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Infection occurs when skin comes in contact with contaminated freshwater in which certain types of snails that carry the parasite are living. Freshwater becomes contaminated by schistosome eggs when infected people urinate or defecate in the water. The eggs hatch, and if the appropriate species of snails are present in the water, the parasites infect, develop and multiply inside the snails. The parasite leaves the snail and enters the water where it can survive for about 48 hours. Larval schistosomes (cercariae) can penetrate the skin of persons who come in contact with contaminated freshwater, typically when wading, swimming, bathing, or washing. Over several weeks, the parasites migrate through host tissue and develop into adult worms inside the blood vessels of the body. Once mature, the worms mate and females produce eggs. Some of these eggs travel to the bladder or intestine and are passed into the urine or stool.

Symptoms of schistosomiasis are caused not by the worms themselves but by the body’s reaction to the eggs. Eggs shed by the adult worms that do not pass out of the body can become lodged in the intestine 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, spleen, lungs, and bladder.
Common Symptoms

Most people have no symptoms when they are first infected. However, within days after becoming infected, they may develop a rash or itchy skin. Within 1-2 months of infection, symptoms may develop including fever, chills, cough, and muscle aches.
Chronic schistosomiasis

Without treatment, schistosomiasis can persist for years. Signs and symptoms of chronic schistosomiasis include: abdominal pain, enlarged liver, blood in the stool or blood in the urine, and problems passing urine. Chronic infection can also lead to increased risk of liver fibrosis or bladder cancer.
Epidemiology & Risk Factors

Schistosomiasis is an important cause of disease in many parts of the world, most commonly in places with poor sanitation. School-age children who live in these areas are often most at risk because they tend to spend time swimming or bathing in water containing infectious cercariae.
If you live in, or travel to, areas where schistosomiasis is found and are exposed to contaminated freshwater, you are at risk.

Areas where human schistosomiasis is found include:

Schistosoma mansoni
Distributed throughout Africa: There is risk of infection in freshwater in southern and sub-Saharan Africa–including the great lakes and rivers as well as smaller bodies of water. Transmission also occurs in the Nile River valley in Sudan and Egypt.
South America: Including Brazil, Suriname, and Venezuela.
S. haematobium
Distributed throughout Africa: There is risk of infection in freshwater in southern and sub-Saharan Africa–including the great lakes and rivers as well as smaller bodies of water. Transmission also occurs in the Nile River valley in Egypt and the Mahgreb region of North Africa.
Found in areas of the Middle East.
A recent focus of ongoing transmission has been identified in Corsica.
Diagnosis

Stool or urine samples can be examined microscopically for parasite eggs (stool for S. mansoni or S. japonicum eggs and urine for S. haematobium eggs). The eggs tend to be passed intermittently and in small amounts and may not be detected, so it may be necessary to perform a blood (serologic) test.
Safe and effective medication is available for treatment of both urinary and intestinal schistosomiasis. Praziquantel, a prescription medication, is taken for 1-2 days to treat infections caused by all schistosome species.

Page last reviewed: June 22, 2018
Content source: Global Health, Division of Parasitic Diseases
Schistosomiasis

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