Schistosomiasis is a neglected tropical disease that mainly affects poor and rural communities, especially agricultural and fishing populations.
Patients most commonly present with complications of chronic infection; either genitourinary or intestinal symptoms depending on the Schistosoma species.
Diagnosis is made by microscopic visualization of eggs in stools or urine; supplemental approaches include serologic testing or biopsy of affected tissues (rectum or bladder) for detection of parasite eggs.
Praziquantel is the preferred treatment for all schistosome infections. At-risk communities in endemic areas are given preventive chemotherapy with praziquantel.
Serious complications of chronic infection include anemia, portal hypertension, genital disease, renal failure, seizures, spinal cord compression, and neoplasms.
A snail-borne parasitic disease caused by multicellular trematodes of the Schistosoma blood fluke species. It is acquired through skin exposure to freshwater that harbors infectious schistosome larval forms known as cercariae. Cercariae are released by aquatic snails that are the parasite's intermediate host.
History and exam
Key diagnostic factors
- geographic exposure
- abdominal pain
Other diagnostic factors
- bloody diarrhea
- pelvic pain
- infertility or history of ectopic pregnancy
- genital ulcers
- skin exposure to contaminated freshwater
- travel to endemic areas
- age 4 to 15 years
- occupational exposure
1st investigations to order
- stool or urine microscopy
- complete blood count
- blood culture
- thick and thin blood smears
Investigations to consider
- 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
persistent infection despite praziquantel treatment
- Crohn disease
- Ulcerative colitis
- Colon cancer
- WHO guideline on control and elimination of human schistosomiasis
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