Pulmonary schistosomiasis
Section snippets
Schistosoma life cycle
The life cycle of Schistosoma involves two hosts: humans and snails. An infected human sheds the schistosome eggs into fresh water via the urine or feces. Snails, the intermediate hosts, ingest the eggs that subsequently hatch and go through several cycles of multiplication. They are then excreted into the water as cercariae, the infective form. Cercariae have the ability to penetrate human skin or, if ingested, penetrate the gut. People mostly become infected while swimming in contaminated
Clinical manifestations of schistosomiasis
The clinical manifestations can be divided into three major stages. (1) The first stage occurs within 24 hours after skin penetration by the cercariae and manifests as a pruritic papular rash (swimmer's itch; S chistosoma dermatitis). This symptom can occur also after infestation with a nonhuman schistosome and lasts less than 48 hours. (2) The second stage usually occurs 3 to 8 weeks after infection during the maturation of the adult fluke. This stage, termed “Katayama fever” or “toxemic
Pulmonary involvement in schistosomiasis
Although the lungs are not an end organ in the life cycle of schistosome infection in humans, pulmonary pathology exists. For many years, pulmonary pathology was described mainly as a late complication of the infection. It recently has been recognized that pulmonary involvement also may occur in the early, acute stages [10], [17]. Early-stage pulmonary involvement is unique to nonimmune patients, that is, populations never previously exposed to schistosomal infection, usually travelers from
Clinical manifestations
Early pulmonary manifestations occur usually 3 to 8 weeks after schistosome penetration [10], [17]. Patients with pulmonary schistosomiasis reported shortness of breath, wheezing, and dry cough, mainly while recumbent. Reports show that in some cases the pulmonary symptoms coincided with febrile illness (Katayama fever) [18], [19]. Most patients, however, presented several weeks after the fever had subsided. Almost all the patients could recall having had febrile disease before the onset of
Chronic pulmonary disease: late complication
Ectopic migration of schistosome eggs can reach the pulmonary beds. In the case of S haematobium infection, the final station of the adult flukes is in the perivesical plexus. From there the eggs laid by the mature flukes can be swept by the systemic venous system that drains the venous plexus to reach the lungs. As for S mansoni and S japonicum, their ova are swept with the portal blood flow and become lodged in the venules of the liver. There, the host immune system creates a granuloma around
Prevention
Control and prevention of the disease in the endemic countries is beyond the scope of this article. Among travelers to endemic areas, mainly Africa, prevention of the disease is primarily by avoiding contact with freshwater lakes or rivers (there is no risk of contracting schistosomiasis in salt water). The author's experience with travelers shows that this advice often is not followed, because water entertainment (such as diving in Lake Malawi or rafting on rivers in Africa) is too enticing.
Summary
Schistosoma infection is one of the most common infectious diseases, limited in the past only to the endemic countries. With the enormous increase in migration and travel, we encounter more and more cases in developed, nonendemic countries. Although the disease has been known for many years from studies in the endemic countries, the new patient population of nonimmune travelers presents with a different clinical pattern that requires further investigation. One of the features of the disease in
Acknowledgements
The author thanks Dr. Judith Rozenman, Department of Radiology, Sheba Medical Center, for her valuable assistance in preparing the radiology section of the article, and Dr. Marina Perelman, Department of Pathology, Sheba Medical Center, for her valuable assistance in preparing the pathologic specimen.
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New Insights on Acute and Chronic Schistosomiasis: Do We Need a Redefinition?
2020, Trends in ParasitologyCitation Excerpt :While the pathophysiology of CS is universally accepted, that of AS remains poorly characterized and therefore controversial. Four main pathophysiological mechanisms have been proposed: (i) serum sickness (type 3) hypersensitivity reaction triggered by egg deposition [10]; (ii) 'a systemic hypersensitivity reaction against the migrating schistosomula and eggs' [11]; (iii) 'a toxemic and allergic reaction to the migrating and maturing larvae of Schistosoma', but not to eggs [12]; and (iv) a more generalized systemic, immunologically mediated, Loeffler-like reaction, not specifically related either to larvae or to adult worms or to eggs [13]. Because of this etiological uncertainty, the treatment during the timeframe generally defined as, and in particular the optimal timing of praziquantel (PZQ) administration, remains undetermined.
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