Acute Schistosomniasis

Acute Schistosomniasis - Vol 39 I No 9 MMWR[1 travelers who...

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Unformatted text preview: Vol. 39 I No. 9 MMWR [1/ / travelers who had recently returned to the United States from Botswana and Céte d’lvoire, respectively, had experienced illnesses characterized by an influenza-like syndrome and eosinophilia. Subsequent investigations documented the occurrence of acute schistosomiasis in each group. Botswana. From September 14 to October 2, 1988, a group of 16 persons visited the Okavango Delta region of Botswana. Twelve of 13 travelers who responded to mailed questionnaires reported cantact with fresh water (e.g., wading, swimming, fever, sweats, chills, headache, and gastrointestinal discomfort. These symptoms lasted 1-30 days (mean: 8 days) and recurred in five persons 11—20 days (mean: 15 days) after the initial episode. ' Complete blood caunts done for sixpersons found peripheral eosinophilia (range: 10%—57%; normal: 041%). Of fecalspecimens from 11 persons, nine contained small numbers of SchistoSoma eggs having characteristics of both S. mansoni and 8. rod— schistosorniasis. Céte d'lvoire. From March 1 to April 15, 1989, eight persons traveled to a remote rural area of western Céte d'ivoire. During their Vi's'ifseven members of this group were briefly in contact (bathing, wading, and/or swimming) with fresh river water. None had recently traveled to other areas in which schistosomiasis was endemic. All seven persons reported transient pruritus immediately after their exposures. Two to 4 weeks later, six of these seven persons developed symptoms including fever, chills, fatigue, headache, and gastrointestinal discomfort. initial symptoms lasted 2-25 days (mean: 12 days) but recurred within 1—4 weeks in all six patients. Four persons required hospitalization, and five were treated presumptively for malaria. Eosinophilia (range: 15%-—48%) occurred in all patients. Fecal examinations in four persons detected ova of S. mansoni ; egg counts were low and ranged from 16 to 24 eggs per gram of feces. For all seven persons, urine examinations were negative for Schistosoma ova. For six persons, serum specimens were positive for antibodies to Schistosoma sp. All six were successfully treated with praziquantel. 142 MMWR March 9, 1990 Schistosomiasis «— Continued L Szczukowski, MD, Denver; RE Hoffman, MD, State Epidemiologist, Colorado Dept of Health. M Kohan, MD, Coral Springs; CL MacLeod, MD, Miami, Florida. KE Droulard, MD, Dept of Pathology, Mercy Medical Center, Nampa; FR Dixon, MD, State Epidemiologist, Div of Health, ldaho Dept of Health and Welfare. BL Graham, MD, Jackson, Mississippi. 8 Wilson, MD, Dept of Pathologlc San Juan Regional Medical Center, Farmington; CM Sewell, DrPH, State Epidemiol- ogist, New Mexico Health and Environment Dept. S Vogh, MD, Copenhagen, Denmark. Parasitic Diseases Br, Div of Parasitic Diseases, Center for infectious Diseases; Div of Field Svcs, Epidemiology Program Office, CDC. Editorial Note: The occurrence of these two outbreaks within a 9-month period and. the high infection rates emphasize that schistosomiasis poses a continuing hazard for persons traveling in areas in which the disease is endemic. Reports of at least five similar outbreaks among US. and European tourists since 1975 have indicated similarly high infection rates (range: 5596—10096; mean: 77%). in these five outbreaks, symptoms of acute schistosomiasis (Katayama syndrome) were reported to occur in 40%—93% (mean: 76%) of those infected ( 1—6 ). These symptoms are thought to result from an immunologic response to the maturation of adult worms and subsequent {Continued on page 147} TABLE 1. Summary - cases of specified notifiablediseases, United States 9th Week Ending Cumulative, 9th Week Ending Mar. 3, Mar. 4, Median Mar. 3. Mar. 4. 1990 1989 1985-1989 1990 1989 439 U“ 68 75 78 Disease Acquired Immunodeficiency Syndrome (AIDS) Aseptic menin itis Encephalitis: rimarylarthropod-borne 7,219 5,431 2.953 717 725 725 81 unspec) 13 12 16 101 100 135 Post-infectious . 2 7 2 20 17 13 Gonorrhea: Civilian 13,785 14,471 14,471 114,913 116,512 139,876 Military 207 214 217 1,860 1,895 2,600 Hepatitis: Type A 448 791 537 4,414 5,764 3,980 Type B 384 553 553 3,029 3,397 3,918 Non A, Non B 31 50 62 315 410 475 Unspecified 24 71 71 280 444 576 Legionellosis 24 17 14 188 161 130 Leprosy A - 5 21 25 39 Malaria 23 22 21 164 177 116 Measles: Total' 139 268 52 1,992 913 318 indigenous 133 257 54 1,733 867 296 Imported 6 12 8 259 47 43 Meningococcal intections 74 80 85 528 566 566 Mumps 120 128 128 889 951 802 Pertussis 52 29 41 463 341 307 Rubella (German measles) 21 9 7 76 45 41 Syphilis (Primary 8: Secondary): Civilian 1,398 948 606 ' 8,179 5.792 5,916 Military 3 3 3 87 51 39 Toxic Shock syndrome 8 10 7 67 53 50 Tuberculosis 380 380 434 2,996 2,897 2,897 Tularemia 1 - 1 7 9 14 Typhoid Fever 3 5 2 56 50 41 Typhus fever, tick-borne (RMSF) 2 — - 15 17 9 Babies, animal 50 92 92 476 665 665 TABLE II. Notifiabie diseases of low frequency, United States Anthrax - Leptospirosis 5 Botulism: Foodborne 1 Plague - infant 5 Poliomyelitis, Paralytic‘ . Other 1 Psittecosis (Va. 1) 30 Brucellosis 8 Babies, human - Cholera - Tetanus 9 Congenital rubella syndrome - Trichinosis (Minn. 2, Calif. 1) 9 Congenital syphilis, ages < 1 year - Diphtheria 1 ‘Because AIDS cases are not received weekly from all reporting areas, comparison of weekly figures may be misleading. *Six of the 139 reported cases for this week were imponed from a foreign country or can be directly traceable to a known internationally imported case within two generations. sOne case of suspected poliomyelitis has been reported in 1990: none of 13 suspected cases in 1989 have been confirmed to date. Nine of 14 suspected cases in 1988 were confirmed and all were vaccine-associated. Vol. 39 I No. 9 MMWR 147 Schistosomiasis —- Continued egg deposition in the vasculature surrounding the intestines and bladder (7) (Figure ,1). Although the clinical outcome in travelers is usually benign, hospitalization is sometimes necessary, and manifestations can be severe. For example, in 1984, two U.S. students developed transverse myelitis and paraplegia after acquiring infection in Kenya (4 ). Eariy manifestations of acute schistosomiasis are often nonspecific and may easily be misdiagnosed. The diagnosis should be considered when eosinophilia is associ- ated with fever, fatigue, headache, and/or gastrointestinal distress in persons who have been exposed to fresh water in areas in which schistosomiasis is endemic. Early diagnosis and treatment based on clinical, epidemiologic, and serologic criteria may be important in preventing serious sequelae (e.g., transverse myelitis) of acute infection. Screening stool and urine Specimens for ova and parasites is the traditional method of diagnosis, but signs and symptoms of acute infection can occur before detectable egg excretion (8 ). Sensitive and specific serologic tests have recently been developed that can help establish the diagnosis before substantial egg deposition or excretion (9 ). Single-day therapy with praziquantel (40-60 mg/kg) is effective against all Species of schistosomes (10 ). Although side effects to treatment have been reported, they are generally mild and transient (7). Because there is no practical way to distinguish infected from noninfected water, all fresh water in schistosomiasis-endemic areas should be considered suspect. If fresh water contact is unavoidable, bathing water should be heated to 50 C (122 F) for 5 minutes or treated with iodine or chlorine in a manner similar to that used for treating drinking water. in addition, water can be strained with paper filters or allowed FIGURE 1. Life cycle of human schistosomes represented by S. mansam' (S.M.i and S. haematobium (S.H.) lntective Cercariae Free-swimming cercariae penetrate intact skin in contact with infected fresh water. Adults developing within the human host mate and begin depositing eggs in the vasculature surrounding the intestine and bladder. Eggs released into the stool or Urine develop into forms infective for intermediate snail host's when deposited into fresh water. infected snails release cercariae to reinitiate the cycle. 14s MMWR March 9. 1990 Schistosomiasis — Continued health~care providers should be aware of the clinical manifestations, methods for diagnosis, and appropriate treatment of this disease. In addition, health and travel professionals should provide more intensive preventive counseling to persons planning travel to areas endemic for schistosomiasis. References 1. Zuidema PJ. The Katayama syndrome: an outbreak in Dutch tourists to the Omo National Park, Ethiopia. Trop Geogr Med 1981;33:30—5. 2. CDC. Cercarial dermatitis among bathers in California; Katayama syndrome among travel- ers in Ethiopia. MMWR 1982;31:435-8. 3. lstre GR, Fontaine RE, Tarr J, Hopkins RS. Acute schistosomiasis among Americans rafting the Omo River, Ethiopia. JAMA 1984;251:508—10. 4. CDC. Acute schistosomiasis with transverse myelitis in American students returning from Kenya. MMWR 1984;33:445—7. 5. Chapman PJC, Wilkinson PR, Davidson RN. Acute schistosomiasis (Katayama fever) among British air crew. Br Med J 1988;297:1101. ' 6. Stuiver PC. Acute schistosomiasis in Schistosoma haematobium infection. in: Steffen R, Lobel HO, Haworth J, Bradley DJ, eds. Travel medicine. Berlin: Springer—Verlag, 1989:381—3. 7. Nash TE, Cheever AW, Otteson EA, Cook JA. Schistosome infection in humans: perspectives and recent findings. Ann intern Med 1982;97:740—54. 8. Hiatt RA, Sotomayor ZR, Sanchez G, Zambrana M. Knight WB. Factors in the pathogenesis , of acute schi'stosomiasis mansoni. J Infect Dis 1979;139:659—66. 9. Hancock K, Tsang VCW. Development and optimization of the FAST-ELISA for detecting antibodies to Schistosoma mansoni. J immunol 1986;92:167—86. 10. World Health Organization. The control of schistosomiasis. Geneva: World Health Organi- zation, 1985. (WHO technical report series, no. 728). Low Birthweight -— United States, 1975—1987 The incidence of low birthweight (LBW) is monitored in the United States because it is an important indicator of infant morbidity and mortality. This report highlights findings on trends in LBW in the United States from 1975 through 1987 (the most recent year for which data are available) (1 ). These findings are based on analysis of birth certificate data provided by the 50 states and the District ofCoiumbia to CDC’s National Center for Health Statistics. For each birth, data include birthweight and related demographic and health information for the mother and infant. From 1975 through 1985, the incidence of LBW (<2500 9 [<5 lbs. 8 oz.]) declined from 73.9 per 1000 live births to 67.5 per 1000, a 9% decrease (Table 1). However, LBW increased 2.2% from 1985 through 1987. Moderately low birthweight (MLBW) (1500— 2499 g [3 lbs. 4 oz. to 5 lbs. 8 oz.]) declined by 11% from 1975 through 1985 but also increased 2.2% from 1985 through 1987. Very low birthweight (VLBW) (<1500 9 [<3 lbs. 4 02.)) increased by 4% from 1975 through 1985 and increased another 2.5% from 1985 through 1987. Most of the decline in LBW and MLBW occurred before 1980 (86% and 78%, respectively); all the increase in VLBW occurred after 1980. _ Although LBW declined for both white infants and black infants before 1980, the decline was nearly twice as great for white (9%) as for black infants (5%) (Table 1). The decline in LBW rates in the first half of the 19805 was s1% for both white infants ...
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Acute Schistosomniasis - Vol 39 I No 9 MMWR[1 travelers who...

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