Schistosomiasis natural history, complications and prognosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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Natural History and Complications

Above all, schistosomiasis is a chronic disease. Pathology of S. mansoni and S. japonicum schistosomiasis includes: Katayama fever, hepatic perisinusoidal egg granulomas, Symmers’ pipe stem periportal fibrosis, portal hypertension, and occasional embolic egg granulomas in brain or spinal cord. Pathology of S. haematobium schistosomiasis includes: hematuria, scarring, calcification, squamous cell carcinoma, and occasional embolic egg granulomas in brain or spinal cord. Bladder cancer diagnosis and mortality are generally elevated in affected areas.

Occasionally central nervous system lesions occur: cerebral granulomatous disease may be caused by ectopic S. japonicum eggs in the brain, and granulomatous lesions around ectopic eggs in the spinal cord from S. mansoni and S. haematobium infections may result in a transverse myelitis with flaccid paraplegia. Continuing infection may cause granulomatous reactions and fibrosis in the affected organs, which may result in manifestations that include:

• Colonic polyposis with bloody diarrhea (Schistosoma mansoni mostly);
• Portal hypertension with hematemesis and splenomegaly (S. mansoni, S. japonicum);
• Cystitis and ureteritis (S. haematobium) with hematuria, which can progress to bladder cancer;
• Pulmonary hypertension (S. mansoni, S. japonicum, more rarely S. haematobium);
• Glomerulonephritis; and central nervous system lesions.