Medication Summary

The aim of chemotherapy is 2-fold. The first goal is to cure the disease or at least minimize morbidity. The second goal is to control transmission of the parasite in the endemic areas. Praziquantel and oxamniquine (no longer available in the United States) are used commonly, but praziquantel is the treatment of choice for all species of schistosomiasis. Clinical studies show that artemether, which is used as antimalarial treatment, is also active against all 3 major schistosome parasites (mainly schistosomula).^[65]

In addition, the combination of artemether and praziquantel can kill schistosomula during the first 3 weeks of infection and is synergistic with praziquantel in killing adult worms.^[71]The high efficacy of mefloquine-artesunate against S haematobium warrants further investigation. Individuals co-infected with Plasmodium and Schistosoma who are treated with a mefloquine-artesunate combination against malaria may experience a dual benefit: clearance of malaria parasitemia and reduction of schistosomiasis-related morbidity.^[72]

Class Summary

Parasite biochemical pathways are sufficiently different from the human host to allow selective interference by chemotherapeutic agents in relatively small doses.

Praziquantel (Biltricide)

View full drug information

Praziquantel is usually well tolerated. It is used for the treatment of individual patients and for mass community treatment programs. The drug's mechanism of action is complex; it induces ultrastructural changes resulting in increased permeability to calcium ions. Calcium ions accumulate in the parasite cytosol, leading to muscle contractions and ultimate paralysis of adult worms. The worm's tegument membrane (the natural covering of the worm body) is damaged, exposing the worm to the patient's immune response, which leads to worm death. The cure rate with praziquantel is 85% or greater. In persons not cured, the egg burden is markedly decreased.

Oxamniquine (Vansil)

Oxamniquine is no longer available in the United States. Its mechanism of action is complex. The drug is metabolized into an ester by schistosomes. It damages the tegument of male schistosome worms so that the patient's immune system is able to kill the organisms. It also stops female worms from producing eggs. Oxamniquine is effective only against S mansoni. The cure rate with the drug is 60-90%.

Questions

Schistosomiasis, Fact Sheet No 115; February 2010. World Health Organization. Available at http://www.who.int/mediacentre/factsheets/fs115/en/. Accessed: Oct 5, 2010.
GBD 2017 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018 Nov 10. 392 (10159):1789-1858. [Medline].
WHO. Available at https://www.who.int/news-room/fact-sheets/detail/schistosomiasis.
Weekly epidemiological record 30 April No.18,2010, 85, 157-164. World health Organization. Available at http://www.who.int/wer. Accessed: Sept. 27,2010.
Chistulo L, Loverde P, Engels D. Disease Watch: Schistosomiasis. TDR Nature Reviews Microbiology. 2004. 2:12:
Nawal M. Nour. Schistosomiasis: Health Effects on Women. Reviews in Obstetrics & Gynecology. 2010. 3:28-32.
Corachan M. Schistosomiasis and international travel. Clin Infect Dis. 2002 Aug 15. 35(4):446-50. [Medline].
Houston S, Kowalewska-Grochowska K, Naik S, McKean J, Johnson ES, and Warren K. First Report of Schistosoma mekongi Infection with Brain Involvement. Clinical Infectious Diseases. 2004. 38:e1-6.
Mohammed AZ, Edino ST, Samaila AA. Surgical pathology of schistosomiasis. J Natl Med Assoc. 2007 May. 99(5):570-4. [Medline]. [Full Text].
Leder K, Weller P. Epidemiology; pathogenesis; and clinical features of schistosomiasis. UpToDate. April 24, 2009. 1-9. [Full Text].
Sturrock RF. The Schistosomiasis and their intermediate hosts. Mahmood AAF. Schistosomiasis. Imperial College London; 2001. 7-83.
Lesham E, Meltzer E, Marva E, Schwartz E. Travel-related Schistosomiasis Acquired in Laos. Emerging Infectious Diseases. 15:1823. [Full Text].
Epidemiological situation. WHO. Available at http://www.who.int/schistosomiasis/epidemiology/en. Accessed: Sept. 27,2010.
WHO-TDR. World health organization. Available at http://www.who.int/tdr. Accessed: Oct. 5,2010.
Friedman JF, Mital P, Kanzaria HK, Olds GR, Kurtis JD. Schistosomiasis and pregnancy. Trends Parasitol. 2007 Apr. 23(4):159-64. [Medline].
Kabatereine N, Brooker S, Tukahebwa E, et al. Epidemiology and geography of Schistosoma mansoni in Uganda: implications for planning control. Trp Med Int Health. 2004. 9:372.
Hagan P, Gryeels B. Schistosomiasis research and the European Community. Trop geogr Med. 1994. 46:256.
King CH, Keating CE, Muruka JF, Ouma JH, Houser H, Siongok TK. Urinary tract morbidity in schistosomiasis haematobia: associations with age and intensity of infection in an endemic area of Coast Province, Kenya. Am J Trop Med Hyg. 1988 Oct. 39(4):361-8. [Medline].
Badmos KB, Komolafe AO, Rotimi O. Schistosomiasis presenting as acute appendicitis. East Afr Med J. 2006 Oct. 83(10):528-32. [Medline].
Terada T. Schistosomal appendicitis: incidence in Japan and a case report. World J Gastroenterol. 2009 Apr 7. 15(13):1648-9. [Medline]. [Full Text].
Argemi X, Camuset G, Abou-Bakar A, et al. Case report: rectal perforation caused by Schistosoma haematobium. Am J Trop Med Hyg. 2009 Feb. 80(2):179-81. [Medline].
Lapa M, Dias B, Jardim C, Fernandes CJ, Dourado PM, Figueiredo M. Cardiopulmonary manifestations of hepatosplenic schistosomiasis. Circulation. 2009 Mar 24. 119(11):1518-23. [Medline].
Nmorsi O, Ukwandu N, Egwungenya O, Obhiemi N. Evaluation of CD4(+)/CD8(+) status and urinary tract infections associated with urinary schistosomiasis among some rural Nigerians. Afr Health Sci. 2005 Jun. 5(2):126-30. [Medline]. [Full Text].
Coutinho HM, Acosta LP, Wu HW, et al. Th2 cytokines are associated with persistent hepatic fibrosis in human Schistosoma japonicum infection. J Infect Dis. 2007 Jan 15. 195(2):288-95. [Medline].
John R, Ezekiel M, Philbert C, Andrew A. Schistosomiasis transmission at high altitude crater lakes in western Uganda. BMC Infect Dis. 2008 Aug 11. 8:110. [Medline]. [Full Text].
King CH. Toward the elimination of schistosomiasis. N Engl J Med. 2009 Jan 8. 360(2):106-9. [Medline].
Wang LD, Chen HG, Guo JG, et al. A strategy to control transmission of Schistosoma japonicum in China. N Engl J Med. 2009 Jan 8. 360(2):121-8. [Medline].
Wang LD, Guo JG, Wu XH, et al. China's new strategy to block Schistosoma japonicum transmission: experiences and impact beyond schistosomiasis. Trop Med Int Health. 2009 Dec. 14(12):1475-83. [Medline].
Kallestrup P, Zinyama R, Gomo E, et al. 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].
Mwanakasale V, Siziya S, Mwansa J, Koukounari A, Fenwick A. Impact of iron supplementation on schistosomiasis control in Zambian school children in a highly endemic area. Malawi Med J. 2009 Mar. 21(1):12-8. [Medline].
Vennervald BJ, Dunne DW. Morbidity in schistosomiasis: an update. Curr Opin Infect Dis. 2004 Oct. 17(5):439-47. [Medline].
Savioli L, Crompton DW, Neira M. Use of anthelminthic drugs during pregnancy. Am J Obstet Gynecol. 2003 Jan. 188(1):5-6. [Medline].
Leshem E, Maor Y, Meltzer E, Assous M, Schwartz E. Acute Schistosomiasis Outbreak: Clinical Features and Economic Impact. Clinical Infectious Diseases. Dec/2008. 47:1499-1506.
Mosunjac MB, Tadros T, Beach R, et al. Cervical schistosomiasis, human papilloma virus (HPV), and human immunodeficiency virus (HIV): a dangerous coexistence or coincidence?. Gynecol Oncol. 2003 Jul. 90(1):211-4. [Medline].
Leutscher PD, Ramarokoto CE, Hoffmann S, Jensen JS, Ramaniraka V, Randrianasolo B. Coexistence of urogenital schistosomiasis and sexually transmitted infection in women and men living in an area where Schistosoma haematobium is endemic. Clin Infect Dis. 2008 Sep 15. 47(6):775-82. [Medline].
Walker M, Zunt JR. Parasitic central nervous system infections in immunocompromised hosts. Clin Infect Dis. 2005 Apr 1. 40(7):1005-15. [Medline].
Wan H, Lei D, Mao Q. Cerebellar schistosomiasis: a case report with clinical analysis. Korean J Parasitol. 2009 Mar. 47(1):53-6. [Medline].
Ross AG, Vickers D, Olds GR, Shah SM, McManus DP. Katayama syndrome. Lancet Infect Dis. 2007 Mar. 7(3):218-24. [Medline].
Kjetland EF, Mduluza T, Ndhlovu PD, Gomo E, Gwanzura L, Midzi N. Genital schistosomiasis in women: a clinical 12-month in vivo study following treatment with praziquantel. Trans R Soc Trop Med Hyg. 2006 Aug. 100(8):740-52. [Medline].
Abdel-Wahab MF, Esmat G, Farrag A, el-Boraey YA, Strickland GT. Grading of hepatic schistosomiasis by the use of ultrasonography. Am J Trop Med Hyg. 1992 Apr. 46(4):403-8. [Medline].
Fowler R, Lee C, Keystone JS. The Role Of Corticosteroids In The Treatment Of Cerebral Schistosomiasis Caused By Schistosoma mansoni: Case Report and Discussion. Am J Trop Med Hyg. 1999. 6(1):47-50.
Mbabazi PS, Andan O, Fitzgerald DW, Chitsulo L, Engels D, Downs JA. Examining the relationship between urogenital schistosomiasis and HIV infection. PLoS Negl Trop Dis. 2011 Dec. 5 (12):e1396. [Medline].
Sandoval N, Siles-Lucas M, Pérez-Arellano JL, Carranza C, Puente S, López-Abán J. A new PCR-based approach for the specific amplification of DNA from different Schistosoma species applicable to human urine samples. Parasitology. 2006 Nov. 133(Pt 5):581-7. [Medline].
Lier T, Simonsen GS, Haaheim H, Hjelmevoll SO, Vennervald BJ, Johansen MV. Novel real-time PCr for detection of Schistosoma japonicum in stool. Southeast Asian J Trop Med Public Health. 2006 Mar. 37(2):257-64. [Medline].
Midzi N, Butterworth AE, Mdluza T,et al. Use of circulating cathodic antigen strips for the diagnosis of urinary schistosomiasis. Trans T Soc Trop Med Hyg. 2009. 103:45.
Peters P, Kazura JW. Update on diagnostic methods for schistosomiasis. Baillere's Clinical Tropical Medicine and Communicable Diseases. 1987. 2:
King C, Mahmouud AA. Schistosomiasis. In: Tropical Infectious Diseases. Guerrant R, Walker DH, Weller PF. Principles, Pathogens and Practice,. Philadelphia: Churchill Livingstone; 1999. Vol 2: 1031.
Al-Sherbiny MM, Osman AM, Hancock K, et al. Application of immunodiagnostic assays: detection of antibodies and circulating antigens in human schistosomiasis and correlation with clinical findings. Am J Trop Med Hyg. 1999 Jun. 60(6):960-6. [Medline]. [Full Text].
Sulahian A, Garin YJ, Izri A, Verret C, Delaunay P, van Gool T, et al. Development and evaluation of a Western blot kit for diagnosis of schistosomiasis. Clin Diagn Lab Immunol. 2005 Apr. 12(4):548-51. [Medline]. [Full Text].
van Lieshout L, Polderman AM, Deelder AM. Immunodiagnosis of schistosomiasis by determination of the circulating antigens CAA and CCA, in particular in individuals with recent or light infections. Acta Trop. 2000 Oct 23. 77(1):69-80. [Medline].
ten Hove RJ, Verweij JJ, Vereecken K, et al. Multiplex real-time PCR for the detection and quantification of Schistosoma mansoni and Schistosoma hematobium infection in stool samples collected in northern Senegal. Trans R Soc Trop Med Hyg. 2008. 102:179.
Caffrey CR. Chemotherapy of schistosomiasis: present and future. Curr Opin Chem Biol. 2007 Aug. 11(4):433-9. [Medline].
Gryseels B, Polman K, Clerinx J, Kestens L. Human schistosomiasis. Lancet. 2006 Sep 23. 368(9541):1106-18. [Medline].
Harries AD, Fryatt R, Walker J, Chiodini PL, Bryceson AD. Schistosomiasis in expatriates returning to Britain from the tropics: a controlled study. Lancet. 1986 Jan 11. 1(8472):86-8. [Medline].
Shimazu C, Pien FD, Parnell D. Bronchoscopic diagnosis of Schistosoma japonicum in a patient with hemoptysis. Respir Med. 1991 Jul. 85(4):331-2. [Medline].
Schaberg T, Rahn W, Racz P, Lode H. Pulmonary schistosomiasis resembling acute pulmonary tuberculosis. E Respir J. 1991. 4:1023.
Ferrari TC. Spinal cord schistosomiasis. A report of 2 cases and review emphasizing clinical aspects. Medicine (Baltimore). 1999. 78:176.
Fenwick A, Rollinson D, Southgate V. Implementation of human schistosomiasis control: Challenges and prospects. Adv Parasitol. 2006. 61:567-622. [Medline].
Olds GR. Administration of praziquantel to pregnant and lactating women. Acta Trop. 2003 May. 86(2-3):185-95. [Medline].
Ismail M, Botros S, Metwally A, et al. Resistance to praziquantel: direct evidence from Schistosoma mansoni isolated from Egyptian villagers. Am J Trop Med Hyg. 1999 Jun. 60(6):932-5. [Medline].
Ismail M, Metwally A, Farghaly A, Bruce J, Tao LF, Bennett JL. Characterization of isolates of Schistosoma mansoni from Egyptian villagers that tolerate high doses of praziquantel. Am J Trop Med Hyg. 1996 Aug. 55(2):214-8. [Medline].
Adam I, Elwasila el T, Homeida M. Is praziquantel therapy safe during pregnancy?. Trans R Soc Trop Med Hyg. 2004 Sep. 98(9):540-3. [Medline].
Leder K, Weller PF. Treatment and prevention of schistosomiasis. Available at http://www.uptodate.com. Accessed: 9/20/2010.
Tweyongyere R, Mawa PA, Ngom-Wegi S, et al. Effect of praziquantel treatment during pregnancy on cytokine responses to schistosome antigens: results of a randomized, placebo-controlled trial. J Infect Dis. 2008 Dec 15. 198(12):1870-9. [Medline]. [Full Text].
N'Goran EK, Utzinger J, Gnaka HN, et al. Randomized, double-blind, placebo-controlled trial of oral artemether for the prevention of patent Schistosoma haematobium infections. Am J Trop Med Hyg. 2003 Jan. 68(1):24-32. [Medline]. [Full Text].
Posey DL, Blackburn BG, Weinberg M, Flagg EW, Ortega L, Wilson M. High prevalence and presumptive treatment of schistosomiasis and strongyloidiasis among African refugees. Clin Infect Dis. 2007 Nov 15. 45(10):1310-5. [Medline].
Ramaswamy K, He YX, Salafsky B, Shibuya T. Topical application of DEET for schistosomiasis. Trends Parasitol. 2003 Dec. 19(12):551-5. [Medline].
World Health Organization. Preventive chemotherapy in human helminthiasis. November, 2006. Available at http://whqlibdoc.who.int/publications/2006/9241547103_eng.pdf.
McManus DP. Defeating Schistosomiasis. N Engl J Med. 2019 Dec 26. 381 (26):2567-2568. [Medline].
Deol AK, Fleming FM, Calvo-Urbano B, Walker M, Bucumi V, Gnandou I, et al. Schistosomiasis - Assessing Progress toward the 2020 and 2025 Global Goals. N Engl J Med. 2019 Dec 26. 381 (26):2519-2528. [Medline].
Utzinger J, Keiser J, Shuhua X, Tanner M, Singer BH. Combination chemotherapy of schistosomiasis in laboratory studies and clinical trials. Antimicrob Agents Chemother. 2003 May. 47(5):1487-95. [Medline]. [Full Text].
Keiser J, N'Guessan NA, Adoubryn KD, Silué KD, Vounatsou P, Hatz C. Efficacy and safety of mefloquine, artesunate, mefloquine-artesunate, and praziquantel against Schistosoma haematobium: randomized, exploratory open-label trial. Clin Infect Dis. 2010 May 1. 50(9):1205-13. [Medline].
Savioli L, Fenwick A, Rollinson D, Albonico M, Ame SM. An achievable goal: control and elimination of schistosomiasis. Lancet. 2015 Aug 22. 386 (9995):739. [Medline].

Media Gallery

Egg of Schistosoma hematobium, with its typical terminal spine.
Granuloma in the liver due to Schistosoma mansoni. The S mansoni egg is at the center of the granuloma.

of 2

Species		Geographical distribution
Intestinal schistosomiasis	Schistosoma mansoni (mesenteric venules of the colon)	Africa, the Middle East, the Caribbean, and South America
	Schistosoma japonicum (mesenteric venules of the small intestine)	Asia only: China, Indonesia, the Philippines, and Thailand
	Schistosoma mekongi (mesenteric venules of the small intestine)	Several districts of Cambodia and the Lao People’s Democratic Republic. 200-km area of Mekong river basin; now extending toward northern provinces
	Schistosoma intercalatum (mesenteric venules of the colon) and related S guineensis	Rain forest areas of Central and West Africa
Urogenital schistosomiasis	Schistosoma haematobium (vesical venous plexus)	Africa, the Middle East, India, and Turkey

Schistosomiasis (Bilharzia) Medication

Medication Summary

Anthelmintics

Class Summary

Praziquantel (Biltricide)

Praziquantel (Biltricide)

Oxamniquine (Vansil)

Schistosomiasis (Bilharzia) Medication

Medication Summary

Anthelmintics

Class Summary

Praziquantel (Biltricide)

Praziquantel (Biltricide)

Oxamniquine (Vansil)

References

Tables

Contributor Information and Disclosures

What would you like to print?