Pediatric Schistosomiasis Differential Diagnoses

  • Author: Vinod K Dhawan, MD, FACP, FRCP(C), FIDSA; Chief Editor: Russell W Steele, MD   more...
 
Updated: Nov 16, 2011
 
 

Diagnostic Considerations

Potentially serious asymptomatic infections are common in travelers returning to developed countries. A detailed freshwater exposure history, symptom history, and physical examination may add little in detecting cases. Stool microscopy, schistosomal serology, and the eosinophil count tend to be the best tools for evaluating suspected disease.

Patients with schistosomiasis are, by default, at risk for other parasitic infections because areas that are endemic for schistosomiasis are also endemic for other parasites. After treatment, patients should be monitored for other symptomatology characteristic of parasitic infections.

In addition to the conditions listed in the differential diagnosis, other problems to be considered include the following:

  • Bacterial or viral gastrointestinal (GI) infection in the acute presentation
  • Idiopathic epilepsy
  • Postinfectious viral transverse myelitis
  • Congenital hydronephrosis
  • Congenital heart disease and cor pulmonale
  • Renal disease

Differential Diagnoses

Proceed to Workup
 
 
Contributor Information and Disclosures
Author

Vinod K Dhawan, MD, FACP, FRCP(C), FIDSA  Professor, Department of Clinical Medicine, University of California, Los Angeles, David Geffen School of Medicine; Chief, Division of Infectious Diseases, Rancho Los Amigos National Rehabilitation Center

Vinod K Dhawan, MD, FACP, FRCP(C), FIDSA is a member of the following medical societies: American College of Physicians, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, and Royal College of Physicians and Surgeons of Canada

Disclosure: Pfizer Inc Honoraria Speaking and teaching

Chief Editor

Russell W Steele, MD  Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association

Disclosure: Nothing to disclose.

Additional Contributors

Leslie L Barton, MD Professor Emerita of Pediatrics, University of Arizona College of Medicine

Leslie L Barton, MD is a member of the following medical societies: American Academy of Pediatrics, Association of Pediatric Program Directors, Infectious Diseases Society of America, and Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Michael D Nissen, MBBS, FRACP, FRCPA, Associate Professor in Biomolecular, Biomedical Science & Health, Griffith University; Director of Infectious Diseases and Unit Head of Queensland Paediatric Infectious Laboratory, Sir Albert Sakzewski Viral Research Centre, Royal Children's Hospital

Michael D Nissen, MBBS, FRACP, FRCPA is a member of the following societies : American Academy of Pediatrics, American Society for Microbiology, Pediatric Infectious Diseases Society,Royal Australasian College of Physicians, Royal College of Pathologists of Australasia

Disclosure: Nothing to disclose.

Robert W Tolan Jr, MD Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine

Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility

Disclosure: GlaxoSmithKline Honoraria Speaking and teaching; MedImmune Honoraria Speaking and teaching; Merck Honoraria Speaking and teaching; Sanofi Pasteur Honoraria Speaking and teaching; Baxter Healthcare Honoraria Speaking and teaching; Novartis Honoraria Speaking and teaching

John Charles Walker, MSc, PhD Head, Department of Parasitology, Center for Infectious Diseases and Microbiology, Westmead Hospital, Westmead, Australia; Senior Lecturer, Department of Medicine, University of Sydney, Australia

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

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

  2. Salvana EM, King CH. Schistosomiasis in travelers and immigrants. Curr Infect Dis Rep. Mar 2008;10(1):42-9. [Medline].

  3. Chitsulo L, Engels D, Montresor A, et al. The global status of schistosomiasis and its control. Acta Trop. Oct 23 2000;77(1):41-51. [Medline].

  4. Yosry A. Schistosomiasis and neoplasia. Contrib Microbiol. 2006;13:81-100. [Medline].

  5. Kallestrup P, Zinyama R, Gomo E, Butterworth AE, van Dam GJ, Gerstoft J. 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].

  6. Tsang VC, Wilkins PP. Immunodiagnosis of schistosomiasis. Screen with FAST-ELISA and confirm with immunoblot. Clin Lab Med. Dec 1991;11(4):1029-39. [Medline].

  7. Kamal S, Madwar M, Bianchi L. Clinical, virological and histopathological features: long-term follow-up in patients with chronic hepatitis C co-infected with S. mansoni. Liver. Jul 2000;20(4):281-9. [Medline].

  8. Weber-Donat G, Donat N, Margery J. Acute Pulmonary Schistosomiasis: Computed Tomography (CT) Findings. Am J Trop Med Hyg. Mar 2010;82(3):364. [Medline].

  9. Richter J. Evolution of schistosomiasis-induced pathology after therapy and interruption of exposure to schistosomes: a review of ultrasonographic studies. Acta Trop. Oct 23 2000;77(1):111-31. [Medline].

  10. Cao J, Liu WJ, Xu XY, Zou XP. Endoscopic findings and clinicopathologic characteristics of colonic schistosomiasis: a report of 46 cases. World J Gastroenterol. Feb 14 2010;16(6):723-7. [Medline].

  11. Hayashi S, Ohtake H, Koike M. Laparoscopic diagnosis and clinical course of chronic schistosomiasis japonica. Acta Trop. Oct 23 2000;77(1):133-40. [Medline].

  12. McManus DP, Loukas A. Current status of vaccines for schistosomiasis. Clin Microbiol Rev. Jan 2008;21(1):225-42. [Medline].

  13. Andersson KL, Chung RT. Hepatic schistosomiasis. Curr Treat Options Gastroenterol. Dec 2007;10(6):504-12. [Medline].

  14. Doenhoff MJ, Hagan P, Cioli D, Southgate V, Pica-Mattoccia L, Botros S, et al. Praziquantel: its use in control of schistosomiasis in sub-Saharan Africa and current research needs. Parasitology. Nov 2009;136(13):1825-35. [Medline].

  15. van der Vliet HJ, van Kemenade FJ, Hekker TA, Craanen ME. Schistosomiasis. Clin Gastroenterol Hepatol. Jun 2005;3(6):A26. [Medline].

  16. Adam I, Elwasila E, Homeida M. Praziquantel for the treatment of schistosomiasis mansoni during pregnancy. Ann Trop Med Parasitol. Jan 2005;99(1):37-40. [Medline].

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Cercarial dermatitis secondary to avian schistosomes is shown. Photography taken by A. Joseph Bearup and provided by John Walker, MD.
Two 10-year-old boys with abdominal distension secondary to chronic Schistosoma japonicum infection.
CT scan of the brain reveals a right cerebral hemisphere lesion due to Schistosoma japonicum. The patient presented with focal motor seizures.
Egg of Schistosoma japonicum from a fecal smear is shown. Note lateral umbilicated spine on the right side of the egg.
Egg of Schistosoma mekongi (53 X 45 μm) in the feces of a woman from Laos.
Egg of Schistosoma mansoni from a fecal smear.
Egg of Schistosoma haematobium from a fecal smear.
Eggs of Schistosoma japonicum within the intestinal mucosa.
Liver granulomata secondary to Schistosoma japonicum infestation.
Granuloma within the intestinal mucosa secondary to Schistosoma mansoni infestation.
Eggs of Schistosoma haematobium isolated from urinary sediment.
Eggs of Schistosoma haematobium detected in the bladder.
 
 
 
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