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      Schistosomiasis: a case of severe infection with fatal outcome

      case-report

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          Abstract

          Schistosomiasis is one of the most common parasitic diseases, still considered of public health significance. Acute schistosomiasis is of difficult diagnosis and therefore has been overlooked, misdiagnosed, underestimated and underreported in endemic areas. The delay between the exposure to contaminated water and the initial symptoms may explain this challenging diagnosis. Acute schistosomiasis is frequently reported in non-immune individuals while reinfection cases occurring in endemic areas is scarcely documented. The later usually shows a benign course but fatal cases do exist. The authors report a case of a young female patient, in the late puerperium, with a three-month history of weight loss, intermittent fever, cough, thoracic and abdominal pain and increased abdominal girth. Physical examination showed a tachycardia, tachypnea and hypotension. Laboratory tests showed a mild anemia, eosinophilia, and a slightly elevation of liver enzymes. Thorax and abdominal multidetector computed tomography evidenced a diffuse and bilateral pulmonary micronodules and peritoneal and intestinal wall thickening. The patient progressed rapidly to hepatic insufficiency, and death after respiratory insufficiency. An autopsy was performed and the findings were compatible with acute Schistosomiasis in a patient previously exposed to Schistosoma mansoni.

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          Most cited references22

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          Schistosomiasis and water resources development: systematic review, meta-analysis, and estimates of people at risk.

          An estimated 779 million people are at risk of schistosomiasis, of whom 106 million (13.6%) live in irrigation schemes or in close proximity to large dam reservoirs. We identified 58 studies that examined the relation between water resources development projects and schistosomiasis, primarily in African settings. We present a systematic literature review and meta-analysis with the following objectives: (1) to update at-risk populations of schistosomiasis and number of people infected in endemic countries, and (2) to quantify the risk of water resources development and management on schistosomiasis. Using 35 datasets from 24 African studies, our meta-analysis showed pooled random risk ratios of 2.4 and 2.6 for urinary and intestinal schistosomiasis, respectively, among people living adjacent to dam reservoirs. The risk ratio estimate for studies evaluating the effect of irrigation on urinary schistosomiasis was in the range 0.02-7.3 (summary estimate 1.1) and that on intestinal schistosomiasis in the range 0.49-23.0 (summary estimate 4.7). Geographic stratification showed important spatial differences, idiosyncratic to the type of water resources development. We conclude that the development and management of water resources is an important risk factor for schistosomiasis, and hence strategies to mitigate negative effects should become integral parts in the planning, implementation, and operation of future water projects.
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            Schistosomiasis.

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              Schistosomiasis in the People's Republic of China: prospects and challenges for the 21st century.

              Schistosomiasis japonica is a serious communicable disease and a major disease risk for more than 30 million people living in the tropical and subtropical zones of China. Infection remains a major public health concern despite 45 years of intensive control efforts. It is estimated that 865,000 people and 100,250 bovines are today infected in the provinces where the disease is endemic, and its transmission continues. Unlike the other schistosome species known to infect humans, the oriental schistosome, Schistosoma japonicum, is a true zoonotic organism, with a range of mammalian reservoirs, making control efforts extremely difficult. Clinical features of schistosomiasis range from fever, headache, and lethargy to severe fibro-obstructive pathology leading to portal hypertension, ascites, and hepatosplenomegaly, which can cause premature death. Infected children are stunted and have cognitive defects impairing memory and learning ability. Current control programs are heavily based on community chemotherapy with a single dose of the drug praziquantel, but vaccines (for use in bovines and humans) in combination with other control strategies are needed to make elimination of the disease possible. In this article, we provide an overview of the biology, epidemiology, clinical features, and prospects for control of oriental schistosomiasis in the People's Republic of China.
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                Author and article information

                Journal
                Autops Case Rep
                Autops Case Rep
                Autopsy & Case Reports
                São Paulo, SP: Universidade de São Paulo, Hospital Universitário
                2236-1960
                30 March 2012
                Jan-Mar 2012
                : 2
                : 1
                : 7-17
                Affiliations
                [a ]Anatomic Pathology Service - Hospital Universitário - Universidade de São Paulo , São Paulo/SP - Brazil.
                [b ]Department of Internal Medicine - Hospital Universitário - Universidade de São Paulo , São Paulo/SP - Brazil.
                [c ]Department of Internal Medicine Hospital das Clínicas - Faculdade de Medicina - Universidade de São Paulo , São Paulo/SP – Brasil.
                [d ]Department of Radiology - Hospital Universitário - Universidade de São Paulo , São Paulo/SP - Brazil.
                Author notes

                Conflict of interest: None

                Correspondence: Serviço de Anatomia Patológica
Av. Prof. Lineu Prestes, 2565 – Cidade Universitária – São Paulo/SP – Brazil
CEP: 05508-000 – Phone: +55 (11) 3091-9384
E-mail: crisrf@ 123456hu.usp.br
                Article
                autopsy-02-01007
                10.4322/acr.2012.002
                6735636
                f5c887a4-6b4a-4395-a4bd-421cafbc83f5
                Copyright © 2012 Autopsy and Case Reports

                This is an Open Access article distributed of terms of the Creative Commons Attribution Non-Commercial License which permits unrestricted non-commercial use, distribution, and reproduction in any médium provided article is properly cited.

                History
                : 06 February 2012
                : 28 February 2012
                Categories
                Article / Autopsy Case Report

                schistosomiasis,hepatic insufficiency,respiratory insufficiency,autopsy

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