WEBVTT - Ep 47 Schistosomiasis: A Snail's Pace 0:00:01.320 --> 0:00:03.840 Soon after my attention had been directed to the liver 0:00:03.920 --> 0:00:06.440 and its associated structures, I found in the blood of 0:00:06.440 --> 0:00:09.760 the portal vein a number of long white helmets, which, 0:00:09.880 --> 0:00:12.639 with the naked eye I considered to be nematodes, but 0:00:12.720 --> 0:00:16.400 soon recognized as something new. A look into the microscope 0:00:16.400 --> 0:00:19.680 revealed a splendid dystomum with a flat body and a 0:00:19.760 --> 0:00:22.520 spiral tail at least ten times as long as the body. 0:00:22.960 --> 0:00:24.840 I have not yet reported the new stages of my 0:00:24.880 --> 0:00:27.920 portal vein worm. It did not, as I had expected, 0:00:28.000 --> 0:00:31.200 develop into an old wives tail, but into something more wonderful, 0:00:31.600 --> 0:00:35.879 a treematode with divided sex. I performed an autopsy on 0:00:35.920 --> 0:00:39.360 a boy who died of meningitis. Upon opening the urinary bladder, 0:00:39.400 --> 0:00:43.760 we found lentil to pea size soft, spongy excrescences. When 0:00:43.760 --> 0:00:46.320 I cut through the largest of the excrescences, a white 0:00:46.360 --> 0:00:49.599 thread adhered to the knife. Examining it more closely, I 0:00:49.640 --> 0:00:54.240 recognized our dystomum hematobium. I searched the depth of the 0:00:54.280 --> 0:00:56.920 incision and pulled out several more the areas of the 0:00:56.920 --> 0:00:59.760 bladder mucosa, where the earliest stages of the tumors appeared 0:00:59.800 --> 0:01:03.440 were covered with viscous, clear mucus containing large numbers of 0:01:03.520 --> 0:01:08.880 dystomum hematobium eggs singly or in clumps. When I showed 0:01:08.880 --> 0:01:12.399 Doctor Lautner the dystomum hematobium found in the bladder, he 0:01:12.480 --> 0:01:15.560 remarked that he too had seen the eggs while studying 0:01:15.560 --> 0:01:17.880 the pathologic changes of the bladder, but had not been 0:01:17.880 --> 0:01:21.280 able to explain them. He and doctor Greisinger encouraged me 0:01:21.319 --> 0:01:23.880 to examine the pathologic changes of the bladder, which were 0:01:23.920 --> 0:01:27.840 so similar to those found in dysenteric degenerations of the intestine. 0:01:28.400 --> 0:01:31.840 Further investigations in this country, which I shall continue zealously, 0:01:32.040 --> 0:01:34.959 as well as those being carried out in Europe, investigations 0:01:35.040 --> 0:01:37.560 to which I invite my colleagues, will have to decide 0:01:37.560 --> 0:01:41.240 whether Dystomum hematobium stands in the same relation to dysentery 0:01:41.319 --> 0:02:29.400 as a Kears scabii does to the itch. All right, then, 0:02:29.800 --> 0:02:36.080 So that was from excerpts from letters from Theodore Billar's 0:02:36.639 --> 0:02:40.799 to his supervisor von Siebold while conducting research in Egypt, 0:02:41.320 --> 0:02:48.280 and this was essentially the discovery of Schista's soma hematopium. 0:02:48.200 --> 0:02:50.200 The subject of today's. 0:02:49.760 --> 0:02:56.680 Episode one of the subjects just a semiasis in jen Hi. 0:02:56.639 --> 0:02:59.720 I'm erin Welsh and I'm erin Oman Updyke and this. 0:02:59.800 --> 0:03:04.359 Is this podcast will kill you. Yeah, welcome to just 0:03:04.480 --> 0:03:05.360 a Semiasis. 0:03:05.680 --> 0:03:09.720 Just a semiasis my first true love of disease. 0:03:12.040 --> 0:03:17.160 I like the qualifier there, not just well. Yeah, I'm 0:03:17.200 --> 0:03:21.639 excited too. I mean, we love a good multi host parasite. Yeah, 0:03:22.440 --> 0:03:26.920 fascinating the ecologies there. It typically has some long history. 0:03:27.160 --> 0:03:28.919 You know, I can't wait. 0:03:28.800 --> 0:03:30.679 To hear the history because I know nothing about it. 0:03:30.960 --> 0:03:34.960 Oh man, this I'm I'm very excited about this. This 0:03:35.080 --> 0:03:37.640 is like a full rich history. I didn't have to 0:03:37.800 --> 0:03:41.200 like color in the edges with some other. 0:03:41.120 --> 0:03:42.960 External historic et cetera. 0:03:44.200 --> 0:03:50.080 Hey, now, no, that was great, not true. Okay, so 0:03:50.240 --> 0:03:52.000 what are we drinking this week? 0:03:52.560 --> 0:03:54.640 We're drinking just a fluke. 0:03:57.120 --> 0:03:59.320 Because also shist ames are known as flukes. 0:03:59.400 --> 0:04:01.440 Flukes. Yeah, it's a type of platform. 0:04:01.640 --> 0:04:11.160 Yeah, and in justin luke is pomegranate juice, vodka, club soda, mint, 0:04:11.160 --> 0:04:14.040 simple syrup, maybe a little bit of lime juice, and 0:04:14.040 --> 0:04:17.240 then you garnish with some pomegranate seeds if we can 0:04:17.240 --> 0:04:18.200 find them from the store. 0:04:20.480 --> 0:04:22.640 And as always, will post the full recipe for this 0:04:22.760 --> 0:04:26.320 quarantini as well as our non alcoholic plusy burrita on 0:04:26.440 --> 0:04:30.000 our social media and our website, so you can check 0:04:30.000 --> 0:04:30.479 it out there. 0:04:30.800 --> 0:04:31.120 Yeah. 0:04:32.080 --> 0:04:35.800 Now let's dive into schisto. 0:04:36.000 --> 0:05:06.240 After this quick break. So shst a semiasis also called 0:05:06.520 --> 0:05:11.040 bill harcia. Yeah, because of as you mentioned from our 0:05:11.040 --> 0:05:13.839 first hand account, the person who discovered. 0:05:13.360 --> 0:05:15.000 It, Theodore bill Ars. 0:05:16.240 --> 0:05:17.920 Can we call him Teddy? Do you think you went 0:05:17.960 --> 0:05:18.440 by Teddy? 0:05:19.839 --> 0:05:24.240 I have no way of knowing. There probably is Google actually. 0:05:23.880 --> 0:05:26.160 But Teddy bill Ars. That's a cute name. 0:05:26.240 --> 0:05:27.679 I like it. I like the name Teddy. 0:05:28.160 --> 0:05:31.600 So shst a semiasis aka bill harcia. It's caused by 0:05:31.800 --> 0:05:34.919 a worm. We haven't done a ton of worms, so 0:05:35.000 --> 0:05:39.839 this is exciting. It's a flatworm, and specifically one that's 0:05:39.880 --> 0:05:43.279 called a fluke. That's like the type of worm that 0:05:43.400 --> 0:05:43.720 it is. 0:05:44.160 --> 0:05:45.279 Why is it called a fluke? 0:05:46.279 --> 0:05:46.479 You know? 0:05:46.600 --> 0:05:49.400 That's a good question that I don't know. Okay, I 0:05:49.440 --> 0:05:50.800 feel like that's a history question. 0:05:51.480 --> 0:05:52.719 Oh dang it, how dare you? 0:05:56.320 --> 0:05:59.599 So? There are a number of different species of shist 0:05:59.640 --> 0:06:03.960 as ome that infect humans. The three most common are 0:06:04.120 --> 0:06:10.720 Schistosoma Mansoni japonicum and Hematobium. There are a few other 0:06:10.800 --> 0:06:13.839 species as well that are less common, and they all 0:06:13.880 --> 0:06:18.560 have the same basic life cycle and overriding general pathways 0:06:18.600 --> 0:06:21.880 by which they travel through the human body and cause disease, 0:06:22.600 --> 0:06:27.520 but they do cause slightly different diseases, especially between Schistosoma, 0:06:27.600 --> 0:06:30.360 Mansoni Japonicum and Hematobium. 0:06:30.400 --> 0:06:32.480 It's kind of like the special one. 0:06:32.880 --> 0:06:38.920 So what we're gonna do is talk about the general 0:06:39.000 --> 0:06:42.520 life cycle and pathway first as a group, like all 0:06:42.560 --> 0:06:46.560 the shistosomes, and then we'll talk about the symptoms. We'll 0:06:46.560 --> 0:06:48.680 talk specifically about the differences between them. 0:06:48.680 --> 0:06:49.400 Does that sound good? 0:06:49.960 --> 0:06:54.599 Sounds great? Also, I just looked up fluke etomology, Oh 0:06:54.680 --> 0:06:57.800 tell me, and apparently it means it's like the old 0:06:57.800 --> 0:07:01.520 English word flock means flatfish, and so the worms were 0:07:01.520 --> 0:07:03.400 called that because they resembled. 0:07:03.680 --> 0:07:07.960 Flat flat fish little flounders. I can see that. Cool. 0:07:08.600 --> 0:07:16.520 Thanks Aaron, answering your own question. All right, So, like 0:07:16.600 --> 0:07:20.680 we mentioned briefly, one of the reasons that Aaron and 0:07:20.720 --> 0:07:23.160 I get excited about a parasite like this is that 0:07:23.240 --> 0:07:26.840 it has a very complex life cycle and transmission cycle. 0:07:27.880 --> 0:07:30.080 So it goes a little something like this. 0:07:30.760 --> 0:07:35.440 I'm I'm simplifying this a little bit, but this is 0:07:35.480 --> 0:07:36.679 the general overview. 0:07:36.720 --> 0:07:37.040 Okay. 0:07:37.440 --> 0:07:39.560 So we'll start with the eggs, because you have to 0:07:39.560 --> 0:07:42.840 start somewhere in a cycle. So the eggs are present 0:07:42.920 --> 0:07:46.840 in the environment, and they hatch in fresh water. 0:07:47.120 --> 0:07:48.040 Okay. 0:07:48.120 --> 0:07:52.080 And out of these eggs hatch these little mirrorciitia is 0:07:52.120 --> 0:07:55.240 what they're called, but we'll call them baby shisto. 0:07:55.600 --> 0:07:56.200 Okay, okay. 0:07:57.040 --> 0:08:00.960 So baby shisto have all these little still around their 0:08:01.040 --> 0:08:05.000 edges which act like swimmers so that they can swim 0:08:05.240 --> 0:08:09.760 through their environment. Aaron I wrote, they swim their way 0:08:09.800 --> 0:08:10.720 into a crab. 0:08:11.440 --> 0:08:15.560 Why did I write crab? What that is incorrect? That 0:08:15.640 --> 0:08:18.240 is incorrect is one percent incorrect. I can't believe I 0:08:18.280 --> 0:08:19.760 wrote crab. How funny. 0:08:21.040 --> 0:08:23.960 So with these little swimmers, they swim their way through 0:08:24.000 --> 0:08:25.840 fresh water into a snail. 0:08:26.400 --> 0:08:26.840 Okay. 0:08:27.800 --> 0:08:32.240 And it depends on what species of schistosome what species 0:08:32.280 --> 0:08:34.360 of snail they go into, but they all make their 0:08:34.360 --> 0:08:39.559 way into snails, and inside these snails, the baby shistos 0:08:39.640 --> 0:08:41.920 begin to multiply asexually. 0:08:42.880 --> 0:08:46.400 When you say, so, that's really interesting, it is, that's 0:08:46.440 --> 0:08:50.480 really wild. I started to talk as you were finishing 0:08:50.480 --> 0:08:54.840 that sentence. Also, how do they get into the snail. 0:08:54.880 --> 0:08:56.719 Do they penetrate the snails? 0:08:57.080 --> 0:08:59.240 Yep, little fleshy body parts. 0:08:59.720 --> 0:09:04.400 Yeah, okay, but they so they replicate a sexually, which 0:09:04.440 --> 0:09:07.760 is wild considering in the first hand account we learn. 0:09:07.760 --> 0:09:09.280 That will get there. 0:09:09.520 --> 0:09:10.520 Okay, don't you worry. 0:09:10.760 --> 0:09:15.000 These are just these are baby shistos. Okay, baby through 0:09:15.679 --> 0:09:19.200 life stage by live stage. So the baby shistos swam 0:09:19.240 --> 0:09:23.040 their way into a snail. They begin to replicate asexually, 0:09:23.640 --> 0:09:28.280 so multiply and multiply, and then they change into what 0:09:28.320 --> 0:09:30.960 are called sir Carrie a mm hmm. 0:09:31.679 --> 0:09:32.560 And these are. 0:09:32.880 --> 0:09:38.480 Kind of like a kid shisto. Okay, kiddo shistos. They 0:09:38.520 --> 0:09:42.199 look kind of like sperms. Okay okay, not quite like 0:09:42.240 --> 0:09:45.200 a sperm, but sperm esque. They have like a head 0:09:45.360 --> 0:09:48.680 and a tail that they use for swimming. So these 0:09:49.000 --> 0:09:53.880 kiddo shistos, spermy looking things, swim burrow their way back 0:09:53.960 --> 0:09:58.959 out of the snail and are released again into fresh water, 0:09:59.040 --> 0:10:01.920 and then they use that to swim around through fresh water. 0:10:02.920 --> 0:10:06.079 How over how many days or how long do they 0:10:06.080 --> 0:10:07.320 replicate in the stale? 0:10:07.679 --> 0:10:09.400 I knew you were gonna ask that question, so let 0:10:09.400 --> 0:10:13.200 me tell you. The eggs they can live in the 0:10:13.280 --> 0:10:17.640 environment for up to seven days, and then once the 0:10:17.679 --> 0:10:20.560 baby shistos make it into the snail, it takes four 0:10:20.559 --> 0:10:24.959 to six weeks before they start shedding the kiddo shistos. 0:10:24.440 --> 0:10:27.000 The cir carrier. It's a long time, it is. 0:10:27.280 --> 0:10:30.520 And now these cir carrier can live in the environment 0:10:30.559 --> 0:10:34.120 for up to seventy two hours, so they're swimming around time. 0:10:34.240 --> 0:10:34.960 That's a short time. 0:10:35.000 --> 0:10:38.720 They're swimming around in fresh water. And now here you come, 0:10:38.960 --> 0:10:43.559 as a human mammal walking around for a nice walk 0:10:43.679 --> 0:10:48.360 through these fresh water ponds or whatever. You're obviously barefoot 0:10:48.360 --> 0:10:51.360 because you wouldn't want to get your shoes wet. And 0:10:51.480 --> 0:10:56.480 these little kiddo shistos see you, swim right up and 0:10:56.679 --> 0:10:59.720 burrow their way through your. 0:10:59.480 --> 0:11:07.120 Skin and into your foot. Okay, okay, all right, okay. 0:11:08.040 --> 0:11:12.160 So now these little spermy circaria have wormed their way 0:11:12.240 --> 0:11:16.679 into your body, okay, and then they're going to change 0:11:16.760 --> 0:11:19.480 yet again. That spermy tail is going to fall off 0:11:19.920 --> 0:11:23.440 and they are going to start to swim in your 0:11:23.520 --> 0:11:27.800 body a mammal body and make their way into your bloodstream. 0:11:28.080 --> 0:11:30.559 So now you can think of them kind of as teenagers. 0:11:30.800 --> 0:11:34.680 These are called schistosomula at this point. Okay, so they're 0:11:34.679 --> 0:11:37.880 like the sperm without the tail, just the little head part. Okay, Okay, 0:11:39.040 --> 0:11:41.480 So inside of you, they make their way, as many 0:11:41.520 --> 0:11:46.160 parasites do, into your bloodstream, either directly through your little 0:11:46.160 --> 0:11:48.800 capillaries or through your lymphatic system. 0:11:48.960 --> 0:11:49.400 First. 0:11:50.120 --> 0:11:52.559 Then they're going to travel. This is where it gets 0:11:52.640 --> 0:11:56.480 really fun. It's already fun because how complicated is this. 0:11:57.640 --> 0:12:02.680 They travel through your venous system, and remember your veins 0:12:02.760 --> 0:12:06.880 are what carried the deoxygenated blood back to your heart, right, 0:12:07.480 --> 0:12:10.400 so they're going to travel through your veins to the 0:12:10.480 --> 0:12:13.360 right side of your heart. The right side of your 0:12:13.360 --> 0:12:18.040 heart is going to pump these teenage schistos out into 0:12:18.080 --> 0:12:22.280 your lungs, where they can then cross the capillaries and 0:12:22.440 --> 0:12:27.360 travel to the arterials, which go back to the left 0:12:27.440 --> 0:12:30.920 side of your heart, and then your heart can pump 0:12:31.000 --> 0:12:33.800 them out yet again to the rest of your body. 0:12:35.480 --> 0:12:38.240 And where they go from there is actually they make 0:12:38.280 --> 0:12:39.600 their way from your heart. 0:12:39.440 --> 0:12:40.120 To your liver. 0:12:41.120 --> 0:12:45.480 Okay, this is a very complicated route. Okay, they've entered 0:12:45.520 --> 0:12:49.280 your foot, they travel through your bloodstream, make their way 0:12:49.520 --> 0:12:53.960 to your lungs in order to get to your heart. 0:12:54.480 --> 0:12:56.000 In order to get to your liver. 0:12:56.840 --> 0:12:59.880 Okay, So it's kind of like it almost follows the 0:13:00.320 --> 0:13:03.080 root of the hookworm up until the liver part. 0:13:03.480 --> 0:13:06.800 Yeah, exactly, yes, or no, it's before the liver part 0:13:07.120 --> 0:13:07.800 to the lungs. 0:13:07.960 --> 0:13:08.800 Yeah, to the lungs. 0:13:08.880 --> 0:13:11.840 So yeah, hookworms also make it to your lungs, but 0:13:11.840 --> 0:13:13.880 then they make you cough and then you swallow them 0:13:13.880 --> 0:13:15.240 to get into your intestine. 0:13:15.559 --> 0:13:17.720 So these guys go a different way. In your lungs. 0:13:17.760 --> 0:13:20.720 They stay in your blood stream, so they're basically just 0:13:20.840 --> 0:13:23.200 riding your blood flow all the way to your liver. 0:13:23.679 --> 0:13:28.960 The that's their target destination for now, Okay. Then in 0:13:29.040 --> 0:13:32.480 your liver, and this is all all the different species 0:13:32.480 --> 0:13:36.160 of schistosoma do this, okay, Okay, They make their way 0:13:36.200 --> 0:13:40.280 to your liver, and then they're going to in your 0:13:40.320 --> 0:13:42.679 Like your liver has so much blood flow, lots of veins, 0:13:42.679 --> 0:13:46.440 lots of arteries all in there, and so in your liver, 0:13:46.480 --> 0:13:49.439 they're gonna leave the arterial system yet again and make 0:13:49.720 --> 0:13:52.360 make their way back into the veins in your liver, 0:13:53.080 --> 0:13:55.400 and that is where they're going to mature into full 0:13:55.400 --> 0:14:01.000 fledged adult sistosomes. And like you mentioned in the first hand, account, 0:14:02.080 --> 0:14:07.320 they now have male and female shistos Okay. I don't 0:14:07.360 --> 0:14:10.160 know whether you could identify them previously, but at this 0:14:10.280 --> 0:14:14.400 point as adults, there are male schistosomes and female schistosomes. 0:14:15.000 --> 0:14:17.959 And then just like on Love Island, UK. 0:14:19.080 --> 0:14:26.120 Yes, they're going to coupull up okay and sleep in 0:14:26.160 --> 0:14:29.000 the same bed together. Just kidding. 0:14:29.600 --> 0:14:34.720 What happens is the female schistosome literally wedges into a 0:14:34.800 --> 0:14:39.800 canal in the male sistosome called a gaynacophoral canal, and 0:14:39.840 --> 0:14:45.320 then as a pair, they traveled together to their final destination. 0:14:46.280 --> 0:14:46.680 Okay. 0:14:47.840 --> 0:14:52.880 For Schistosoma Mansoni and Japanicum, this final destination is the 0:14:53.000 --> 0:15:01.400 venus plexus around your intestines, the mesenteric veins. For schistosoma hematobium, 0:15:01.600 --> 0:15:03.960 it's the venus plexus around your bladder. 0:15:04.560 --> 0:15:05.000 Huh. 0:15:05.520 --> 0:15:09.240 Okay, I don't know why. Okay, I can see on 0:15:09.280 --> 0:15:13.440 your face you're about to ask me that I was. Yeah. 0:15:13.840 --> 0:15:16.760 It's a very interesting question as to why these like 0:15:17.040 --> 0:15:19.920 most species of shistosoma tend to go to the veins 0:15:19.920 --> 0:15:23.040 around your intestines, but hematobium goes to your bladder. 0:15:23.400 --> 0:15:26.040 It's a really interesting question that I don't know the 0:15:26.080 --> 0:15:26.560 answer to. 0:15:28.200 --> 0:15:30.560 But that is where they go, and then they live 0:15:30.600 --> 0:15:35.680 their lives as adult schistosomes where the female just lays 0:15:35.720 --> 0:15:39.040 eggs and eggs and eggs and eggs, so many eggs. 0:15:39.840 --> 0:15:42.080 And then what has to happen for them to complete 0:15:42.120 --> 0:15:45.520 their life cycle is these eggs have to make their 0:15:45.560 --> 0:15:49.160 way out of your body. So the way that they 0:15:49.200 --> 0:15:52.000 do that if they're in the veins around your intestine 0:15:52.040 --> 0:15:55.320 is those eggs will burrow through those veins into your 0:15:55.320 --> 0:15:59.400 intestine and you poop them out. If they're in your bladder, 0:15:59.440 --> 0:16:01.560 they have to borrow their way all the way through 0:16:01.560 --> 0:16:04.800 your bladder, which is a really thick organ like it 0:16:04.840 --> 0:16:08.360 has a thick wall, cool into your bladder and then 0:16:08.560 --> 0:16:09.360 you pee them out. 0:16:09.880 --> 0:16:14.680 Okay, okay, is there ever any recoupling? 0:16:16.680 --> 0:16:22.080 Recoupling Aaron I practiced for like ten minutes last night 0:16:22.120 --> 0:16:25.120 how to say couple up, and I think I still 0:16:25.120 --> 0:16:26.360 did a terrible job of it. 0:16:27.320 --> 0:16:30.400 Do you mean you watched ten episodes of violence? 0:16:31.040 --> 0:16:35.080 I literally sat with Brett saying the words couple up, 0:16:35.440 --> 0:16:38.920 like for ten solid minutes, trying to get a good accent. 0:16:41.800 --> 0:16:43.320 Anyways, time well spent. 0:16:43.760 --> 0:16:48.960 Mm hmm. So that's the life cycle of schistosama. 0:16:49.120 --> 0:16:49.400 Cool. 0:16:50.040 --> 0:16:50.680 Cool. 0:16:50.920 --> 0:16:53.240 They can live in your body, these adult worms. 0:16:53.280 --> 0:16:55.560 You haven't asked me, but let me tell you, for 0:16:56.240 --> 0:16:57.640 three to ten. 0:16:57.640 --> 0:17:00.880 Years in your That's impressive. 0:17:01.080 --> 0:17:02.960 Just layand eggs, laying eggs, lant eggs. 0:17:03.080 --> 0:17:07.719 Okay, that also makes it very difficult to get rid 0:17:07.800 --> 0:17:09.560 of environmental. 0:17:11.119 --> 0:17:15.520 Do you want to know what the theoretical reproductive potential 0:17:15.680 --> 0:17:24.560 of one schistosome pair is? Six hundred billion sistosomes? Oh, 0:17:24.680 --> 0:17:28.800 because not only are the adults living in you shedding 0:17:29.080 --> 0:17:35.440 for years, but one single Mirricidium that infects a snail 0:17:35.760 --> 0:17:40.840 can shed thousands of circaria every day for months. They 0:17:40.880 --> 0:17:42.240 live in the snail for months. 0:17:43.760 --> 0:17:45.320 That is incredible. 0:17:45.600 --> 0:17:52.720 I know whoa yep, Yeah, it's incredible, and it does 0:17:52.800 --> 0:17:56.840 it makes control of this very very difficult. Okay, so 0:17:56.920 --> 0:18:00.280 let's talk about the path of physiology of how this 0:18:00.280 --> 0:18:03.040 this We know how it moves through your body, but 0:18:03.400 --> 0:18:05.600 how does it actually cause symptoms? How does it actually 0:18:05.600 --> 0:18:08.560 make you sick? What's really important to keep in mind 0:18:08.680 --> 0:18:11.199 about shi just a semiasis is that the symptoms that 0:18:11.240 --> 0:18:15.240 we see from this disease are not from the worms themselves. 0:18:15.520 --> 0:18:19.960 They're from the eggs, and they're also not even necessarily 0:18:19.960 --> 0:18:22.720 from the eggs doing what eggs are supposed to do, 0:18:22.800 --> 0:18:25.440 which is leave your body through your poop or pee. 0:18:26.440 --> 0:18:28.919 But the symptoms are caused by what happens when the 0:18:28.960 --> 0:18:30.840 eggs don't leave your body. 0:18:31.480 --> 0:18:34.600 Really, yes, the fact that the. 0:18:34.560 --> 0:18:37.359 Eggs have to cross through, so they have to leave 0:18:37.400 --> 0:18:40.200 your veins. Right, they're living in the veins around your 0:18:40.200 --> 0:18:43.760 intestines or around your bladder. They have to penetrate through 0:18:43.880 --> 0:18:48.360 your vein walls and either into your bowels or your bladder. 0:18:48.920 --> 0:18:51.480 So you can imagine that this causes inflammation. 0:18:51.600 --> 0:18:51.800 Right. 0:18:51.840 --> 0:18:54.840 They have to make holes in your veins and your 0:18:54.920 --> 0:18:57.520 bowel or bladder wall to make their way into the 0:18:57.720 --> 0:19:02.680 lumen of these organs. So in the case of the 0:19:02.760 --> 0:19:06.680 bowels in your intestines, what can happen is they can 0:19:07.040 --> 0:19:10.560 leave essentially little holes behind, so you can get micro tears, 0:19:10.640 --> 0:19:15.480 micro perforations, you can get intestinal bleeding. Anytime you damage 0:19:15.520 --> 0:19:18.320 the wall of the intestine, you can mess up its 0:19:18.400 --> 0:19:22.960 absorptive capacity, so you can have malabsorption, which means diarrhea 0:19:23.000 --> 0:19:27.840 and also potentially malnutrition because of this, because you have 0:19:28.000 --> 0:19:31.280 bleeding from these little ulcerations, you can end up with anemia, 0:19:31.480 --> 0:19:36.840 especially in children. Who are already prone to anemia. Yeah, okay, 0:19:37.560 --> 0:19:41.960 so that's in the intestine. In the bladder, what can 0:19:42.000 --> 0:19:45.280 happen really commonly is that the bladder wall is very thick, 0:19:45.720 --> 0:19:47.840 so and this can happen in the bowels as well, 0:19:47.840 --> 0:19:50.320 but especially in the bladder because of how thick it is, 0:19:50.640 --> 0:19:53.480 the eggs don't always penetrate all the way through, so 0:19:53.520 --> 0:19:55.720 they can get stuck in the wall of the bladder. 0:19:56.280 --> 0:19:58.600 And what happens when the eggs get stuck in the 0:19:58.640 --> 0:20:03.160 wall of your tissue, essentially, is it causes a massive 0:20:03.359 --> 0:20:08.159 inflammatory response in your body, and your body tries to 0:20:08.280 --> 0:20:10.800 wall off this egg. Like your body recognizes this egg 0:20:10.840 --> 0:20:13.639 doesn't belong here, I'm going to wall it off, and 0:20:13.680 --> 0:20:17.320 it forms what's called a granuloma, which is basically inflammatory 0:20:17.400 --> 0:20:21.640 cells and tissue and debris walling off this egg. It's 0:20:21.680 --> 0:20:26.000 the same thing that we saw in tuberculosis. It happens 0:20:26.000 --> 0:20:30.600 in your lungs. Yeah, so that happens as well in 0:20:31.480 --> 0:20:34.760 shs a semiasis, and in the bladder wall. This can 0:20:34.800 --> 0:20:38.239 cause chronic inflammation. So one of the hallmark symptoms is 0:20:38.640 --> 0:20:45.680 bleeding in your p so huematuria, and that's from actual 0:20:45.720 --> 0:20:49.240 penetration through but also from this chronic inflammation that happens 0:20:49.240 --> 0:20:53.000 in the wall of your bladder. And then the other 0:20:53.080 --> 0:20:56.720 thing that can happen is that if you think about 0:20:57.240 --> 0:21:03.280 which direction blood flow in your veins, blood is flowing 0:21:03.800 --> 0:21:07.240 away from most of your organs in your veins, right, 0:21:07.440 --> 0:21:10.760 So the blood in the veins around your intestines is 0:21:10.760 --> 0:21:14.040 not flowing into the intestine. It's flowing away from the intestine. 0:21:14.119 --> 0:21:16.280 But the eggs are trying to get into the intestine, 0:21:16.280 --> 0:21:17.840 so they're swimming against the current. 0:21:19.080 --> 0:21:20.919 They don't all make it, so. 0:21:20.800 --> 0:21:23.760 Some of them get swept up backwards, and where they 0:21:23.800 --> 0:21:27.680 go is the liver because that's where those veins drain to. Oh, 0:21:27.880 --> 0:21:31.240 the liver, that's where they came from, right, yeah, So 0:21:31.760 --> 0:21:33.960 then they can get lodged in the liver and also 0:21:34.040 --> 0:21:36.800 the spleen because a lot of blood flow drains into 0:21:36.800 --> 0:21:39.720 the spleen as well. So then you have the same 0:21:39.800 --> 0:21:41.919 thing happening that happened in the wall of the bladder, 0:21:41.960 --> 0:21:46.320 these granulomas forming this intense inflammation in the liver and 0:21:46.359 --> 0:21:51.080 the spleen. So this can cause hippatosplenomegaly, so that means 0:21:51.400 --> 0:21:53.760 enlargement of the liver and the spleen. 0:21:54.040 --> 0:21:55.880 Wait, we just talked about this and I said it 0:21:55.960 --> 0:21:56.600 was a great word. 0:21:56.800 --> 0:21:57.440 Yeah you did. 0:21:57.480 --> 0:21:58.320 Which episode? 0:21:58.640 --> 0:22:03.639 Oh, let's see in is it hepsy? No, because hepsy 0:22:03.720 --> 0:22:09.520 doesn't cause spleen? Dangae dangay. It was okay, yeah, dangay. 0:22:09.920 --> 0:22:10.280 Cool. 0:22:10.800 --> 0:22:18.800 Yeah, so fun So connections yep. So it can cause hepatosplinamagally. 0:22:18.840 --> 0:22:20.760 It can also cause what we did talk about with 0:22:20.760 --> 0:22:25.520 hepatitis C, which is fibrosis of the liver. Especially now, 0:22:25.640 --> 0:22:29.080 anytime that you have veins being clogged, like we talked 0:22:29.080 --> 0:22:32.680 about in the hepsy episode, you can have portal hypertension, 0:22:33.240 --> 0:22:36.359 so the veins are being clogged, so the pressure is 0:22:36.400 --> 0:22:38.639 building up on the back end. So you can see 0:22:38.680 --> 0:22:41.200 all the same symptoms that you see with other chronic 0:22:41.640 --> 0:22:46.159 liver disease, like acide's fluid being filled up in your belly. 0:22:46.640 --> 0:22:50.679 You can get esophageal varices, so Varico's veins in your esophagus, 0:22:50.920 --> 0:22:53.080 which can cause massive bleeding if they rupture. 0:22:53.560 --> 0:22:55.880 Oh my gosh, yeah. 0:22:55.400 --> 0:22:57.760 Yeah, isn't that Isn't that fascinating? 0:22:58.560 --> 0:23:01.639 It is. So that's kind of like the pathophysiology of 0:23:01.720 --> 0:23:04.720 how and why it causes the disease that it causes. 0:23:04.760 --> 0:23:07.840 It's not the worms themselves, it's the eggs getting lodged 0:23:07.840 --> 0:23:11.200 in places and then our bodies mounting a massive immune 0:23:11.200 --> 0:23:13.080 response to try and wall these eggs off. 0:23:14.400 --> 0:23:16.240 Okay, fascinating. 0:23:16.560 --> 0:23:18.919 Okay, So then let's talk about the actual symptoms. We've 0:23:19.000 --> 0:23:20.800 kind of touched on them, but we'll go through the 0:23:20.920 --> 0:23:29.200 stages of infection. Okay, okay, so super acutely, like hours 0:23:29.240 --> 0:23:33.120 after you get infected, especially the first time you ever 0:23:33.160 --> 0:23:36.919 get infected. You're right, there is symptoms that happen right 0:23:36.960 --> 0:23:41.639 away from the circarria themselves, and that is an itch 0:23:42.320 --> 0:23:47.480 uh huh, where those little spurmes penetrate your body. Okay, 0:23:47.560 --> 0:23:49.200 This is sometimes called swimmers itch. 0:23:50.359 --> 0:23:53.680 It's also really funny to me that you're calling them 0:23:53.680 --> 0:23:56.159 little spurmes because of something that I'll talk about in 0:23:56.160 --> 0:23:57.040 the history section. 0:23:57.440 --> 0:24:03.200 Oh really yeah yeah, So yeah, you can get a rash. 0:24:03.240 --> 0:24:05.880 It's sometimes called swimmer's itch because again this is from 0:24:05.960 --> 0:24:09.040 freshwater ponds and things like that. That is where they live, 0:24:10.280 --> 0:24:14.200 and it'll be blistery, it'll be itchy, but it's generally 0:24:14.240 --> 0:24:16.760 self limited and it kind of goes away over time. 0:24:17.000 --> 0:24:23.360 Right then there is an acute disease that can happen 0:24:23.880 --> 0:24:27.320 in a number of weeks, usually like two to ten 0:24:27.400 --> 0:24:34.359 weeks after infection. It tends to only really happen with 0:24:34.840 --> 0:24:42.280 Schistosoma japonicum infection, but it also can happen in travelers 0:24:42.640 --> 0:24:46.480 who get infected with Sistosoma mansoni and hematobium, But it 0:24:46.520 --> 0:24:49.600 doesn't tend to happen in people who live in areas 0:24:49.640 --> 0:24:52.280 where this disease is endemic with the other two species, 0:24:52.320 --> 0:24:52.960 if that makes. 0:24:52.840 --> 0:24:54.720