Summary
Definition
History and exam
Key diagnostic factors
- geographic exposure
- abdominal pain
- hematuria
- hematemesis
Other diagnostic factors
- rash
- fever
- dysuria
- hepatosplenomegaly
- dyspnea
- bloody diarrhea
- pelvic pain
- infertility or history of ectopic pregnancy
- ascites
- genital ulcers
Risk factors
- skin exposure to contaminated freshwater
- travel to endemic areas
- age 4 to 15 years
- occupational exposure
Diagnostic tests
1st tests to order
- stool or urine microscopy
- urinalysis
- complete blood count
- blood culture
- thick and thin blood smears
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
Treatment algorithm
cercarial dermatitis
acute schistosomiasis
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.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
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.
Differentials
- Crohn disease
- Ulcerative colitis
- Colon cancer
More DifferentialsGuidelines
- 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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