Schistosomiasis (Bilharzia)

Schistosomiasis, also known as bilharzia, is a disease caused by parasitic worms. Infection with Schistosoma mansoni, S. haematobium, and S. japonicum causes illness in humans; less commonly, S. mekongi and S. intercalatum can cause disease. Although the worms that cause schistosomiasis are not found in the United States, more than 200 million people are infected worldwide.

Infection occurs when your skin comes in contact with contaminated freshwater in which certain types of snails that carry schistosomes are living.

Freshwater becomes contaminated by Schistosoma eggs when infected people urinate or defecate in the water. The eggs hatch, and if certain types of freshwater snails are present in the water, the parasites develop and multiply inside the snails. The parasite leaves the snail and enters the water where it can survive for about 48 hours. Schistosoma parasites can penetrate the skin of persons who are wading, swimming, bathing, or washing in contaminated water. Within several weeks, the parasites mature into adult worms and live in the blood vessels of the body where the females produce eggs. Some of the eggs travel to the bladder or intestine and are passed into the urine or stool.

Within days after becoming infected, you may develop a rash or itchy skin. Fever, chills, cough, and muscle aches can begin within 1-2 months of infection. Most people have no symptoms at this early phase of infection.

When adult worms are present, the eggs that are produced usually travel to the intestine, liver or bladder, causing inflammation or scarring. Children who are repeatedly infected can develop anemia, malnutrition, and learning difficulties. After years of infection, the parasite can also damage the liver, intestine, lungs, and bladder. Rarely, eggs are found in the brain or spinal cord and can cause seizures, paralysis, or spinal cord inflammation.

Symptoms of schistosomiasis are caused by the body's reaction to the eggs produced by worms, not by the worms themselves.

See your health care provider. If you have traveled to countries where schistosomiasis is found and had contact with freshwater, describe in detail where and for how long you traveled. Explain that you may have been exposed to contaminated water.

Your health care provider may ask you to provide stool or urine samples to see if you have the parasite. A blood sample can also be tested for evidence of infection. For accurate results, you must wait 6-8 weeks after your last exposure to contaminated water before samples are taken.

Safe and effective drugs are available for the treatment of schistosomiasis. Praziquantel is the recommended treatment drug. See your doctor for appropriate diagnosis and treatment.

If you live in or travel to areas where schistosomiasis occurs and your skin comes in contact with freshwater from canals, rivers, streams, ponds, or lakes, you are at risk of getting schistosomiasis.

• Africa: contact with any freshwater in southern and sub-Saharan Africa -- including the great lakes and rivers as well as smaller bodies of water -- should be considered a risk for schistosomiasis transmission. Transmission also occurs in the Mahgreb region of North Africa and the Nile River valley in Egypt and Sudan.
• South America: Brazil, Suriname, Venezuela
• Caribbean: Dominican Republic, Guadeloupe, Martinique, Saint Lucia (risk in Caribbean is very low)
• The Middle East: Iran, Iraq, Saudi Arabia, Yemen Southern China
• Parts of Southeast Asia and the Philippines, Laos
• A recent focus of ongoing transmission has been identified in Corsica.

• Avoid swimming or wading in freshwater when you are in countries in which schistosomiasis occurs. Swimming in the ocean and in chlorinated swimming pools is safe.
• Drink safe water. Although schistosomiasis is not transmitted by swallowing contaminated water, if your mouth or lips come in contact with water containing the parasites, you could become infected. Because water coming directly from canals, lakes, rivers, streams, or springs may be contaminated with a variety of infectious organisms, you should either boil water for 1 minute or filter water before drinking it. Boiling water for at least 1 minute will kill any harmful parasites, bacteria, or viruses present. Iodine treatment alone will not guarantee that water is safe and free of all parasites.
• Bath water should be heated to a rolling boil for at least 1 minute. Water held in a storage tank for at least 1-2 days should be safe for bathing.
• Vigorous towel drying after an accidental, very brief water exposure may help to prevent the Schistosoma parasite from penetrating the skin. However, you should not rely on vigorous towel drying to prevent schistosomiasis.