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Pediatric Schistosomiasis Treatment & Management

  • Author: Vinod K Dhawan, MD, FACP, FRCPC, FIDSA; Chief Editor: Russell W Steele, MD  more...
Updated: Feb 26, 2015

Approach Considerations

Praziquantel is currently the main antischistosomal agent. Other oral agents are oxamniquine and metrifonate, but these have limited parasite specificity. Artemether appears to be beneficial in some settings.

Surgery may be necessary in severe or chronic schistosomiasis. Patients who have chronic liver disease or are experiencing further episodes of gastrointestinal (GI) bleeding or bacterial sepsis should be admitted for further inpatient care.

No special diet is required for acute disease. Individuals with chronic liver disease may benefit from a high-protein, low-salt diet. Limit activity for patients with acute GI bleeding or severe thrombocytopenia.

As a preventive measure, patients should be advised to avoid further freshwater contact in endemic areas if possible. An improved understanding of the immune response to schistosome infection suggests that development of a vaccine may be possible in the future.[13]


Pharmacologic Therapy

Praziquantel remains the drug of choice for treating all species of schistosomes.[14, 15] Typical dosages are 20 mg/kg orally twice daily on day 1 for S haematobium, S intercalatum,andS mansoni and 20 mg/kg orally 3 times daily on day 1 for S japonicumandS mekongi. Cure rates range from 65-90% after a single treatment.[16] Egg excretion is reduced by more than 90% in persons not cured.

Praziquantel appears to be safe during pregnancy, as demonstrated in a prospective study carried out in eastern Sudan involving 25 pregnant women with S mansoni infection.[17] The drug was given to 6 (24%), 12 (48%), and 7 (28%) of the women during the first, second, and third trimesters of their pregnancies, respectively. No stillbirths or congenital abnormalities were reported among the newborns. One patient aborted (3 weeks after treatment), but this rate of abortion was considered typical in the local community.

Patients should be monitored during therapy for any seizures or other neurologic consequences of dying cysticerci. Corticosteroid therapy has been used to reduce inflammation and mitigate reactions that develop in response to killing the parasites. Maturing schistosomes are less susceptible to chemotherapy than adult worms; therefore, a second course of therapy should be given several weeks after the first.

Oxamniquine has been used for treatment of S mansoni infections with equally good results, but this agent is no longer available in the United States.

Metrifonate is effective only against urinary schistosomes; it requires 3 doses administered 2 weeks apart and is not currently available in the United States.

Artemether can kill schistosomula during the first 3 weeks of infection and has been shown to be effective for prophylaxis in areas of high endemicity. Used as an antimalarial, artemether is also active against schistosome parasites (mainly schistosomula). Trials involving the combination of artemether and praziquantel show beneficial effect.


Surgical Management of Associated Conditions

Surgery may be necessary in severe or chronic schistosomiasis. Procedures that may be indicated include the following:

  • Resection of bladder and colonic polyps
  • Correction of obstructive uropathy
  • Partial colectomy for GI polyposis and fibrosis
  • Placement of a distal splenorenal shunt for reversal of portal hypertension
  • Resection of cerebral cortical granulomas after failure of chemotherapy


Consultations may be indicated with the following specialists:

  • Infectious diseases specialist
  • Gastroenterologist
  • General surgeon
  • Nephrologist
  • Neurologist
  • Neurosurgeon
  • Urologist

Long-Term Monitoring

Patients who have been treated with antischistosomal chemotherapy should be monitored for treatment effectiveness. Stool and urine samples should be examined for 1 year after therapy. Successful therapy results in decreased in egg excretion.

Newer tests that measure antigens may help assess therapeutic response. Persistent circulating antigen and continued excretion of eggs indicate residual infection and the need for retreatment with praziquantel.

It should be kept in mind that serologic tests may remain positive for several years after successful treatment and thus may not be helpful as a test of cure.

Contributor Information and Disclosures

Vinod K Dhawan, MD, FACP, FRCPC, 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, FRCPC, FIDSA is a member of the following medical societies: American College of Physicians, American Medical Association, American Society for Microbiology, Infectious Diseases Society of America, Royal College of Physicians and Surgeons of Canada

Disclosure: Received honoraria from Pfizer Inc for speaking and teaching.

Chief Editor

Russell W Steele, MD Clinical Professor, Tulane University School of Medicine; Staff Physician, Ochsner Clinic Foundation

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, Southern Medical Association

Disclosure: Nothing to disclose.


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.

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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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