Acute Schistosomiasis in Returning Pediatric Travelers

Background: Schistosomiasis is a common infection, highly endemic in many developing countries. Repetitive exposure to the parasite from a young age may lead to chronic complications in the urinary or gastrointestinal tracts. In contrast, schistosomiasis in non-immune travelers tends to cause a distinct presentation of “acute schistosomiasis”, characterized by fever, urticarial rash, cough, fatigue, myalgia, headache and eosinophilia.

Objective: Description of acute schistosomiasis in children and comparison to adults.

Methods: A retrospective study which examines pediatric travelers (0-19 years old) diagnosed with schistosomiasis at the Sheba Medical Center from 2007-2012. Patients’ findings are compared to those of adult travelers from the same travel groups with the same exposure by Fisher’s exact test.

Results: 18 children and 24 adults were included, returning from five different trips. 11 cases were confirmed by serology and the rest were clinically diagnosed. Two children contracted the disease in Laos, Asia, and the rest in Sub- Saharan Africa: Tanzania, Uganda and Nigeria. The mean age of the children was 13 years. The most common presentations were respiratory symptoms (72%), eosinophilia (72%) and fever (61%). Three children required hospitalization and three were asymptomatic. Fatigue was significantly less common in children compared to adults (33% vs 71%, p<0.05). Rates of hospitalization and steroid treatment were similar.

Conclusion: Similar to adult travelers, children may develop “acute schistosomiasis” following a short exposure to contaminated freshwater, demonstrating high infection rates. Severity is equivalent, but adults suffer more from fatigue. Disease should also be suspected in asymptomatic children with a known at-risk exposure.