Schistosomiasis
Description Medicine Treatment ICD-10 code: B65.0-3/B65.8-9 *Notifiable medical condition. DESCRIPTION A parasitic infestation with: Schistosoma haematobium : primarily involves the bladder and renal tract, or Schistosoma mansoni : primarily involves the intestinal tract. Acute schistosomiasis syndrome Typically occurs in travellers to endemic areas with freshwater exposure 3-7 weeks before onset
ICD-10 code: B65.0-3/B65.8-9
*Notifiable medical condition.
DESCRIPTION
A parasitic infestation with:
- Schistosoma haematobium: primarily involves the bladder and renal tract, or
- Schistosoma mansoni: primarily involves the intestinal tract.
Acute schistosomiasis syndrome
- Typically occurs in travellers to endemic areas with freshwater exposure 3-7 weeks before onset.
- Clinical features include fever, rigors/chills, urticaria, angioedema, myalgias, arthralgias, dry cough, diarrhoea, abdominal pain, and headache. Symptoms are usually relatively mild and resolve spontaneously over a period of a few days to a few weeks.
- The eosinophil count is almost invariably markedly elevated.
- Diagnosis is confirmed serologically – eggs are seldom seen in stool or urine.
- Differential diagnosis includes urinary tract infection; glomerulonephritis; HIV; gastroenteritis (Salmonella); hepatitis A, B and C; and malaria.
Chronic schistosomiasis
- Most individuals with schistosomiasis infection are asymptomatic.
- S. haematobium may present with macroscopic haematuria and urinary symptoms. Chronic bladder involvement and urinary tract involvement may cause urinary incontinence and obstructive uropathy.
- S. mansoni may present with chronic or intermittent dysentery. Periportal fibrosis and portal hypertension may occur.
- Pulmonary hypertension and central nervous system involvement (particularly myelopathy) are uncommon complications.
- Definitive diagnosis is by finding eggs in urine (S. haematobium), stool (S. mansoni), or on biopsy. Serology is usually positive.
MEDICINE TREATMENT
Acute schistosomiasis syndrome
- Corticosteroids (intermediate-acting) e.g.:
- Prednisone, oral, 40 mg daily for 5 days.
Note:
Praziquantel may cause life-threatening deterioration if given in acute schistosomiasis.
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4-6 weeks later, after symptoms have resolved:
- Praziquantel, oral, 40mg/kg as a single dose.
AND
- Corticosteroids (intermediate-acting) e.g.:
- Prednisone, oral, 40mg daily for 5 days.
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Note:
Optimum time for administration of praziquantel is uncertain but sufficient time is required for the worms to mature.
If eosinophilia and high antibody titres are still present after 4-6 weeks, repeat praziquantel treatment:
- Praziquantel, oral, 40 mg/kg as a single dose.
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Chronic schistosomiasis
Manage as recommended in PHC STGs and EML, Schistosomiasis (bilharzia).
Standard Treatment Guidelines and Essential Medicines List for South Africa, Adult Hospital Level, 2020-2024_Version 1.2_20 January 2025
Chapter 9 Systemic and Healthcare-Associated Infections_9.8 Schistosomiasis