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Schistosomiasis

Last reviewed: 15 Apr 2025
Last updated: 12 Mar 2024

Summary

Definition

History and exam

Key diagnostic factors

  • geographic exposure
  • abdominal pain
  • hematuria
  • hematemesis
Full details

Other diagnostic factors

  • rash
  • fever
  • dysuria
  • hepatosplenomegaly
  • dyspnea
  • bloody diarrhea
  • pelvic pain
  • infertility or history of ectopic pregnancy
  • ascites
  • genital ulcers
Full details

Risk factors

  • skin exposure to contaminated freshwater
  • travel to endemic areas
  • age 4 to 15 years
  • occupational exposure
Full details

Diagnostic tests

1st tests to order

  • stool or urine microscopy
  • urinalysis
  • complete blood count
  • blood culture
  • thick and thin blood smears
Full details

Tests to consider

  • serology
  • liver function tests (LFTs)
  • renal function tests
  • abdominal ultrasound
  • tissue biopsy
  • computed tomography (CT) or magnetic resonance imaging (MRI) abdomen
  • MRI brain and spinal cord
  • chest x-ray
  • CT chest
  • urinary circulating anodic antigen (CAA)
  • schistosome DNA/RNA
Full details

Treatment algorithm

ACUTE

cercarial dermatitis

acute schistosomiasis

ONGOING

chronic schistosomiasis

persistent infection despite praziquantel treatment

Contributors

Authors

J. Martin Rodriguez, MD

Professor of Medicine

Division of Infectious Diseases

University of Alabama at Birmingham

Birmingham

AL

Disclosures

JMR declares that he has no competing interests.

Nathan D. Gundacker, MD

Assistant Professor

Division of Infectious Diseases

Department of Medicine

Medical College of Wisconsin

Milwaukee

WI

Disclosures

NDG declares that he has no competing interests.

Acknowledgements

Dr J. Martin Rodriguez and Dr Nathan D. Gundacker would like to gratefully acknowledge the late Dr Ildefonso Tellez, who was previously a co-contributor to this topic. Dr Rodriguez would also like to gratefully acknowledge Dr Arlene Dent and Dr Charles H. King, previous contributors to this topic.

Disclosures

IT declared that he had no competing interests. AD and CHK also declare that they have no competing interests.

Peer reviewers

Richard Olds, MD, FACP

Professor

Medical College of Wisconsin

Milwaukee

WI

Disclosures

RO declares that he has no competing interests.

Jose Roberto Lambertucci, MD

Professor

Faculty of Medicine

Federal University of Minas Gerais

Belo Horizonte

Minas Gerais

Brazil

Disclosures

JRL declares that he has no competing interests.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

World Health Organization. Schistosomiasis (Bilharzia). 2022 [internet publication].Full text

World Health Organization. WHO guideline on control and elimination of human schistosomiasis. Feb 2022 [internet publication].Full text

McManus DP, Dunne DW, Sacko M, et al. Schistosomiasis. Nat Rev Dis Primers. 2018 Aug 9;4(1):13. Abstract

Mutapi F, Maizels R, Fenwick A, et al. Human schistosomiasis in the post mass drug administration era. Lancet Infect Dis. 2017 Feb;17(2):e42-8.Full text  Abstract

Weerakoon KG, Gobert GN, Cai P, et al. Advances in the diagnosis of human schistosomiasis. Clin Microbiol Rev. 2015 Oct;28(4):939-67. Abstract

Centers for Disease Control and Prevention. Parasites - Schistosomiasis: resources for health professionals. Oct 2020 [internet publication].Full text

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
  • Schistosomiasis images
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  • Guidelines

    • CDC health information for international travel (Yellow Book 2024): schistosomiasis
    • WHO guideline on control and elimination of human schistosomiasis
    More Guidelines
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