eMedicine Specialties > Emergency Medicine > Infectious Diseases

Schistosomiasis: Treatment & Medication

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

Treatment

Prehospital Care

Support and stabilization are provided for acute complications of infection, if present. These might include volume depletion, heart failure, and gastrointestinal (GI) bleeding.

Emergency Department Care

In the ED, the physician confirms the diagnosis, begins antibiotic therapy, and stabilizes patients with acute complications of schistosomiasis. Management of hepatosplenic, gastrointestinal, urinary, cardiopulmonary, and CNS complications are summarized briefly below. Readers are referred to articles on these topics for a more comprehensive discussion of procedures.

  • Volume depletion secondary to diarrhea is rarely severe. It is treated with intravenous or oral volume replacement. Minor lower GI bleeding may be present but rarely requires transfusion.
  • In portal hypertension with hematemesis, treatment with fluid resuscitation, transfusion, endoscopic treatment, or surgery may be required.
  • Urinary obstruction may require stenting or other drainage procedures.
  • Salmonellal sepsis may require antibiotics and fluids.
  • Pulmonary hypertension and cor pulmonale may require oxygen, diuresis, antiarrhythmics, or other interventions.
  • Cerebral infection may require seizure control or management of intracranial pressure.
  • Transverse myelitis may require steroids and supportive care as well as antihelminthic therapy.
  • Corticosteroids may be needed in the management of acute schistosomiasis to suppress the hypersensitivity reaction, which may worsen at first with antihelminthic treatment.

Consultations

  • Clearly communicating with the hospital's diagnostic laboratory personnel is crucial for optimal egg detection in stool and urine specimens.
  • Consult specialists as indicated by the complications present (see above) or the need for diagnostic procedures, such as colonoscopy.

Medication

Definitive therapy can be initiated and often completed in the ED if the diagnosis is clear. During acute infections, treatment may exacerbate symptoms as a result of increased antigen release, usually requiring corticosteroid support. Treatment may produce a Loefflerlike syndrome in cases of heavy infestation, which may require pulmonary support.

Schistosomiasis is unusual in that only one drug, Praziquantel, see below, is widely in use. Drug resistance has been reported and can be produced in laboratory settings but appears still to be uncommon in human infections. Myrrh derivatives have not demonstrated success in testing, but artemisinins4 are showing efficacy, and trioxolanes5 also show promise as future drugs.

Anthelmintics

Drug regimens result in curing the infection in 60-98% of cases and reduce egg burden in the remainder. Dead eggs may continue to shed for months, but treatment should arrest egg-laying, granuloma formation, and future complications. Although frank fibrosis may not reverse, evidence indicates that portal and pulmonary hypertension from granulomatous changes may improve significantly after treatment, particularly in younger patients.


Praziquantel (Biltricide)

DOC in most infections. Increases cell membrane permeability in susceptible worms, resulting in loss of intracellular calcium, massive contractions, and paralysis of their musculature. In addition, produces vacuolization and disintegration of schistosome tegument. This is followed by attachment of phagocytes to parasite and death. The drug has no effect on eggs and immature worms. Tablets should be swallowed whole with some liquid during meals. Keeping tablets in mouth may reveal bitter taste that can produce nausea or vomiting.

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

<4 years: Not established
>4 years: Administer as in adults

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 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 associated with cerebral cysticercosis, hospitalize patient for duration of treatment

More on Schistosomiasis

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