"Schistosomiasis world map - DALY - WHO2002" city Lokal_Profil. Licensed under CC BY-SA 2.5 via Commons - https://commons.wikimedia.org/wiki/File:Schistosomiasis_world_map_-_DALY_-_WHO2002.svg#/media/File:Schistosomiasis_world_map_-_DALY_-_WHO2002.svg

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

• Arthritis (arthritis) is described (reference: Rakotomala HN, 2017)

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

• Hinz R, 2017
• Wikipedia

Tropic diseases, BINDEVEVSSYKDOMMER.no

---

• Bindevevssykdommer.no
• Vaskulitt.no