Diagnosis of schistosomiasis
- Patrick Soentjens, MD
Patrick Soentjens, MD
- Department of Clinical Sciences
- Institute of Tropical Medicine, Antwerp
- Centre for Infectious Diseases
- Military Hospital, Brussels
- Joannes Clerinx, MD, DTM
Joannes Clerinx, MD, DTM
- Institute of Tropical Medicine Antwerp
Schistosomiasis is a disease caused by infection with parasitic blood flukes. The three major species are Schistosoma mansoni (Africa and South America), S. japonicum (East Asia), and S. haematobium (Africa and the Middle East). The two minor species are S. mekongi (Laos, Cambodia) and S. intercalatum (West and Central Africa).
The parasites that cause schistosomiasis live in certain types of freshwater snails. Emergence of cercariae (the infectious form of the parasite) from the snail leads to contamination of the water. Individuals can become infected when skin comes in contact with contaminated water and is penetrated by cercariae.
The diagnosis of schistosomiasis will be reviewed here. The epidemiology, pathogenesis, clinical features, treatment, and prevention of these infections are discussed separately. (See "Epidemiology, pathogenesis, and clinical manifestations of schistosomiasis" and "Treatment and prevention of schistosomiasis".)
Clinical approach — The approach to diagnosis in returned travelers differs from the approach to diagnosis in endemic settings. Among returned travelers, serology is the most sensitive and useful test for screening. Among individuals living in endemic areas, the parasite burden should be determined by microscopy for egg detection and antigen detection. The infecting species can be determined via microscopy and molecular tests (polymerase chain reaction [PCR]), although these are less sensitive in the setting of early infection (<3 months).
Diagnostic evaluation is warranted for patients with clinical manifestations suggestive of schistosomiasis in the setting of appropriate epidemiologic exposure; these are discussed further separately (see "Epidemiology, pathogenesis, and clinical manifestations of schistosomiasis"). In addition, diagnostic screening for schistosomiasis is warranted for individuals with freshwater exposure in endemic regions, even in the absence of symptoms; this includes travelers as well as individuals with current or prior residence in an endemic area [1-7].
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