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Schistosomiasis

Nature Reviews Disease Primers volume 4, Article number: 13 (2018) Cite this article

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Abstract

Schistosomiasis (bilharzia) is a neglected tropical disease caused by parasitic flatworms (blood flukes) of the genus Schistosoma, with considerable morbidity in parts of the Middle East, South America, Southeast Asia and, particularly, in sub-Saharan Africa. Infective larvae grow in an intermediate host (fresh-water snails) before penetrating the skin of the definitive human host. Mature adult worms reside in the mesenteric (Schistosoma mansoni and Schistosoma japonicum) or pelvic (Schistosoma haematobium) veins, where female worms lay eggs, which are secreted in stool or urine. Eggs trapped in the surrounding tissues and organs, such as the liver and bladder, cause inflammatory immune responses (including granulomas) that result in intestinal, hepato-splenic or urogenital disease. Diagnosis requires the detection of eggs in excreta or worm antigens in the serum, and sensitive, rapid, point-of-care tests for populations living in endemic areas are needed. The anti-schistosomal drug praziquantel is safe and efficacious against adult worms of all the six Schistosoma spp. infecting humans; however, it does not prevent reinfection and the emergence of drug resistance is a concern. Schistosomiasis elimination will require a multifaceted approach, including: treatment; snail control; information, education and communication; improved water, sanitation and hygiene; accurate diagnostics; and surveillance-response systems that are readily tailored to social-ecological settings.

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Fig. 1: Schistosome life cycle exemplified by Schistosoma mansoni.
Fig. 2: Prevalence of schistosomiasis.
Fig. 3: Hepatic granulomas.
Fig. 4: Established active and late chronic schistosomiasis.
Fig. 5: Urogenital schistosomiasis.

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Reviewer information

Nature Reviews Disease Primers thanks P. M. Z. Coelho, J. Friedman, N. Midzi, E. Secor and the other anonymous referee(s) for their contribution to the peer review of this work.

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Authors and Affiliations

  1. Immunology Department, QIMR Berghofer Medical Research Institute, Herston, Brisbane, Queensland, Australia

    Donald P. McManus

  2. Department of Pathology, University of Cambridge, Cambridge, UK

    David W. Dunne

  3. Department of Diagnostic and Biomedical Research, Institut National de Recherche en Santé Publique, Bamako, Mali

    Moussa Sacko

  4. Swiss Tropical and Public Health Institute, Basel, Switzerland

    Jürg Utzinger

  5. University of Basel, Basel, Switzerland

    Jürg Utzinger

  6. Department of Veterinary and Animal Science, University of Copenhagen, Copenhagen, Denmark

    Birgitte J. Vennervald

  7. National Institute of Parasitic Diseases, Shanghai, People’s Republic of China

    Xiao-Nong Zhou

Authors
  1. Donald P. McManus
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  2. David W. Dunne
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  3. Moussa Sacko
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  4. Jürg Utzinger
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  5. Birgitte J. Vennervald
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  6. Xiao-Nong Zhou
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Contributions

Introduction (D.P.M. and J.U.); Epidemiology (X.-N.Z. and J.U.); Mechanisms/pathophysiology (B.J.V., D.W.D. and M.S.); Diagnosis, screening and prevention (B.J.V., M.S., D.W.D. and D.P.M.); Management (D.P.M.); Quality of life (J.U.); Outlook (D.P.M. and B.J.V.); Overview of Primer (D.P.M.).

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Correspondence to Donald P. McManus.

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McManus, D.P., Dunne, D.W., Sacko, M. et al. Schistosomiasis. Nat Rev Dis Primers 4, 13 (2018). https://doi.org/10.1038/s41572-018-0013-8

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