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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. Disclaimer. Nothing to disclose

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Vaginal Schistosomiasis : A Case That Will Make You Squirm

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  1. Vaginal Schistosomiasis:A Case That Will Make You Squirm LT Laura Mace, DO LCDR Kristina St.Clair, DO, MTM&H Naval Medical Center Portsmouth

  2. 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

  3. 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

  4. Case

  5. Case

  6. 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

  7. The Missing Link

  8. The Missing Link • 23 year old Active Duty boyfriend • Evaluation in the Infectious Disease Clinic

  9. 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

  10. 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

  11. 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

  12. Schistosomiasis Epidemiology • 200 million people infected worldwide • Third most devastating tropical disease worldwide • Greater than 200,000 deaths annually • 5 species: • S. mansoni • S. haematobium • S. japonicum • S. intercalatum • S. mekongi CDC

  13. Schistosomiasis Epidemiology S. mansoni S. hematobium S. mekongi S. mansoni S. hematobium S. intercalatum S. japonicum S. mansoni CDC

  14. A Complex Lifecycle CDC

  15. A Complex Lifecycle Biomphalaria CDC

  16. Clinical Presentation • “Swimmer’s itch” • Minutes to days • Katayama Fever: • 14 to 84 days • Fever • General malaise • Headache • Cough • Lymphadenopathy • Hepatosplenomegaly • Urticaria • Arthralgias & myalgias • Diarrhea • Eosinophilia Manson’s Tropical Disease

  17. Morbidity & Mortality: • Urinary obstruction • Squamous cell carcinoma • Liver fibrosis • Portal hypertension • Ectopic eggs • CNS • Infertility Manson’s Tropical Disease

  18. tmrc.usu.edu

  19. 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.

  20. 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?

  21. navyseals.com

  22. Thank You

  23. Questions? helenrigden.wordpress.com

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