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  • Caused by parasitic trematodes of the species Schistosoma
  • Reservoir is freshwater snails
  • Endemic in areas of Africa and Southern Asia
  • The Cercariae (the stage of trematode released by the snail) can infect by direct penetration through the skin
  • Infects >200million people worldwide with 10% suffering severe consequences

Clinical Features

  • Mostly a chronic condition
    • Second most common cause of esophageal varicies worldwide
    • Greatly elevated bladder cancer rates in endemic areas
    • Can cause renal failure, liver failure, pulmonary hypertension, GI bleeds and rarely CNS symptoms
      • Mostly through fibrosis of affected organs
    • Genitourinary schistosomiasis
      • Caused by sores in the genital tract
      • May persist even after treatment
      • Greatly increases risk of HIV infection
  • Acute presentations
    • Cutaneous rash/itching from cercariae penetration (immediate)
    • Katayama fever-Fever, Abdominal pain, Fatigue, Cough, Diarrhea, Eosinophilia (lasts 4-8 weeks)

Differential Diagnosis



  • PCR from stool or urine
  • Stool and Urine for ova/parasites
    • biopsy may be needed for those who do not show ova/parasites in stool/urine
  • CBC, Alk Phos, GGT, ALT/AST, Cr, Blood cultures
  • Consider ultrasound for hepatosplenic (periportal fibrosis) or urinary disease (hydro)
  • Echo and CXR for pulmonary hypertension and/or cor pulmonale
  • Consider CT or MRI for CNS disease or further workup of periportal fibrosis


  • Praziquantel 20mg/kg PO for two doses in 1 day [1]
    • S.japnonicum requires 3 doses in 1 day


  • Generally may be discharged
  • Admit if concern for CNS infection

See Also

External Links