1887

Abstract

Introduction. Diagnosis of schistosomiasis in travellers is a clinical challenge, since cases may present with no symptoms or a few non-specific symptoms. Here, we report on the laboratory and clinical findings in Danish travellers exposed to Schistosoma-infested water during white-water rafting on the Ugandan part of the upper Nile River in July 2009.

Case presentation. Forty travellers were offered screening for Schistosoma-specific antibodies. Serological tests were performed 6–65 weeks after exposure. A self-reporting questionnaire was used to collect information on travel activity and health history, fresh water exposure, and symptoms. Seropositive cases were referred to hospitals where clinical and biochemical data were collected. Schistosoma-specific antibodies were detected in 13/35 (37 %) exposed participants, with 4/13 (31 %) seroconverting later than 2 months following exposure. Four of thirteen (31 %) cases reported ≥3 symptoms compatible with schistosomiasis, with a mean onset of 41 days following exposure. No Schistosoma eggs were detected in stool or urine in any of the cases. Peripheral eosinophilia (>0.45×10 cells l) was seen in 4/13 cases, while IgE levels were normal in all cases.

Conclusion. Schistosomiasis in travellers is not necessarily associated with specific signs or symptoms, eosinophilia, raised IgE levels, or detection of eggs. The only prognostic factor for infection was exposure to freshwater in a Schistosoma-endemic area. Seroconversion may occur later than 2 months after exposure and therefore – in the absence of other diagnostic evidence – serology testing should be performed up to at least 2–3 months following exposure to be able to rule out schistosomiasis.

Loading

Article metrics loading...

/content/journal/jmmcr/10.1099/jmmcr.0.005141
2018-02-02
2019-10-19
Loading full text...

Full text loading...

/deliver/fulltext/jmmcr/5/4/jmmcr005141.html?itemId=/content/journal/jmmcr/10.1099/jmmcr.0.005141&mimeType=html&fmt=ahah

References

  1. Gryseels B, Polman K, Clerinx J, Kestens L. Human schistosomiasis. Lancet 2006;368:1106–1118 [CrossRef][PubMed]
    [Google Scholar]
  2. Whitfield PJ, Bartlett A, Brown MB, Marriott C. Invasion by schistosome cercariae: studies with human skin explants. Trends Parasitol 2003;19:339–340 [CrossRef][PubMed]
    [Google Scholar]
  3. Visser LG, Polderman AM, Stuiver PC. Outbreak of schistosomiasis among travelers returning from Mali, West Africa. Clin Infect Dis 1995;20:280–285 [CrossRef][PubMed]
    [Google Scholar]
  4. Ross AG, Vickers D, Olds GR, Shah SM, McManus DP et al. Katayama syndrome. Lancet Infect Dis 2007;7:218–224 [CrossRef][PubMed]
    [Google Scholar]
  5. Ross AG, Bartley PB, Sleigh AC, Olds GR, Li Y et al. Schistosomiasis. N Engl J Med 2002;346:1212–1220 [CrossRef][PubMed]
    [Google Scholar]
  6. Jauréguiberry S, Paris L, Caumes E. Acute schistosomiasis, a diagnostic and therapeutic challenge. Clin Microbiol Infect 2010;16:225–231 [CrossRef][PubMed]
    [Google Scholar]
  7. de Vlas SJ, Gryseels B. Underestimation of Schistosoma mansoni prevalences. Parasitol Today 1992;8:274–277 [CrossRef][PubMed]
    [Google Scholar]
  8. Duus LM, Christensen AV, Navntoft D, Tarp B, Nielsen HV et al. The schistosoma-specific antibody response after treatment in non-immune travellers. Scand J Infect Dis 2009;41:285–290 [CrossRef][PubMed]
    [Google Scholar]
  9. Thors C, Holmblad P, Maleki M, Carlson J, Linder E et al. Schistosomiasis in Swedish travellers to sub-Saharan Africa: can we rely on serology?. Scand J Infect Dis 2006;38:794–799 [CrossRef][PubMed]
    [Google Scholar]
  10. Fallon PG, Hamilton JV, Doenhoff MJ. Efficacy of treatment of murine Schistosoma mansoni infections with praziquantel and oxamniquine correlates with infection intensity: role of host antibody. Parasitology 1995;111:59–66 [CrossRef][PubMed]
    [Google Scholar]
  11. Garcés JM, Rubiés-Prat J, Menoyd E, Serrano R. Outbreak of schistosomiasis in a tourist group returning from Mali. Eur J Clin Microbiol Infect Dis 1990;9:58 [CrossRef][PubMed]
    [Google Scholar]
  12. Colebunders R, Verstraeten T, Van Gompel A, Van den Ende J, De Roo A et al. Acute schistosomiasis in travelers returning from Mali. J Travel Med 1995;2:235–238 [CrossRef][PubMed]
    [Google Scholar]
  13. Tarp B, Black FT, Petersen E. The immunofluorescence antibody test (IFAT) for the diagnosis of schistosomiasis used in a non-endemic area. Trop Med Int Health 2000;5:185–191 [CrossRef][PubMed]
    [Google Scholar]
  14. Morgan OW, Brunette G, Kapella BK, McAuliffe I, Katongole-Mbidde E et al. Schistosomiasis among recreational users of Upper Nile River, Uganda, 2007. Emerg Infect Dis 2010;16:866–868 [CrossRef][PubMed]
    [Google Scholar]
  15. Schwartz E, Kozarsky P, Wilson M, Cetron M. Schistosome infection among river rafters on Omo River, Ethiopia. J Travel Med 2005;12:3–8 [CrossRef][PubMed]
    [Google Scholar]
  16. Cetron MS, Chitsulo L, Sullivan JJ, Pilcher J, Wilson M et al. Schistosomiasis in lake Malawi. Lancet 1996;348:1274–1278 [CrossRef][PubMed]
    [Google Scholar]
  17. Odongo-Aginya EI, Kironde FK, Kabatereine NB, Kategere P, Kazibwe F et al. Effect of seasonal rainfall and other environmental changes, on snail density and infection rates with Schistosoma mansoni fifteen years after the last snails' study in Kigungu, Entebbe, Uganda. East Afr Med J 2008;85:556–563[PubMed]
    [Google Scholar]
  18. Uganda Bureau of Statistics. Monthly Rainfall Statistics for Selected Centres (mm), 2005-2009 Kampala:: Meteorology Department, Ministry of Water and Environment, Uganda;; 2010.;http://www.ubos.org/onlinefiles/uploads/ubos/pdf%20documents/2010StatAbstract.pdf
    [Google Scholar]
  19. Grandière-Pérez L, Ansart S, Paris L, Faussart A, Jaureguiberry S et al. Efficacy of praziquantel during the incubation and invasive phase of Schistosoma haematobium schistosomiasis in 18 travelers. Am J Trop Med Hyg 2006;74:814–818[PubMed]
    [Google Scholar]
  20. Helleberg M, Thybo S. Schistosomiasis in Danish travellers and immigrants. Ugeskr Laeger 2009;171:3694–3697[PubMed]
    [Google Scholar]
  21. Whitty CJ, Mabey DC, Armstrong M, Wright SG, Chiodini PL et al. Presentation and outcome of 1107 cases of schistosomiasis from Africa diagnosed in a non-endemic country. Trans R Soc Trop Med Hyg 2000;94:531–534 [CrossRef][PubMed]
    [Google Scholar]
  22. Alexander CL, Cottom L, Smith K, Perrow K, Coyne M et al. Schistosomiasis in Scottish travellers: public health importance of laboratory testing and the need for enhanced surveillance. J Public Health 2017;14:1–8 [CrossRef][PubMed]
    [Google Scholar]
  23. Health Protection Scotland.. Establishment of the Scottish Schistosomiasis National Advice, Investigation and Liaison Group (SNAIL). Glasgow:: Health Protection Scotland;; 2016.;www.hps.scot.nhs.uk/travel/wrdetail.aspx?id=71400&wrtype=9
    [Google Scholar]
http://instance.metastore.ingenta.com/content/journal/jmmcr/10.1099/jmmcr.0.005141
Loading
/content/journal/jmmcr/10.1099/jmmcr.0.005141
Loading

Data & Media loading...

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error