Schistosomiasis, or bilharziasis is a chronic disease by certain flukes or flatworms that live in various parts of the bloodstream. There are three major types, known as masoni, japonicum, and haematobium. Next to malaria, schistosomiasis is man’s most serious parasitic infection. More than 150,000,000  people are infected with this disease. It is widely distributed in Egypt, Africa, Madagascar, Arabia, the West Indies, North and South America, Central and South China, Japan, the Philippines, Celebes, the Middle East, Portugal, and near Bombay, India.

The adult worms may live up to twenty-five years, pouring out thousands of eggs every day, first of all into the bloodstream of the infected person. From there they find their way into either the intestine or the urinary bladder and are evacuated from the body. On contact with fresh water, the larval form hatches from the egg, swim about until it finds an appropriate snail which it penetrates. It lives there, passes through two generations, and then leaves the body of the snail as a small, free-swimming creature, ready to penetrate the next human who is bathing, swimming, working, or washing clothes in the  contaminated water.

As soon as the parasite contacts human skin, it burrows down and enter the capillaries where it is carried to the heart and lungs. People who drink the contaminated water are even more quickly infected. Most of the parasites are destroyed by the body’s defense mechanism, but enough of these flatworms survive to find their way to the blood vessels leading to the lungs. Here they grow rapidly and are mature worms about three weeks from the time they enter the body.

The presence of the parasites  produces marked itching, swelling, asthmatic attacks, tenderness of the liver probably due to hepatitis. This may be followed by fever, sweating diarrhea, dysentery, weight loss, and lock of appetite. Chronic inflammatory changes  appear in various parts of the body with abscesses and ulceration. Eggs from the flukes may become embedded in the appendix and  produce appendicitis.

Multiple abscesses may develop in the liver, eventually producing cirrhosis, especially with the japonicum infection. Headache, diarrhea, and abdominal pain are common, and the patient has relapse which may  continue for years. Various nervous disorders may arise beacuse of the eggs passing through the general circulation and filtering out into the brain and spinal cord.

The patient may be disoriented, suffer from forgetfulness, lack of speech, and become confused, and even have epileptic attacks at times, depending on which part of the brain may be involved. Patients with severe infections of the lungs to suffer from shortness of breath, pneumonia, and heart failure.

Schistosomiasis Treatment:

Antimony compounds, such as Faudin, also known as Stibophen, is recommended. The dosage is 1.5 cc. given intramuscular the first day, 3.5 cc. the second day then 5 cc. ever other day until a total of 40 cc. has been injected. In children the dosage should be reduced according to size and age, but each child should have a total of 25 cc. Local public health centers may also recommend the use of sodium antimony tartrate by mouth in relatively small doses.

For bladder flukes, Miracil-D or Nilodin administered orally, have been used with  considerable success. These act upon the reproductive organs of the parasites, reducing the number of eggs, but unfortunately they do not remove the parasites themselves. Antibiotic medicines are often necessary for the control of germ infection following the presence of the parasites.

Schistosomiasis Prevention:

Sanitary disposal of all human feces and urine is essential for the control of  schistosomiasis. Unfortunately in many of these lands human fertilizer is used, and the possibilities of constant contamination are only too obvious. In  Muslim countries a further complication arise due to the religious practice of ablution at various times of the day. This serious disease cannot be eradicated until populations are educated to use sanitary toilet facilities and to avoid contact with infected water. Safe facilities for bathing and washing of clothes must be provided. Someday we may have chemical agent capable of bringing this serious disease under control. Until then, proper hygienic measure are essential to all who value one.