eMedicine Specialties > Infectious Diseases > Parasitic Infections

Schistosomiasis: Follow-up

Author: Palaniandy Kogulan, MBBS, MD, Assistant Director of Internal Medicine, Synergy Medical Education Alliance; Assistant Professor of Medicine, Michigan State University College of Human Medicine
Coauthor(s): Daniel R Lucey, MD, MPH, Chief, Fellowship Program Director, Department of Internal Medicine, Division of Infectious Diseases, Washington Hospital Center; Professor, Department of Internal Medicine, Uniformed Services University of the Health Sciences
Contributor Information and Disclosures

Updated: Nov 26, 2007

Follow-up

Further Inpatient Care

  • Patients with severe complications, such as GI bleeding, GI obstruction, renal failure, cardiac failure, bacteremia due to Salmonella, and CNS complications, need inpatient care.

Further Outpatient Care

  • Response to treatment is evaluated by counting the amount of decrease in egg excretion.
    • In the initial 2 weeks after treatment, the egg count may not decrease because eggs laid before the treatment require 2 weeks to be shed.
    • Viable eggs can be excreted for 6-8 weeks after treatment.
  • When measured 5-10 days after treatment, newer tests that measure antigens may help assess therapeutic response.
  • Persistent circulating antigen and the excretion of eggs indicate residual infection. These patients should be retreated with praziquantel.

Deterrence/Prevention

  • No vaccine or prophylactic chemotherapy is currently available.
  • Clinical trials involving human volunteers are underway to develop an effective vaccine against schistosomiasis.
  • Clinical studies show artemether may be used as a prophylactic agent if given once every 2-4 weeks.4
  • Travelers to endemic areas should avoid contact with fresh water.
  • Suspect acute schistosomiasis in a setting of recent contact with fresh water and treat early if diagnostic test results are positive or clinical suspicion is high.
  • Controlling schistosomiasis in an endemic area should include the following:
    • Population-based preventive chemotherapy: The WHO has recommended preventive chemotherapy for at-risk populations in endemic areas6
    • Providing a safe water supply
    • Health education that includes improving water sanitation and avoiding schistosome-contaminated urine or stool
    • Snail control

Complications

  • GI bleeding
  • GI obstruction
  • Malnutrition
  • Schistosomal nephropathy
  • Renal failure
  • Pyelonephritis
  • Bladder cancer
  • Sepsis (Salmonella)
  • Pulmonary hypertension
  • Cor pulmonale
  • Neuroschistosomiasis

Prognosis

  • Early disease usually improves with treatment.
  • Hepatic, renal, and intestinal pathology improves with treatment.
  • Hepatosplenic schistosomiasis carries a relatively good prognosis because hepatic function is preserved until the end of the disease (unless variceal bleeding occurs).
  • Cor pulmonale usually does not improve significantly with treatment.
  • Depending on location and size, brain lesions usually improve with treatment.
  • Spinal cord schistosomiasis carries a guarded prognosis. Praziquantel should be administered as soon as possible.

Miscellaneous

Medicolegal Pitfalls

  • Failure to record travel and residence history in the appropriate clinical setting
  • Delayed diagnosis and failure to institute early, aggressive treatment of spinal cord schistosomiasis
  • Failure to provide advice in a traveler's clinic (eg, to avoid exposure to fresh water in endemic areas)

Special Concerns

  • The following manifestations of schistosomiasis may also indicate other disorders:
 


More on Schistosomiasis

Overview: Schistosomiasis
Differential Diagnoses & Workup: Schistosomiasis
Treatment & Medication: Schistosomiasis
Follow-up: Schistosomiasis
Multimedia: Schistosomiasis
References
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References

  1. Mosunjac MB, Tadros T, Beach R, et al. Cervical schistosomiasis, human papilloma virus (HPV), and human immunodeficiency virus (HIV): a dangerous coexistence or coincidence?. Gynecol Oncol. Jul 2003;90(1):211-4. [Medline].

  2. Friedman JF, Mital P, Kanzaria HK, Olds GR, Kurtis JD. Schistosomiasis and pregnancy. Trends Parasitol. Apr 2007;23(4):159-64. [Medline].

  3. Al-Sherbiny MM, Osman AM, Hancock K, et al. Application of immunodiagnostic assays: detection of antibodies and circulating antigens in human schistosomiasis and correlation with clinical findings. Am J Trop Med Hyg. Jun 1999;60(6):960-6. [Medline]. [Full Text].

  4. N'Goran EK, Utzinger J, Gnaka HN, et al. Randomized, double-blind, placebo-controlled trial of oral artemether for the prevention of patent Schistosoma haematobium infections. Am J Trop Med Hyg. Jan 2003;68(1):24-32. [Medline]. [Full Text].

  5. Utzinger J, Keiser J, Shuhua X, et al. Combination chemotherapy of schistosomiasis in laboratory studies and clinical trials. Antimicrob Agents Chemother. May 2003;47(5):1487-95. [Medline]. [Full Text].

  6. World Health Organization. Preventive chemotherapy in human helminthiasis. Geneva: World Health Organization; November, 2006. [Full Text].

  7. Barsoum RS. Schistosomiasis and the kidney. Semin Nephrol. Jan 2003;23(1):34-41. [Medline].

  8. Bergquist NR, Leonardo LR, Mitchell GF. Vaccine-linked chemotherapy: can schistosomiasis control benefit from an integrated approach?. Trends Parasitol. Mar 2005;21(3):112-7. [Medline].

  9. Brown M, Mawa PA, Joseph S, et al. Treatment of Schistosoma mansoni infection increases helminth-specific type 2 cytokine responses and HIV-1 loads in coinfected Ugandan adults. J Infect Dis. May 15 2005;191(10):1648-57. [Medline].

  10. Corachan M. Schistosomiasis and international travel. Clin Infect Dis. Aug 15 2002;35(4):446-50. [Medline].

  11. Cunha BA. Antibiotic Essentials. Royal Oak, Mich: Physicians Press; 2005.

  12. King CH, Mahmoud AAF. Schistosomiasis. In: Guerrant RL, Walker DH, Weller PF, eds. Tropical Infectious Diseases: Principals, Pathogen, & Practice. Vol 2. ed. Philadelphia, Pa: Churchill Livingstone; 1999:1031-8.

  13. Lucey DR, Maguire JH. Schistosomiasis. Infect Dis Clin North Am. Sep 1993;7(3):635-53. [Medline].

  14. MMWR. Acute schistosomiasis with transverse myelitis in American students returning from Kenya. MMWR Morb Mortal Wkly Rep. Aug 10 1984;33(31):445-7. [Medline].

  15. Pearce EJ. Progress towards a vaccine for schistosomiasis. Acta Trop. May 2003;86(2-3):309-13. [Medline].

  16. Ross AG, Bartley PB, Sleigh AC, et al. Schistosomiasis. N Engl J Med. Apr 18 2002;346(16):1212-20. [Medline].

  17. Shoff WH, Chen EH, Shepherd SM. Shistosomiasis (part I and II). Infect Dis Pract. 2005;29:419-36.

  18. Vennervald BJ, Dunne DW. Morbidity in schistosomiasis: an update. Curr Opin Infect Dis. Oct 2004;17(5):439-47. [Medline].

  19. WHO Expert Committee. Prevention and control of schistosomiasis and soil-transmitted helminthiasis. World Health Organ Tech Rep Ser. 2002;912:i-vi, 1-57, back cover. [Medline].

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Further Reading

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Keywords

schistosomiasis, bilharzia, Schistosoma hematobium, Schistosoma mansoni, Schistosoma japonicum, Schistosoma intercalatum, Schistosoma mekongi, S hematobium, S mansoni, S japonicum, S intercalatum, S mekongi, blood flukes, Katayama fever, acute schistosomiasis, chronic schistosomiasis, gastrointestinal schistosomiasis, periportal fibrosis, Symmers clay pipestem fibrosis, urinary tract schistosomiasis, female genital schistosomiasis, FGS, schistosomal cor pulmonale, CNS schistosomiasis, transverse myelitis, hepatic schistosomiasis, cardiopulmonary schistosomiasis, liver schistosomiasis

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Contributor Information and Disclosures

Author

Palaniandy Kogulan, MBBS, MD, Assistant Director of Internal Medicine, Synergy Medical Education Alliance; Assistant Professor of Medicine, Michigan State University College of Human Medicine
Palaniandy Kogulan, MBBS, MD is a member of the following medical societies: American College of Physicians, Infectious Diseases Society of America, and Michigan State Medical Society
Disclosure: Nothing to disclose.

Coauthor(s)

Daniel R Lucey, MD, MPH, Chief, Fellowship Program Director, Department of Internal Medicine, Division of Infectious Diseases, Washington Hospital Center; Professor, Department of Internal Medicine, Uniformed Services University of the Health Sciences
Daniel R Lucey, MD, MPH is a member of the following medical societies: Alpha Omega Alpha and American College of Physicians
Disclosure: Nothing to disclose.

Medical Editor

Wesley W Emmons, MD, FACP, Assistant Professor, Department of Medicine, Thomas Jefferson University; Consulting Staff, Infectious Diseases Section, Department of Internal Medicine, Christiana Care, Newark, DE
Wesley W Emmons, MD, FACP is a member of the following medical societies: American College of Physicians, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, and International AIDS Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Joseph F John Jr, MD, FACP, FIDSA, FSHEA, Professor of Medicine, Molecular Genetics and Microbiology, Medical University of South Carolina; Associate Chief of Staff for Education, Ralph H Johnson Veteran's Administration Medical Center
Disclosure: Nothing to disclose.

CME Editor

Eleftherios Mylonakis, MD, Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital
Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD, Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital
Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

 
 
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