Schistosomiasis history and symptoms

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]

Overview

The majority of patients with schistosomiasis in early phase are asymptomatic, unless katayama fever, an acute immune complex disease, occurs. Late schistosomiasis is symptomatic and includes hepatosplenic schistosomiasis (presinusoidal portal hypertension), urinary and urogenital schistosomiasis (urinary obstruction, genital symptoms), schistosomal glomerulopathy (chronic immune complex deposition in the kidney), and ectopic disease in areas such as the lungs and central nervous system (CNS).

History

The significant information that needs to focused in the history of the patient includes

  • Any history of travel to the endemic areas
  • Any ill contact with similar complaints

Symptoms

Clinical manifestations of schistosomiasis can be divided into:

  • Schistosome dermatitis
  • Acute schistosomiasis (katayama fever)
  • Chronic schistosomiasis[1]

Acute schistosomiasis(Katayama fever)

Chronic schistosomiasis

Intestinal schistosomiasis

Schistosomal nephropathy

Urogenital schistosomiasis

Pulmonary schistosomiasis

Neuroschistosomiasis

  • In hospitalized adult patients with S. japonicum infection, cerebral schistosomiasis occurs in 1.7 to 4.3%.
  • It may occur as early as 6 weeks after infection, and the most common sign is focal jacksonian epilepsy.
  • Signs and symptoms of generalized encephalitis may occasionally be found.
  • In S. mansoni infection, neurologic involvement is rare and mainly characterized by transverse myelitis, which occurs mainly in patients without liver fibrosis and hepatosplenomegaly.

Schistosome dermatitis

  • Schistosome dermatitis, or swimmer's itch, is an uncommon manifestation seen mainly when avian cercariae penetrate the skin and are destroyed.[7][8]
  • Schistosome dermatitis is a sensitization phenomenon occurring in previously exposed persons.
  • The cercariae evoke an acute inflammatory response with edema, early infiltration of neutrophils and lymphocytes, and later invasion of eosinophils.
  • A pruritic papular rash occurs within 24 hours after the penetration of cercariae and reaches maximal intensity in 2 to 3 days.

The table below summarizes the symptoms of schistosomiasis

Symtoms
Acute schistosomiasis

(Katayama fever)

Chronic schistosomiasis Schistosomal nephropathy present with varying degrees of fatigue and asthenia
Intestinal schistosomiasis may develop episodic intestinal bleeding and tenesmus.

Hepatosplenic schistosomiasis may present with cataclysmic esophageal variceal hemorrhage.

Neuro-schistosomiasis may present with seizures, transverse myelitis or symptoms similar to those of cauda equina syndrome (eg, low back pain, lower extremity weakness, bowel and bladder symptoms) due to inflammation at the nerve roots

Granulomatous inflammation in the CNS can result in conus medullaris syndrome or schistosomal cerebritis (most commonly caused by S. japonicum)

Pulmonary schistosomiasis experience dyspnea on exertion, fatigue, and hemoptysis.
Schistosome dermatitis

( swimmer's itch)

Uncommon manifestation.

A pruritic papular rash occurs within 24 hours after the penetration of cercariae and reaches maximal intensity in 2 to 3 days.

References

  1. Gray DJ, Ross AG, Li YS, McManus DP (2011). "Diagnosis and management of schistosomiasis". BMJ. 342: d2651. PMC 3230106. PMID 21586478.
  2. Jensen T, Rønne-Rasmussen JO, Bygbjerg IC (1995). "[Acute schistosomiasis (Katayama fever)]". Ugeskr. Laeg. (in Danish). 157 (35): 4825–7. PMID 7676521.
  3. Doherty JF, Moody AH, Wright SG (1996). "Katayama fever: an acute manifestation of schistosomiasis". BMJ. 313 (7064): 1071–2. PMC 2352353. PMID 8898604.
  4. Baharoon S, Al-Jahdali H, Bamefleh H, Elkeir A, Yamani N (2011). "Acute pulmonary schistosomiasis". J Glob Infect Dis. 3 (3): 293–5. doi:10.4103/0974-777X.83539. PMC 3162819. PMID 21887064.
  5. King CH, Dangerfield-Cha M (2008). "The unacknowledged impact of chronic schistosomiasis". Chronic Illn. 4 (1): 65–79. doi:10.1177/1742395307084407. PMID 18322031.
  6. Mourra N, Lesurtel M, Paye F, Flejou JF (2006). "Chronic schistosomiasis: an incidental finding in sigmoid volvulus". J. Clin. Pathol. 59 (1): 111. PMC 1860253. PMID 16394292.
  7. MILLER MJ, MUNROE E (1951). "Schistosome dermatitis in Quebec". Can Med Assoc J. 65 (6): 571–5. PMC 1822311. PMID 14886855.
  8. González E (1989). "Schistosomiasis, cercarial dermatitis, and marine dermatitis". Dermatol Clin. 7 (2): 291–300. PMID 2670374.