Diagnostic Considerations

Potentially serious asymptomatic infections are common in travelers returning to developed countries. A detailed freshwater exposure history, symptom history, and physical examination may add little in detecting cases. Stool microscopy, schistosomal serology, and the eosinophil count tend to be the best tools for evaluating suspected disease.

Patients with schistosomiasis are, by default, at risk for other parasitic infections because areas that are endemic for schistosomiasis are also endemic for other parasites. After treatment, patients should be monitored for other symptomatology characteristic of parasitic infections.

In addition to the conditions listed in the differential diagnosis, other problems to be considered include the following:

Bacterial or viral gastrointestinal (GI) infection in the acute presentation
Idiopathic epilepsy
Postinfectious viral transverse myelitis
Congenital hydronephrosis
Congenital heart disease and cor pulmonale
Renal disease

Differential Diagnoses

Workup

Lapa M, Dias B, Jardim C, Fernandes CJ, Dourado PM, Figueiredo M, et al. Cardiopulmonary manifestations of hepatosplenic schistosomiasis. Circulation. 2009 Mar 24. 119(11):1518-23. [QxMD MEDLINE Link].
Salvana EM, King CH. Schistosomiasis in travelers and immigrants. Curr Infect Dis Rep. 2008 Mar. 10(1):42-9. [QxMD MEDLINE Link].
Chitsulo L, Engels D, Montresor A, et al. The global status of schistosomiasis and its control. Acta Trop. 2000 Oct 23. 77(1):41-51. [QxMD MEDLINE Link].
Yosry A. Schistosomiasis and neoplasia. Contrib Microbiol. 2006. 13:81-100. [QxMD MEDLINE Link].
Kalinda C, Mutengo M, Chimbari M. A meta-analysis of changes in schistosomiasis prevalence in Zambia: implications on the 2020 elimination target. Parasitol Res. 2020 Jan. 119 (1):1-10. [QxMD MEDLINE Link].
Kallestrup P, Zinyama R, Gomo E, Butterworth AE, van Dam GJ, Gerstoft J. Schistosomiasis and HIV in rural Zimbabwe: efficacy of treatment of schistosomiasis in individuals with HIV coinfection. Clin Infect Dis. 2006 Jun 15. 42(12):1781-9. [QxMD MEDLINE Link].
Xu X, Zhang Y, Lin D, Zhang J, Xu J, Liu YM, et al. Serodiagnosis of Schistosoma japonicum infection: genome-wide identification of a protein marker, and assessment of its diagnostic validity in a field study in China. Lancet Infect Dis. 2014 Jun. 14(6):489-97. [QxMD MEDLINE Link].
Tsang VC, Wilkins PP. Immunodiagnosis of schistosomiasis. Screen with FAST-ELISA and confirm with immunoblot. Clin Lab Med. 1991 Dec. 11(4):1029-39. [QxMD MEDLINE Link].
Kamal S, Madwar M, Bianchi L. Clinical, virological and histopathological features: long-term follow-up in patients with chronic hepatitis C co-infected with S. mansoni. Liver. 2000 Jul. 20(4):281-9. [QxMD MEDLINE Link].
Weber-Donat G, Donat N, Margery J. Acute Pulmonary Schistosomiasis: Computed Tomography (CT) Findings. Am J Trop Med Hyg. 2010 Mar. 82(3):364. [QxMD MEDLINE Link]. [Full Text].
Richter J. Evolution of schistosomiasis-induced pathology after therapy and interruption of exposure to schistosomes: a review of ultrasonographic studies. Acta Trop. 2000 Oct 23. 77(1):111-31. [QxMD MEDLINE Link].
Cao J, Liu WJ, Xu XY, Zou XP. Endoscopic findings and clinicopathologic characteristics of colonic schistosomiasis: a report of 46 cases. World J Gastroenterol. 2010 Feb 14. 16(6):723-7. [QxMD MEDLINE Link]. [Full Text].
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Media Gallery

Cercarial dermatitis secondary to avian schistosomes is shown. Photography taken by A. Joseph Bearup and provided by John Walker, MD.
Two 10-year-old boys with abdominal distension secondary to chronic Schistosoma japonicum infection.
CT scan of the brain reveals a right cerebral hemisphere lesion due to Schistosoma japonicum. The patient presented with focal motor seizures.
Egg of Schistosoma japonicum from a fecal smear is shown. Note lateral umbilicated spine on the right side of the egg.
Egg of Schistosoma mekongi (53 X 45 μm) in the feces of a woman from Laos.
Egg of Schistosoma mansoni from a fecal smear.
Egg of Schistosoma haematobium from a fecal smear.
Eggs of Schistosoma japonicum within the intestinal mucosa.
Liver granulomata secondary to Schistosoma japonicum infestation.
Granuloma within the intestinal mucosa secondary to Schistosoma mansoni infestation.
Eggs of Schistosoma haematobium isolated from urinary sediment.
Eggs of Schistosoma haematobium detected in the bladder.

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Author

Vinod K Dhawan, MD, FACP, FRCPC, FIDSA Clinical Professor, Department of Clinical Medicine, University of California, Los Angeles, David Geffen School of Medicine; Clinical Professor, Department of Clinical Medicine, Charles R Drew University of Medicine and Science

Vinod K Dhawan, MD, FACP, FRCPC, FIDSA is a member of the following medical societies: American College of Physicians, American Medical Association, American Society for Microbiology, Infectious Diseases Society of America, Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Chief Editor

Russell W Steele, MD Clinical Professor, Tulane University School of Medicine; Staff Physician, Ochsner Clinic Foundation

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, Southern Medical Association

Disclosure: Nothing to disclose.

Acknowledgements

Leslie L Barton, MD Professor Emerita of Pediatrics, University of Arizona College of Medicine

Leslie L Barton, MD is a member of the following medical societies: American Academy of Pediatrics, Association of Pediatric Program Directors, Infectious Diseases Society of America, and Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Michael D Nissen, MBBS, FRACP, FRCPA, Associate Professor in Biomolecular, Biomedical Science & Health, Griffith University; Director of Infectious Diseases and Unit Head of Queensland Paediatric Infectious Laboratory, Sir Albert Sakzewski Viral Research Centre, Royal Children's Hospital

Michael D Nissen, MBBS, FRACP, FRCPA is a member of the following societies : American Academy of Pediatrics, American Society for Microbiology, Pediatric Infectious Diseases Society,Royal Australasian College of Physicians, Royal College of Pathologists of Australasia

Disclosure: Nothing to disclose.

Robert W Tolan Jr, MD Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine

Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility

Disclosure: GlaxoSmithKline Honoraria Speaking and teaching; MedImmune Honoraria Speaking and teaching; Merck Honoraria Speaking and teaching; Sanofi Pasteur Honoraria Speaking and teaching; Baxter Healthcare Honoraria Speaking and teaching; Novartis Honoraria Speaking and teaching

John Charles Walker, MSc, PhD Head, Department of Parasitology, Center for Infectious Diseases and Microbiology, Westmead Hospital, Westmead, Australia; Senior Lecturer, Department of Medicine, University of Sydney, Australia

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Pediatric Schistosomiasis Differential Diagnoses

Diagnostic Considerations

Differential Diagnoses

References

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