Bilharzia B65.90

Tropical disease caused by infection with schistosomes (couple's flukes), in which untreated egg deposition in multiple organs occurs with subsequent granulomatous-fibrotic connective tissue reaction. Duration of parasitosis up to 20 years.

• S. haematobium: Africa, Middle East.
• S. mansoni: Africa, Arabian Peninsula, South America (northern states), scattered in the Caribbean (eastern Caribbean).
• S. intercalatum: West Africa.
• S. japonicum: China, Philippines, Indonesia, only sporadically in Japan.
• S. mekongi: Laos, Cambodia, Thailand.

• Itchy, urticarial, papular exanthema at the entry points of the cercaria (cercarial dermatitis).
• Acute phase: migration of the cercaria into the mesenteric vessels: fever, diarrhoea, nausea, urticaria and development of oedema.
• Chronic phase: the worm eggs get stuck in small vessels. Inflammatory reaction of the surrounding tissues: Small connective tissue nodules and papular growths and granulomas, especially in the anal and genital region. Also on vulva, vagina and cervix (sandy patches). The local proliferative tissue reactions are caused by the release of proteolytic enzymes by the schistosoma eggs.
• Chronic bladder, bowel, lung and brain bilharzia.
• Carcinomatous growths are possible: liver, bladder, rectal cancer.

• Praziquantel (e.g. Biltricide Filmtbl.) 40 mg/kg bw as single dose, for S. japonicum 3 doses with 20 mg/kg bw. Cure rate 70%; if vital eggs are found during urine control or biopsy, repeat treatment.
• Alternatively: In case of infection with S. mansoni oxamniquin 15-30 mg/kg bw p.o. over 1-2 days, in case of infection with S. haematobium 7.5-10 mg/kg bw with a total of 3 single doses at intervals of 2 weeks each.

• In each endemic area avoid contact with fresh water from natural or artificial sources (bathing, wading, washing, drinking).
• Basic prophylaxis: destruction of snails, change of irrigation methods.

A 32-year-old female Caucasian patient developed itchy papular and plaque-like changes in the vulva for 6 months. She reported an earlier itchy papular exanthema on the trunk and lower extremity. This had occurred after a bathing stay at several Malian lakes 2 years earlier. This had subsided after a while.

Findings: In the region of the labia minora and labia majora, red papules and plaques about 0.4-0.5 cm in size, disseminated and aggregated.

Clinical diagnosis: Condylomata acuminata.

Laboratory: conspicuous eosinophilia (14%).

Histology: eosinophilic and plasma cell-rich infiltrate with epithelial cell granulomas and Schistomosoma eggs.

Urinalysis: detection of large amounts of Schistosoma haematobium eggs (evidence of bilharzia of the urinary bladder).

Ultrasound of the urinary bladder: o.B.

Therapy: ED of 3g praziquantel p.o. Surgical removal of the "condyloma-like" papules.

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