Schistosomiasis Treatment & Management

  • Author: Shadab Hussain Ahmed, MD, FACP, FIDSA, AAHIVS; Chief Editor: Burke A Cunha, MD   more...
 
Updated: Oct 28, 2011
 

Approach Considerations

Prehospital care should include treating acute complications, such as acute intestinal bleeding. Stabilize patients who have acute complications. If appropriate, include schistosomiasis as one of the differential diagnoses.

Send urine or stool samples to the parasitology laboratory with a special request to look for eggs indicative of schistosomiasis.

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

Acute schistosomiasis and Katayama fever

Patients should receive antischistosomal drugs and corticosteroids, especially if acutely ill. Steroids reduce inflammation and help suppress changes that result from killing of the parasites. As maturing schistosomes are less susceptible to therapy than adult worms, a second course of treatment is necessary. This is given several weeks after the first course of therapy.

The drug of choice for treating all species of schistosomes is praziquantel. Cure rates of 65-90% have been described after a single treatment with praziquatel. In individuals not cured, the drug causes egg excretion to be reduced by 90%.[52] Praziquatel affects the membrane permeability of the parasite, which causes vacuolation of the tegument. It paralyses the worm and exposes it to attack by the host immune system. However, as praziquantel is ineffective on developing schistosomula, it may not abort early infection. Praziquantel can be used in pregnant and lactating women.[53] Resistance to praziquatel occurs in the field and is well defined.[54, 55] Adverse effects include dizziness, headache, nausea, vomiting, diarrhea, abdominal discomfort, bloody stool, urticaria, and fever following initiation of treatment. These are usually mild and last about 24 hours. These are reactions from dying worms.

Neurologic disease

Treatment of schistosomiasis affecting the CNS consists of praziquantel with glucocorticoids. In CNS disease, corticosteroids are used to reduce inflammation and edema around eggs. If patients present with seizures, anticonvulsant therapy may also be needed. Observe patients with suspected or known cysticercosis as they may deveop seizures or neurologic effects from dying cysticerci.

Surgical care

Surgical care includes removal of tumor masses, ligation of esophageal varices, and porta-caval shunt surgeries. Large granulomas in urinary bladder or lungs may warrant surgical extirpation.

Consultations

Appropriate consultations depend on the suspected complications but may include an infectious disease physician, urologist, gynecologist, or gastroenterologist.

Next

Corticosteroids

The symptoms of Katayama syndrome often require administration of corticosteroids to suppress the inflammatory process, but no consensus exists regarding proper antihelminthic treatment. Prednisolone 40mg daily for 5 days can be used for the hypersensitivity reaction. Treatment is essentially supportive.

Persons with CNS involvement should be given corticosteroids to prevent inflammation and edema around eggs. Repeated courses of corticosteroid therapy may be warranted to suppress recrudescent neurologic symptoms.

Previous
Next

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 to assess therapeutic response. Persistent circulating antigen and the excretion of eggs indicate residual infection. These patients should be retreated with praziquantel.

Follow-up

Antischistosomal drugs inhibit egg-laying by adult worms. Therefore, patients’ stool and urine should be tested for 6 months after treatment. Treatment is repeated for those excreting eggs. If symptoms recur, hematuria occurs, or eosinophilia is noted, repeat parasite investigation should be performed. However, serology can remain positive for years.

Previous
Next

Pregnancy

Schistosomiasis affects the uterine environment during pregnancy. These pregnant women develop severe anemia, have low ̶ birth-weight infants, and are at increased risk for infant and maternal mortality. Schistosomiasis has been found in placenta, and newborns have been diagnosed with this condition, thus confirming congenital infection.[3] Infected pregnant women have a higher rate of spontaneous abortions and a higher risk for ectopic pregnancies. In addition, increased pelvic blood flow during pregnancy is thought to increase the infection load. WHO recommends giving praziquantel to pregnant and lactating women to decrease the disease burden and improve the pregnancy and fetal outcomes.[28]

A retrospective study of 88 women with schistosomiasis who received praziquantel during pregnancy, in a mass treatment campaign, did not show an increase in the rate of abortion, preterm deliveries, or congenital abnormalities compared with untreated women.[56]

Starting treatment after the first trimester may be advisable.[57] Praziquantel is excreted in human breast milk. No adverse effects of praziquantel administration during lactation have been reported.[57, 58]

Previous
Next

Deterrence and Prevention

No vaccine or prophylactic chemotherapy for schistosomiasis is currently available. However, clinical trials involving human volunteers are underway to develop an effective vaccine against schistosomiasis. Moreover, clinical studies show that artemether may be used as a prophylactic agent if given once every 2-4 weeks.[59]

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. Early treatment after high-risk exposures should minimize morbidity.

People returning from endemic areas with history of exposure to fresh water should be screened by serologic testing for schistosomiasis. Many infections are silent and may remain asymptomatic. Urine and stool screening should be obtained in patients with positive serologies for species identification.[57] Rates of schistosomiasis seropositivity have been recorded as 44% and 23% in African refugees.[60]

Topical lipid formulations of N,N-diethyl-m-toluamide (DEET), such as LipoDEET, are effective in killing schistosome cercariae. Minimal absorption, low cost, and a range of activity against insects and schistosomes make this compound an excellent prophylactic agent against human and animal schistosomiasis, especially for travelers.[61]

Endemic regions

Controlling schistosomiasis in an endemic area should include the following:

  • Population-based preventive chemotherapy - WHO has recommended preventive chemotherapy for at-risk populations in endemic areas[62]
  • Provision of a safe water supply
  • Health education that includes improvement of water sanitation and avoidance of schistosome-contaminated urine or stool
  • Snail control
Previous
Proceed to Medication
 
 
Contributor Information and Disclosures
Author

Shadab Hussain Ahmed, MD, FACP, FIDSA, AAHIVS  Associate Professor of Clinical Medicine, The School of Medicine at Stony Brook University Medical Center; Adjunct Clinical Associate Professor, Department of Medicine, New York College of Osteopathic Medicine of New York Institute of Technology; Attending Physician, Department of Medicine, Division of Infectious Diseases, Director of HIV Prevention Services, Administrative HIV Designee, Nassau University Medical Center

Shadab Hussain Ahmed, MD, FACP, FIDSA, AAHIVS is a member of the following medical societies: American College of Physicians, Infectious Diseases Society of America, and International AIDS Society

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.

Additional Contributors

Joseph F John Jr, MD, FACP, FIDSA, FSHEA Clinical Professor of Medicine, Molecular Genetics and Microbiology, Medical University of South Carolina; Associate Chief of Staff for Education, Ralph H Johnson Veterans Affairs Medical Center

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Reference Salary Employment

Additional Contributors

Joseph F John Jr, MD, FACP, FIDSA, FSHEA Clinical Professor of Medicine, Molecular Genetics and Microbiology, Medical University of South Carolina; Associate Chief of Staff for Education, Ralph H Johnson Veterans Affairs Medical Center

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Reference Salary Employment

References

  1. Scistosomiasis, Fact Sheet No 115; Feburary 2010. World Health Organization. Available at http://www.who.int/mediacentre/facesheets/fs115/en/index.html. Accessed Oct 5,2010.

  2. Weekly epidemiological record 30 April No.18,2010, 85, 157-164. World health Organization. Available at http://www.who.int/wer. Accessed Sept. 27,2010.

  3. [Best Evidence] Nawal M. Nour. Schistosomiasis: Health Effects on Women. Reviews in Obstetrics & Gynecology. 2010;3:28-32.

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

  5. Houston S, Kowalewska-Grochowska K, Naik S, McKean J, Johnson ES, and Warren K. First Report of Schistosoma mekongi Infection with Brain Involvement. Clinical Infectious Diseases. 2004;38:e1-6.

  6. Mohammed AZ, Edino ST, Samaila AA. Surgical pathology of schistosomiasis. J Natl Med Assoc. May 2007;99(5):570-4. [Medline]. [Full Text].

  7. Leder K, Weller P. Epidemiology; pathogenesis; and clinical features of schistosomiasis. UpToDate [serial online]. April 24, 2009;1-9. Accessed Sept. 20,2010. Available at http://www.uptodate.com.

  8. Sturrock RF. The Schistosomiasis and their intermediate hosts. In: Mahmood AAF. Schistosomiasis. Imperial College London; 2001:7-83.

  9. Lesham E, Meltzer E, Marva E, Schwartz E. Travel-related Schistosomiasis Acquired in Laos. Emerging Infectious Diseases [serial online]. 15:1823. Available at http://www.cdc.gov/eid.

  10. Epidemiological situation. WHO. Available at http://www.who.int/schistosomiasis/epidemiology/en. Accessed Sept. 27,2010.

  11. WHO-TDR. World health organization. Available at http://www.who.int/tdr. Accessed Oct. 5,2010.

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

  13. Kabatereine N, Brooker S, Tukahebwa E, et al. Epidemiology and geography of Schistosoma mansoni in Uganda: implications for planning control. Trp Med Int Health. 2004;9:372.

  14. Hagan P, Gryeels B. Schistosomiasis research and the European Community. Trop geogr Med. 1994;46:256.

  15. King CH, Keating CE, Muruka JF, Ouma JH, Houser H, Siongok TK. Urinary tract morbidity in schistosomiasis haematobia: associations with age and intensity of infection in an endemic area of Coast Province, Kenya. Am J Trop Med Hyg. Oct 1988;39(4):361-8. [Medline].

  16. Badmos KB, Komolafe AO, Rotimi O. Schistosomiasis presenting as acute appendicitis. East Afr Med J. Oct 2006;83(10):528-32. [Medline].

  17. Terada T. Schistosomal appendicitis: incidence in Japan and a case report. World J Gastroenterol. Apr 7 2009;15(13):1648-9. [Medline]. [Full Text].

  18. Argemi X, Camuset G, Abou-Bakar A, et al. Case report: rectal perforation caused by Schistosoma haematobium. Am J Trop Med Hyg. Feb 2009;80(2):179-81. [Medline].

  19. Lapa M, Dias B, Jardim C, Fernandes CJ, Dourado PM, Figueiredo M. Cardiopulmonary manifestations of hepatosplenic schistosomiasis. Circulation. Mar 24 2009;119(11):1518-23. [Medline].

  20. Nmorsi O, Ukwandu N, Egwungenya O, Obhiemi N. Evaluation of CD4(+)/CD8(+) status and urinary tract infections associated with urinary schistosomiasis among some rural Nigerians. Afr Health Sci. Jun 2005;5(2):126-30. [Medline]. [Full Text].

  21. John R, Ezekiel M, Philbert C, Andrew A. Schistosomiasis transmission at high altitude crater lakes in western Uganda. BMC Infect Dis. Aug 11 2008;8:110. [Medline]. [Full Text].

  22. King CH. Toward the elimination of schistosomiasis. N Engl J Med. Jan 8 2009;360(2):106-9. [Medline].

  23. Wang LD, Chen HG, Guo JG, et al. A strategy to control transmission of Schistosoma japonicum in China. N Engl J Med. Jan 8 2009;360(2):121-8. [Medline].

  24. Wang LD, Guo JG, Wu XH, et al. China's new strategy to block Schistosoma japonicum transmission: experiences and impact beyond schistosomiasis. Trop Med Int Health. Dec 2009;14(12):1475-83. [Medline].

  25. Kallestrup P, Zinyama R, Gomo E, et al. Schistosomiasis and HIV in rural Zimbabwe: efficacy of treatment of schistosomiasis in individuals with HIV coinfection. Clin Infect Dis. Jun 15 2006;42(12):1781-9. [Medline].

  26. Mwanakasale V, Siziya S, Mwansa J, Koukounari A, Fenwick A. Impact of iron supplementation on schistosomiasis control in Zambian school children in a highly endemic area. Malawi Med J. Mar 2009;21(1):12-8. [Medline].

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

  28. Savioli L, Crompton DW, Neira M. Use of anthelminthic drugs during pregnancy. Am J Obstet Gynecol. Jan 2003;188(1):5-6. [Medline].

  29. Leshem E, Maor Y, Meltzer E, Assous M, Schwartz E. Acute Schistosomiasis Outbreak: Clinical Features and Economic Impact. Clinical Infectious Diseases. Dec/2008;47:1499-1506.

  30. 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].

  31. Leutscher PD, Ramarokoto CE, Hoffmann S, Jensen JS, Ramaniraka V, Randrianasolo B. Coexistence of urogenital schistosomiasis and sexually transmitted infection in women and men living in an area where Schistosoma haematobium is endemic. Clin Infect Dis. Sep 15 2008;47(6):775-82. [Medline].

  32. Walker M, Zunt JR. Parasitic central nervous system infections in immunocompromised hosts. Clin Infect Dis. Apr 1 2005;40(7):1005-15. [Medline].

  33. Wan H, Lei D, Mao Q. Cerebellar schistosomiasis: a case report with clinical analysis. Korean J Parasitol. Mar 2009;47(1):53-6. [Medline].

  34. Ross AG, Vickers D, Olds GR, Shah SM, McManus DP. Katayama syndrome. Lancet Infect Dis. Mar 2007;7(3):218-24. [Medline].

  35. Abdel-Wahab MF, Esmat G, Farrag A, el-Boraey YA, Strickland GT. Grading of hepatic schistosomiasis by the use of ultrasonography. Am J Trop Med Hyg. Apr 1992;46(4):403-8. [Medline].

  36. Fowler R, Lee C, Keystone JS. The Role Of Corticosteroids In The Treatment Of Cerebral Schistosomiasis Caused By Schistosoma mansoni: Case Report and Discussion. Am J Trop Med Hyg. 1999;6(1):47-50.

  37. Sandoval N, Siles-Lucas M, Pérez-Arellano JL, Carranza C, Puente S, López-Abán J. A new PCR-based approach for the specific amplification of DNA from different Schistosoma species applicable to human urine samples. Parasitology. Nov 2006;133(Pt 5):581-7. [Medline].

  38. Lier T, Simonsen GS, Haaheim H, Hjelmevoll SO, Vennervald BJ, Johansen MV. Novel real-time PCr for detection of Schistosoma japonicum in stool. Southeast Asian J Trop Med Public Health. Mar 2006;37(2):257-64. [Medline].

  39. Midzi N, Butterworth AE, Mdluza T,et al. Use of circulating cathodic antigen strips for the diagnosis of urinary schistosomiasis. Trans T Soc Trop Med Hyg. 2009;103:45.

  40. Peters P, Kazura JW. Update on diagnostic methods for schistosomiasis. In: Baillere's Clinical Tropical Medicine and Communicable Diseases. 2. 1987.

  41. King C, Mahmouud AA. Schistosomiasis. In: Tropical Infectious Diseases. In: Guerrant R, Walker DH, Weller PF. Principles, Pathogens and Practice,. Vol 2. Philadelphia: Churchill Livingstone; 1999:1031.

  42. 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].

  43. Sulahian A, Garin YJ, Izri A, Verret C, Delaunay P, van Gool T, et al. Development and evaluation of a Western blot kit for diagnosis of schistosomiasis. Clin Diagn Lab Immunol. Apr 2005;12(4):548-51. [Medline]. [Full Text].

  44. van Lieshout L, Polderman AM, Deelder AM. Immunodiagnosis of schistosomiasis by determination of the circulating antigens CAA and CCA, in particular in individuals with recent or light infections. Acta Trop. Oct 23 2000;77(1):69-80. [Medline].

  45. ten Hove RJ, Verweij JJ, Vereecken K, et al. Multiplex real-time PCR for the detection and quantification of Schistosoma mansoni and Schistosoma hematobium infection in stool samples collected in northern Senegal. Trans R Soc Trop Med Hyg. 2008;102:179.

  46. Caffrey CR. Chemotherapy of schistosomiasis: present and future. Curr Opin Chem Biol. Aug 2007;11(4):433-9. [Medline].

  47. Gryseels B, Polman K, Clerinx J, Kestens L. Human schistosomiasis. Lancet. Sep 23 2006;368(9541):1106-18. [Medline].

  48. Harries AD, Fryatt R, Walker J, Chiodini PL, Bryceson AD. Schistosomiasis in expatriates returning to Britain from the tropics: a controlled study. Lancet. Jan 11 1986;1(8472):86-8. [Medline].

  49. Shimazu C, Pien FD, Parnell D. Bronchoscopic diagnosis of Schistosoma japonicum in a patient with hemoptysis. Respir Med. Jul 1991;85(4):331-2. [Medline].

  50. Schaberg T, Rahn W, Racz P, Lode H. Pulmonary schistosomiasis resembling acute pulmonary tuberculosis. E Respir J. 1991;4:1023.

  51. Ferrari TC. Spinal cord schistosomiasis. A report of 2 cases and review emphasizing clinical aspects. Medicine (Baltimore). 1999;78:176.

  52. Fenwick A, Rollinson D, Southgate V. Implementation of human schistosomiasis control: Challenges and prospects. Adv Parasitol. 2006;61:567-622. [Medline].

  53. Olds GR. Administration of praziquantel to pregnant and lactating women. Acta Trop. May 2003;86(2-3):185-95. [Medline].

  54. Ismail M, Botros S, Metwally A, et al. Resistance to praziquantel: direct evidence from Schistosoma mansoni isolated from Egyptian villagers. Am J Trop Med Hyg. Jun 1999;60(6):932-5. [Medline].

  55. Ismail M, Metwally A, Farghaly A, Bruce J, Tao LF, Bennett JL. Characterization of isolates of Schistosoma mansoni from Egyptian villagers that tolerate high doses of praziquantel. Am J Trop Med Hyg. Aug 1996;55(2):214-8. [Medline].

  56. Adam I, Elwasila el T, Homeida M. Is praziquantel therapy safe during pregnancy?. Trans R Soc Trop Med Hyg. Sep 2004;98(9):540-3. [Medline].

  57. Leder K, Weller PF. Treatment and prevention of schistosomiasis. Available at http://www.uptodate.com. Accessed 9/20/2010.

  58. Tweyongyere R, Mawa PA, Ngom-Wegi S, et al. Effect of praziquantel treatment during pregnancy on cytokine responses to schistosome antigens: results of a randomized, placebo-controlled trial. J Infect Dis. Dec 15 2008;198(12):1870-9. [Medline]. [Full Text].

  59. 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].

  60. Posey DL, Blackburn BG, Weinberg M, Flagg EW, Ortega L, Wilson M. High prevalence and presumptive treatment of schistosomiasis and strongyloidiasis among African refugees. Clin Infect Dis. Nov 15 2007;45(10):1310-5. [Medline].

  61. Ramaswamy K, He YX, Salafsky B, Shibuya T. Topical application of DEET for schistosomiasis. Trends Parasitol. Dec 2003;19(12):551-5. [Medline].

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

  63. 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].

  64. Keiser J, N'Guessan NA, Adoubryn KD, Silué KD, Vounatsou P, Hatz C. Efficacy and safety of mefloquine, artesunate, mefloquine-artesunate, and praziquantel against Schistosoma haematobium: randomized, exploratory open-label trial. Clin Infect Dis. May 1 2010;50(9):1205-13. [Medline].

 
Previous
Next
 
Egg of Schistosoma hematobium, with its typical terminal spine.
Granuloma in the liver due to Schistosoma mansoni. The S mansoni egg is at the center of the granuloma.
Table 1. Parasitic Species and Geographical Distribution of Schistosomiasis[1, 7]
SpeciesGeographical distribution
Intestinal schistosomiasisSchistosoma mansoni



(mesenteric venules of the colon)



Africa, the Middle East, the Caribbean, and South America
Schistosoma japonicum



(mesenteric venules of the small intestine)



Asia only: China, Indonesia, the Philippines, and Thailand
Schistosoma mekongi



(mesenteric venules of the small intestine)



Several districts of Cambodia and the Lao People’s Democratic Republic. 200-km area of Mekong river basin; now extending toward northern provinces
Schistosoma intercalatum



(mesenteric venules of the colon) and related S guineensis



Rain forest areas of Central and West Africa
Urogenital schistosomiasisSchistosoma haematobium



(vesical venous plexus)



Africa, the Middle East, India, and Turkey
Previous
Next
 
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.