Bilharziose (Schistomiasis) and rheumatic disease Please rate this page (bottom of page)

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Bilharziosis (Schistomiasis) (B65)

Definition

Tropic disease caused by parasite. Most often chronic condition. Attacks skin, urinary bladder and bowel, but can also give arthritis (arthritis).

Disease Causes

1-2 cm long worms (Termatoder).

  • Urinary Bladder bilharzinose: S. haematobium
  • Perkutan infection by swimming in infected lakes
  • Intestinal bilharzidose: S. mansoni, S. japonicum, S. intercalaticum, S. mekongi.

Occurrence

Trooper, subtroper. 85% is contaminated in sub-Saharan Africa. Asylum seekers from Africa

Contamination

Transferring via contaminated bathing water. The parasites originate from infected freshwater snails. In particularly, children (who are playing in water) are infected

Incubation

  • 2-7 weeks to first symptoms (itchy skin on feet and other parts that have been exposed to contaminated freshwater)
  •  4-12 weeks for symptoms of internal organs

Symptoms

Initially

  • Itchy small nodules in the skin that have been in contact with contaminated water (especially feet)

Later

  • Fever
  • Abdominal (stomach) pain (intestinal manifestation)
  • May cause chronic back pain and headaches
    • Diagnosis by MRI (localized inflammation) and Serum Schistoma IF antigen, ELISA Egg titer, Serum Schistoma IF
  • Diarrhea (bloody)
  • Exhaustion
  • Coughing (lung infection)
  • Genital mucosal bleeding (genital affection)
  • Blood in urine (urinary bladder infection)

Rheumatic symptoms

Medical examinations of blood and urine

  • Extreme eosinophilia in blood (by differential counting of leukocytes)
  • Effective screening of parasite antigen with ELISA blood test
    • Serum Schistoma IF antigen, ELISA Egg titer, Serum Schistoma IF
  • Antibody can be detected in blood test
  • Microscopic examination of parasite eggs in stools (eventual even in urine)
  • Biopsy of rectal mucosa (or bladder) can detect eggs if they are not detected by microscopy
  • Urinary bladder: Hematuria (blood in urine)

Complications

  • Increased risk of cancer of the urinary bladder, colon and liver in the long term
  • Portal hypertension
  • Focal epilepsy at S. japonicum

Diagnosis

  • Trope anamneses + Detection in urine, stool or tissue
  • Antibody detection

Treatment

Praziquantel (Biltricide) (a single dose annually). More than 80% will be healthy

Prophylaxis

  • Prohibition of swimming in infected lakes. Avoid infected drinking water.
  • A vaccine is under trial

NB Harmless bilharzia species cause bathing dermatitis in Central Europe and North America (reference: Omar HN, 2016)

Literature

Tropic diseases, BINDEVEVSSYKDOMMER.no


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