Approach
Clinicians who are unfamiliar with the treatment of schistosomiasis should consult an infectious disease or topical medicine specialist. Treatment should be guided by the infecting Schistosoma species and the disease stage and severity.
Standard treatment should be followed for acute and chronic infection for individuals who are immunosuppressed. Treatment in individuals with HIV and documented schistosomiasis infection may have a favourable effect on CD4 counts.[70]
Cercarial dermatitis (several days after exposure)
Skin rash (cercarial dermatitis) often resolves in a few days and may not need to be treated. Severe cercarial dermatitis can be treated with topical corticosteroids. Pruritus can be controlled with oral antihistamines, cool compresses, and calamine lotion.[37]
Acute schistosomiasis (several weeks or months after exposure)
Acute infection typically occurs 4 to 8 weeks after exposure (commonly with S mansoni and S japonicum). Symptoms are the result of hypersensitivity to migrating larvae and early egg deposition. Chronic diarrhoea may occur with inflammation of the bowel wall due to migrating larvae during acute disease.[19][38][55]
Praziquantel, an antiparasitic drug, is the treatment of choice for infection caused by all major Schistosoma species. People across all age groups benefit significantly from treatment with praziquantel to cure infection, reduce worm burden, and reduce other schistosomiasis-related morbidities.[6][71]
The World Health Organization (WHO) recommends praziquantel in all infected people regardless of age including adults, pregnant women after the first trimester, breastfeeding women, and preschool-aged children ≥2 years of age.[6]
Data is limited in the first trimester of pregnancy. Available studies did not find any major safety events (including fetal outcomes); however, the number of women in the first trimester of pregnancy included in the data was low.
Data is limited in children <2 years of age. The decision to administer praziquantel to children <2 years of age should be based on testing and clinical judgment. Specific paediatric formulations of praziquantel are in development. If paediatric formulations are not available, the tablet may be crushed in soft food.
Praziquantel is most effective against adult forms of the parasite. It requires an immune response to the adult worm to be fully effective. A single dose is usually curative; however, repeat treatment may be needed in some patients in order to improve efficacy.[71] A systematic review and meta-analysis found that a single dose of praziquantel had an 89.8% cure rate for the treatment of human schistosomiasis in Ethiopia.[72]
Treatment with praziquantel is well tolerated across all age groups with only transient, mild, adverse effects (e.g., headache, dizziness, abdominal pain). People with high-intensity infections may have a higher incidence of mild adverse effects. The overall certainty for the safety of praziquantel for the treatment of schistosomiasis in at-risk populations is moderate.[6]
Additional treatment with a corticosteroid is warranted to reduce symptoms of inflammation. Corticosteroids reduce immunological reaction severity and are given until the worst symptoms resolve.[57]
If symptoms persist following treatment with a corticosteroid and praziquantel, further work-up by a gastroenterology specialist should be pursued.
Chronic schistosomiasis (years after exposure)
In chronic disease, most symptoms result from the host immune response to Schistosoma eggs. Chronic diarrhoea may occur with inflammation of the bowel wall due to egg deposition.[19][38][55] Treating schistosomiasis can diminish or even reverse the complications of infection, particularly in children.[73][74]
Praziquantel is the treatment of choice for infection caused by all major Schistosoma species (see Acute schistosomiasis [several weeks or months after exposure]). Treatment with praziquantel is usually effective, but if symptoms persist, further work-up by a gastroenterology specialist should be pursued.
Additional therapies focus on relieving symptoms, and advanced late complications often require specialised assistance from urological, gastrointestinal, gynaecological, cardiac, hepatic, and pulmonary consultants.
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