Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Diagnosis of schistosomiasis

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


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].

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: Nov 03, 2017.
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 ©2017 UpToDate, Inc.
  1. Clerinx J, Van Gompel A. Schistosomiasis in travellers and migrants. Travel Med Infect Dis 2011; 9:6.
  2. Jauréguiberry S, Paris L, Caumes E. Acute schistosomiasis, a diagnostic and therapeutic challenge. Clin Microbiol Infect 2010; 16:225.
  3. Meltzer E, Schwartz E. Schistosomiasis: current epidemiology and management in travelers. Curr Infect Dis Rep 2013; 15:211.
  4. Soentjens P, Clerinx J, Aerssens A, et al. Diagnosing acute schistosomiasis. Clin Infect Dis 2014; 58:304.
  5. Meltzer E, Artom G, Marva E, et al. Schistosomiasis among travelers: new aspects of an old disease. Emerg Infect Dis 2006; 12:1696.
  6. 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.
  7. 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.
  8. 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.
  9. Coltart CE, Chew A, Storrar N, et al. Schistosomiasis presenting in travellers: a 15 year observational study at the Hospital for Tropical Diseases, London. Trans R Soc Trop Med Hyg 2015; 109:214.
  10. Utzinger J, Becker SL, van Lieshout L, et al. New diagnostic tools in schistosomiasis. Clin Microbiol Infect 2015; 21:529.
  11. Gryseels B, Polman K, Clerinx J, Kestens L. Human schistosomiasis. Lancet 2006; 368:1106.
  12. Weerakoon KG, Gobert GN, Cai P, McManus DP. Advances in the Diagnosis of Human Schistosomiasis. Clin Microbiol Rev 2015; 28:939.
  13. Elliott DE. Schistosomiasis. Pathophysiology, diagnosis, and treatment. Gastroenterol Clin North Am 1996; 25:599.
  14. Glinz D, Silué KD, Knopp S, et al. Comparing diagnostic accuracy of Kato-Katz, Koga agar plate, ether-concentration, and FLOTAC for Schistosoma mansoni and soil-transmitted helminths. PLoS Negl Trop Dis 2010; 4:e754.
  15. Coulibaly JT, Ouattara M, Becker SL, et al. Comparison of sensitivity and faecal egg counts of Mini-FLOTAC using fixed stool samples and Kato-Katz technique for the diagnosis of Schistosoma mansoni and soil-transmitted helminths. Acta Trop 2016; 164:107.
  16. Keiser J, N'Guessan NA, Adoubryn KD, et al. Efficacy and safety of mefloquine, artesunate, mefloquine-artesunate, and praziquantel against Schistosoma haematobium: randomized, exploratory open-label trial. Clin Infect Dis 2010; 50:1205.
  17. Van Nassauw L, Toovey S, Van Op den Bosch J, et al. Schistosomicidal activity of the antimalarial drug, mefloquine, in Schistosoma mansoni-infected mice. Travel Med Infect Dis 2008; 6:253.
  18. Peters PAS, Kazura JW. Update on diagnostic methods for schistosomiasis. Bailliere's Clin Trop Med Commun Dis 1987; 2:419.
  19. Schaberg T, Rahn W, Racz P, Lode H. Pulmonary schistosomiasis resembling acute pulmonary tuberculosis. Eur Respir J 1991; 4:1023.
  20. Shimazu C, Pien FD, Parnell D. Bronchoscopic diagnosis of Schistosoma japonicum in a patient with hemoptysis. Respir Med 1991; 85:331.
  21. Harries AD, Fryatt R, Walker J, et al. Schistosomiasis in expatriates returning to Britain from the tropics: a controlled study. Lancet 1986; 1:86.
  22. World Health Organization Expert Committee. Prevention and Control of Schistosomiasis and Soil-transmitted Helminthiasis. World Health Organization, Geneva 2002. Report No.: 912.
  23. Soentjens P, Cnops L, Huyse T, et al. Diagnosis and Clinical Management of Schistosoma haematobium–Schistosoma bovis Hybrid Infection in a Cluster of Travelers Returning From Mali. Clin Infect Dis 2016.
  24. Huyse T, Webster BL, Geldof S, et al. Bidirectional introgressive hybridization between a cattle and human schistosome species. PLoS Pathog 2009; 5:e1000571.
  25. 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.
  26. Jones ME, Mitchell RG, Leen CL. Long seronegative window in schistosoma infection. Lancet 1992; 340:1549.
  27. Tsang VC, Wilkins PP. Immunodiagnosis of schistosomiasis. Screen with FAST-ELISA and confirm with immunoblot. Clin Lab Med 1991; 11:1029.
  28. Sulahian A, Garin YJ, Izri A, et al. Development and evaluation of a Western blot kit for diagnosis of schistosomiasis. Clin Diagn Lab Immunol 2005; 12:548.
  29. Corachán M, Almeda J, Vinuesa T, et al. [Schistosomiasis imported by Spanish travelers: clinico-epidemiologic study of 80 cases]. Med Clin (Barc) 1997; 108:721.
  30. Hamilton JV, Klinkert M, Doenhoff MJ. Diagnosis of schistosomiasis: antibody detection, with notes on parasitological and antigen detection methods. Parasitology 1998; 117 Suppl:S41.
  31. Pardo J, Arellano JL, López-Vélez R, et al. Application of an ELISA test using Schistosoma bovis adult worm antigens in travellers and immigrants from a schistosomiasis endemic area and its correlation with clinical findings. Scand J Infect Dis 2007; 39:435.
  32. Van Gool T, Vetter H, Vervoort T, et al. Serodiagnosis of imported schistosomiasis by a combination of a commercial indirect hemagglutination test with Schistosoma mansoni adult worm antigens and an enzyme-linked immunosorbent assay with S. mansoni egg antigens. J Clin Microbiol 2002; 40:3432.
  33. Kinkel HF, Dittrich S, Bäumer B, Weitzel T. Evaluation of eight serological tests for diagnosis of imported schistosomiasis. Clin Vaccine Immunol 2012; 19:948.
  34. 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.
  35. Rabello AL, Garcia MM, Pinto da Silva RA, et al. Humoral immune responses in patients with acute Schistosoma mansoni infection who were followed up for two years after treatment. Clin Infect Dis 1997; 24:304.
  36. De Jonge N, Gryseels B, Hilberath GW, et al. Detection of circulating anodic antigen by ELISA for seroepidemiology of schistosomiasis mansoni. Trans R Soc Trop Med Hyg 1988; 82:591.
  37. Hassan MM, Medhat A, Makhlouf MM, et al. Detection of circulating antigens in patients with active Schistosoma haematobium infection. Am J Trop Med Hyg 1998; 59:295.
  38. Salah F, El Bassiouny A, Rabia I, et al. Human schistosomiasis haematobium: effective diagnosis of active infection using a pair of monoclonal antibodies against soluble egg antigen. Parasitol Res 2006; 99:528.
  39. Van 't Wout AB, De Jonge N, Tiu WU, et al. Schistosome circulating anodic antigen in serum of individuals infected with Schistosoma japonicum from the Philippines before and after chemotherapy with praziquantel. Trans R Soc Trop Med Hyg 1992; 86:410.
  40. van Lieshout L, Polderman AM, Deelder AM. Immunodiagnosis of schistosomiasis by determination of the circulating antigens CAA and CCA, in particular in individuals with recent or light infections. Acta Trop 2000; 77:69.
  41. de Jonge N, De Caluwé P, Hilberath GW, et al. Circulating anodic antigen levels in serum before and after chemotherapy with praziquantel in schistosomiasis mansoni. Trans R Soc Trop Med Hyg 1989; 83:368.
  42. Coulibaly JT, N'Gbesso YK, Knopp S, et al. Accuracy of urine circulating cathodic antigen test for the diagnosis of Schistosoma mansoni in preschool-aged children before and after treatment. PLoS Negl Trop Dis 2013; 7:e2109.
  43. Gundersen SG, Ravn J, Haagensen I. Early detection of circulating anodic antigen (CAA) in a case of acute schistosomiasis mansoni with Katayama fever. Scand J Infect Dis 1992; 24:549.
  44. van Dam GJ, de Dood CJ, Lewis M, et al. A robust dry reagent lateral flow assay for diagnosis of active schistosomiasis by detection of Schistosoma circulating anodic antigen. Exp Parasitol 2013; 135:274.
  45. Deelder AM, Qian ZL, Kremsner PG, et al. Quantitative diagnosis of Schistosoma infections by measurement of circulating antigens in serum and urine. Trop Geogr Med 1994; 46:233.
  46. Sousa-Figueiredo JC, Betson M, Kabatereine NB, Stothard JR. The urine circulating cathodic antigen (CCA) dipstick: a valid substitute for microscopy for mapping and point-of-care diagnosis of intestinal schistosomiasis. PLoS Negl Trop Dis 2013; 7:e2008.
  47. Coelho PM, Siqueira LM, Grenfell RF, et al. Improvement of POC-CCA Interpretation by Using Lyophilization of Urine from Patients with Schistosoma mansoni Low Worm Burden: Towards an Elimination of Doubts about the Concept of Trace. PLoS Negl Trop Dis 2016; 10:e0004778.
  48. Lier T, Simonsen GS, Wang T, et al. Real-time polymerase chain reaction for detection of low-intensity Schistosoma japonicum infections in China. Am J Trop Med Hyg 2009; 81:428.
  49. Sandoval N, Siles-Lucas M, Pérez-Arellano JL, et al. A new PCR-based approach for the specific amplification of DNA from different Schistosoma species applicable to human urine samples. Parasitology 2006; 133:581.
  50. Cnops L, Tannich E, Polman K, et al. Schistosoma real-time PCR as diagnostic tool for international travellers and migrants. Trop Med Int Health 2012; 17:1208.
  51. Wichmann D, Panning M, Quack T, et al. Diagnosing schistosomiasis by detection of cell-free parasite DNA in human plasma. PLoS Negl Trop Dis 2009; 3:e422.
  52. Meurs L, Brienen E, Mbow M, et al. Is PCR the Next Reference Standard for the Diagnosis of Schistosoma in Stool? A Comparison with Microscopy in Senegal and Kenya. PLoS Negl Trop Dis 2015; 9:e0003959.
  53. ten Hove RJ, Verweij JJ, Vereecken K, et al. Multiplex real-time PCR for the detection and quantification of Schistosoma mansoni and S. haematobium infection in stool samples collected in northern Senegal. Trans R Soc Trop Med Hyg 2008; 102:179.
  54. Wichmann D, Poppert S, Von Thien H, et al. Prospective European-wide multicentre study on a blood based real-time PCR for the diagnosis of acute schistosomiasis. BMC Infect Dis 2013; 13:55.
  55. Cnops L, Soentjens P, Clerinx J, Van Esbroeck M. A Schistosoma haematobium-specific real-time PCR for diagnosis of urogenital schistosomiasis in serum samples of international travelers and migrants. PLoS Negl Trop Dis 2013; 7:e2413.
  56. 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.
  57. Webster BL, Rollinson D, Stothard JR, Huyse T. Rapid diagnostic multiplex PCR (RD-PCR) to discriminate Schistosoma haematobium and S. bovis. J Helminthol 2010; 84:107.
  58. Boissier J, Grech-Angelini S, Webster BL, et al. Outbreak of urogenital schistosomiasis in Corsica (France): an epidemiological case study. Lancet Infect Dis 2016; 16:971.
  59. Härter G, Frickmann H, Zenk S, et al. Diagnosis of neuroschistosomiasis by antibody specificity index and semi-quantitative real-time PCR from cerebrospinal fluid and serum. J Med Microbiol 2014; 63:309.
  60. Lucey DR, Maguire JH. Schistosomiasis. Infect Dis Clin North Am 1993; 7:635.
  61. 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.
  62. Ferrari TC. A laboratory test for the diagnosis of neuroschistosomiasis. Neurol Res 2010; 32:252.
  63. Braga BP, da Costa Junior LB, Lambertucci JR. Magnetic resonance imaging of cerebellar schistosomiasis mansoni. Rev Soc Bras Med Trop 2003; 36:635.
  64. Ferrari TC. Involvement of central nervous system in the schistosomiasis. Mem Inst Oswaldo Cruz 2004; 99:59.
  65. Mackenzie IR, Guha A. Manson's schistosomiasis presenting as a brain tumor. Case report. J Neurosurg 1998; 89:1052.
  66. Sanelli PC, Lev MH, Gonzalez RG, Schaefer PW. Unique linear and nodular MR enhancement pattern in schistosomiasis of the central nervous system: report of three patients. AJR Am J Roentgenol 2001; 177:1471.
  67. Lesprit P, Adle-Biasette H, Liance M, et al. Photo quiz: cerebral S. mansoni infection. Clin Infect Dis 2001; 32:1347, 1371.
  68. Ferrari TC, Moreira PR. Neuroschistosomiasis: clinical symptoms and pathogenesis. Lancet Neurol 2011; 10:853.