eMedicine Specialties > Emergency Medicine > Infectious Diseases
Schistosomiasis: Differential Diagnoses & Workup
Updated: Apr 2, 2008
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
Differential Diagnoses
Other Problems to Be Considered
Cirrhosis
Pulmonary hypertension
Co-infection with malaria
Co-infection with HIV
Co-infection with hepatitis B or hepatitis C
Workup
Laboratory Studies
- Blood tests are occasionally useful in supporting the diagnosis or assessing the severity of schistosomal infection. Serologies, and, more recently, polymerase chain reaction (PCR) – based testing can confirm a diagnosis.2,3
- A complete blood cell (CBC) count may reveal peripheral eosinophilia, particularly in acute infection, anemia, or both.
- Chemistries
- Increased alkaline phosphatase level and gamma-glutamyltransferase (GGT) level are observed with hepatic granulomatosis.
- Transaminase levels generally are not affected, and elevations are usually caused by coexisting hepatitis.
- Renal function may be decreased if obstructive nephropathy is severe.
- Blood cultures are indicated for patients with persistent or recurrent fever and for those who may have developed recurrent salmonellal infection with severe enteric schistosomiasis.
- Urine microbiology is key when diagnosing vesicular infection from S haematobium. Gross and microscopic hematuria is common. Concentration methods may be necessary, and a rough determination of egg-load can be obtained. However, this should not be used as a firm measure of disease severity as egg counts can vary markedly between specimens in one patient.
- Fecal microbiology, usually on thick smears, is key when diagnosing schistosomiasis with primary bowel infection. Stool specimens may be positive for heme or grossly bloody. Concentration methods will be needed to identify light infestations. Rough quantitation can also be performed in these specimens with the same limitations as above.
Imaging Studies
- Ultrasonography
- Ultrasonography (US) is a sensitive means of assessing hepatosplenic disease with periportal fibrosis or urinary obstruction.
- It can demonstrate periportal fibrosis, splenomegaly, portal collaterals, periportal adenopathy, ureteral obstruction, and obstructive nephropathy.
- Echocardiography can demonstrate pulmonary hypertension and cor pulmonale, if present.
- Chest radiographs may show patchy infiltrates in acute schistosomiasis and can indicate pulmonary hypertension and cor pulmonale in end-stage chronic infection, if present.
- CT scanning may be useful in the evaluation of CNS disease or in the detection of periportal fibrosis.
- Magnetic resonance imaging (MRI) may be useful in the evaluation of CNS disease or in the detection of periportal fibrosis.
Other Tests
- Serology
- Enzyme-linked immunosorbent assay (ELISA) testing is available and can be helpful to confirm past exposure. However, antibody testing cannot distinguish active infection from inactive infection.
- The use of schistosomal antigen testing to help distinguish between active and inactive infection is promising but unlikely to assist in emergency management.
- Antigen titers from serum and urine correlate with the degree of infection, as indicated by concomitant egg counts.
- These tests may be particularly useful during acute or end-stage disease, when egg shedding can be minimal.
- Microscopy
- The finding of schistosomal eggs in the urine supports a definitive diagnosis.
- Urine samples can be examined qualitatively after centrifuging. However, eggs are not shed at a steady rate during the day, and quantitative egg counts are useful for determining the degree of infestation and response to therapy. Therefore, 24-hour urine collections may be recommended.
- The finding of schistosomal eggs in the stool supports a definitive diagnosis.
- Stool specimens usually are examined in a thick smear clarified with glycerol (Kato-Katz technique). Schistosomal species can be distinguished using egg morphology.
- Microscopy is not part of a standard ova and parasite evaluation and must be ordered specifically.
- Quantitative evaluation allows assessment of the degree of infection and treatment response.
- Hatching assays may be performed on fresh stool specimens to distinguish active from treated infection because dead eggs may be shed for up to 1 year after treatment.
Procedures
- Colonic biopsy
- Use of multiple crush specimens from the colon and/or rectum to visualize parasite eggs is a sensitive and specific test for enteric schistosomiasis.
- In the United States, where schistosomiasis is rare, most cases are diagnosed by this method.
- Cystoscopy may be useful in schistosomiasis with primary bladder involvement for definitive diagnosis or to evaluate secondary ulcers and polyps, biopsy for malignancy, rule out other sources of hematuria and dysuria, and identify eggs in mucosal biopsy specimens.
- Endoscopy and sclerotherapy may be indicated emergently in the presence of hematemesis caused by portal hypertension.
- Liver biopsy may be appropriate in patients with unclear diagnoses or suspected co-infections.
More on Schistosomiasis |
| Overview: Schistosomiasis |
 Differential Diagnoses & Workup: Schistosomiasis |
| Treatment & Medication: Schistosomiasis |
| Follow-up: Schistosomiasis |
| References |
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Further Reading
Keywords
schistosomiasis, bilharziasis, bilharzia, bilharziosis, snail fever, parasitic trematodes, human schistosomiasis, Schistosoma haematobium, S haematobium, Schistosoma mansoni, S mansoni, Schistosoma japonicum, S japonicum, Schistosoma mekongi, S mekongi, Schistosoma intercalatum, S intercalatum, schistosomes, swimmer’s itch, dermatitis, schistosomal infections, acute schistosomiasis, chronic schistosomiasis, Katayama fever, cercarial dermatitis
