Japanese Schistosomiasis
This is also called Katayama disease and in its early stages urticarial fever or Yangtse fever. It is caused by the nontuberculated species, S. japonicum, which is characterized by the egg without a spine.
Laning, in a study of 7 well-controlled cases, has shown that the disease sets in after two or three days from the time of exposure to infection, by wading through paddy fields or still waters of infected ponds or lakes. The disease occurs in China, Japan and possibly in the Philippine Islands.
A B
Fig. 111.—A and B, Case of Schistosoma japonicum. Severe infection of three years’ duration. Ova very abundant in stools. Liver dullness diminished. Spleen not enlarged. (From Jefferys and Maxwell.)
The course of the disease may be divided into 3 stages: the 1st, that of urticarial, pulmonary and febrile manifestations, which lasts about a month; the 2d, where ova begin to show in the small mass of bloody mucus which may cap the stool, and finally the 3d stage with cirrhosis of the liver, ascites, cachexia and death.
In the 1st stage we have headache and an evening rise of temperature to about 101°F. or 102°F. Shortly after the onset urticarial lesions, which may be 2 or 3 inches in diameter, may appear and disappear on various parts of the body.
The pulse rate is usually low. Very characteristic and early manifestations are those of the pulmonary involvement. Here oedematous patches may give the signs of crepitation and consolidation to rapidly disappear and reappear in another part of the lungs.
These pulmonary manifestations and the associated fever frequently cause a diagnosis of broncho-pneumonia to be made. A dry hacking cough appears early and with the fever, etc., may make one think of tuberculosis. The urticarial lesions often cause a diagnosis of ptomaine poisoning to be made. The blood examination shows a marked eosinophilia, of from 30 to 60%.