A 35-year-old female presents to your emergency department complaining of fever, malaise, myalgias, headache and an urticarial rash. Her physical exam reveals a papular rash and hepatosplenomegaly. You also find out that she traveled to Sudan 6 weeks earlier. She stayed mostly in Kharotum, but while there, she swam in the Nile. You send a smear for malaria, which is negative. What other major parasite should you consider?
Diagnosis:
Schistosomiasis, also know as bilharzia, is a disease caused by parasitic worms.
While not found in the US, it impacts more than 200 million people globally, and is second only to malaria as a major parasitic infection.
Discussion:
While the acute presentation is generally non-specific, chronic complications may be more serious. Many organ systems can be impacted and symptoms of chronic infection can include liver dysfunction, including portal hypertension and esophageal varacies or hematuria and renal failure.
Treatment:
Treatment is a one-day course of Praziquantel but must be initiated 6-8 weeks after infection. (It's most effective against the adult worm so timing is key!)
Bottom Line:
Consider a broader differential in travelers. There are many infectious killers that can be easily treated.
University of Maryland Section of Global Emergency Health
