Acute schistosomiasis: clinical, diagnostic and therapeutic features

Lambertucci, J. R.

doi:10.1590/S0036-46651993000500003

Abstracts

Three distinct syndromes caused by schistosomiasis have been described: cercarial dermatitis or swimmer's itch, acute schistosomiasis or Katayama fever, and chronic schistosomiasis. Complications of acute schistosomiasis have also been reported. The absence of a serological marker for the acute stage has hindered early diagnosis and treatment. Recently, an ELISA test using KLH (keyhole limpet haemocyanin) as antigen, has proved useful in differentiating acute from chronic schistosomiasis mansoni. Clinical and experimental evidence indicate that steroids act synergistically with schistosomicides in the treatment of Katayama syndrome. In this paper, clinical, diagnostic and therapeutic features of acute schistosomiasis are updated.

Acute schistosomiasis; Oxamniquine; Praziquantel; Corticosteroids

A esquistossomose apresenta-se clinicamente em três formas distintas: dermatite cercariana, esquistossomose aguda ou febre de Katayama e esquistossomose crônica. Há na literatura relatos de complicações da fase aguda. A ausencia de um marcador sorológico simples e confiável tem dificultado o diagnóstico precoce e, como consequência, o tratamento adequado de pacientes na fase aguda da doença. Recentemente, o teste de ELISA, realizado com o antígeno KLM (hemocianina do caramujo Megathura crenulata), tem se mostrado util na identificação dos pacientes com febre de Katayama. Evidências clínicas e experimentais apontam no sentido de uma ação sinérgica entre os corticosteróides e os esquistossomicidas no tratamento da esquistossomose toxêmica. Neste artigo, alguns aspectos clínicos, diagnósticos e terapêuticos da esquistossomose aguda são atualizados.

ORIGINAL ARTICLES

Acute schistosomiasis: clinical, diagnostic and therapeutic features

Esquistossomose aguda: aspectos clínicos, diagnósticos e terapêuticos

J. R. Lambertucci

^{Address for correspondence} Address for correspondence: Prof. J. R. Lambertucci Department of Internal Medicine, Federal University of Minas Gerais 30.130-100 Belo Horizonte, MG, Brazil

SUMMARY

Three distinct syndromes caused by schistosomiasis have been described: cercarial dermatitis or swimmer's itch, acute schistosomiasis or Katayama fever, and chronic schistosomiasis. Complications of acute schistosomiasis have also been reported. The absence of a serological marker for the acute stage has hindered early diagnosis and treatment. Recently, an ELISA test using KLH (keyhole limpet haemocyanin) as antigen, has proved useful in differentiating acute from chronic schistosomiasis mansoni. Clinical and experimental evidence indicate that steroids act synergistically with schistosomicides in the treatment of Katayama syndrome. In this paper, clinical, diagnostic and therapeutic features of acute schistosomiasis are updated.

Key words: Acute schistosomiasis; Oxamniquine; Praziquantel; Corticosteroids.

RESUMO

A esquistossomose apresenta-se clinicamente em três formas distintas: dermatite cercariana, esquistossomose aguda ou febre de Katayama e esquistossomose crônica. Há na literatura relatos de complicações da fase aguda. A ausencia de um marcador sorológico simples e confiável tem dificultado o diagnóstico precoce e, como consequência, o tratamento adequado de pacientes na fase aguda da doença. Recentemente, o teste de ELISA, realizado com o antígeno KLM (hemocianina do caramujo Megathura crenulata), tem se mostrado util na identificação dos pacientes com febre de Katayama. Evidências clínicas e experimentais apontam no sentido de uma ação sinérgica entre os corticosteróides e os esquistossomicidas no tratamento da esquistossomose toxêmica. Neste artigo, alguns aspectos clínicos, diagnósticos e terapêuticos da esquistossomose aguda são atualizados.

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ACKNOWLEDGEMENT

This article was adapted from a background paper, "Hospital-based treatment of acute schistosomiasis", prepared by request for the WHO Expert Committee on the Control of Schistosomiasis (Geneva, November, 1991), and was made possible by a grant from CNPq-Brasil.

Recebido para publicação em 2/10/1992.

Aceito para publicação em 5/03/1993.

1. ALVES-BRITO, C.F.; SIMPSON, A.J.G.; BAHIA-OLIVEIRA, L.M.G.; RABELLO, A.L.T.; ROCHA, R.S.; LAMBERTUCCI, J.R.; GAZZINELLI, G.; KATZ, N. & CORREA-OLIVEIRA, R. - Analysis of anti-keyhole limpet haemocyanin antibody in Brazilians supports its use for the diagnosis of acute schistosomiasis mansoni. Trans. roy. Soc. trop. Med. Hyg., 86: 53-56, 1992.
2. AMER, M. - Cutaneous schistosomiasis. Int. J. Derm., 21: 44-46, 1982.
3. ANDRADE, Z.A.; ANDRADE, S.G. & PEREIRA, L. - Influence of ACTH and DOCA on the lesions of experimental schistosomiasis. Bol. Fund. G. Moniz, 5: 1-10, 1955.
4. ANDRADE, Z.A. & AZEVEDO, T.M. - Treatment of acute experimental schistosomiasis. Mem. Inst. Oswaldo Cruz, 84: 477-484, 1989.
5. BOGLIOLO, L. - Subsídios para o estudo da anatomia patológica da forma aguda toxęmica da esquistossomose mansônica. Belo Horizonte, 1958. (Tese de Doutoramento da Faculdade de Medicina da Universidade Federal de Minas Gerais).
6. BOGLIOLO, L. & NEVES, J. - Ocorręncia da hepatite na forma aguda da esquistossomose mansoni, antes da maturaçăo dos vermes e da postura dos ovos. An. Fac. Med. Minas Gerais, 2: 47-74, 1965.
7. CHAPMAN, P.J.C.; WILKINSON, P.R. & DAVIDSON, R.N. - Acute schistosomiasis among British air crew. Brit. med. J., 297: 1098-1101, 1989.
8. CHEN, M.G. & MOTT, K.E. - Progress in assessment of morbidity due to Schistosoma japonicum infection. Trop. Dis. Bull., 85: R1-R45, 1988.
9. DIAZ-RIVERA, R.S.; RAMOS-MORALES, F.; KOPPISH, E.; GARCIA-PALMIERI, M.R.; CINTRON-RIVERA, A.A.; MARCHAND, E.J.; GONZALEZ, O. & TORREGROSSA, M.V. - Acute Manson's Schistosomiasis. Amer. J. Med., 21: 918-943, 1956.
10. EFTHIMIOU, J. & DENNING, D. - Spinal cord disease due to Schistosoma mansoni successfully treated with oxamniquine. Brit. med. J., 288: 1343-1344, 1984.
11. EVANS, A.C.; MARTIN, D.J. & GINSBURG, B.D. - Katayama fever in scuba divers: a report of 3 cases. S. Afr. med. J., 79: 271-274, 1991.
12. FARID, Z.; WOODY, J. & KAMAL, M. - Praziquantel and acute urban schistosomiasis. Trop. geogr. Med., 41: 172, 1989.
13. GAZZINELLI, G.; LAMBERTUCCI, J.R.; KATZ, N.; ROCHA, R.S.; LIMA, D.P. & COLLEY, D.G. - Immune responses during human schistosomiasis mansoni. XI. Immunologic status of patients with acute infections and after treatment. J. Immunol., 135: 2121-2127, 1985.
14. GRZYCH, J.M.; DISSOUS, C.; CAPRON, M.; TORRES, S.; LAMBERT, P.H. & CAPRON, A. - Schistosoma mansoni shares a protective carbohydrate epitope with keyhole limpet haemo-cyanin. J. exp. Med., 165: 865-878, 1987.
15. HARIBHAI, H.C.; BHIGJEE, A.I.; BILL, P.L.A.; PAMMENTER, M.D.; MODI, G.; HOFFMAN, M.; KELBE, C. & BECKER, P. - Spinal cord schistosomiasis: a clinical, laboratory and radiological study, with a note on therapeutic aspects. Brain, 114: 709-726, 1991.
16. HARRIES, A.D. & COOK, G.C. - Acute schistosomiasis (Katayama fever): clinical deterioration after chemotherapy. J. Infect., 14: 159-161, 1987.
17. KANAMURA, H.Y.; HOSHINO-SHIMIZU, S.; CAMARGO, M.E. & SILVA, L.C. - Class specific antibodies and fluorescent staining patterns in acute and chronic schistosomiasis. Amer. J. trop. Med. Hyg., 28: 242-248, 1979.
18. KATZ, N. & BITTENCOURT, D. - Sobre um provável caso de forma toxęmica no decurso da forma hepatoesplęnica da esquistossomose mansônica. Hospital (Rio de J.), 67: 847-858, 1965.
19. KATZ, N.; ROCHA, R.S.; LAMBERTUCCI, J.R.; GRECO, D.B.; PEDROSO, E.R.P.; ROCHA, M.O.C. & FLAN, S. - Clinical trial with oxamniquine and praziquantel in the acute and chronic phases of schistosomiasis mansoni. Rev. Inst. Med. trop. S. Paulo, 25: 173-177, 1983.
20. KING, C.H. - Acute and chronic Schistosomiasis. Hosp. Pract., 26: 117-130, 1991.
21. KIRCHOFF, L.V. & NASH, T.E. - A case of schistosomiasis japonica: resolution of CAT scan detected cerebral abnormalities without specific therapy. Amer. J. trop. Med. Hyg., 33: 1155-1158, 1984.
22. LAMBERTUCCI, J.R. - Treatment of the acute (toxaemic) phase of schistosomiasis mansoni. Trans. roy. Soc. trop. Med. Hyg., 82: 350-351, 1988.
23. LAMBERTUCCI, J.R. - A new approach to the treatment of acute schistosomiasis. Mem. Inst. Oswaldo Cruz, 84 (suppl. 1): 23-30, 1989.
24. LAMBERTUCCI, J.R.; MODHA, J.; CURTIS, R. & DOENHOFF, M. - The association of steroids and schistosomicides in the treatment of experimental schistosomiasis. Trans. roy. Soc. trop. Med. Hyg., 83: 354-357, 1989.
25. LAMBERTUCCI, J.R.; GRECO, D.B.; PEDROSO, E.R.P.; ROCHA, M.O.C.; SALAZAR, H.M. & LIMA, D.P. - A double blind trial with oxamniquine in chronic schistosomiasis mansoni. Trans. roy. Soc. trop. Med. Hyg., 76: 751-755, 1982.
26. LAMBERTUCCI, J.R.; TEIXEIRA, R.; NAVARRO, M.M.M.; COELHO, P.M.Z. & FERREIRA, M.D. - Liver abscess and schistosomiasis. A new association. Rev. Soc. bras. Med. trop., 23: 239-240, 1990.
27. LAWLEY, T.J.; OTTENSEN, E.A.; HIATT, R.A. & GAZZE, L.A. - Circulating immune complexes in acute schistosomiasis. Clin. exp. Immunol., 37: 221-227, 1979.
28. MANSOUR, M.M.; OMER, A.P.; FARID, Z.; SIMPSON, A.J.G. & WOODY, J.W.; - Serological differentiation of acute and chronic schistosomiasis mansoni by antibody responses to keyhole limpet haemocyanin. Amer. J. trop. Med. Hyg., 41: 338-344, 1989.
29. MATTOCIA, L.P. & CIOLI, D. - Studies on the mode of action of oxamniquine and related schistosomicidal drugs. Amer. J. trop. Med. Hyg., 34: 112-118, 1985.
30. MOHAMED, A.S. - A fatal case of massive bilharzia mansoni infection (acute fatal Egyptian splenomegaly). J. Egypt. med. Ass., 19: 749-762, 1955.
31. NASH, T.E.; GARCIA-GOYCO, C.; RUIZ-TIBEN, E.; NAZARIO-LOPEZ, H.A.; VAZQUEZ, G. & TORRES-BORGES, A. - Differentiation of acute and chronic schistosomiasis by antibody responses to specific schistomose antigens. Amer. J. trop. Med. Hyg., 32: 776-784, 1983.
32. PINTO DA SILVA, R.A. & LAMBERTUCCI, J.R. - O valor da ultrassonografia no diagnóstico da esquistossomose hepatoesplęnica. An. Fac. Med. Minas Gerais, 35: 28-38, 1986.
33. PITELLA, J.E.H. - The relation between involvement of the central nervous system in schistosomiasis and the clinical forms of the parasitosis. A review. J. trop. Med. Hyg., 94: 15-21, 1991.
34. RASO, P. & NEVES, J. - Contribuiçăo ao estudo da açăo dos corticoďdes na forma toxęmica da esquistossomose humana. An. Fac. Med. Minas Gerais, 22: 167-180, 1965.
35. SABAH, A.A.; FLETCHER, C.; WEBBE, G. & DOENHOFF, M. - Schistosoma mansoni: chemotherapy of infections of different ages. Exp. Parasit., 61: 294-303, 1986.
36. WATT, G.; LONG, G.L.U.; RANOA, C.P.; ADAPON, B.; FERNANDO, M. & CROSS, J.H. - Praziquantel in the treatment of cerebral schistosomiasis. Lancet, 2: 529-532, 1986.
37. WEBBE, G. - Treatment of schistosomiasis. Europ. J. Pharmacol., 32: 433,1987.
38. YI-SHENG, W.; KUO-CHU, C.; CHENG-WEI, S.; PO-CHUNG, L.; FONG, Y. & CITUAN-JUNG, S. - Treatment of acute schistosomiasis. An analysis of 545 cases. Chin. med. J., 79: 458-459, 1959.

Address for correspondence:

Prof. J. R. Lambertucci

Department of Internal Medicine, Federal University of Minas Gerais

30.130-100 Belo Horizonte, MG, Brazil

Publication Dates

Publication in this collection
04 July 2006
Date of issue
Oct 1993

History

Received
02 Oct 1992
Accepted
05 Mar 1993

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. ALVES-BRITO, C.F.; SIMPSON, A.J.G.; BAHIA-OLIVEIRA, L.M.G.; RABELLO, A.L.T.; ROCHA, R.S.; LAMBERTUCCI, J.R.; GAZZINELLI, G.; KATZ, N. & CORREA-OLIVEIRA, R. - Analysis of anti-keyhole limpet haemocyanin antibody in Brazilians supports its use for the diagnosis of acute schistosomiasis mansoni. Trans. roy. Soc. trop. Med. Hyg., 86: 53-56, 1992.

[2] 2. AMER, M. - Cutaneous schistosomiasis. Int. J. Derm., 21: 44-46, 1982.

[3] 3. ANDRADE, Z.A.; ANDRADE, S.G. & PEREIRA, L. - Influence of ACTH and DOCA on the lesions of experimental schistosomiasis. Bol. Fund. G. Moniz, 5: 1-10, 1955.

[4] 4. ANDRADE, Z.A. & AZEVEDO, T.M. - Treatment of acute experimental schistosomiasis. Mem. Inst. Oswaldo Cruz, 84: 477-484, 1989.

[5] 5. BOGLIOLO, L. - Subsídios para o estudo da anatomia patológica da forma aguda toxęmica da esquistossomose mansônica. Belo Horizonte, 1958. (Tese de Doutoramento da Faculdade de Medicina da Universidade Federal de Minas Gerais).

[6] 6. BOGLIOLO, L. & NEVES, J. - Ocorręncia da hepatite na forma aguda da esquistossomose mansoni, antes da maturaçăo dos vermes e da postura dos ovos. An. Fac. Med. Minas Gerais, 2: 47-74, 1965.

[7] 7. CHAPMAN, P.J.C.; WILKINSON, P.R. & DAVIDSON, R.N. - Acute schistosomiasis among British air crew. Brit. med. J., 297: 1098-1101, 1989.

[8] 8. CHEN, M.G. & MOTT, K.E. - Progress in assessment of morbidity due to Schistosoma japonicum infection. Trop. Dis. Bull., 85: R1-R45, 1988.

[9] 9. DIAZ-RIVERA, R.S.; RAMOS-MORALES, F.; KOPPISH, E.; GARCIA-PALMIERI, M.R.; CINTRON-RIVERA, A.A.; MARCHAND, E.J.; GONZALEZ, O. & TORREGROSSA, M.V. - Acute Manson's Schistosomiasis. Amer. J. Med., 21: 918-943, 1956.

[10] 10. EFTHIMIOU, J. & DENNING, D. - Spinal cord disease due to Schistosoma mansoni successfully treated with oxamniquine. Brit. med. J., 288: 1343-1344, 1984.

[11] 11. EVANS, A.C.; MARTIN, D.J. & GINSBURG, B.D. - Katayama fever in scuba divers: a report of 3 cases. S. Afr. med. J., 79: 271-274, 1991.

[12] 12. FARID, Z.; WOODY, J. & KAMAL, M. - Praziquantel and acute urban schistosomiasis. Trop. geogr. Med., 41: 172, 1989.

[13] 13. GAZZINELLI, G.; LAMBERTUCCI, J.R.; KATZ, N.; ROCHA, R.S.; LIMA, D.P. & COLLEY, D.G. - Immune responses during human schistosomiasis mansoni. XI. Immunologic status of patients with acute infections and after treatment. J. Immunol., 135: 2121-2127, 1985.

[14] 14. GRZYCH, J.M.; DISSOUS, C.; CAPRON, M.; TORRES, S.; LAMBERT, P.H. & CAPRON, A. - Schistosoma mansoni shares a protective carbohydrate epitope with keyhole limpet haemo-cyanin. J. exp. Med., 165: 865-878, 1987.

[15] 15. HARIBHAI, H.C.; BHIGJEE, A.I.; BILL, P.L.A.; PAMMENTER, M.D.; MODI, G.; HOFFMAN, M.; KELBE, C. & BECKER, P. - Spinal cord schistosomiasis: a clinical, laboratory and radiological study, with a note on therapeutic aspects. Brain, 114: 709-726, 1991.

[16] 16. HARRIES, A.D. & COOK, G.C. - Acute schistosomiasis (Katayama fever): clinical deterioration after chemotherapy. J. Infect., 14: 159-161, 1987.

[17] 17. KANAMURA, H.Y.; HOSHINO-SHIMIZU, S.; CAMARGO, M.E. & SILVA, L.C. - Class specific antibodies and fluorescent staining patterns in acute and chronic schistosomiasis. Amer. J. trop. Med. Hyg., 28: 242-248, 1979.

[18] 18. KATZ, N. & BITTENCOURT, D. - Sobre um provável caso de forma toxęmica no decurso da forma hepatoesplęnica da esquistossomose mansônica. Hospital (Rio de J.), 67: 847-858, 1965.

[19] 19. KATZ, N.; ROCHA, R.S.; LAMBERTUCCI, J.R.; GRECO, D.B.; PEDROSO, E.R.P.; ROCHA, M.O.C. & FLAN, S. - Clinical trial with oxamniquine and praziquantel in the acute and chronic phases of schistosomiasis mansoni. Rev. Inst. Med. trop. S. Paulo, 25: 173-177, 1983.

[20] 20. KING, C.H. - Acute and chronic Schistosomiasis. Hosp. Pract., 26: 117-130, 1991.

[21] 21. KIRCHOFF, L.V. & NASH, T.E. - A case of schistosomiasis japonica: resolution of CAT scan detected cerebral abnormalities without specific therapy. Amer. J. trop. Med. Hyg., 33: 1155-1158, 1984.

[22] 22. LAMBERTUCCI, J.R. - Treatment of the acute (toxaemic) phase of schistosomiasis mansoni. Trans. roy. Soc. trop. Med. Hyg., 82: 350-351, 1988.

[23] 23. LAMBERTUCCI, J.R. - A new approach to the treatment of acute schistosomiasis. Mem. Inst. Oswaldo Cruz, 84 (suppl. 1): 23-30, 1989.

[24] 24. LAMBERTUCCI, J.R.; MODHA, J.; CURTIS, R. & DOENHOFF, M. - The association of steroids and schistosomicides in the treatment of experimental schistosomiasis. Trans. roy. Soc. trop. Med. Hyg., 83: 354-357, 1989.

[25] 25. LAMBERTUCCI, J.R.; GRECO, D.B.; PEDROSO, E.R.P.; ROCHA, M.O.C.; SALAZAR, H.M. & LIMA, D.P. - A double blind trial with oxamniquine in chronic schistosomiasis mansoni. Trans. roy. Soc. trop. Med. Hyg., 76: 751-755, 1982.

[26] 26. LAMBERTUCCI, J.R.; TEIXEIRA, R.; NAVARRO, M.M.M.; COELHO, P.M.Z. & FERREIRA, M.D. - Liver abscess and schistosomiasis. A new association. Rev. Soc. bras. Med. trop., 23: 239-240, 1990.

[27] 27. LAWLEY, T.J.; OTTENSEN, E.A.; HIATT, R.A. & GAZZE, L.A. - Circulating immune complexes in acute schistosomiasis. Clin. exp. Immunol., 37: 221-227, 1979.

[28] 28. MANSOUR, M.M.; OMER, A.P.; FARID, Z.; SIMPSON, A.J.G. & WOODY, J.W.; - Serological differentiation of acute and chronic schistosomiasis mansoni by antibody responses to keyhole limpet haemocyanin. Amer. J. trop. Med. Hyg., 41: 338-344, 1989.

[29] 29. MATTOCIA, L.P. & CIOLI, D. - Studies on the mode of action of oxamniquine and related schistosomicidal drugs. Amer. J. trop. Med. Hyg., 34: 112-118, 1985.

[30] 30. MOHAMED, A.S. - A fatal case of massive bilharzia mansoni infection (acute fatal Egyptian splenomegaly). J. Egypt. med. Ass., 19: 749-762, 1955.

[31] 31. NASH, T.E.; GARCIA-GOYCO, C.; RUIZ-TIBEN, E.; NAZARIO-LOPEZ, H.A.; VAZQUEZ, G. & TORRES-BORGES, A. - Differentiation of acute and chronic schistosomiasis by antibody responses to specific schistomose antigens. Amer. J. trop. Med. Hyg., 32: 776-784, 1983.

[32] 32. PINTO DA SILVA, R.A. & LAMBERTUCCI, J.R. - O valor da ultrassonografia no diagnóstico da esquistossomose hepatoesplęnica. An. Fac. Med. Minas Gerais, 35: 28-38, 1986.

[33] 33. PITELLA, J.E.H. - The relation between involvement of the central nervous system in schistosomiasis and the clinical forms of the parasitosis. A review. J. trop. Med. Hyg., 94: 15-21, 1991.

[34] 34. RASO, P. & NEVES, J. - Contribuiçăo ao estudo da açăo dos corticoďdes na forma toxęmica da esquistossomose humana. An. Fac. Med. Minas Gerais, 22: 167-180, 1965.

[35] 35. SABAH, A.A.; FLETCHER, C.; WEBBE, G. & DOENHOFF, M. - Schistosoma mansoni: chemotherapy of infections of different ages. Exp. Parasit., 61: 294-303, 1986.

[36] 36. WATT, G.; LONG, G.L.U.; RANOA, C.P.; ADAPON, B.; FERNANDO, M. & CROSS, J.H. - Praziquantel in the treatment of cerebral schistosomiasis. Lancet, 2: 529-532, 1986.

[37] 37. WEBBE, G. - Treatment of schistosomiasis. Europ. J. Pharmacol., 32: 433,1987.

[38] 38. YI-SHENG, W.; KUO-CHU, C.; CHENG-WEI, S.; PO-CHUNG, L.; FONG, Y. & CITUAN-JUNG, S. - Treatment of acute schistosomiasis. An analysis of 545 cases. Chin. med. J., 79: 458-459, 1959.