Schistosomiasis is a disease caused by parasites. Schistosoma is the genus of the several species of flatworms that are responsible for causing this disease. Schistosomiasis is popularly known as snail fever. Theodor Bilharz was the first to describe the cause of urinary schistosomiasis in 1851, and this disease is also called Bilharzia or Bilharziosis in many countries after him.

Causes of Bilharzia

This disease mostly affects the tropical countries like Africa , the Caribbean islands, and eastern part of South America , East Asia , and the Middle East . Estimation shows that about 207 million people are suffering from this disease, and about another 120 million are displaying the symptoms. Different types of Schistosomiasis are found in different areas as follows:

Schistosoma mansoni—parts of South America and the Caribbean , Africa , and the Middle East

Schistosoma haematobium— Africa and the Middle East

Schistosoma japonicum— Far East . S. Mekongi and S. intercalatum are found focally in Southeast Asia and central West Africa , respectively

Types of Bilharzia

Schistosoma mansoni (ICD-10 B65.1)— intestinal schistosomiasis

Schistosoma intercalatum (B65.8)—intestinal schistosomiasis

Schistosoma haematobium (B65.0)—urinary schistosomiasis

Schistosoma japonicum (B65.2)—intestinal schistosomiasis

Schistosoma mekongi (B65.8)—intestinal schistosomiasis

Symptoms of Bilharzia

Abdominal pain

Diarrhea

Cough

Fever

Fatigue

Central nervous system lesions can also occur sometimes

Granulomatous reactions and fibrosis in the affected organs can lead to

Colonic polyposis with bloody diarrhea mostly in Schistosoma mansoni;

Portal hypertension with hematemesis and splenomegaly in Schistosoma mansoni, Schistosoma japonicum;

Glomerulonephritis; and central nervous system lesions.

How is the disease diagnosed?

Eggs of the infecting parasite can be identified in the stool or urine of the patient under a microscope. Examination of stool for the identification of the parasites is more common. An egg per gram (epg) is the scientific unit used to measure the eggs in the feces of the affected patient. Stool examination is recommended to patients affected with schistosoma mansoni or schistosoma japonicum; and urine examination for schistosoma haematobium.

Sometimes the Kato-Katz technique (20 to 50 mg of fecal material) or the Ritchie technique is also used for field surveys and investigational purposes.

Treatment of Bilharzia

Schistosomiasis can be successfully treated using an oral drug Praziquantel. Though a single dose of this drug can cure the infection, it is not effective in preventing re-infection of the patient, which is highly probable in an affected area. Researches are presently being carried on to develop a vaccine for this disease.

The toxic metalloid, antimony was initially used in low doses to treat schistosomiasis, but this is not used in present days. Another drug called Oxamniquine is used outside the U.S to treat Schistosoma mansoni.

Investigations are being carried on a new Egyptian drug, Mirazid for the treatment of this disease.

Other forms of oral medication that are being experimented with are medicinal castor oil, Gopo Berry (by Dr Chidzere of Zimbabwe in 1980s), etc.

Prevention of Bilharzia

Avoiding snails

Acrolein, copper sulfate, and niclosamide can be used to eliminate the fresh-water snails that cause the disease.

Crayfish breeding can also be helpful for the purpose though it must be done with caution.

Avoiding water bodies previously detected with snails.

Use of sapindus plant(Phytolacca dodecandra) to prevent the disease by controlling snails. Aklilu Lemma and Legesse Wolde-Yohannes received the Right Livelihood Award in 1989 for their research.

Proper civic designs

Better plans and designs while creating dams and irrigation schemes can prevent this disease from spreading among the nearby population.

Properly designed Campaigns

Egypt is an example of how a wrongly designed campaign can give rise to further complications. Since Egypt had the highest rate of schistosomiasis infected patients due to its large number of canals and dams built along river Nile, a campaign was carried out to give shots of tartar emetics to the patients from late 1950s till the early 1980s.Unfortunately however, instead of controlling one disease, this led to the spread of Hepatitis C virus through unclean needles. This proves the necessity of proper campaigns.

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