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Diagnosis and management of schistosomiasis

2011; BMJ; Volume: 342; Issue: may17 1 Linguagem: Inglês

10.1136/bmj.d2651

0959-8138

Darren J. Gray, Allen G. Ross, Yuesheng S. Li, Donald P. McManus,

Global Health and Surgery

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. 3Meta-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. 4w1 5 Figure 1 shows the proposed pathway of schistosomiasis associated disease and disability derived from meta-analyses of disability-related outcomes. 4histosome transmission requires contamination of water by faeces or urine containing eggs, a specific freshwater snail as intermediate host, and human contact with water inhabited by the intermediate host snail. 1 2 Schistosomiasis transmission is highly dependent on environmental conditions, particularly those affecting the snail host.Climate change will alter aquatic environments and subsequently the transmission and distribution of waterborne diseases.6w2In this review, we introduce the schistosome parasites and describe the pathophysiology and the clinical disease they cause.We discuss current diagnostic tools and the management of schistosomiasis, based on evidence from studies of both high and lower quality as well as information from current international guidelines. What are the clinical features of schistosomiasis?Schistosomiasis progresses in three distinct phases: acute, chronic, and advanced disease.