Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

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]

Next

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.

Previous
Next

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
Previous
Next

Consultations

Consultations may be indicated with the following specialists:

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

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.

Previous
 
 
Contributor Information and Disclosures
Author

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.

Acknowledgements

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. 2009 Mar 24. 119(11):1518-23. [Medline].

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

  3. Chitsulo L, Engels D, Montresor A, et al. The global status of schistosomiasis and its control. Acta Trop. 2000 Oct 23. 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. 2006 Jun 15. 42(12):1781-9. [Medline].

  6. Xu X, Zhang Y, Lin D, Zhang J, Xu J, Liu YM, et al. Serodiagnosis of Schistosoma japonicum infection: genome-wide identification of a protein marker, and assessment of its diagnostic validity in a field study in China. Lancet Infect Dis. 2014 Jun. 14(6):489-97. [Medline].

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

  8. 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. 2000 Jul. 20(4):281-9. [Medline].

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

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

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

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

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

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

  15. 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. 2009 Nov. 136(13):1825-35. [Medline].

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

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

 
Previous
Next
 
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.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.