Schistosomiasis history and symptoms

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]

The majority of patients with schistosomiasis in early phase are asymptomatic, unless katayama fever, an acute immune complex disease, occurs. Late schistosomiasis is symptomatic and includes hepatosplenic schistosomiasis (presinusoidal portal hypertension), urinary and urogenital schistosomiasis (urinary obstruction, genital symptoms), schistosomal glomerulopathy (chronic immune complex deposition in the kidney), and ectopic disease in areas such as the lungs and central nervous system (CNS).

The significant information that needs to focused in the history of the patient includes

• Any history of travel to the endemic areas
• Any ill contact with similar complaints

Clinical manifestations of schistosomiasis can be divided into:

• Schistosome dermatitis
• Acute schistosomiasis (katayama fever)
• Chronic schistosomiasis^[1]

• Acute schistosomiasis occurs 20 to 50 days after primary exposure.^[2][3][4]
• Presents with malaise, diarrhea, weight loss, cough, dyspnea, chest pain, restrictive respiratory insufficiency, and pericarditis.
• The clinical syndrome (i.e., fever, chills, liver and spleen enlargement, and marked eosinophilia) is specific for ”S. japonicum” infection.
• Acute disease is not observed in individuals living in endemic areas of schistosomiasis because of the down-modulation of the immune response by antigens or idiotypes transferred from mother to child.

Intestinal schistosomiasis

• In chronic schistosomiasis abdominal pain, irregular bowel movements, and blood in the stool are the main symptoms of intestinal involvement.^[5][6]
• Hepatosplenic involvement is the most important cause of morbidity with S. mansoni and S. japonicum infection.
• Patients may remain asymptomatic until the manifestation of hepatic fibrosis and portal hypertension develops.
• Hepatic fibrosis is caused by a granulomatous reaction to Schistosoma eggs that have been carried to the liver.
• Hematemesis from bleeding esophageal or gastric varices may occur.
• Concomitant infection by Salmonella species is observed.

Schistosomal nephropathy

• Patients with schistosomal nephropathy present with fatigue and asthenia.
• Glomerulonephritis is also found in untreated schistosomiasis.

Urogenital schistosomiasis

• Patients with urogenital schistosomiasis present with genital pain, pelvic pain, coital bleeding, and dyspareunia.

Pulmonary schistosomiasis

• Patients with acute pulmonary schistosomiasis present with wheezing, cough, and fever.
• Patients with chronic pulmonary schistosomiasis experience dyspnea on exertion, fatigue, and hemoptysis.
• Pulmonary hypertension, which used to be exclusively linked to the hepatosplenic form of the disease, has been documented in patients without liver fibrosis.

Neuroschistosomiasis

• In hospitalized adult patients with S. japonicum infection, cerebral schistosomiasis occurs in 1.7 to 4.3%.
• It may occur as early as 6 weeks after infection, and the most common sign is focal jacksonian epilepsy.
• Signs and symptoms of generalized encephalitis may occasionally be found.
• In S. mansoni infection, neurologic involvement is rare and mainly characterized by transverse myelitis, which occurs mainly in patients without liver fibrosis and hepatosplenomegaly.

• Schistosome dermatitis, or swimmer’s itch, is an uncommon manifestation seen mainly when avian cercariae penetrate the skin and are destroyed.^[7][8]
• Schistosome dermatitis is a sensitization phenomenon occurring in previously exposed persons.
• The cercariae evoke an acute inflammatory response with edema, early infiltration of neutrophils and lymphocytes, and later invasion of eosinophils.
• A pruritic papular rash occurs within 24 hours after the penetration of cercariae and reaches maximal intensity in 2 to 3 days.

The table below summarizes the symptoms of schistosomiasis