II. Pathophysiology

  1. Trematode Parasite
    1. Schistosoma mansoni (South America, Caribbean, Africa)
      1. Affects hepatic and intestinal tract
    2. Schistosoma japonicum (Asia)
      1. Affects hepatic and intestinal tract
    3. Schistosoma haematobium (Africa)
      1. Affects genitourinary tract
  2. Vectors
    1. Fluke
    2. Intermediary freshwater snail host
  3. Affected regions
    1. Sub-Saharan Africa
    2. Southeast Asia
  4. Parasite enters unbroken skin in infested fresh water
    1. Boating or swimming in endemic regions
    2. Illness is secondary to immunologic response to schistosomal worms
  5. Incubation period
    1. Illness onset 4-8 weeks after exposure

III. Symptoms: Acute Illness (Katayama Fever)

  1. Flu-like illness symptoms
    1. Fever
    2. Fatigue
    3. Malaise
    4. Arthralgias
  2. Respiratory symptoms
    1. Nonproductive Cough
    2. Bronchospasm
  3. Gastrointestinal symptoms
    1. Abdominal Pain
    2. Diarrhea
    3. Weight loss

IV. Differential Diagnosis: Acute Illness (Katayama Fever)

V. Imaging: Acute Illness (Katayama Fever)

VI. Diagnosis: Microscopic exam of stool and urine

  1. Eggs (uncommonly seen in light infections)
  2. Eosinophilia
    1. Differentiates Schistosomiasis from other causes of Fever in the Returning Traveler

VII. Complications

  1. Chronic infection affecting liver, Bladder, Uterus, gastrointestinal tract
  2. Severe neurologic sequelae (rare)
    1. CNS or spinal cord lesions (Schistosoma japonicum)

VIII. Management: Acute Toxemic Schistosomiasis (Katayama Fever)

  1. Prednisone for 3-6 days
  2. Praziquantel 40-60 mg/kg for 1-3 doses on same day
    1. Consider repeating Praziquantel in 4-6 weeks after worms have matured

IX. References

  1. Black, Martin, DeVos (2018) Crit Dec Emerg Med 32(8): 3-12
  2. (2018) Sanford Guide, Accessed on IOS 8/2/2018

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Ontology: Schistosomiasis (C0036323)

Definition (MSH) Infection with flukes (trematodes) of the genus SCHISTOSOMA. Three species produce the most frequent clinical diseases: SCHISTOSOMA HAEMATOBIUM (endemic in Africa and the Middle East), SCHISTOSOMA MANSONI (in Egypt, northern and southern Africa, some West Indies islands, northern 2/3 of South America), and SCHISTOSOMA JAPONICUM (in Japan, China, the Philippines, Celebes, Thailand, Laos). S. mansoni is often seen in Puerto Ricans living in the United States.
Definition (NCI) A parasitic infection caused by flukes of the genus Schistosoma. Signs and symptoms include fever, abdominal pain, eosinophilia and hepatosplenomegaly. If left untreated it may eventually cause liver damage leading to cirrhosis, bladder cancer and kidney failure.
Definition (CSP) parasitic disease of tropical and subtropical countries; characterized initially by fever, chills, and abdominal and lower back pain; untreated patients may develop jaundice, liver cirrhosis, bladder tumors, and kidney failure.
Concepts Disease or Syndrome (T047)
MSH D012552
ICD9 120.9, 120
ICD10 B65.9 , B65
SnomedCT 187520009, 187122005, 154415009, 187111006, 266222003, 10087007, 105661001
English Bilharziases, Bilharziasis, Schistosomiases, Schistosomiasis, Schistosomiasis (bilharziasis), Schistosomiasis, unspecified, Schistosomiasis,unspecified, [X]Schistosomiasis, unspecified, [X]Schistosomiasis,unspecified, schistosomiasis (diagnosis), schistosomiasis, Unspecified schistosomiasis, Schistosomiasis NOS, Schistosomiasis [bilharziasis], Schistosomiasis [Disease/Finding], bilharzia, bilharzias, blood flukes, Katayama Fever, [X]Schistosomiasis, unspecified (disorder), Schistosomiasis NOS (disorder), Bilharzia, Hemic distomiasis, Schistosomosis, Blood fluke infection, Schistosomiasis - bilharziasis, Disease due to Schistosomatidae (disorder), Disease due to Schistosomatidae, Haemic distomiasis, Infection by Schistosoma (disorder), Infection by Schistosoma, bilharziasis, blood; fluke disease, disease (or disorder); liver, in schistosomiasis (bilharziasis) (etiology), fluke disease; blood, liver; disease, in schistosomiasis (bilharziasis) (etiology), liver; disease, in schistosomiasis (bilharziasis) (manifestation), Blood flukes, NOS, Infection by Schistosoma, NOS, Blood flukes NOS
Dutch schistosomiasis, niet-gespecificeerd, niet-gespecificeerde schistosomiasis, schistosomiasis (bilharziasis), Trematodenziekte; bloed, aandoening; lever, bij schistosomiasis (bilharziasis), bloed; Trematodenziekte, lever; aandoening, bij schistosomiasis (bilharziasis), Schistosomiasis, niet gespecificeerd, schistosomiasis, Schistosomiasis [bilharziasis], Bilharziasis, Schistosomiasis
French Schistosomiase non précisée, Schistosomiase (bilharziose), Schistosomiase, non précisée, Bilharziose, Schistosomiase, Schistosomose
German Schistosomiasis (bilharziasis), unspezifische Schistosomiasis, Schistosomiasis, unspezifisch, Schistosomiasis [Bilharziose], Schistosomiasis, nicht naeher bezeichnet, Bilharziasis, Bilharziose, Schistosomiasis
Italian Schistosomiasi (bilharziosi), Schistosomiasi, non specificata, Bilharziosi, Schistosomiasi
Portuguese Schistosomíase (bilharzíase), Schistosomíase NE, Schistosomíase, Bilharzíase, Esquistossomose
Spanish Esquistosomiasis (bilharziasis), Esquistosomiasis no especificada, [X]esquistosomiasis, no especificada (trastorno), [X]esquistosomiasis, no especificada, esquistosomiasis, SAI (trastorno), esquistosomiasis, SAI, bilarziasis, bilarziosis, bilharziasis, bilharziosis, distomiasis hémica, duela sanguínea, enfermedad por Schistosomatidae (trastorno), enfermedad por Schistosomatidae, esquistosomiasis, esquistosomosis, infección por Schistosoma (trastorno), infección por Schistosoma, trematodos sanguíneos, Esquistosomiasis, Bilharziasis
Japanese ビルハルツ住血吸虫症, 詳細不明の住血吸虫症, 住血吸虫症、詳細不明, ジュウケツキュウチュウショウ, ジュウケツキュウチュウショウショウサイフメイ, ショウサイフメイノジュウケツキュウチュウショウ, ビルハルツジュウケツキュウチュウショウ, 住血吸虫症
Swedish Snäckfeber
Czech schistosomiasis, schistosomóza, bilharzióza, Schistozomóza (bilharzióza), Blíže neurčená schistozomiáza, Schistozomóza
Finnish Skistosomiaasi
Russian BIL'GARTSIOZ, SHISTOSOMOZ, БИЛЬГАРЦИОЗ, ШИСТОСОМОЗ
Korean 주혈흡충증, 상세불명의 주혈흡충증
Croatian SHISTOSOMIJAZA
Polish Schistosomoza, Bilharcjoza
Hungarian Schistosomiasis (bilharziasis), Nem meghatározott schistosomiasis, Schistosomiasis, schistosomiasis, nem meghatározott
Norwegian Schistosomiasis, Sneglefeber

Ontology: Katayama Fever (C3495690)

Concepts Disease or Syndrome (T047)
MSH D012552
SnomedCT 268981007, 187114003, 240788003, 268058007, 6421008
English Katayama fever, Asiatic schistosomiasis, Katayama fever (diagnosis), acute schistosomiasis, Fever, Katayama, Katayama Fever, Schistosoma japonicum (& Katayama disease) (disorder), Katayama fever (disorder), Schistosoma japonicum (& Katayama disease), Katayama disease, Katamaya fever, Katamaya syndrome, Katayama; fever, Katayama, fever; Katayama, Katayama fever [Ambiguous], Katayama disease or fever
Dutch Katayama-koorts, Katayama; koorts, koorts; Katayama
French Fièvre de Katayama
German Katayama-Fieber
Italian Febbre di Katayama
Portuguese Febre de Katayama
Spanish Fiebre de Katayama, enfermedad de Katayama, esquistosomiasis asiática, fiebre de Katayama (trastorno), fiebre de Katayama, esquistosomiasis oriental, enfermedad de Katamaya, fiebre de Katamaya, síndrome de Katamaya
Japanese 片山熱, カタヤマネツ
Czech Horečka Katayama
Hungarian Katayama láz