Education And Debate

Lesson of the Week: Katayama fever: an acute manifestation of schistosomiasis

BMJ 1996; 313 doi: (Published 26 October 1996) Cite this as: BMJ 1996;313:1071
  1. J F Doherty, senior registrar AH Moody, laboratory manager SG Wright, consultant physiciana,
  2. A H Moody,
  3. S G Wright
  1. a Hospital for Tropical Diseases, London NW1 0PE
  1. Correspondence to: Dr J F Doherty, Medical Research Council Laboratories, Fajara, PO Box 273, Banjul, the Gambia.
  • Accepted 29 July 1996

Schistosomiasis is prevalent throughout sub-Saharan Africa and parts of south east Asia. It is contracted through contact with any fresh (but not salt) water that harbours the intermediate snail host. Katayama fever is a manifestation of acute schistosomiasis. Typical features include fever, an urticarial rash, enlarged liver and spleen, and bronchospasm. The precise pathogenesis of Katayama fever is unknown, but it is thought to be an immune complex phenomenon, initiated by eggs laid by maturing schistosomes. Typically, symptoms occur four to six weeks after infection. Diagnosis is on clinical grounds as there is no definitive serological or immunological test. Conventional antibody titres may take three months or more to become positive.1 As a result, the diagnosis is often missed, occasionally with disastrous results, such as schistosomal myelopathy, which may result in permanent neurological damage.2

Katayama fever often mimics the symptoms of malaria in feverish travellers

Case reports

Sixteen patients were admitted to the Hospital for Tropical Diseases in London between August 1994 and December 1995 with suspected acute schistosomiasis. All had travelled to sub-Saharan Africa. Fourteen had been exposed to fresh water only in Lake Malawi; the other two, travelling together, had swum in a river in a rural area of Mozambique. Symptoms at presentation were …

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