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Epidemiology, pathogenesis, and clinical manifestations of schistosomiasis

Joannes Clerinx, MD, DTM
Patrick Soentjens, MD
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. 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], and hybrid infection of S. haematobium with S. bovis has been described in Mali [6].

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Literature review current through: Nov 2017. | This topic last updated: Mar 22, 2017.
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