II. Pathophysiology
- Trematode Parasite
- Schistosoma mansoni (South America, Caribbean, Africa)
- Affects hepatic and intestinal tract
- Schistosoma japonicum (Asia)
- Affects hepatic and intestinal tract
- Schistosoma haematobium (Africa)
- Affects genitourinary tract
- Schistosoma mansoni (South America, Caribbean, Africa)
- Vectors
- Fluke
- Intermediary freshwater snail host
- Affected regions
- Sub-Saharan Africa
- Southeast Asia
-
Parasite enters unbroken skin in infested fresh water
- Boating or swimming in endemic regions
- Illness is secondary to immunologic response to schistosomal worms
-
Incubation Period
- Illness onset 4-8 weeks after exposure
III. Symptoms: Acute Illness (Katayama Fever)
- Flu-like illness symptoms
- Fever
- Fatigue
- Malaise
- Arthralgias
- Respiratory symptoms
- Nonproductive Cough
- Bronchospasm
- Gastrointestinal symptoms
- Abdominal Pain
- Diarrhea
- Weight loss
- Skin
IV. Differential Diagnosis: Acute Illness (Katayama Fever)
- See Fever in the Returning Traveler
- Malaria
- Typhoid
V. Imaging: Acute Illness (Katayama Fever)
-
Chest XRay with Pulmonary Infiltrates
- Present 4 to 6 weeks after travel
VI. Labs
VII. Diagnosis: Microscopic exam of stool and urine
- Eggs (uncommonly seen in light infections)
-
Eosinophilia
- Differentiates Schistosomiasis from other causes of Fever in the Returning Traveler
VIII. Complications
- Chronic infection affecting liver, Bladder, Uterus, Gastrointestinal Tract
- Severe neurologic sequelae (rare)
- CNS or spinal cord lesions (Schistosoma japonicum)
IX. Management: Acute Toxemic Schistosomiasis (Katayama Fever)
- Prednisone for 3-6 days
-
Praziquantel 40-60 mg/kg for 1-3 doses on same day
- Consider repeating Praziquantel in 4-6 weeks after worms have matured
X. References
- Black, Martin, DeVos (2018) Crit Dec Emerg Med 32(8): 3-12
- (2018) Sanford Guide, Accessed on IOS 8/2/2018