Schistosomiasis (Bilharzia)

Description

Diagnostic criteria

General and supportive measures

Medicine treatment

Referral

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ICD-10 code: B65.0/B65.1

DESCRIPTION

• Disease manifestations caused by infestation by species of the genus Schistosoma.
• Infestations with S. haematobium and S. mansoni are endemic in certain areas of South Africa.
• Nematodes reside in the venous plexus draining the bladder wall (haematobium) or intestine (mansoni).

Complications include:  

• haematuria,
• strictures,
• dysuria,
• hepatosplenomegaly,
• cystitis,
• portal hypertension,
• calcifications in the bladder wall,
• cirrhosis,
• obstructive uropathy,
• ascites,
• bladder stones,
• pulmonary hypertension,
• intestinal perforation,
• bladder cancer,
• fistulas,    
• spinal cord granulomas with pressure effects.

DIAGNOSTIC CRITERIA

Clinical

• Transient pruritic papular rash (swimmers itch) after exposure to cercariae in the water.
• A few weeks after exposure:
  • fever,
  • wheezing,
  • chills,
  • hepatosplenomegaly,
  • headache,
  • arthralgia,
  • urticaria,
  • lymphadenopathy,
  • cough, and
  • eosinophilia.
• Haematuria and dysuria.
• Abdominal pain and diarrhoea often after ingestion of food.

Investigations:

• Serology for schistosomiasis.
• Urine and stools microscopy for viable eggs or rectal biopsy specimens.

GENERAL AND SUPPORTIVE MEASURES

• Educate patient/caregiver on preventative measures.
• Symptomatic and supportive treatment.
• Avoid exposure to water contaminated by schistosoma.
• Surgical intervention to correct or prevent complications.

MEDICINE TREATMENT

Acute Schistosomiasis

• Prednisone, oral, 0.5–1 mg/kg daily for 5 days.

Start antihelmintic once acute symptoms have resolved:

• Praziquantel, oral, 40 mg/kg as a single dose or in 2 divided doses on the same day.

Chronic Schistosomiasis

• Praziquantel, oral, 40 mg/kg as a single dose or in 2 divided doses on the same day.
• If given within 6 weeks of exposure, to be repeated in 4–6 weeks.

REFERRAL

• Schistosomiasis with suspected complications following adequate therapy.

Click here for the pdf.

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Standard Treatment Guidelines and Essential Medicines List for South Africa Paediatric Hospital _2023, 5th edition_Updated July 2024 

Chapter 8: Infective/Infectious Diseases,  8.5 Schistosomiasis (Bilharzia)