Bilharzia B65.90

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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Bilharziosis cutanea tarda; Schistosomiasis; Schistosomosis; vein nail infection

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Renoult, 1808; Bilharz, 1851; Katsurada, 1904

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Tropical disease caused by infection with schistosomes (couple's flukes), in which untreated egg deposition in multiple organs occurs with subsequent granulomatous-fibrotic connective tissue reaction. Duration of parasitosis up to 20 years.

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Schistosoma species; Schistosoma haematobium (preferably infestation of the urogenital tract), Schistosoma mansoni, Schistosoma japonicum (infestation of the large intestine and/or liver and spleen), Schistosoma mekongi, Schistosoma intercalatum (intestinal infestation). End hosts of the schistosomes (pair flukes) belonging to the sucking worms (trematodes) are humans and mammals.

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About 200 million people in 70-80 countries worldwide are affected. 120 million are symptomatically ill, 20 million of them with severe clinical symptoms. Geographical distribution:
  • S. haematobium: Africa, Middle East.
  • S. mansoni: Africa, Arabian Peninsula, South America (northern states), scattered in the Caribbean (eastern Caribbean).
  • S. intercalatum: West Africa.
  • S. japonicum: China, Philippines, Indonesia, only sporadically in Japan.
  • S. mekongi: Laos, Cambodia, Thailand.

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Contamination of waters by faeces containing worm eggs (excreta are humans, dogs, cattle, etc.). From this, cervaria develop in freshwater snails (intermediate host). Direct human contact with the contaminated water leads to active percutaneous intrusion of cercaria; these develop into adult worms (schistosomes) in the veins and lymph vessels, especially the liver; after mating, the female lays eggs, which enter multiple organs with the bloodstream and are excreted with faeces and urine.

Clinical features
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  • Itchy, urticarial, papular exanthema at the entry points of the cercaria (cercarial dermatitis).
  • Acute phase: migration of the cercaria into the mesenteric vessels: fever, diarrhoea, nausea, urticaria and development of oedema.
  • Chronic phase: the worm eggs get stuck in small vessels. Inflammatory reaction of the surrounding tissues: Small connective tissue nodules and papular growths and granulomas, especially in the anal and genital region. Also on vulva, vagina and cervix (sandy patches). The local proliferative tissue reactions are caused by the release of proteolytic enzymes by the schistosoma eggs.
  • Chronic bladder, bowel, lung and brain bilharzia.
  • Carcinomatous growths are possible: liver, bladder, rectal cancer.

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Detection of schistosomal eggs in stool and urine, possibly also in biopsies of the bladder or intestinal wall (detection is possible after 5-12 weeks at the earliest). In individual cases histological examination of liver or lung biopsies. Detection of specific antibodies in serum (IFT, PHA, ELISA).

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  • Praziquantel (e.g. Biltricide Filmtbl.) 40 mg/kg bw as single dose, for S. japonicum 3 doses with 20 mg/kg bw. Cure rate 70%; if vital eggs are found during urine control or biopsy, repeat treatment.
  • Alternatively: In case of infection with S. mansoni oxamniquin 15-30 mg/kg bw p.o. over 1-2 days, in case of infection with S. haematobium 7.5-10 mg/kg bw with a total of 3 single doses at intervals of 2 weeks each.

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  • In each endemic area avoid contact with fresh water from natural or artificial sources (bathing, wading, washing, drinking).
  • Basic prophylaxis: destruction of snails, change of irrigation methods.

Case report(s)
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A 32-year-old female Caucasian patient developed itchy papular and plaque-like changes in the vulva for 6 months. She reported an earlier itchy papular exanthema on the trunk and lower extremity. This had occurred after a bathing stay at several Malian lakes 2 years earlier. This had subsided after a while.

Findings: In the region of the labia minora and labia majora, red papules and plaques about 0.4-0.5 cm in size, disseminated and aggregated.

Clinical diagnosis: Condylomata acuminata.

Laboratory: conspicuous eosinophilia (14%).

Histology: eosinophilic and plasma cell-rich infiltrate with epithelial cell granulomas and Schistomosoma eggs.

Urinalysis: detection of large amounts of Schistosoma haematobium eggs (evidence of bilharzia of the urinary bladder).

Ultrasound of the urinary bladder: o.B.

Therapy: ED of 3g praziquantel p.o. Surgical removal of the "condyloma-like" papules.

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  1. Bialasiewicz AA et al (2001) Subretinal granuloma, retinal vasculitis and keratouveitis with secondary open-angle glaucoma in schistosomiasis. Ophthalmologist 98: 972-975
  2. Bilharz T, by Siebold CT (1852-1853) A contribution to the Helminthographia humana, from letters of Dr. Bilharz in Cairo, together with remarks by Prof. C. Th. von Siebold in Breslau. Z Wiss Zool 4: 53-76
  3. Eichenlaub D et al (2003) Parasite detection and symptoms of parasitic diseases. 1: Blood parasites. Internist (Berl) 44: 337-346
  4. Katsurada F (1904) The etiology of parasitic disease. Iji Shinbun 669: 1325-1332
  5. Kempf W (2016) Condylomata acuminatum and bilharziasis cutanea tarda in the same vulvar lesion. J Dtsch Dermatol Ges 14: 624-626
  6. Renoult AJ (1808) Notice sur l'hematurie qu epruvent les Europeens dans la haute Egypte et la Nubie J Gen Med Chir Pharm 17: 366-370
  7. Judge J (2003) The impact of chemotherapy on morbidity due to schistosomiasis. Acta Trop 86: 161-183
  8. Ross AG et al (2002) Schistosomiasis. N Engl J Med 346: 1212-1220

Outgoing links (2)

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Last updated on: 29.10.2020