Case history
Case history #1
A 45-year-old man raised in Tanzania presents to his local physician with a long history of vague abdominal pain and occasional diarrhea accompanied by frank blood. He states that he is often fatigued and may have lost weight recently. He settled in the US 5 years ago. Physical exam shows mild hepatomegaly and a palpable spleen tip, and occult blood is detected in a stool sample.
Case history #2
A 19-year-old woman visiting the US from Ghana presents with lower abdominal pain and an intermittent history of vaginal discomfort. Examination reveals minimal vaginal discharge and a cervical ulcer.
Other presentations
The presentation of schistosomiasis varies according to the stage of infection. On initial entry of cercariae into skin, there may be a transient pruritic cercarial dermatitis (swimmer's itch). Acute schistosomiasis (Katayama syndrome) may occur several weeks after exposure. Its symptoms are nonspecific, including fever, fatigue, cough, abdominal pain, diarrhea, and transient hepatosplenomegaly. Once established, chronic schistosomiasis causes granulomatous inflammation and fibrosis in areas of the body where mature worms localize. Intestinal schistosomiasis caused by Schistosoma mansoni and S japonicum may result in portal hypertension with esophageal varices and splenomegaly. S mansoni is also associated with colonic polyposis and intermittent bloody diarrhea. Urinary schistosomiasis caused by S haematobium results in cystitis (with ulceration and hematuria) and can later progress to obstructive uropathy, pelvic inflammatory disease, or bladder cancer. With aberrant migration of Schistosoma parasites, ectopic eggs in the CNS can result in cerebral lesions or in spinal transverse myelitis or radiculitis.
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