The Complication of Schistosomiasis Japonica

1
Wasilatus Sholehah and 2Yudha Nurdian
1Student,
Faculty of Medicine, University of Jember, Indonesia
2Faculty
of Medicine, University of Jember, Indonesia.
Coresponding author: Wasilatus Sholehah, sylewasil@gmail.com; 152010101021@students.unej.ac.id

Abstract
Background
Schistosomiasis is an infectious disease caused by trematode parasites of the genus Schistosoma. S.
japonicum is one of three main species of schistosomes that found in China, the Philippines, and
Indonesia. Schistosomiasis is endemic in Indonesia in two isolated areas, Lindu valley and Napu
valley, both located in the Province of Central Sulawesi. The prevalence of schistosomiasis in
endemic villages in this area was 0.8% in 2008 and 5.9% in 2010. The adult male and female worms
live within the veins of their human host, where they mate and produce fertilised eggs. Ectopic
deposition of schistosoma eggs can lead to unexpected morbidities. The most common involves
migration of parasite or eggs to the central nervous system (CNS), with symptoms of spinal
compression or encephalopathy. Cerebral schistosomiasis occurs most commonly during S.
japonicum infestations, as many as 2% to 5% of infestations and accounting for high rates of epilepsy
in endemic areas. Clinical presentation includes symptoms of meningoencephalitis with pyrexia,
headache, vomiting, blurred vision, and altered sensorium or jacksonian epilepsy. Spinal cord
involvementmore common with acute schistosomiasiscan present as acute transverse myelitis or
subacute myeloradiculopathy, and can result in paralysis or lumbar and leg pain, with muscle
weakness, sensory loss, and bladder. In some cases, eosinophil-mediated toxicity leading to vasculitis
and small vessel thrombosis may be responsible for neurologic disease during acute infection. Patients
with acute schistosomal encephalopathy present with headache, altered mental status, and often
seizures and focal deficits. Computed tomography (CT) and magnetic resonance imaging (MRI) show
edema and multifocal enhancing lesions and occasionally border zone infarctions. The drug of choice
for treating all species of schistosomes is praziquantel, which affects membrane permeability to
calcium ions in the parasite. Persons with schistosomal disease of the CNS should also take
corticosteroids to reduce the inflammation and edema around eggs because miracidia in eggs in
tissues remain viable and secrete antigenic proteins for several weeks.

Conclusion
In most cases, the resulting lesions schistosomiasis do not produce symptoms, but involvement of the
CNS can cause serious cerebral and spinal cord disease. This most commonly occurs during S.
japonicum infestations, as many as 2% to 5% of infestations and accounting for high rates of epilepsy
in endemic areas.

References
Maguire, J. H. 2015. Trematodes (Schistosomes and Liver, Intestinal, and Lung Flukes). In: Bennett,
J. E., Dolin, R., Blaser, M. J. (Eds.). Mandell, Douglas, Bennetts Principles and Prantice of
Infectious Diseases, Eighth Ed., Vol. 1, Philadelphia: Elsevier. p. 3215-3226.

Colley, D. G., Bustinduy, A. L., Secor, W. E., and King, C. H. 2014. Human Schistosomiasis. Lancet,
383(9936): 22532264. doi:10.1016/S0140-6736(13)61949-2

Satrija, F., Ridwan, Y., Jastal., Samarang., and Rauf, A., 2013. Current Status of Schistosomiasis in
Indonesia. Acta Trop., 141(Pt B):349-53. doi: 10.1016/j.actatropica.2013.06.014