eMedicine Specialties > Infectious Diseases > Parasitic Infections
Schistosomiasis: Treatment & Medication
Updated: Nov 26, 2007
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
- Multimedia
Treatment
Medical Care
- Prehospital care should include treating acute complications, such as acute intestinal bleeding.
- Emergency department care
- Stabilize patients who have acute complications.
- If appropriate, include schistosomiasis as one of the differential diagnoses.
- Send urine or stool sample to the parasitology laboratory with a special request to look for eggs indicative of schistosomiasis.
Consultations
Appropriate consultations depend on the suspected complications but may include an infectious disease physician, urologist, or gastroenterologist.
Medication
The aim of chemotherapy is 2-fold. The first goal is to cure the disease or at least minimize morbidity. The second goal is to control transmission of the parasite in the endemic areas. Praziquantel and oxamniquine (no longer available in the United States) are used commonly, but praziquantel is the treatment of choice for all species of schistosomiasis. Clinical studies show that artemether, which is used as antimalarial treatment, is also active against all 3 major schistosome parasites (mainly schistosomula).4 In addition, trials that involve the combination of artemether and praziquantel show beneficial effect.5
The following drugs and doses are based on recommendations in the August 2004 publication in The Medical Letter, "Drugs for Parasitic Infections."
Anthelmintics
Parasite biochemical pathways are sufficiently different from the human host to allow selective interference by chemotherapeutic agents in relatively small doses.
Praziquantel (Biltricide)
Usually well tolerated. Mechanism of action is complex. Damages the tegument membrane (the natural covering of the worm body) and exposes the worm to the body's immune response, which leads to worm death. Cure rate is equal to or greater than 85%. In persons not cured, the egg burden is markedly decreased.
Adult
S haematobium and S mansoni: 40 mg/kg/d PO divided bid for 1 d
S japonicum and S mekongi: 60 mg/kg/d PO divided tid for 1 d
Pediatric
S haematobium and S mansoni: 40 mg/kg/d PO divided bid for 1 d
S japonicum and S mekongi: 60 mg/kg/d PO divided tid for 1 d
Hydantoins may reduce serum praziquantel concentrations, possibly leading to treatment failures
Documented hypersensitivity; ocular cysticercosis
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Destruction of parasite within the eyes can cause irreparable lesions (ocular cysticercosis should not be treated with praziquantel); caution while driving or performing other tasks requiring alertness on the day of and following treatment; minimal increases in liver enzyme levels reported; when schistosomiasis or fluke infection is associated with cerebral cysticercosis, hospitalize patient for duration of treatment
Oxamniquine (Vansil)
No longer available in the United States. Mechanism of action is complex. Metabolized into an ester by schistosomes. Damages tegument surface of male schistosome worms so that the immune system is able to kill the worm. Stops female from producing eggs. Only effective against S mansoni. Cure rate is 60-90%.
Adult
15 mg/kg PO as single dose
Pediatric
20 mg/kg PO divided bid for 1 d
None reported; food may delay absorption
Documented hypersensitivity
Pregnancy
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
Use caution and closely monitor in patients with history of seizures because they may experience epileptiform convulsions; EEG abnormalities may develop in patients with normal pretreatment recordings
More on Schistosomiasis |
| Overview: Schistosomiasis |
| Differential Diagnoses & Workup: Schistosomiasis |
 Treatment & Medication: Schistosomiasis |
| Follow-up: Schistosomiasis |
| Multimedia: Schistosomiasis |
| References |
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References
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].
Friedman JF, Mital P, Kanzaria HK, Olds GR, Kurtis JD. Schistosomiasis and pregnancy. Trends Parasitol. Apr 2007;23(4):159-64. [Medline].
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].
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].
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].
World Health Organization. Preventive chemotherapy in human helminthiasis. Geneva: World Health Organization; November, 2006. [Full Text].
Barsoum RS. Schistosomiasis and the kidney. Semin Nephrol. Jan 2003;23(1):34-41. [Medline].
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].
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].
Corachan M. Schistosomiasis and international travel. Clin Infect Dis. Aug 15 2002;35(4):446-50. [Medline].
Cunha BA. Antibiotic Essentials. Royal Oak, Mich: Physicians Press; 2005.
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.
Lucey DR, Maguire JH. Schistosomiasis. Infect Dis Clin North Am. Sep 1993;7(3):635-53. [Medline].
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].
Pearce EJ. Progress towards a vaccine for schistosomiasis. Acta Trop. May 2003;86(2-3):309-13. [Medline].
Ross AG, Bartley PB, Sleigh AC, et al. Schistosomiasis. N Engl J Med. Apr 18 2002;346(16):1212-20. [Medline].
Shoff WH, Chen EH, Shepherd SM. Shistosomiasis (part I and II). Infect Dis Pract. 2005;29:419-36.
Vennervald BJ, Dunne DW. Morbidity in schistosomiasis: an update. Curr Opin Infect Dis. Oct 2004;17(5):439-47. [Medline].
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].
Further Reading
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
