eMedicine Specialties > Emergency Medicine > Infectious Diseases

Schistosomiasis: Follow-up

Author: Amy J Behrman, MD, Associate Professor, Department of Emergency Medicine, Director, Division of Occupational Medicine, University of Pennsylvania School of Medicine
Contributor Information and Disclosures

Updated: Apr 2, 2008

Follow-up

Further Inpatient Care

  • Initiate inpatient care for unstable patients with complications, such as GI bleeding, decompensated heart failure, and toxicity, according to the usual indications.
  • Inpatient care is indicated for CNS infections.

Further Outpatient Care

  • Reevaluate patients for symptom resolution and determination of cure. For uncomplicated cases, 4-6 weeks is the optimal follow-up time, corresponding with the maturation of eggs and immature worms that may have survived initial treatment.
  • Response may be evaluated by quantitatively decreased egg counts from urine or stool specimens or by antigen testing. Some patients require re-treatment.
  • Patients with evidence of portal hypertension, pulmonary hypertension, CNS infection, or urinary obstruction require long-term follow-up care.

Inpatient & Outpatient Medications

  • Treat schistosomiasis with definitive antihelminthic therapy, as described above (see Medication).

Deterrence/Prevention

  • Travelers to endemic areas should avoid exposure to freshwater that is likely to be contaminated. No accepted prophylactic regimens have been developed, and no vaccines are currently available, although vaccine development is increasingly promising. Early treatment after high-risk exposures should minimize morbidity.
  • Prevention for groups residing in endemic areas is more difficult than prevention for travelers.
    • Improved sanitation to decrease freshwater contamination with sewage should decrease disease prevalence.
    • Behavioral interventions to decrease occupational and recreational contact with contaminated water may be useful. These interventions are particularly problematic with children.
    • Molluscicides to decrease the prevalence of the snail hosts have some usefulness but require frequent reapplication and are used less frequently now than in the past.
    • Mass treatment of targeted populations with the newer less toxic antischistosomal agents may have utility. It can be combined with molluscicide treatment if needed.
    • Vaccines hold the promise of significantly reducing infection in endemic areas.
    • Genomic studies of the parasites may lead to improved therapeutics.

Complications

  • End-organ disease
  • Pulmonary hypertension
  • Cor pulmonale
  • Portal hypertension
  • Obstructive uropathy
  • Gastrointestinal bleeding
  • Pregnancy complications from vulvar or fallopian granuloma
  • Carcinoma of the liver, bladder, or gallbladder

Prognosis

  • Almost all patients improve with treatment.
  • Most patients with early disease or without severe end-organ complications recover completely.
  • Surprisingly, patients with hepatic and urinary disease, even with fibrosis, may improve significantly over months or years following treatment.
  • Resolution of pulmonary disease is less well documented.
    • Patients with heavier worm burdens are less likely to improve and are more likely to require re-treatment.
    • Treatment is indicated for patients with end-stage complications of portal hypertension and severe pulmonary hypertension, but these patients are much less likely to benefit.
  • Co-infection (with malaria, HIV, or hepatitis) worsens the prognosis.

Miscellaneous

Medicolegal Pitfalls

  • Taking a complete travel and residence history and considering the diagnosis of schistosomiasis in appropriate patients who present with nonspecific findings, such as fever, bloody diarrhea, hematuria, portal hypertension, pulmonary hypertension, or CNS abnormalities, are important. Antischistosomal treatment can arrest or improve many of these processes and prevent further complications.

Special Concerns

  • Pregnancy: Physicians may prefer to defer treatment until after the first trimester.
  • Pediatric
    • Pediatric and adolescent patients who have traveled or lived in endemic areas are at the highest risk for exposure to schistosomes and are at risk for serious long-term complications.
    • These patients usually respond well to drug therapy and should receive aggressive treatment and follow-up care.
 


More on Schistosomiasis

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

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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

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Contributor Information and Disclosures

Author

Amy J Behrman, MD, Associate Professor, Department of Emergency Medicine, Director, Division of Occupational Medicine, University of Pennsylvania School of Medicine
Amy J Behrman, MD is a member of the following medical societies: American College of Occupational and Environmental Medicine, American College of Physicians-American Society of Internal Medicine, American Public Health Association, Phi Beta Kappa, and Sigma Xi
Disclosure: Nothing to disclose.

Medical Editor

Joseph A Salomone, III, MD, Associate Professor, Department of Emergency Medicine, Truman Medical Center, University of Missouri at Kansas City School of Medicine
Joseph A Salomone, III, MD is a member of the following medical societies: American Academy of Emergency Medicine, Society for Academic Emergency Medicine, and Southern Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

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

Managing Editor

Jeter (Jay) Pritchard Taylor III, MD, Compliance Officer, Attending Physician Emergency Medicine Residency, Department of Emergency Medicine, Palmetto Richland Memorial Hospital, University of South Carolina
Jeter (Jay) Pritchard Taylor III, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Robert E O'Connor, MD, MPH, Professor and Chair, Department of Emergency Medicine, University of Virginia Health System
Robert E O'Connor, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Physician Executives, American Heart Association, American Medical Association, Medical Society of Delaware, National Association of EMS Physicians, Society for Academic Emergency Medicine, and Wilderness Medical Society
Disclosure: Nothing to disclose.

 
 
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