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47-592: The swampy zone is 196 kilometres (122 mi) long and has a greatest width of 25 kilometres (16 mi), covering an area of 231,000 hectares (570,000 acres). Apart from the Ewaso Ngiro river, the swamp is also fed by wadis from the southwest and the northeast. The swamp is less than 300 metres (980 ft) above sea level. The swamp lies in an arid zone, with the local annual rainfall averaging between 180 and 250 mm, but varies widely from year to year. It may be much higher in wet years and much lower in dry years, so

94-404: A cough , bloody diarrhea , chills, or lymph node enlargement. Some patients may also experience dyspnea and hypoxia associated with the development of pulmonary infiltrates . The first potential reaction is an itchy, maculopapular rash that results from cercariae penetrating the skin within the first 12 hours to days of cercarial skin penetration. The first time a non-sensitized person

141-1081: A granulomatous reaction . They mostly affect the large bowel and rectum, and involvement of the small bowel is more rare. This immune response can lead to obstruction of the colon and blood loss. The infected individual may have what appears to be a potbelly. There is a strong correlation between morbidity of intestinal schistosomiasis and the intensities of infection. In cases of light infections, symptoms may be mild and can go unrecognized. The most common species to cause intestinal schistosomiasis are S. mansoni and S. japonicum , however, S. mekongi and S. intercalatum can also cause this disease. Symptoms may include: Complications may include: Approximately 10-50% of people living in endemic regions of S. mansoni and S. japonicum develop intestinal schistosomiasis. S. mansoni infection epidemiologically overlaps with high HIV prevalence in Sub-Saharan Africa, where gastrointestinal schistosomiasis has been linked to increased HIV transmission. Eggs also migrate to

188-548: A large amount of eggs are unable to finish their journey and remained stuck within the tissues where they can elicit an immune response. The miracidia in these eggs can then release antigens that stimulate an inflammatory immune response. The miracidia within the eggs live for around 6–8 weeks before they die and stop releasing the antigens. The granulomatous response is a cellular immune response mediated by CD4 T cells, neutrophils, eosinophils, lymphocytes, macrophages, and monocytes, and this chronic inflammatory response elicited by

235-681: A tingling sensation or light rash , commonly referred to as " swimmer's itch ", due to irritation at the point of entrance. The rash that may develop can mimic scabies and other types of rashes. The manifestation of a schistosomal infection varies over time as the larval form of the parasite cercariae and later adult worms and their eggs migrate through the body. If eggs migrate to the brain or spinal cord, seizures, paralysis, or spinal-cord inflammation are possible. Manifestation of an acute infection from schistosoma includes cercarial dermatitis (hours to days) and acute systemic schistosomiasis (2–8 weeks) which can include symptoms of fever , myalgia ,

282-423: A urine sample under a microscope would reveal the eggs of S. haematobium and rarely, the eggs of S. mansori. After larvae hatch from these eggs, the larvae infect a very specific type of freshwater snail. For example, in S. haematobium and S. intercalatum it is snails of the genus Bulinus , in S. mansoni it is Biomphalaria , and in S. japonicum it is Oncomelania . The schistosome larvae undergo

329-418: Is also a concern of cattle husbandry and mice . O-methyl-threonine is weakly effective in mouse schistosomiasis but is not in use. The infectious stage starts when the free-swimming larval form of the schistosome, cercariae, penetrates the human skin using their suckers, proteolytic enzymes , and tail movements; the cercariae transformed into schistosomulae by losing its tail and subsequently travels to

376-448: Is also common among women, who may have greater exposure through daily chores that involve water, such as washing clothes and fetching water. Other high-risk groups include farmers, fishermen, and people using unclean water during daily living. Schistosomiasis belongs to the group of helminth infections . Diagnosis is made by finding the parasite’s eggs in a person's urine or stool. It can also be confirmed by finding antibodies against

423-763: Is associated with heavy infection. It is seen, however, in native residents of China infected with S. japonicum . S. japonicum can cause acute schistosomiasis in chronically infected population, and it can lead to a more severe form of acute schistosomiasis. Symptoms may include: Acute schistosomiasis usually self-resolves in 2–8 weeks in most cases, but a small proportion of people have persistent weight loss, diarrhea, diffuse abdominal pain, and rash. Complications may include: Neurological side effects may include Cardiac side effects may include Treatment may include: In long-established disease, adult worms lay eggs that can cause inflammatory reactions. The eggs secrete proteolytic enzymes that help them migrate to

470-531: Is enhanced by repeated examinations or concentration procedures, or both. In addition, for field surveys and investigational purposes, the egg output can be quantified by using the Kato-Katz technique (20 to 50 mg of fecal material) or the Ritchie technique . Eggs can be found in the urine in infections with S. haematobium (recommended time for collection: between noon and 3 PM) and with S. japonicum . Quantification

517-451: Is exposed, the rashes are usually mild with an associated prickling sensation that quickly disappear on its own since this is a type of hypersensitivity reaction. In sensitized people who have previously been infected, the rash can develop into itchy, red, raised lesions ( papules ) with some turning into fluid-filled lesions ( vesicles ). Previous infections with cercariae causes a faster developing and worse presentation of dermatitis due to

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564-415: Is known about the swamp, due to the hostile terrain and insecurity in the area. It is not protected. The swamp is infested with malarial mosquitos and with vectors of the organisms that cause bilharzia . It is home to crocodiles and is visited by many large savannah mammals. Because of the dangers, cattle are not grazed far into the swamp, but they do make extensive use of the shallow waters, particularly in

611-544: Is not contagious and can not be transmitted from person-to-person. Symptoms may include: Scratching the rash can lead to secondary bacterial infection of the skin, thus it is important to refrain from scratching. Some common treatments for itching include corticosteroid cream, anti-itch lotion, application of cool compresses to rash, bathing in Epsom salts or baking soda, and in severe itching cases, prescription strength cream and lotions. Oral antihistamines can also help relieve

658-426: Is possible by using filtration through a nucleopore filter membrane of a standard volume of urine followed by egg counts on the membrane. Tissue biopsy (rectal biopsy for all species and biopsy of the bladder for S. haematobium ) may demonstrate eggs when stool or urine examinations are negative. Malaise In medicine , malaise is a feeling of general discomfort , uneasiness or lack of wellbeing and often

705-464: Is reached, mating occurs and eggs are produced. Eggs enter the bladder/intestine and are excreted through urine and feces and the process repeats. If the eggs do not get excreted, they can become engrained in the body tissues and cause a variety of problems such as immune reactions and organ damage. While transmission typically occurs only in countries where the freshwater snails are native, a case in Germany

752-408: Is second only to malaria among parasitic diseases with the greatest economic impact. Schistosomiasis is listed as a neglected tropical disease . Many individuals do not experience symptoms. If symptoms do appear, they usually take 4–6 weeks from the time of infection. The first symptom of the disease may be a general feeling of illness . Within 12 hours of infection, an individual may complain of

799-417: Is stagnant or in recession (compare depression ). The term is particularly associated with the 1973–75 United States recession . An era of American automotive history, centered around the 1970s, is similarly called the " malaise era ." The "Crisis of Confidence" speech made by US President Jimmy Carter in 1979 is commonly referred to as the " malaise speech ", although the word itself was not actually in

846-467: Is the most practical method for diagnosis. Stool examination should be performed when infection with S. mansoni or S. japonicum is suspected, and urine examination should be performed if S. haematobium is suspected. Eggs can be present in the stool in infections with all Schistosoma species. The examination can be performed on a simple smear (1 to 2 mg of fecal material). Because eggs may be passed intermittently or in small numbers, their detection

893-540: The World Health Organization (WHO) for those who are known to be infected. Schistosomiasis affected about 236.6 million people worldwide in 2019. An estimated 4,400 to 200,000 people die from it each year. The disease is most commonly found in Africa, Asia, and South America. Around 700 million people, in more than 70 countries, live in areas where the disease is common. In tropical countries, schistosomiasis

940-435: The anomalous migration of the adult worm, which appears to be the only mechanism by which Schistosoma can reach the central nervous system in people with schistosomiasis. The destructive action on the nervous tissue and the mass effect produced by a large number of eggs surrounded by multiple, large granulomas in circumscribed areas of the brain characterize the pseudotumoral form of neuroschistosomiasis and are responsible for

987-401: The appearance of clinical manifestations: headache, hemiparesis, altered mental status, vertigo, visual abnormalities, seizures, and ataxia. Similarly, granulomatous lesions from S. mansoni and S. haematobium eggs in the spinal cord can lead to transverse myelitis (inflammation of the spinal cord) with flaccid paraplegia . In cases with advanced hepatosplenic and urinary schistosomiasis,

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1034-400: The area of the swamp varies considerably. Potential evaporation rates in the swamp are as much as 2,600 mm per year. The swamp may almost completely dry up in drought periods. The area of permanent swamp has shrunk from 150 square kilometres (58 sq mi) in 1913 to around 39 square kilometres (15 sq mi) in 1962 and 8 square kilometres (3.1 sq mi) in 1990. Little

1081-498: The bladder and intestines to be shed. The enzymes also cause an eosinophilic inflammatory reaction when eggs get trapped in tissues or embolize to the liver, spleen, lungs , or brain . The long-term manifestations are dependent on the species of schistosome, as the adult worms of different species migrate to different areas. Many infections are mildly symptomatic, with anemia and malnutrition being common in endemic areas. The worms of S. mansoni and S. japonicum migrate to

1128-424: The bladder cancer rate. The risk of bladder cancer appears to be especially high in male smokers, perhaps due to chronic irritation of the bladder lining allowing it to be exposed to carcinogens from smoking. In women, genitourinary disease can also include genital lesions that may lead to increased rates of HIV transmission. If lesions involve the fallopian tubes or ovaries, it may lead to infertility. If

1175-536: The brain or spinal cord through the circulatory system, and they can potentially develop irreversible scarring without proper treatment. Cerebral granulomatous disease may be caused by S. japonicum eggs in the brain during both the acute and chronic phase of the disease. Communities in China affected by S. japonicum have rates of seizures eight times higher than baseline. Cerebral granulomatous infection may also be caused by S. mansoni . In situ egg deposition following

1222-502: The continuous embolization of eggs from the portal mesenteric system ( S. mansoni ) or portal mesenteric-pelvic system ( S. haematobium ) to the brain, results in a sparse distribution of eggs associated with scant periovular inflammatory reaction, usually with little or no clinical significance. Spinal cord inflammation ( transverse myelitis ) symptoms may include: Cerebral granulomatous infection symptoms may include: Corticosteroids are used to prevent permanent neurological damage from

1269-405: The disease in the blood. Methods of preventing the disease include improving access to clean water and reducing the number of snails. In areas where the disease is common, the medication praziquantel may be given once a year to the entire group. This is done to decrease the number of people infected, and consequently, the spread of the disease. Praziquantel is also the treatment recommended by

1316-455: The dry season. Sources 0°38′46″N 39°36′14″E  /  0.64611°N 39.60389°E  / 0.64611; 39.60389 Bilharzia Schistosomiasis , also known as snail fever , bilharzia , and Katayama fever , is a disease caused by parasitic flatworms called schistosomes . The urinary tract or the intestines may be infected. Symptoms include abdominal pain , diarrhea , bloody stool , or blood in

1363-471: The eggs can cause fibrosis, tissue destruction, and granuloma nodules that disrupt the functions of the organs involved. Th1 helper cell response is prominent releasing cytokines such as IFN- γ during the early phases of infection, and it transitions to Th2 response leading to increase in level of IgE, IL-4, and eosinophils as egg production progresses. In chronic infections, the Th2 response shifts to increasing

1410-470: The eggs entrapment within tissues resulting in granuloma formation and chronic inflammation. Adult worms live together in pairs (one male and female), sexually reproduce, and lay eggs in the veins around the intestines and bladder depending on the species, and these eggs can rupture the wall of the veins to escape to the surrounding tissues. The eggs make their way through the tissues to the intestinal or bladder lumen with help of proteolytic enzymes, however,

1457-484: The first sign of an infection or other disease. The word has existed in French since at least the 12th century. The term is often used figuratively in other contexts, in addition to its meaning as a general state of angst or melancholia . Malaise is a non-specific symptom and can be present in the slightest ailment, such as an emotion (causing fainting, a vasovagal response ) or hunger (light hypoglycemia ), to

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1504-425: The heart and lungs through venous system until it eventually reach the liver where it will mature into the adult form. The diseases caused by the schistomes are characterized into acute schistosomiasis and chronic schistosomiasis, and they can vary dependent on the species of schistosome. Acute infection Chronic infection The clinical manifestations of chronic infection is mainly caused by immune reaction to

1551-401: The inflammatory response to the eggs, and sometimes anticonvulsants are needed to stop the seizures. Corticosteroids are given prior to administration of praziquantel. Infected Schistosoma individuals release eggs into water via their fecal material or urine. A collection of stool samples under a microscope will show the eggs of S. intercalatum , S. mansori , and S. japonicum . Looking at

1598-433: The itching. Acute schistosomiasis (Katayama fever) may occur weeks or months (around 2–8 weeks) after the initial infection as a systemic reaction against migrating schistosomulae as they pass through the bloodstream through the lungs to the liver and also against the antigens of eggs. Similarly to swimmer's itch, Katayama fever is more commonly seen in people with their first infection such as migrants and tourists, and it

1645-427: The level of IL-10, IL-13, and IgG4, which reverses the progression of the granulomas and lead to collagen deposition at the sites of the granulomas. The specific clinical symptoms and severity of the disease this causes depends on the type of schistosome infection, duration of infection, number of eggs, and the organ at which the eggs are deposited. The amount of eggs entrapped in the tissues will continue to increase if

1692-855: The liver leading to fibrosis in 4 to 8% of people with chronic infection, mainly those with long-term heavy infection. Eggs can become lodged in the liver , leading to portal hypertension , splenomegaly , the buildup of fluid in the abdomen, and potentially life-threatening dilations or swollen areas in the esophagus or gastrointestinal tract that can tear and bleed profusely ( esophageal varices ). This condition can be separated into two distinct phases: inflammatory hepatic schistosomiasis (early inflammatory reaction) and chronic hepatic schistosomiasis. Most common species to cause this condition are S. mansoni , S. japonicum , and S. mekongi . Inflammatory hepatic schistosomiasis Chronic (fibrotic) hepatic schistosomiasis Portal hypertension secondary to hepatosplenic schistosomiasis can cause vessel connections between

1739-406: The most serious conditions ( cancer , stroke , heart attack , internal bleeding , etc.). Malaise expresses a patient's uneasiness that "something is not right" that may need a medical examination to determine the significance. Malaise is thought to be caused by the activation of an immune response, and the associated pro-inflammatory cytokines . " Economic malaise " refers to an economy that

1786-450: The next phase of their lifecycles in these snails, spending their time reproducing and developing. Once this step has been completed, the parasite leaves the snail and enters the water column. The parasite can live in the water for only 48 hours without a mammalian host. Once a host has been found, the worm enters its blood vessels. For several weeks, the worm remains in the vessels, continuing its development into its adult phase. When maturity

1833-417: The portal (liver and gut) circulation and systemic circulation to develop, which creates a pathway for the eggs and worms to travel to the lungs. The eggs can be deposited around the alveolar capillary beds and causes granulomatous inflammation of the pulmonary arterioles followed by fibrosis. This leads to high blood pressure in the pulmonary circulation system ( pulmonary hypertension ), increased pressure in

1880-414: The reproductive organs in male are affected, there could be blood in the sperm. Urinary symptoms may include: Genital symptoms may include: Kidney function is unaffected in many cases, and the lesions are reversible with proper treatment to eliminate the worms. Central nervous system lesions occur occasionally due to inflammation and granuloma development around eggs or worms that find their way to

1927-457: The right heart, enlargement of the pulmonary artery and right atria, and thickening of the right ventricular wall . Symptoms of pulmonary hypertension may include: The worms of S. haematobium migrate to the veins around the bladder and ureters where they reproduce. S. haematobium can produce up to 3000 eggs per day, these eggs migrate from the veins to the bladder and ureter lumens, but up to 50 percent of them can become trapped in

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1974-568: The schistosoma are not eliminated. Diagnosis of infection is confirmed by the identification of eggs in stools. Eggs of S. mansoni are about 140 by 60 μm in size and have a lateral spine. The diagnosis is improved through the use of the Kato-Katz technique , a semiquantitative stool examination technique. Other methods that can be used are enzyme-linked immunosorbent assay , circumoval precipitation test, and alkaline phosphatase immunoassay. Microscopic identification of eggs in stool or urine

2021-551: The stronger immune response. The round bumps are usually one to three centimeters across. Because people living in affected areas have often been repeatedly exposed, acute reactions are more common in tourists and migrants. The rash can occur between the first few hours and a week after exposure, and they normally resolve on their own in around 7–10 days. For human schistosomiasis, a similar type of dermatitis called "swimmer's itch" can also be caused by cercariae from animal trematodes that often infect birds. Cercarial dermatitis

2068-524: The surrounding tissues causing granulomatous inflammation, polyps formation, and ulceration of bladder, ureter, and genital tract tissues. This can lead to blood in the urine 10 to 12 weeks after infection. Over time, fibrosis can lead to obstruction of the urinary tract, hydronephrosis , and kidney failure . Bladder cancer diagnosis and mortality are generally elevated in affected areas; efforts to control schistosomiasis in Egypt have led to decreases in

2115-556: The urine . Those who have been infected for a long time may experience liver damage , kidney failure , infertility , or bladder cancer . In children, schistosomiasis may cause poor growth and learning difficulties . Schistosomiasis is spread by contact with fresh water contaminated with parasites. These parasites are released from infected freshwater snails . The disease is especially common among children in underdeveloped and developing countries, because these kids are more likely to play in contaminated water. Schistosomiasis

2162-429: The veins of the gastrointestinal tract and liver. Eggs in the gut wall can lead to pain, blood in the stool , and diarrhea (especially in children). Severe disease can lead to narrowing of the colon or rectum . In intestinal schistosomiasis, eggs become lodged in the intestinal wall during their migration from the mesenteric venules to the intestinal lumen, and the trapped eggs cause an immune system reaction called

2209-418: Was reported where a man got schistosomiasis from an infected snail in his aquarium. Humans encounter larvae of the schistosome parasite when they enter contaminated water while bathing, playing, swimming, washing, fishing, or walking through the water. The life cycle stages: Schistosomes can live an average of 3–5 years, and the eggs can survive for more than 30 years after infection. Schistosomiasis

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