DPDoctor's PassportEducation
Infectious diseases, microbiology and sexual health indexPassport
Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
Textbook/Infectious diseases, microbiology and sexual health/Schistosomiasis/Rapid
RapidMLAMSRAFoundation

Schistosomiasis

Essential points for quick revision.

2 min synopsisUK scopeSources checked 27 Aug 2026Clinical review pending
!
Neurological schistosomiasis

New limb weakness, sensory loss, sphincter disturbance, severe radicular pain, seizure, focal deficit or encephalopathy after freshwater exposure may reflect egg-associated spinal cord or cerebral inflammation.

Action: Arrange emergency neurological assessment and MRI, involve tropical infection and neurology, begin specialist-directed corticosteroid treatment when inflammatory neuroschistosomiasis is suspected, and coordinate praziquantel timing rather than waiting for eggs to be found.

Synopsis

Recognise acute and chronic schistosomiasis after freshwater exposure, choose time- and species-appropriate tests, treat mature infection safely, and identify neurological, portal and urogenital complications.

  • Schistosome cercariae penetrate intact skin during contact with contaminated freshwater containing infected snails; properly chlorinated pools and seawater do not transmit infection.
  • An itchy cercarial rash can occur within days, while Katayama fever with urticaria, cough, diarrhoea and eosinophilia usually appears weeks later during early egg production.
  • S. haematobium causes urogenital disease with terminal haematuria, bladder and ureteric fibrosis and squamous-cell bladder-cancer risk; S. mansoni and S. japonicum cause intestinal and hepatosplenic disease.

Key red flags

Acute weakness, saddle sensory change, urinary retention or incontinence after endemic freshwater contact requires emergency spinal imaging and specialist treatment.

Katayama syndrome

Fever, chills, urticaria, cough, myalgia, abdominal pain or diarrhoea with eosinophilia several weeks after first heavy exposure reflects systemic immune-complex disease.

Investigation priorities

01
First-line exposure and eosinophil assessmentFirst stepFirst line

Establish whether schistosomiasis is plausible and identify systemic or organ injury.

Management branches

SCREENEvaluate freshwater exposure

A traveller or migrant reports skin contact with untreated freshwater in a schistosomiasis-risk region.

  1. Record the country, water body, exposure date and duration, then ask about rash, fever, cough, bowel, urinary, genital and neurological symptoms.
  2. Request FBC with eosinophils and plan serology after the appropriate post-exposure interval; symptomatic or eosinophilic patients need earlier specialist assessment.

Key medicines

Praziquantel for S. haematobium or S. mansoniGive a total of 40 mg/kg orally with food over one day, commonly divided as 20 mg/kg followed by 20 mg/kg four to six hours later.
Praziquantel for S. japonicum or S. mekongiUse a specialist-confirmed total of 60 mg/kg orally with food over one day, divided into two or three doses separated by approximately four to six hours.
Open full textbook →Answer 2 questions
Sources and review status5 sources · checked 27 Aug 2026 · clinical review pending
Sources

Sources and review status

National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.

Authoring stateRapid draftClinical stateAwaiting reviewJurisdictionUnited Kingdom