Intended for healthcare professionals

Clinical Review Clinical Review

Diagnosis and management of schistosomiasis

BMJ 2011; 342 doi: (Published 17 May 2011) Cite this as: BMJ 2011;342:d2651
  1. Darren J Gray, research fellow1, visiting scientist2,
  2. Allen G Ross, professor and chair of public health1, director, population health research3,
  3. Yue-Sheng Li, senior research fellow2, honorary director4,
  4. Donald P McManus, laboratory head and National Health and Medical Research Council (Australia) senior principal research fellow2
  1. 1Griffith Health Institute, Griffith University, Brisbane, Australia
  2. 2Molecular Parasitology Laboratory, Infectious Diseases Division, Queensland Institute of Medical Research, Herston, Brisbane, Queensland, Australia
  3. 3School of Public Health, Griffith University, Meadowbrook, Australia
  4. 4Hunan Institute of Parasitic Diseases, World Health Organization Collaborating Centre for Research and Control of Schistosomiasis in Lake Region, Yueyang, People’s Republic of China
  1. Correspondence to: D P McManus Don.McManus{at}
  • Accepted 12 April 2011

Summary points

  • Schistosomiasis, or bilharzia, is a common intravascular infection caused by parasitic Schistosoma trematode worms

  • It is prevalent in Africa, the Middle East, South America, and Asia

  • Acute schistosomiasis, or Katayama syndrome, can present as fever, malaise, myalgia, fatigue, non-productive cough, diarrhoea (with or without blood), haematuria (S haematobium), and right upper quadrant pain

  • Chronic and advanced disease results from the host’s immune response to schistosome eggs deposited in tissues and the granulomatous reaction evoked by the antigens they secrete

  • S mansoni, S japonicum, S intercalatum, and S mekongi cause intestinal disease; S haematobium causes urinary disease

  • Neuroschistosomiasis is arguably the most severe clinical syndrome associated with schistosome infection

  • Microscopic examination of excreta (stool, urine) is the gold standard diagnostic test but requires the adult worms to be producing eggs; serological tests can diagnose less advanced infections

  • Praziquantel 60 mg/kg in three doses over one day (S japonicum and S.mekongi); and 40 mg/kg in doses over one day (S mansoni, S haematobium, S intercalatum) remains the treatment of choice although others are being investigated

  • Preventive chemotherapy is with a single oral dose of praziquantel 40 mg/kg

Schistosomiasis, or bilharzia, is a common intravascular infection caused by parasitic Schistosoma trematode worms.1 2 A systematic review and meta-analysis published in 2006 estimated that more than 200 million people are infected across Africa, Asia, and South America, and close to 800 million are at risk of infection.3 Meta-analyses have estimated that the current disease burden may exceed 70 million disability adjusted life years.4 5 The disease is also associated with anaemia, chronic pain, diarrhoea, exercise intolerance, and undernutrition, and female urogenital schistosomiasis may be a risk factor for HIV infection.4 w1 5 Figure 1 shows the proposed pathway of schistosomiasis associated disease and disability …

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