Early Detection of Schistosoma Egg-Induced Pulmonary Granulomas in a Returning Traveler

Schistosoma haematobium infection with pulmonary involvement in a traveller returning from Congo: A case report and systematic review of literature on nodular pulmonary schistosomiasis

BACKGROUND

Schistosomiasis is highly prevalent in sub-Saharan Africa and diagnosis is difficult for travel medicine practitioners, because it can affect different organs with atypical manifestations. S. haematobium is mostly associated with urinary involvement and rarely with pulmonary lesions. This review aims to summarise the pulmonary forms associated with schistosomiasis, especially with S. haematobium.

METHOD

Based on a case report of both pulmonary and urogenital schistosomiasis, we performed a systematic literature review of schistosomiasis occurring in migrants and travellers, with a specific focus on pulmonary schistosomiasis.

RESULTS

Pulmonary schistosomiasis can present two different clinical patterns. On the one hand, there is an acute pattern, which more frequently affects non-immune young travellers within three to eight weeks of their return and, on the other hand, there is a chronic pattern, which has been evolving in recent years and which mostly affects people living in endemic areas or migrating from these countries. Nodular pulmonary lesions are described in both patterns. Genus identification should not focus only on known patterns, and identification of S. haematobium should not be associated exclusively with urinary schistosomiasis.

CONCLUSIONS

Pulmonary schistosomiasis, even when resulting from S. haematobium, is a rare but existing infection that appears to be spreading with increasing travel and global migration. Physicians need to be more aware of non-specific symptoms that may reveal an atypical presentation of a tropical disease, in order to avoid the chronic complications which can result from parasitic diseases.

Evaluation of the returning traveler with fever and neurologic symptoms

ABSTRACT

Exposure to infectious disease increases in tandem with international travel rates. Globally, up to 70% of travelers to developing countries report health problems while traveling, most being self-limiting. Few travelers are ill enough to seek medical care while abroad or upon returning home. Although fever is one of the more common symptoms in these travelers, little attention has been paid to those who return with fever and neurologic symptoms. This article describes conditions that can present with fever and neurologic changes and how to evaluate patients in a timely manner to prevent progression of neural dysfunction and spread of disease in local communities.

New Insights on Acute and Chronic Schistosomiasis: Do We Need a Redefinition?

A precise timeframe to differentiate acute schistosomiasis (AS) and chronic schistosomiasis (CS) is not well defined. Based on recent published literature, lung nodular lesions in AS and CS seem to have the same pathophysiology, that is, eggs laid in situ by adult worms, during an ectopic migration. Moreover, the occurrence of lung nodules due to clusters of eggs and the systemic immunoallergic reaction of AS (Katayama syndrome) may be two separate clinical entities, which may overlap during the early phase of infection. Consequently, the classical distinction between AS and CS loses much of its conceptual validity. If adult worms play a more important role in the early phase of the disease the clinical management of AS should probably be revised.

Restaging Pulmonary Schistosomiasis

Schistosomiasis is traditionally classified into an acute and a chronic phase, although a precise temporal distinction between the two phases has not been established. Lung involvement can be observed in both phases. We previously reported seven cases of pulmonary lesions due to chronic schistosomiasis in African immigrants. All cases were documented with CT scans and demonstrated complete resolution after treatment with praziquantel. Moreover, another case showed spontaneous disappearance of the nodule before treatment with praziquantel. These findings are similar to those observed in the acute phase of schistosomiasis, with well-defined or ground glass nodules that resolve spontaneously. According to these findings, we postulate the presence of an "intermediate" phase of schistosomiasis involving the lungs that can be defined as an "early chronic phase," and presents analogies to the acute phase. We also hypothesize that in the "early chronic phase," the female worms transit through the lungs where they may lay eggs. These passages not only cause transient, but also radiologically visible alterations. The pathophysiology of lung lesions in the late chronic phase is probably different: the adult worms settled in the mesenteric plexuses produce eggs for years. The eggs repeatedly migrate to the perialveolar capillary beds via portal-caval shunting. Thus, in this case it is the eggs and not the adult worms that reach the lungs in a scattered way. Based on our findings, we suggest the alternative hypothesis that the pulmonary involvement is a phase of the natural evolution of the infection, both from Schistosoma mansoni and Schistosoma haematobium.

Schistosoma haematobium causing pulmonary schistosomiasis in a returning traveller

Schistosomiasis is infrequently seen in the UK, but remains an important cause of haematuria in endemic areas. It may also be complicated by systemic illness, and can affect multiple organs, including the bladder, liver and lungs. We discuss a case of haematuria associated with lower abdominal discomfort and dry cough/wheeze in a returning traveller diagnosed as pulmonary and urinary schistosomiasis, caused by Schistosomahaematobium This case was particularly notable for the radiological findings seen on CT scan of the chest (figure 2A,B), as well as the characteristic sago nodules discovered within the bladder. It is also unusual to see pulmonary schistosomiasis associated with S. haematobium, an organism more typically characterised by bladder involvement. It is important to consider schistosomiasis and its complications, while rare in the western world, it remains an important differential diagnosis in at-risk groups with considerable morbidity if untreated.

Pulmonary schistosomiasis in a young male: A case report and review of the literature

Schistosoma is a parasitic infection that affects many people worldwide. However, pulmonary Schistosomiasis is very rare entity which defined as pulmonary involvement develops in persons living or travelling in endemic areas. We report a rare case of 23-year-old Yamani patient admitted as an emergency with a 1-week history of productive cough, hemoptysis, and chest pain. Chest X-ray and computed tomography scan showed right upper lobe peripheral abscess cavity. All routine blood investigations and interventions such as bronchoscopy and bronchoalveolar lavage failed to confirm the diagnosis. However, he underwent right thoracoscopy and excision of this abscess, which unexpectedly showed in the histopathology of the resected specimen Schistosoma parasite infection.

Exploring Structural and Physical Properties of Schistosome Eggs: Potential Pathways for Novel Diagnostics?

In this era of increasing demand for sensitive techniques to diagnose schistosomiasis, there is a need for an increased focus on the properties of the parasite eggs. The eggs are not only directly linked to the morbidity of chronic infection but are also potential key targets for accurate diagnostics. Eggs were the primary target of diagnostic tools in the past and we argue they could be the target of highly sensitive tools in the future if we focus on characteristics of their structure and shell surface that could be exploited for enhanced detection. In this review, we discuss the current state of knowledge of the physical structures of schistosome eggs and eggshells with a view to identifying pathways to a comprehensive understanding of their role in the host-parasite relationship and pathogenesis of infection, and pathways to new strategies for development of diagnostics.

Diagnosis and Clinical Management of Schistosoma haematobium-Schistosoma bovis Hybrid Infection in a Cluster of Travelers Returning From Mali

Ten Belgian travelers returned from Mali with a Schistosoma haematobium-Schistosoma bovis hybrid infection, confirmed by DNA sequencing from eggs. Clinical symptoms and laboratory findings resembled those of classic acute schistosomiasis, but the detected eggs were morphologically unusual.