Consult the medical resource doctors trust

UpToDate is one of the most respected medical information resources in the world, used by over 360,000 doctors and thousands of patients to find answers to medical questions.

  • Content written by a faculty of over 4,000 physicians from leading medical institutions
  • Unbiased: free of advertising or pharmaceutical funding
  • Evidence-based treatment recommendations
  • Continuously updated to incorporate new medical findings

Epidemiology; pathogenesis; and clinical features of schistosomiasis

INTRODUCTION

Schistosomiasis is sometimes referred to as "bilharziasis" after Theodor Bilharz who identified the parasite first in 1852. Schistosomiasis is caused by infection with parasitic blood flukes known as schistosomes.

Schistosomiasis can be associated with serious morbidity and mortality. Chronic complications are generally seen in those with a high parasite load, which usually occurs in individuals who live in endemic areas and have recurrent exposure. However, schistosomiasis can also cause complications in people with even brief exposures, such as travelers [1].

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

SCHISTOSOME SPECIES

Three major species and two less common species produce infection in humans:

  • Of the major species, S. mansoni and S. japonicum, can provoke intestinal and hepatic complications.
  • S. haematobium predominantly leads to renal and bladder sequelae, although occasionally, it results in liver disease.
  • The minor species include S. mekongi and S. intercalatum, both of which can also induce intestinal and liver disease.
To continue reading this article you need to subscribe.

Read the rest of this article and others like it

The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use (click here) ©2009 UpToDate, Inc.
References Top
  1. Blanchard, TJ. Schistosomiasis. Travel Med Infect Dis 2004; 2:5.
  2. Chistulo, L, Loverde, P, Engels, D. Disease Watch: Schistosomiasis. TDR Nature Reviews Microbiology 2004; 2:12.
  3. Elliott, DE. Schistosomiasis. Pathophysiology, diagnosis, and treatment. Gastroenterol Clin North Am 1996; 25:599.
  4. 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.
  5. Gryseels, B, Polman, K, Clerinx, J, Kestens, L. Human schistosomiasis. Lancet 2006; 368:1106.
  6. Hagan, P, Gryseels, B. Schistosomiasis research and the European Community. Trop Geogr Med 1994; 46:259.
  7. King, CH, Keating, CE, Muruka, JF, et al. Urinary tract morbidity in schistosomiasis haematobia: associations with age and intensity of infection in an endemic area of Coast Province, Kenya. Am J Trop Med Hyg 1988; 39:361.
  8. Lucey, DR, Maguire, JH. Schistosomiasis. Infect Dis Clin North Am 1993; 7:635.
  9. Clements, AC, Moyeed, R, Brooker, S. Bayesian geostatistical prediction of the intensity of infection with Schistosoma mansoni in East Africa. Parasitology 2006; 133:711.
  10. Anderson, R. Determinants of infection in human schistosomiasis. Baillere's Clinical Tropical Medicine and Communicable Diseases 1987; 2:301.
  11. Kabatereine, NB, Brooker, S, Tukahebwa, EM, et al. Epidemiology and geography of Schistosoma mansoni in Uganda: implications for planning control. Trop Med Int Health 2004; 9:372.
  12. Posey, DL, Blackburn, BG, Weinberg, M, et al. High prevalence and presumptive treatment of schistosomiasis and strongyloidiasis among African refugees. Clin Infect Dis 2007; 45:1310.
  13. 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.
  14. Meltzer, E, Artom, G, Marva, E, et al. Schistosomiasis among travelers: new aspects of an old disease. Emerg Infect Dis 2006; 12:1696.
  15. Arnon, R. Life span of parasite in schistosomiasis patients. Isr J Med Sci 1990; 26:404.
  16. Keating, JH, Wilson, RA, Skelly, PJ. No overt cellular inflammation around intravascular schistosomes in vivo. J Parasitol 2006; 92:1365.
  17. 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.
  18. Cheever, AW, Hoffmann, KF, Wynn, TA. Immunopathology of schistosomiasis mansoni in mice and men. Immunol Today 2000; 21:465.
  19. Strickland, GT. Gastrointestinal manifestations of schistosomiasis. Gut 1994; 35:1334.
  20. 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.
  21. 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.
  22. Butterworth, AE. Immunological aspects of human schistosomiasis. Br Med Bull 1998; 54:357.
  23. Wilkins, HA, Goll, PH, Marshall, TF, Moore, PJ. Dynamics of Schistosoma haematobium infection in a Gambian community. III. Acquisition and loss of infection. Trans R Soc Trop Med Hyg 1984; 78:227.
  24. 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.
  25. Sleigh, A, Mott, KJ. Schistosomiasis. Clinics in Tropical Medicine and Communicable Diseases 1986; 1:643.
  26. Corachan, M. Schistosomiasis and international travel. Clin Infect Dis 2002; 35:446.
  27. Grobusch, MP, Muhlberger, N, Jelinek, T, et al. Imported schistosomiasis in Europe: sentinel surveillance data from TropNetEurop. J Travel Med 2003; 10:164.
  28. Boggild, AK, Yohanna, S, Keystone, JS, Kain, KC. Prospective analysis of parasitic infections in Canadian travelers and immigrants. J Travel Med 2006; 13:138.
  29. King, C, Mahmouud, AA. Schistosomiasis. In: Tropical Infectious Diseases: Principles, Pathogens and Practice, vol 2, Guerrant R, Walker, DH, Weller, PF, (Eds) Churchill Livingstone, Philadelphia 1999. p.1031.
  30. Hoeffler, DF. Cercarial dermatitis. Arch Environ Health 1974; 29:225.
  31. Ross, AG, Vickers, D, Olds, GR, et al. Katayama Syndrome. Lancet Infect Dis 2007; 7:218.
  32. 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.
  33. Visser, LG, Polderman, AM, Stuiver, PC. Outbreak of schistosomiasis among travelers returning from Mali, West Africa. Clin Infect Dis 1995; 20:280.
  34. Jelinek, T, Nothdurft, HD, von Sonnenburg, F, Loscher, T. Risk Factors for Typhoid Fever in Travelers. J Travel Med 1996; 3:200.
  35. Stephenson, L. The impact of schistosomiasis on human nutrition. Parasitology 1993; 107 Suppl:S107.
  36. Lamyman, MJ, Noble, DJ, Narang, S, Dehalvi, N. Small bowel obstruction secondary to intestinal schistosomiasis. Trans R Soc Trop Med Hyg 2006; 100:885.
  37. Gabbi, C, Bertolotti, M, Iori, R, et al. Acute abdomen associated with schistosomiasis of the appendix. Dig Dis Sci 2006; 51:215.
  38. Ross, AG, Bartley, PB, Sleigh, AC, et al. Schistosomiasis. N Engl J Med 2002; 346:1212.
  39. Andrade, ZA, Rocha, H. Schistosomal glomerulopathy. Kidney Int 1979; 16:23.
  40. 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.
  41. Kim, AH, Maher, CO, Smith, ER. Lumbar intramedullary spinal schistosomiasis presenting as progressive paraparesis: case report. Neurosurgery 2006; 58:E996;.
  42. 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.
  43. Ferrari, TC. Involvement of central nervous system in the schistosomiasis. Mem Inst Oswaldo Cruz 2004; 99:59.
  44. Ferrari, TC. Spinal cord schistosomiasis. A report of 2 cases and review emphasizing clinical aspects. Medicine (Baltimore) 1999; 78:176.
  45. Amorosa, V, Kremens, D, Wolfe, MS, et al. Schistosoma mansoni in family 5 years after safari. Emerg Infect Dis 2005; 11:339.
  46. Pittella, JE. Neuroschistosomiasis. Brain Pathol 1997; 7:649.
  47. Sarwat, AK, Tag el Din, MA, Bassiouni, M, Ashmawi, SS. Schistosomiasis of the lung. J Egypt Soc Parasitol 1986; 16:359.
  48. Da Silva, LC, Carrilho, FJ. Hepatosplenic schistosomiasis. Pathophysiology and treatment. Gastroenterol Clin North Am 1992; 21:163.
  49. Andrade, ZA, Andrade, SG. Pathogenesis of schistosomal pulmonary arteritis. Am J Trop Med Hyg 1970; 19:305.
  50. Farid, Z, Greer, JW, Ishak, KG, et al. Chronic pulmonary schistosomiasis. Am Rev Tuberc 1959; 79:119.
  51. Lapa, M, Dias, B, Jardim, C, et al. Cardiopulmonary manifestations of hepatosplenic schistosomiasis. Circulation 2009; 119:1518.
  52. 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.
  53. Ottesen, EA, Weller, PF. Eosinophilia following treatment of patients with schistosomiasis mansoni and Bancroft's filariasis. J Infect Dis 1979; 139:343.
  54. 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.
  55. Rocha, H, Kirk, JW, Hearey, CD Jr. Prolonged Salmonella bacteremia in patients with Schistosoma mansoni infection. Arch Intern Med 1971; 128:254.
  56. 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.
  57. 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.
  58. Poggensee, G, Feldmeier, H. Female genital schistosomiasis: facts and hypotheses. Acta Trop 2001; 79:193.
  59. Vennervald, BJ, Dunne, DW. Morbidity in schistosomiasis: an update. Curr Opin Infect Dis 2004; 17:439.
  60. Kjetland, EF, Ndhlovu, PD, Gomo, E, et al. Association between genital schistosomiasis and HIV in rural Zimbabwean women. AIDS 2006; 20:593.
  61. 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.
  62. 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.
  63. 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.
  64. 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.
  65. 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.
  66. Lambertucci, JR, Rayes, AA, Serufo, JC, et al. Schistosomiasis and associated infections. Mem Inst Oswaldo Cruz 1998; 93 Suppl 1:135.
  67. Mohamed, MK, Bakr, I, El-Hoseiny, M, et al. HCV-related morbidity in a rural community of Egypt. J Med Virol 2006; 78:1185.
  68. Strickland, GT. Liver disease in Egypt: hepatitis C superseded schistosomiasis as a result of iatrogenic and biological factors. Hepatology 2006; 43:915.
  69. Farid, A, Al-Sherbiny, M, Osman, A, et al. Schistosoma infection inhibits cellular immune responses to core HCV peptides. Parasite Immunol 2005; 27:189.
  70. 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.
  71. 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.
  72. Yosry, A. Schistosomiasis and neoplasia. Contrib Microbiol 2006; 13:81.
  73. 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.
  74. Ajanga, A, Lwambo, NJ, Blair, L, et al. Schistosoma mansoni in pregnancy and associations with anaemia in northwest Tanzania. Trans R Soc Trop Med Hyg 2006; 100:59.
  75. Friedman, JF, Mital, P, Kanzaria, HK, et al. Schistosomiasis and pregnancy. Trends Parasitol 2007; 23:159.
white circle LOG IN
white circle DEMO