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Epidemiology, pathogenesis, and clinical manifestations of schistosomiasis

Joannes Clerinx, MD, DTM
Patrick Soentjens, MD
Section Editor
Peter F Weller, MD, FACP
Deputy Editor
Elinor L Baron, MD, DTMH


Schistosomiasis is a disease caused by infection with parasitic blood flukes. It is also known as "bilharziasis" after Theodor Bilharz, who first identified the parasite in 1852.

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 epidemiology, pathogenesis, and clinical features of schistosomiasis will be reviewed here. The diagnosis, treatment, and prevention of schistosomiasis are discussed separately. (See "Diagnosis of schistosomiasis" and "Treatment and prevention of schistosomiasis".)


Five schistosome species can cause infection in humans. The three major species are Schistosoma mansoni (Africa and South America), S. japonicum (East Asia), and S. haematobium (Africa and Middle East). In general, S. mansoni and S. japonicum cause intestinal tract disease, while S. haematobium causes genitourinary tract disease. The two minor species are S. mekongi (Laos, Cambodia) and S. intercalatum (West and Central Africa); both are tropic for the intestines and liver. S. mansoni infection occurs primarily among humans (as well as some primates). S. japonicum, S. mekongi, and S. intercalatum are primarily zoonotic species with a broad spectrum of mammalian hosts [1]. Mixed infection has been observed among humans in some regions, predominantly with S. mansoni and S. haematobium [2,3].

Hybridization among phylogenetically related mammalian schistosome species occurs occasionally in areas where the distinctive snail hosts coexist, and it may expand endemicity. As an example, hybrid species of S. haematobium with S. bovis and S. curassoni (related schistosome species with intestinal tropism infecting cattle) have been identified among humans in northern Senegal [4,5].


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  1. Rudge JW, Webster JP, Lu DB, et al. Identifying host species driving transmission of schistosomiasis japonica, a multihost parasite system, in China. Proc Natl Acad Sci U S A 2013; 110:11457.
  2. Meurs L, Mbow M, Vereecken K, et al. Bladder morbidity and hepatic fibrosis in mixed Schistosoma haematobium and S. mansoni Infections: a population-wide study in Northern Senegal. PLoS Negl Trop Dis 2012; 6:e1829.
  3. Meurs L, Mbow M, Vereecken K, et al. Epidemiology of mixed Schistosoma mansoni and Schistosoma haematobium infections in northern Senegal. Int J Parasitol 2012; 42:305.
  4. Huyse T, Webster BL, Geldof S, et al. Bidirectional introgressive hybridization between a cattle and human schistosome species. PLoS Pathog 2009; 5:e1000571.
  5. Webster BL, Diaw OT, Seye MM, et al. Introgressive hybridization of Schistosoma haematobium group species in Senegal: species barrier break down between ruminant and human schistosomes. PLoS Negl Trop Dis 2013; 7:e2110.
  6. King CH, Dickman K, Tisch DJ. Reassessment of the cost of chronic helmintic infection: a meta-analysis of disability-related outcomes in endemic schistosomiasis. Lancet 2005; 365:1561.
  7. Ultroska JA, Chen MG, Dixon H, et al. An estimate of global needs for praziquantel within schistosomiasis control programmes. WHO/SCHISTO/89.102. Division of Control of Tropical Diseases, WHO, Gevena, 1989.
  8. Chitsulo L, Engels D, Montresor A, Savioli L. The global status of schistosomiasis and its control. Acta Trop 2000; 77:41.
  9. Mathers CD, Ezzati M, Lopez AD. Measuring the burden of neglected tropical diseases: the global burden of disease framework. PLoS Negl Trop Dis 2007; 1:e114.
  10. Nicolls DJ, Weld LH, Schwartz E, et al. Characteristics of schistosomiasis in travelers reported to the GeoSentinel Surveillance Network 1997-2008. Am J Trop Med Hyg 2008; 79:729.
  11. Grobusch MP, Mühlberger N, Jelinek T, et al. Imported schistosomiasis in Europe: sentinel surveillance data from TropNetEurop. J Travel Med 2003; 10:164.
  12. Berry A, Moné H, Iriart X, et al. Schistosomiasis haematobium, Corsica, France. Emerg Infect Dis 2014; 20:1595.
  13. Holtfreter MC, Moné H, Müller-Stöver I, et al. Schistosoma haematobium infections acquired in Corsica, France, August 2013. Euro Surveill 2014; 19.
  14. Mott KE, Desjeux P, Moncayo A, et al. Parasitic diseases and urban development. Bull World Health Organ 1990; 68:691.
  15. Lachish T, Tandlich M, Grossman T, Schwartz E. High rate of schistosomiasis in travelers after a brief exposure to the high-altitude Nyinambuga crater lake, Uganda. Clin Infect Dis 2013; 57:1461.
  16. Gryseels B, Polman K, Clerinx J, Kestens L. Human schistosomiasis. Lancet 2006; 368:1106.
  17. Gryseels B, Stelma F, Talla I, et al. Immuno-epidemiology of Schistosoma mansoni infections in a recently exposed community in Senegal. Mem Inst Oswaldo Cruz 1995; 90:271.
  18. Gryseels B, De Vlas SJ. Worm burdens in schistosome infections. Parasitol Today 1996; 12:115.
  19. Tukahebwa EM, Magnussen P, Madsen H, et al. A very high infection intensity of Schistosoma mansoni in a Ugandan Lake Victoria Fishing Community is required for association with highly prevalent organ related morbidity. PLoS Negl Trop Dis 2013; 7:e2268.
  20. Clements AC, Moyeed R, Brooker S. Bayesian geostatistical prediction of the intensity of infection with Schistosoma mansoni in East Africa. Parasitology 2006; 133:711.
  21. Bisharat N, Strahilevitz J, Ephros M, Raz R. Outbreak of acute schistosomiasis among Israeli rafters on the Omo River in Ethiopia. Am J Trop Med Hyg 1998; 59:504.
  22. Istre GR, Fontaine RE, Tarr J, Hopkins RS. Acute schistosomiasis among Americans rafting the Omo River, Ethiopia. JAMA 1984; 251:508.
  23. Lambertucci JR, Drummond SC, Voieta I, et al. An outbreak of acute Schistosoma mansoni Schistosomiasis in a nonendemic area of Brazil: a report on 50 cases, including 5 with severe clinical manifestations. Clin Infect Dis 2013; 57:e1.
  24. Arnon R. Life span of parasite in schistosomiasis patients. Isr J Med Sci 1990; 26:404.
  25. Abel L, Demenais F, Prata A, et al. Evidence for the segregation of a major gene in human susceptibility/resistance to infection by Schistosoma mansoni. Am J Hum Genet 1991; 48:959.
  26. Butterworth AE. Immunological aspects of human schistosomiasis. Br Med Bull 1998; 54:357.
  27. Gryseels B, Stelma FF, Talla I, et al. Epidemiology, immunology and chemotherapy of Schistosoma mansoni infections in a recently exposed community in Senegal. Trop Geogr Med 1994; 46:209.
  28. Kabatereine NB, Vennervald BJ, Ouma JH, et al. Adult resistance to schistosomiasis mansoni: age-dependence of reinfection remains constant in communities with diverse exposure patterns. Parasitology 1999; 118 ( Pt 1):101.
  29. Ouma JH, Fulford AJ, Kariuki HC, et al. The development of schistosomiasis mansoni in an immunologically naive immigrant population in Masongaleni, Kenya. Parasitology 1998; 117 ( Pt 2):123.
  30. Pearce EJ. Priming of the immune response by schistosome eggs. Parasite Immunol 2005; 27:265.
  31. Keating JH, Wilson RA, Skelly PJ. No overt cellular inflammation around intravascular schistosomes in vivo. J Parasitol 2006; 92:1365.
  32. Lambertucci JR, Rayes AA, Barata CH, et al. Acute schistosomiasis: report on five singular cases. Mem Inst Oswaldo Cruz 1997; 92:631.
  33. Coutinho HM, Acosta LP, Wu HW, et al. Th2 cytokines are associated with persistent hepatic fibrosis in human Schistosoma japonicum infection. J Infect Dis 2007; 195:288.
  34. Lambertucci RL. Schistosoma mansoni: Pathological and Clinical Aspects. In: Human Schistosomiasis, Jordan P, Webbe G, Sturrock FS (Eds), CAB International, Wallingford, England 1993. p.195.
  35. Strickland GT. Gastrointestinal manifestations of schistosomiasis. Gut 1994; 35:1334.
  36. Bartley PB, Ramm GA, Jones MK, et al. A contributory role for activated hepatic stellate cells in the dynamics of Schistosoma japonicum egg-induced fibrosis. Int J Parasitol 2006; 36:993.
  37. Cheever AW, Hoffmann KF, Wynn TA. Immunopathology of schistosomiasis mansoni in mice and men. Immunol Today 2000; 21:465.
  38. Magnussen P, Muchiri E, Mungai P, et al. A school-based approach to the control of urinary schistosomiasis and intestinal helminth infections in children in Matuga, Kenya: impact of a two-year chemotherapy programme on prevalence and intensity of infections. Trop Med Int Health 1997; 2:825.
  39. Silva IM, Thiengo R, Conceição MJ, et al. Cystoscopy in the diagnosis and follow-up of urinary schistosomiasis in Brazilian soldiers returning from Mozambique, Africa. Rev Inst Med Trop Sao Paulo 2006; 48:39.
  40. Brinkmann UK, Werler C, Traoré M, et al. Experiences with mass chemotherapy in the control of schistosomiasis in Mali. Trop Med Parasitol 1988; 39:167.
  41. King CH, Muchiri E, Ouma JH, Koech D. Chemotherapy-based control of schistosomiasis haematobia. IV. Impact of repeated annual chemotherapy on prevalence and intensity of Schistosoma haematobium infection in an endemic area of Kenya. Am J Trop Med Hyg 1991; 45:498.
  42. Richter J. The impact of chemotherapy on morbidity due to schistosomiasis. Acta Trop 2003; 86:161.
  43. Stelma FF, Talla I, Verle P, et al. Morbidity due to heavy Schistosoma mansoni infections in a recently established focus in northern Senegal. Am J Trop Med Hyg 1994; 50:575.
  44. Visser LG, Polderman AM, Stuiver PC. Outbreak of schistosomiasis among travelers returning from Mali, West Africa. Clin Infect Dis 1995; 20:280.
  45. Bourée P, Caumes E. [Cercarial dermatitis]. Presse Med 2004; 33:490.
  46. Ross AG, Vickers D, Olds GR, et al. Katayama syndrome. Lancet Infect Dis 2007; 7:218.
  47. Bottieau E, Clerinx J, de Vega MR, et al. Imported Katayama fever: clinical and biological features at presentation and during treatment. J Infect 2006; 52:339.
  48. Loutan L, Farinelli T, Robert CF. [Acute schistosomiasis or Katayama syndrome: apropos of 2 mini-epidemics]. Schweiz Med Wochenschr 1996; 126:1482.
  49. Clerinx J, Van Gompel A. Schistosomiasis in travellers and migrants. Travel Med Infect Dis 2011; 9:6.
  50. Lambertucci JR. Acute schistosomiasis: clinical, diagnostic and therapeutic features. Rev Inst Med Trop Sao Paulo 1993; 35:399.
  51. Leshem E, Maor Y, Meltzer E, et al. Acute schistosomiasis outbreak: clinical features and economic impact. Clin Infect Dis 2008; 47:1499.
  52. Rocha MO, Greco DB, Pedroso ER, et al. Secondary cutaneous manifestations of acute schistosomiasis mansoni. Ann Trop Med Parasitol 1995; 89:425.
  53. Rocha MO, Pedroso ER, Lambertucci JR, et al. Gastro-intestinal manifestations of the initial phase of schistosomiasis mansoni. Ann Trop Med Parasitol 1995; 89:271.
  54. Rocha MO, Rocha RL, Pedroso ER, et al. Pulmonary manifestations in the initial phase of schistosomiasis mansoni. Rev Inst Med Trop Sao Paulo 1995; 37:311.
  55. Clerinx J, Bottieau E, Wichmann D, et al. Acute schistosomiasis in a cluster of travelers from Rwanda: diagnostic contribution of schistosome DNA detection in serum compared to parasitology and serology. J Travel Med 2011; 18:367.
  56. Jauréguiberry S, Ansart S, Perez L, et al. Acute neuroschistosomiasis: two cases associated with cerebral vasculitis. Am J Trop Med Hyg 2007; 76:964.
  57. Lambertucci JR. Acute schistosomiasis mansoni: revisited and reconsidered. Mem Inst Oswaldo Cruz 2010; 105:422.
  58. Puylaert CA, van Thiel PP. IMAGES IN CLINICAL MEDICINE. Katayama Fever. N Engl J Med 2016; 374:469.
  59. Blanchard TJ. Schistosomiasis. Travel Med Infect Dis 2004; 2:5.
  60. Whitty CJ, Mabey DC, Armstrong M, et al. Presentation and outcome of 1107 cases of schistosomiasis from Africa diagnosed in a non-endemic country. Trans R Soc Trop Med Hyg 2000; 94:531.
  61. Lucey DR, Maguire JH. Schistosomiasis. Infect Dis Clin North Am 1993; 7:635.
  62. Gurarie D, Wang X, Bustinduy AL, King CH. Modeling the effect of chronic schistosomiasis on childhood development and the potential for catch-up growth with different drug treatment strategies promoted for control of endemic schistosomiasis. Am J Trop Med Hyg 2011; 84:773.
  63. King CH, Magak P, Salam EA, et al. Measuring morbidity in schistosomiasis mansoni: relationship between image pattern, portal vein diameter and portal branch thickness in large-scale surveys using new WHO coding guidelines for ultrasound in schistosomiasis. Trop Med Int Health 2003; 8:109.
  64. Gryseels B. The epidemiology of schistosomiasis in Burundi and its consequences for control. Trans R Soc Trop Med Hyg 1991; 85:626.
  65. Stephenson L. The impact of schistosomiasis on human nutrition. Parasitology 1993; 107 Suppl:S107.
  66. Stothard JR, Sousa-Figueiredo JC, Betson M, et al. Schistosomiasis in African infants and preschool children: let them now be treated! Trends Parasitol 2013; 29:197.
  67. A 57-Year-Old Woman With a Cecal Mass. Clin Infect Dis 2016; 63:656.
  68. Mu A, Fernandes I, Phillips D. A 57-Year-Old Woman With a Cecal Mass. Clin Infect Dis 2016; 63:703.
  69. Gabbi C, Bertolotti M, Iori R, et al. Acute abdomen associated with schistosomiasis of the appendix. Dig Dis Sci 2006; 51:215.
  70. Lamyman MJ, Noble DJ, Narang S, Dehalvi N. Small bowel obstruction secondary to intestinal schistosomiasis. Trans R Soc Trop Med Hyg 2006; 100:885.
  71. Gryseels B. Morbidity due to infection with Schistosoma mansoni: an update. Trop Geogr Med 1992; 44:189.
  72. Homeida M, Abdel-Gadir AF, Cheever AW, et al. Diagnosis of pathologically confirmed Symmers' periportal fibrosis by ultrasonography: a prospective blinded study. Am J Trop Med Hyg 1988; 38:86.
  73. Homeida MA, el Tom I, Nash T, Bennett JL. Association of the therapeutic activity of praziquantel with the reversal of Symmers' fibrosis induced by Schistosoma mansoni. Am J Trop Med Hyg 1991; 45:360.
  74. Dessein A, Arnaud V, He H, et al. Genetic analysis of human predisposition to hepatosplenic disease caused by schistosomes reveals the crucial role of connective tissue growth factor in rapid progression to severe hepatic fibrosis. Pathol Biol (Paris) 2013; 61:3.
  75. Dessein AJ, Hillaire D, Elwali NE, et al. Severe hepatic fibrosis in Schistosoma mansoni infection is controlled by a major locus that is closely linked to the interferon-gamma receptor gene. Am J Hum Genet 1999; 65:709.
  76. Richter J, Hatz C, Campagne G, Bergquist R, Jenkins JM (Eds). Ultrasound in schistosomiasis. A Practical Guide to the Standardized Use of Ultrasonography for the Assessment of Schistosomiasis-related Morbidity. World Health Organization, Geneva 2000.
  77. Abdel-Wahab MF, Esmat G, Farrag A, et al. Grading of hepatic schistosomiasis by the use of ultrasonography. Am J Trop Med Hyg 1992; 46:403.
  78. Yazdanpanah Y, Thomas AK, Kardorff R, et al. Organometric investigations of the spleen and liver by ultrasound in Schistosoma mansoni endemic and nonendemic villages in Senegal. Am J Trop Med Hyg 1997; 57:245.
  79. Bezerra AS, D'Ippolito G, Caldana RP, et al. Chronic hepatosplenic schistosomiasis mansoni: magnetic resonance imaging and magnetic resonance angiography findings. Acta Radiol 2007; 48:125.
  80. Sarwat AK, Tag el Din MA, Bassiouni M, Ashmawi SS. Schistosomiasis of the lung. J Egypt Soc Parasitol 1986; 16:359.
  81. Andrade ZA, Andrade SG. Pathogenesis of schistosomal pulmonary arteritis. Am J Trop Med Hyg 1970; 19:305.
  82. FARID Z, GREER JW, ISHAK KG, et al. Chronic pulmonary schistosomiasis. Am Rev Tuberc 1959; 79:119.
  83. Lapa M, Dias B, Jardim C, et al. Cardiopulmonary manifestations of hepatosplenic schistosomiasis. Circulation 2009; 119:1518.
  84. Pedroso ER, Lambertucci JR, Greco DB, et al. Pulmonary schistosomiasis mansoni: post-treatment pulmonary clinical-radiological alterations in patients in the chronic phase: a double-blind study. Trans R Soc Trop Med Hyg 1987; 81:778.
  85. Ottesen EA, Weller PF. Eosinophilia following treatment of patients with schistosomiasis mansoni and Bancroft's filariasis. J Infect Dis 1979; 139:343.
  86. Corachan M, Valls ME, Gascon J, et al. Hematospermia: a new etiology of clinical interest. Am J Trop Med Hyg 1994; 50:580.
  87. Crump JA, Murdoch DR, Chambers ST, et al. Female genital schistosomiasis. J Travel Med 2000; 7:30.
  88. Feldmeier H, Daccal RC, Martins MJ, et al. Genital manifestations of schistosomiasis mansoni in women: important but neglected. Mem Inst Oswaldo Cruz 1998; 93 Suppl 1:127.
  89. Randrianasolo BS, Jourdan PM, Ravoniarimbinina P, et al. Gynecological manifestations, histopathological findings, and schistosoma-specific polymerase chain reaction results among women with Schistosoma haematobium infection: a cross-sectional study in Madagascar. J Infect Dis 2015; 212:275.
  90. Devidas A, Lamothe F, Develoux M, et al. [Morbidity due to bilharziasis caused by S. haematobium. Relationship between the bladder lesions observed by ultrasonography and the cystoscopic and anatomo-pathologic lesions]. Acta Trop 1988; 45:277.
  91. Farid Z. Schistosomes with Terminal-spined Eggs: Pathological and Clinical aspects. In: Human Schistosomiasis, Jordan P, Webbe G, Sturrock FS (Eds), CAB International, Wallingford, England 1993.
  92. Feldmeier H, Leutscher P, Poggensee G, Harms G. Male genital schistosomiasis and haemospermia. Trop Med Int Health 1999; 4:791.
  93. Smith JH, Christie JD. The pathobiology of Schistosoma haematobium infection in humans. Hum Pathol 1986; 17:333.
  94. Medhat A, Zarzour A, Nafeh M, et al. Evaluation of an ultrasonographic score for urinary bladder morbidity in Schistosoma haematobium infection. Am J Trop Med Hyg 1997; 57:16.
  95. King CH, Muchiri EM, Ouma JH. Age-targeted chemotherapy for control of urinary schistosomiasis in endemic populations. Mem Inst Oswaldo Cruz 1992; 87 Suppl 4:203.
  96. King CH. Ultrasound monitoring of structural urinary tract disease in Schistosoma haematobium infection. Mem Inst Oswaldo Cruz 2002; 97 Suppl 1:149.
  97. Koukounari A, Gabrielli AF, Toure S, et al. Schistosoma haematobium infection and morbidity before and after large-scale administration of praziquantel in Burkina Faso. J Infect Dis 2007; 196:659.
  98. Richter J, Poggensee G, Kjetland EF, et al. Reversibility of lower reproductive tract abnormalities in women with Schistosoma haematobium infection after treatment with praziquantel--an interim report. Acta Trop 1996; 62:289.
  99. Burki A, Tanner M, Burnier E, et al. Comparison of ultrasonography, intravenous pyelography and cystoscopy in detection of urinary tract lesions due to Schistosoma haematobium. Acta Trop 1986; 43:139.
  100. Dittrich M, Doehring E. Ultrasonographical aspects of urinary schistosomiasis: assessment of morphological lesions in the upper and lower urinary tract. Pediatr Radiol 1986; 16:225.
  101. Bedwani R, Renganathan E, El Kwhsky F, et al. Schistosomiasis and the risk of bladder cancer in Alexandria, Egypt. Br J Cancer 1998; 77:1186.
  102. Kjetland EF, Mduluza T, Ndhlovu PD, et al. Genital schistosomiasis in women: a clinical 12-month in vivo study following treatment with praziquantel. Trans R Soc Trop Med Hyg 2006; 100:740.
  103. Chen W, Flynn EA, Shreefter MJ, Blagg NA. Schistosomiasis: an unusual finding of the cervix. Obstet Gynecol 2012; 119:472.
  104. Kjetland EF, Ndhlovu PD, Gomo E, et al. Association between genital schistosomiasis and HIV in rural Zimbabwean women. AIDS 2006; 20:593.
  105. Mbabazi PS, Andan O, Fitzgerald DW, et al. Examining the relationship between urogenital schistosomiasis and HIV infection. PLoS Negl Trop Dis 2011; 5:e1396.
  106. Secor WE. The effects of schistosomiasis on HIV/AIDS infection, progression and transmission. Curr Opin HIV AIDS 2012; 7:254.
  107. Szekeres C, Galletout P, Jaureguiberry S, et al. Neurological presentation of schistosomiasis. Lancet 2013; 381:1788.
  108. Ferrari TC, Moreira PR, Cunha AS. Clinical characterization of neuroschistosomiasis due to Schistosoma mansoni and its treatment. Acta Trop 2008; 108:89.
  109. Nascimento-Carvalho CM, Moreno-Carvalho OA. Neuroschistosomiasis due to Schistosoma mansoni: a review of pathogenesis, clinical syndromes and diagnostic approaches. Rev Inst Med Trop Sao Paulo 2005; 47:179.
  110. Silva LC, Maciel PE, Ribas JG, et al. Treatment of schistosomal myeloradiculopathy with praziquantel and corticosteroids and evaluation by magnetic resonance imaging: a longitudinal study. Clin Infect Dis 2004; 39:1618.
  111. Lambertucci JR, Sousa-Pereira SR, Silva LC. [Myeloradiculopathy in acute schistosomiasis mansoni]. Rev Soc Bras Med Trop 2005; 38:277.
  112. Ferrari TC, Moreira PR. Neuroschistosomiasis: clinical symptoms and pathogenesis. Lancet Neurol 2011; 10:853.
  113. Ross AG, McManus DP, Farrar J, et al. Neuroschistosomiasis. J Neurol 2012; 259:22.
  114. Scrimgeour EM, Gajdusek DC. Involvement of the central nervous system in Schistosoma mansoni and S. haematobium infection. A review. Brain 1985; 108 ( Pt 4):1023.
  115. Naus CW, Chipwete J, Visser LG, et al. The contribution made by Schistosoma infection to non-traumatic disorders of the spinal cord in Malawi. Ann Trop Med Parasitol 2003; 97:711.
  116. Carod Artal FJ, Vargas AP, Horan TA, et al. Schistosoma mansoni myelopathy: clinical and pathologic findings. Neurology 2004; 63:388.
  117. Ferrari TC. Spinal cord schistosomiasis. A report of 2 cases and review emphasizing clinical aspects. Medicine (Baltimore) 1999; 78:176.
  118. Carod-Artal FJ. Neurological complications of Schistosoma infection. Trans R Soc Trop Med Hyg 2008; 102:107.
  119. Pittella JE, Lana-Peixoto MA. Brain involvement in hepatosplenic Schistosomiasis mansoni. Brain 1981; 104:621.
  120. Camuset G, Wolff V, Marescaux C, et al. Cerebral vasculitis associated with Schistosoma mansoni infection. BMC Infect Dis 2012; 12:220.
  121. Bierman WF, Wetsteyn JC, van Gool T. Presentation and diagnosis of imported schistosomiasis: relevance of eosinophilia, microscopy for ova, and serology. J Travel Med 2005; 12:9.
  122. Checkley AM, Chiodini PL, Dockrell DH, et al. Eosinophilia in returning travellers and migrants from the tropics: UK recommendations for investigation and initial management. J Infect 2010; 60:1.
  123. Pardo J, Carranza C, Muro A, et al. Helminth-related Eosinophilia in African immigrants, Gran Canaria. Emerg Infect Dis 2006; 12:1587.
  124. Rocha MO, Pedroso ER, Greco DB, et al. Pathogenetic factors of acute schistosomiasis mansoni: correlation of worm burden, IgE, blood eosinophilia and intensity of clinical manifestations. Trop Med Int Health 1996; 1:213.
  125. Mahmoud AA. The ecology of eosinophils in schistosomiasis. J Infect Dis 1982; 145:613.
  126. Bustinduy AL, Sousa-Figueiredo JC, Adriko M, et al. Fecal occult blood and fecal calprotectin as point-of-care markers of intestinal morbidity in Ugandan children with Schistosoma mansoni infection. PLoS Negl Trop Dis 2013; 7:e2542.
  127. Harries AD, Fryatt R, Walker J, et al. Schistosomiasis in expatriates returning to Britain from the tropics: a controlled study. Lancet 1986; 1:86.
  128. Sarda RK, Minjas JN, Mahikwano LF. Evaluation of indirect screening techniques for the detection of Schistosoma haematobium infection in an urban area, Dar es Salaam, Tanzania. Acta Trop 1985; 42:241.
  129. Stephenson LS, Latham MC, Kinoti SN, Oduori ML. Sensitivity and specificity of reagent strips in screening of Kenyan children for Schistosoma haematobium infection. Am J Trop Med Hyg 1984; 33:862.
  130. Taylor P, Chandiwana SK, Matanhire D. Evaluation of the reagent strip test for haematuria in the control of Schistosoma haematobium infection in schoolchildren. Acta Trop 1990; 47:91.
  131. King CH, Bertsch D. Meta-analysis of urine heme dipstick diagnosis of Schistosoma haematobium infection, including low-prevalence and previously-treated populations. PLoS Negl Trop Dis 2013; 7:e2431.
  132. Rocha H, Kirk JW, Hearey CD Jr. Prolonged Salmonella bacteremia in patients with Schistosoma mansoni infection. Arch Intern Med 1971; 128:254.
  133. Brown M, Kizza M, Watera C, et al. Helminth infection is not associated with faster progression of HIV disease in coinfected adults in Uganda. J Infect Dis 2004; 190:1869.
  134. Leutscher PD, Pedersen M, Raharisolo C, et al. Increased prevalence of leukocytes and elevated cytokine levels in semen from Schistosoma haematobium-infected individuals. J Infect Dis 2005; 191:1639.
  135. Feldmeier H, Krantz I, Poggensee G. Female genital schistosomiasis as a risk-factor for the transmission of HIV. Int J STD AIDS 1994; 5:368.
  136. Poggensee G, Feldmeier H. Female genital schistosomiasis: facts and hypotheses. Acta Trop 2001; 79:193.
  137. Vennervald BJ, Dunne DW. Morbidity in schistosomiasis: an update. Curr Opin Infect Dis 2004; 17:439.
  138. Kallestrup P, Zinyama R, Gomo E, et al. Schistosomiasis and HIV-1 infection in rural Zimbabwe: effect of treatment of schistosomiasis on CD4 cell count and plasma HIV-1 RNA load. J Infect Dis 2005; 192:1956.
  139. Ganley-Leal LM, Mwinzi PN, Cetre-Sossah CB, et al. Correlation between eosinophils and protection against reinfection with Schistosoma mansoni and the effect of human immunodeficiency virus type 1 coinfection in humans. Infect Immun 2006; 74:2169.
  140. Joseph S, Jones FM, Laidlaw ME, et al. Impairment of the Schistosoma mansoni-specific immune responses elicited by treatment with praziquantel in Ugandans with HIV-1 coinfection. J Infect Dis 2004; 190:613.
  141. de Silva S, Walsh J, Brown M. Symptomatic Schistosoma mansoni infection as an immune restoration phenomenon in a patient receiving antiretroviral therapy. Clin Infect Dis 2006; 42:303.
  142. Lambertucci JR, Rayes AA, Serufo JC, et al. Schistosomiasis and associated infections. Mem Inst Oswaldo Cruz 1998; 93 Suppl 1:135.
  143. Farid A, Al-Sherbiny M, Osman A, et al. Schistosoma infection inhibits cellular immune responses to core HCV peptides. Parasite Immunol 2005; 27:189.
  144. Abdel-Rahman M, El-Sayed M, El Raziky M, et al. Coinfection with hepatitis C virus and schistosomiasis: fibrosis and treatment response. World J Gastroenterol 2013; 19:2691.
  145. Kamal SM, Turner B, He Q, et al. Progression of fibrosis in hepatitis C with and without schistosomiasis: correlation with serum markers of fibrosis. Hepatology 2006; 43:771.
  146. Pierrot C, Wilson S, Lallet H, et al. Identification of a novel antigen of Schistosoma mansoni shared with Plasmodium falciparum and evaluation of different cross-reactive antibody subclasses induced by human schistosomiasis and malaria. Infect Immun 2006; 74:3347.
  147. Yosry A. Schistosomiasis and neoplasia. Contrib Microbiol 2006; 13:81.
  148. Lyke KE, Dicko A, Dabo A, et al. Association of Schistosoma haematobium infection with protection against acute Plasmodium falciparum malaria in Malian children. Am J Trop Med Hyg 2005; 73:1124.