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Today, 22 March 2010

Yesterday, 21 March 2010

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Question

Please may I have some information about bilharzia? My son has just been diagnosed with this disease from a urine test. We live in Midrand and he has not been near a river to my knowledge in the last few months. Where could he have caught this?

Answer

Bilharzia, also called schistosomiasis, is endemic in Africa, meaning that the disease is always present. It can be found in most areas of southern Africa, so your son must have been exposed through a local body of water somewhere.

Bilharzia is caused by a parasite called a trematode. The species which is most common in Africa is Schistosoma haematobium Freshwater snails are the intermediate host and people are infected after swimming in water in which the eggs and larvae of the trematode are present. The larvae which have entered the person then migrate to the blood system of the liver where they mature in one to three months. Adult worms then migrate from the liver and lodge in the small blood vessels of the bladder or intestines.

An infected person often notices an itchy patch where the trematode larva has entered the skin. As the adult worm develops in the liver, the person experiences fever, skin itching and enlargement of the liver and spleen. If the disease is not treated, the worms migrate to the whole body, causing major problems in other organs. Inflammation around the eggs in the liver's blood supply can also result in problems.

Diagnosis is by examining the urine for eggs in the case of S. haematobium. Signs of the parasite can also be seen in a bladder biopsy. If living eggs are found, then treatment should be started. Blood tests which demonstrate exposure to the parasite are not usually regarded as sufficient for starting treatment.

The treatment is with praziquantel.

Patients should be re-examined for the presence of living eggs three and six months after treatment and re-treated if they are found.