medical Laboratory Technology Faculty Of Health Science University Teknology Mara (UiTM)

Introduction
Schistosoma japonicum is digenic trematode "digenic" means that its lifecycle includes two hosts : 1-Definitive host 2-Intermediate host

Intermediate host of S. japonicum are snails of the genus Onchomelania hupensis spp.
S. japonicum occurs in Southeast Asia and western Pacific countries (including China, the Philipines and Indonesia). Apart from humans S. japonicum infect a wide range of animals including cattle, dogs, pigs, and rodents.

Epidemiology
Schistosomiasis is an important cause of disease in many parts of the world, most commonly in places with poor sanitation. School-age children who live in these areas are often most at risk because they tend to spend time swimming or bathing in water containing infectious cercariae. S. japonicum occurs in Southeast Asia and western Pacific countries (including China, the Philipines and Indonesia).

Stage of Shistosoma japonicum

i. ii. iii. iv. v. vi. Egg and miracidium First stage (mother) sporocyst Second stage (daughter) sporocyst Cercaria Schistosomulum Adult schistosome

Morphology : egg
Characteristic Shape Size Miracidium Egg Round to ovoid 40~60 m 55~80 m Contains one miracidium

Spine

Present, small and lateral and often unrecognizable. Inconspicuous

Present but lack

Operculum

Cercaria
Cercaria is infective stage Has a body and a forked tail and has 5 pairs of penetrating glands in the body Emerges from daughter sporocysts Escapes from the snail Infects man by skin penetration

Morphology of adult worm Shape Size Color Organ

Male

Female

Elongated cylindrical with shorter and thicker & sickle-like 10-20 x 0.5-0.55mm Gray white Oral sucker at top near by ventral sucker. Has a longitudinal groovegyncophoral canal in which the female normally resides. Seven testes are situated one by one, each has a delicate defferens which combine to form the vas deferens and dilate to become a seminal vesical opening in the genital pore just behind ventral sucker

Longer and slender than the male 12-26x 0.1-0.3mm The female is much dark. The vitellaria are located in the posterior part of the body surrounding the cecum. The ovary lies in the mid-portion of the body. The uterus lies in the anterior portion of the body filled with 50-300 eggs arranged in a single row, arising from ootype to genital pore behind the ventral sucker.

Oral sucker Male adult Esophagus ventral sucker Genital pore Testes cecum Mehlis gland Gynecophoral canal Vitelline duct Intestine Vitellaria Female adult Ootype Oviduct Ovary

uterus

Different characteristics of Schistosomes

S. haematobium S. mansoni Male Tuberculation on cuticle Fine Coarse Anterior third of the body 6-9 female Position of ovary Uterus Posterior half of the body Long, contain 20 30 ova Anterior half of the body Short, contain 1 - 4 ova Middle of the body Long, contain 50 100 ova None Posterior third of the body 67 S. japonicum

Caecal junction Middle Number of testes 4-5

Diagram of the Life Cycle of Schistosoma japonicum

Shistosomolum migrate into portal circulation and mature in the mesenteric veins forming adult Schistosoma japonicum Cercariae penetrate human skin and leave its tail, forming shistosomolum and first enters the systemic circulation adult ( & ) in the portal vein system

Eggs passed in feces into water via intestinal ulsers

Miracidium hatches from egg swims actively to penetrate intermediate host (Oncomelania sneil)

Daughter sporocysts forming cercariae and escapes from snail into water

Forming mother sporocysts then produced daughter sporocysts in snail tissue

Pathogenesis
The adult worms do not multiply. The egg is the main cause of pathology in schistosomiasis. The eggs penetrate the blood vessel by secreting proteolytic enzymes. Many eggs are stranded in the tissues or are carried by the blood stream to other organs of the body. Location of S. japonicum in the mesenteric veins. S. japonicum, present mainly in the superior masenteric vein and its branches. Pathology produced by S. japonicumis is greater Some eggs find their way into the lumen of the bowel and appear in the faeces.

Pathology
Due to the cercaria and schistosomulum ( adolescent ): 1. The cercarial dermatitis appears. 2. Petechiae and rashes ensue. 3. The migration of the adolescents may induce localized pneumonitis and urticaria.

Due to adults: 1. The mechanical effect and toxic effect of adults and their metabolites cause mesenteric phlebitis, hepatitis, and abdominal pain. 2. The immune complex may cause the damage to the kidney, schistosome nephritis results from type III allergy, the esinophile increase in peripheral blood.

Due to eggs:

The most serious damage is done by eggs.

1. 2. 3. 4. 5. Liver cirrhosis (pipestem fibrosis) Splenomegaly Ascites Granuloma Ulceration

Clinical manifestations
a) Initial phase: i. Fever, ii. Dry cough (pneumonitis), iii. Urticaria
.

b) Acute stage: i. Chill and malaise. ii. Dysentery, blood in stool, pus and mucus. c) Chronic stage: i. Fatigue sand strength deteriorate. ii. Loss of weight and interest. iii. Retardation of both physical and mental growth in children. iv. Spleen and liver enlargement, anemia, v. In women menopause, sterility and abortion may occur. vi. This stage may last from several years to 20 years.

d) Terminal stage:
i. Portal vein hypertension syndrome, ii. Abdomen distention looks like a big drum, iii. Emaciation looks like a fire wood Ascites, iv. Varicosity, splenomegaly and anemia. v. The patients die of secondary infection, upper digestive tract bleeding, hepatic coma. e) Ectopic lesion:

i.

The damage to the central nervous system (brain,

spinal) may cause paralysis (monoplegia, hemiplegia ).

The symptoms, signs and history of living in endemic areas only give a presumptive diagnosis. The definitive diagnosis depends on the pathogen examination. 1. Stool examination: - Direct fecal smear for acute stage - Concentration method:
Water sedimentation method and miracidia hatching test can be done at same time.

Lab diagnosis

2. Biopsy can be done by proctoscope for terminal stage.

3. Immunological tests are subsidiary for reference only.

Prevention: Control of the source of infection: Treat the patients and domestic animal at the same time. Cut off the route of transmission: Snail control & Sanitary disposal of human excreta Protect of susceptive people: Avoid the contact with schistosome-infected water
Treatment: 1. Praziquantel is most active against adult worms administered orally form in one or two doses from 40 60 mg/kg body weight. 2. Artemether is prevents the development of adult worms