Schistosomiasis in Nigeria: Symptoms, Causes & Treatment | aihealz
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Schistosomiasis.Care & specialists in Nigeria
In Nigeria, schistosomiasis is managed by tropical medicines. Schistosomiasis is a chronic parasitic disease caused by blood flukes of the genus Schistosoma, acquired when freshwater contaminated with the larval form (cercariae) penetrates intact human skin during bathing, wading, or fishing. The World Health Organization estimates roughly 251 million people require preventive treatment each year, with more than 90% of cases concentrated in sub-Saharan Africa and over 200,000 deaths annually from late complications.
Schistosomiasis (ICD-10: B65), also called bilharzia or snail fever, is a chronic infection by trematode flatworms of the genus Schistosoma. Five species infect humans: Schistosoma mansoni and Schistosoma japonicum cause intestinal and hepatosplenic disease through eggs lodged in mesenteric venules; Schistosoma haematobium causes urogenital disease through eggs trapped in vesical venules and the bladder wall; Schistosoma mekongi affects the lower Mekong basin; and Schistosoma intercalatum and Schistosoma guineensis cause focal intestinal disease in central and west Africa. The life cycle requires a specific freshwater snail intermediate host — Biomphalaria for S. mansoni, Bulinus for S.
key facts
Prevalence
Approximately 251 million people require preventive treatment annually (WHO 2024); estimated 779 million live in transmission areas
Demographics
More than 90% of cases occur in sub-Saharan Africa; school-age children and adolescents carry the highest egg burden; men in occupational water contact (fishing, irrigation) at elevated risk
Avg. age
Peak intensity of infection age 10-15 years; chronic complications appear after 5-15 years of continuous re-exposure
Global cases
Roughly 200,000-280,000 deaths per year from schistosomiasis-related complications; 1.6 million disability-adjusted life-years lost annually (GBD 2021)
Specialist
Tropical Medicine
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How you might notice it
The key symptoms of Schistosomiasis are: Painless visible blood at the end of urination (terminal hematuria), the hallmark of urogenital schistosomiasis, often appearing in school-age boys 2-6 months after first exposure., Frequency, urgency, dysuria, and suprapubic pain from bladder-wall inflammation and granulomas in chronic S. haematobium infection., Intermittent bloody or mucoid diarrhea with crampy abdominal pain in intestinal schistosomiasis caused by S. mansoni, S. japonicum, or S. mekongi., Itchy maculopapular rash at the site of cercarial penetration within hours of freshwater exposure (cercarial dermatitis or swimmer's itch)., Fever, urticaria, generalized myalgia, fatigue, marked eosinophilia (often >20%), hepatosplenomegaly, and cough 4-8 weeks after first exposure in non-immune travelers — the Katayama syndrome., Progressive abdominal distension with a firm enlarged spleen and prominent abdominal collateral veins in late hepatosplenic disease., Hematemesis, melena, or syncope from ruptured esophageal varices secondary to schistosomal portal hypertension..
01Painless visible blood at the end of urination (terminal hematuria), the hallmark of urogenital schistosomiasis, often appearing in school-age boys 2-6 months after first exposure.
02Frequency, urgency, dysuria, and suprapubic pain from bladder-wall inflammation and granulomas in chronic S. haematobium infection.
03Intermittent bloody or mucoid diarrhea with crampy abdominal pain in intestinal schistosomiasis caused by S. mansoni, S. japonicum, or S. mekongi.
04Itchy maculopapular rash at the site of cercarial penetration within hours of freshwater exposure (cercarial dermatitis or swimmer's itch).
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How it’s diagnosed
diagnosis
Diagnosis begins with travel and exposure history — every freshwater contact in an endemic region within the past five years matters. In the acute phase, marked peripheral eosinophilia (often above 1,500/µL) combined with fever and recent exposure is highly suggestive of Katayama syndrome, but egg-shedding is usually negative for 6-8 weeks after infection. The reference standard for chronic infection is microscopic detection of characteristic eggs: a terminal-spined egg in urine for S. haematobium and a lateral-spined egg in stool for S. mansoni; S. japonicum eggs are small and round with a lateral knob. The Kato-Katz thick-smear technique on stool and filtration of 10 mL of midday urine for S. haematobium remain the WHO-recommended quantitative methods. Sensitivity falls in light infections; in returning travelers and chronic cases serology (ELISA or immunoblot for soluble worm antigens) is more sensitive but cannot distinguish active from past infection. The circulating cathodic antigen (CCA) urine cassette is a point-of-care test that detects active worm infection within 20 minutes and is now widely used in field surveys. Cystoscopy with bladder biopsy is reserved for hematuria with negative urinalysis or to assess fibrosis, and ultrasound of liver, spleen, kidneys, ureters, and bladder grades organ damage. In suspected neuroschistosomiasis, MRI with gadolinium and CSF eosinophilia support the diagnosis.
Key tests
01
Urine microscopy with filtration for S. haematobium eggsConfirms urogenital schistosomiasis by visualizing terminal-spined eggs
02
Stool microscopy (Kato-Katz thick smear)Confirms intestinal schistosomiasis and quantifies eggs per gram
03
Schistosoma serology (ELISA, immunoblot)Detects antibody to soluble worm or egg antigen; most useful in travelers, returning expatriates, and light or early infections
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Treatment & cost
medical treatments
✓Praziquantel (40 mg/kg single oral dose for S. mansoni/haematobium; 60 mg/kg for S. japonicum/mekongi)
Endoscopic band ligation of esophageal varicesEradication of varices in 80-90% of patients over 3-6 sessions; rebleeding rate roughly halved compared with no banding
Splenectomy with esophagogastric devascularization (Sugiura/Hassab)Long-term rebleeding rates of 10-20% in published series; mortality under 5% in centers with expertise
Bladder reconstruction or ureteric reimplantationSymptomatic improvement in 70-85% of selected patients; ureteric reimplant success roughly 90% in non-irradiated tissue
Radical cystectomy for schistosomiasis-associated bladder cancer5-year overall survival 40-55% for cT2 disease in modern series; under 20% once locally advanced
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Causes & risk factors
known causes
Schistosoma haematobium infection acquired in freshwater
Cercariae released by infected Bulinus snails penetrate intact human skin during bathing, washing, or fishing. Schistosomula migrate via lungs to the liver, mature to adult worms, and pair-bond in the vesical venous plexus. Eggs deposited in the bladder wall trigger granulomas and the urogenital syndrome. This species is endemic across sub-Saharan Africa, the Nile valley, and the Arabian peninsula.
Schistosoma mansoni infection acquired in freshwater
Cercariae from Biomphalaria snails enter through skin and adult worms pair in the inferior mesenteric venous plexus. Eggs lodge in the intestinal wall and liver, producing intestinal and hepatosplenic disease. S. mansoni is endemic in sub-Saharan Africa, the Arabian peninsula, Brazil, Suriname, Venezuela, and the Caribbean.
Schistosoma japonicum, mekongi, intercalatum, and guineensis infection
S. japonicum (China, Philippines, Indonesia) uses the Oncomelania snail and produces the heaviest egg burden, the most aggressive hepatic fibrosis, and the highest rate of central-nervous-system involvement. S. mekongi is restricted to the Mekong basin, S. intercalatum and S. guineensis to central and west Africa.
Repeated exposure to contaminated freshwater bodies
Lakes, rivers, irrigation canals, dams, fishponds, and ricepaddies in transmission areas are the typical sources. Even brief exposure (under one minute) can transmit infection if cercarial density is high. Dam construction (Aswan High Dam, Senegal River Diamond, Three Gorges) has historically expanded transmission by creating new snail habitat.
Lack of safe water, sanitation, and hygiene (WASH)
Open defecation and urination near water bodies maintain the parasite life cycle. Communities without piped water rely on infected streams for bathing, laundry, and recreation. WHO modeling links 40-60% of regional transmission risk to inadequate sanitation infrastructure.
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Living with it
01Avoid all freshwater contact (swimming, wading, washing) in lakes, rivers, and irrigation canals in endemic regions; saltwater and properly chlorinated pools are safe.
02Towel-dry vigorously immediately after accidental freshwater exposure and shower with soap as soon as possible — does not eliminate risk but may reduce cercarial penetration.
03Use waterproof footwear and waders for unavoidable occupational water contact and limit duration of exposure.
04Boil, filter, or chemically treat drinking and bathing water in transmission areas; cercariae are killed by water held above 50 °C for five minutes.
05Participate in school- or community-based mass drug administration when offered, even in the absence of symptoms.
06Improve sanitation and water access (latrines, piped water) at the community level — the only sustainable intervention that interrupts transmission.
recommended foods
•Iron-rich foods (lean red meat, liver, lentils, dark leafy greens, fortified cereals) to address chronic anemia
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When to seek help
why see a tropical medicine
Tropical medicine and infectious disease specialists confirm species, exclude co-infections (malaria, strongyloides, HIV), and decide on repeat dosing or steroid cover, especially in Katayama syndrome and neuroschistosomiasis. Hepatology, urology, or gynecology referral is needed once portal hypertension, bladder fibrosis, or female genital schistosomiasis is diagnosed.
01Bladder fibrosis with reduced capacity, frequency, urgency, and recurrent bacterial urinary infection — detect early with ultrasound bladder-wall thickness and post-void residual.
02Squamous-cell carcinoma of the bladder in chronic S. haematobium infection; new gross hematuria after age 30 in an endemic patient warrants cystoscopy.
03Bilateral hydronephrosis and obstructive uropathy progressing to chronic kidney disease — annual ultrasound and creatinine in heavy infections.
04Hepatic periportal (Symmers') fibrosis, splenomegaly, and esophageal varices with potentially fatal hematemesis — screen with abdominal ultrasound and surveillance endoscopy.
05Female genital schistosomiasis with infertility, dyspareunia, and a roughly 3-fold increased risk of HIV acquisition.
Urogenital schistosomiasis (S. haematobium)Adult worms pair in pelvic venous plexuses; eggs deposit in the bladder wall, ureters, seminal vesicles, prostate, cervix, vagina, and fallopian tubes. Classic presentation is painless terminal hematuria. Long-term sequelae include bladder fibrosis, hydronephrosis, infertility, female genital schistosomiasis, and squamous-cell bladder cancer.
Intestinal schistosomiasis (S. mansoni, S. mekongi, S. intercalatum, S. guineensis)Adult worms live in mesenteric venules; eggs traverse the bowel wall and lodge in the intestinal mucosa. Causes intermittent bloody diarrhea, abdominal pain, and eventually polypoid colitis.
Hepatosplenic schistosomiasisLate consequence of intestinal infection. Eggs swept to the liver via portal circulation trigger periportal Symmers' fibrosis without true cirrhosis; portal hypertension, splenomegaly, and esophageal varices follow. Hepatocellular function is usually preserved until very late.
Acute schistosomiasis (Katayama syndrome)A serum-sickness-like febrile illness 14-84 days after primary infection, most often seen in non-immune travelers exposed to S. mansoni or S. japonicum. Driven by immune complexes against migrating schistosomula and early egg deposition.
NeuroschistosomiasisRare ectopic egg deposition in the central nervous system. S. japonicum has a predilection for the brain (causing seizures, focal deficits); S. mansoni and S. haematobium more often involve the spinal cord with transverse myelitis or cauda-equina syndrome.
Living with Schistosomiasis
Timeline
Acute symptoms resolve within 1-2 weeks of praziquantel. Eosinophilia, hematuria, and stool egg counts typically normalize within 3 months. Ultrasound evidence of bladder-wall thickening and hydronephrosis regresses over 6-12 months. Hepatic periportal fibrosis does not regress fully but stabilizes after parasitological cure. Female genital schistosomiasis lesions improve over 6-24 months in 60-80% of women treated early.
Lifestyle
01Complete the full prescribed dose of praziquantel with a meal to maximize absorption and tolerability.
02Return for follow-up urine or stool testing 4-12 weeks after treatment to confirm cure; re-treat if eggs persist.
03Avoid further freshwater contact for at least 8 weeks after treatment to prevent rapid re-infection.
04Limit alcohol intake during treatment and in the presence of liver fibrosis to reduce additional hepatic injury.
05Maintain iron- and protein-rich nutrition during recovery from chronic anemia and growth faltering.
06Disclose travel and water-exposure history to any clinician evaluating hematuria, abdominal pain, eosinophilia, or unexplained varices.
Daily management
01Take praziquantel with food at the prescribed dose, split across the day for the 60 mg/kg regimen.
Complementary approaches
Artemisinin derivatives (artemether, artesunate)Active against migrating immature schistosomula and complement praziquantel in some endemic settings; not approved for first-line treatment but studied for chemoprophylaxis in occupational cohorts.
Mass drug administration with praziquantelWHO-endorsed community-level approach treating school-age children and at-risk adults annually or biennially. Reduces prevalence, intensity, and morbidity at the population level even when individual cure is incomplete.
Choosing a doctor
Look for a clinician with documented work in tropical infectious disease, ideally affiliated with a WHO-collaborating centre, a travel-medicine clinic, or a national reference laboratory that performs schistosome serology and CCA testing. For complications, choose a hepatologist or urologist who manages portal hypertension or bladder reconstruction at high volume.
Schistosomiasis is a parasitic disease caused by blood flukes that live in human veins after entering through skin exposed to contaminated freshwater. Eggs released by the worms cause damage to the bladder, intestines, liver, or genitals over many years. It is treated with a single oral dose of praziquantel.
How do you catch schistosomiasis?▾▴
Infection occurs when freshwater containing larvae (cercariae) released from infected snails contacts intact skin. Bathing, wading, washing clothes, or working in lakes, rivers, dams, or irrigation canals in endemic regions transmits the parasite. Saltwater, chlorinated pools, and brief hand contact with treated water do not transmit infection.
What are the first signs of schistosomiasis?▾▴
Early signs include an itchy skin rash within 24 hours of freshwater exposure and, weeks later, fever, fatigue, muscle aches, and cough during the Katayama phase. Visible blood in urine or stool typically appears 2-6 months after first exposure. Many infections cause no early symptoms and are detected only on screening.
Is praziquantel the only treatment for schistosomiasis?▾▴
Praziquantel is first-line for all five human schistosome species at 40 mg/kg (60 mg/kg for S. japonicum and S. mekongi). Oxamniquine is a second-line option for S. mansoni only. Severe symptoms during the acute phase are managed with short-course corticosteroids alongside praziquantel.
How long does schistosomiasis take to cause damage?▾▴
Damage develops over years of unresolved infection. Children in endemic regions can show bladder-wall thickening within 1-2 years; significant hepatic periportal fibrosis usually appears after 5-15 years of heavy exposure. Bladder cancer related to S. haematobium typically presents in the fourth or fifth decade.
Can schistosomiasis be cured?▾▴
Active worm infection is cured in 60-90% of patients with a single 40 mg/kg dose of praziquantel; egg shedding falls by more than 90%. A second dose at 4-8 weeks raises cure rates further. Established organ damage such as severe bladder fibrosis or hepatic fibrosis does not fully reverse but stabilizes.
Is schistosomiasis contagious between people?▾▴
Schistosomiasis is not contagious from person to person. Transmission requires the freshwater snail intermediate host, so eggs passed in urine or stool must reach a body of fresh water containing the right species of snail to continue the life cycle. Sexual transmission has not been documented.
What does urinary schistosomiasis look like?▾▴
The hallmark is painless visible blood at the end of urination, usually in school-age boys and young men in endemic regions. Other features include frequency, urgency, dysuria, and lower abdominal pain. Long-term changes include bladder calcifications, hydronephrosis, and an increased risk of squamous-cell bladder cancer.
How is schistosomiasis diagnosed in travelers?▾▴
Returning travelers are screened with serology (ELISA), full blood count for eosinophilia, urine filtration, and three stool samples on consecutive days. Serology becomes positive 6-12 weeks after exposure. The CCA urine cassette can detect active S. mansoni infection at the point of care.
How can I prevent schistosomiasis when traveling?▾▴
Avoid swimming or wading in lakes, rivers, and irrigation canals in endemic regions. If exposure occurs, towel-dry vigorously and shower as soon as possible. Boil or filter drinking and bathing water, and seek pre-travel advice on testing and possible empirical post-exposure treatment.
Can children take praziquantel?▾▴
Yes. Praziquantel 40 mg/kg as a single oral dose is safe and effective in children aged 4 years and older, and WHO has approved formulations for younger preschool children. School-based mass drug administration with praziquantel is the largest deworming program in the world.
Does schistosomiasis cause infertility?▾▴
Female genital schistosomiasis can cause cervical, vaginal, fallopian, and ovarian lesions, leading to infertility, ectopic pregnancy, and chronic pelvic pain. In men, seminal vesicle and prostatic involvement can impair fertility. Early diagnosis and praziquantel treatment improve outcomes in 60-80% of women.
What is Katayama syndrome?▾▴
Katayama syndrome is an acute serum-sickness-like illness 4-8 weeks after first exposure, with fever, urticaria, myalgia, cough, hepatosplenomegaly, and marked eosinophilia. It is treated with corticosteroids (prednisolone 1 mg/kg/day for 5-7 days) plus praziquantel, with a repeat praziquantel dose 4-8 weeks later.
Does schistosomiasis increase HIV risk?▾▴
Yes, in women. Female genital schistosomiasis causes mucosal lesions and increased local immune activation that approximately triple the risk of HIV acquisition during heterosexual exposure. Treating female genital schistosomiasis is now part of WHO-recommended HIV-prevention strategies in endemic settings.
Is bilharzia the same as schistosomiasis?▾▴
Yes. Bilharzia is the common name, especially in Africa, named after Theodor Bilharz who identified the parasite in 1851. Schistosomiasis is the medical term. Snail fever is another colloquial name, particularly for the Asian S. japonicum form.
How long do schistosoma worms live in the body?▾▴
Adult worm pairs typically live 3-10 years in human blood vessels, but documented survival of more than 30 years has been reported in untreated migrants. Without treatment, egg-laying continues for the lifetime of the worms, driving cumulative organ damage.
Can schistosomiasis come back after treatment?▾▴
Praziquantel does not produce immunity, so re-infection from continued freshwater exposure in endemic regions is common. Children may be re-infected within 6-18 months without behavior change or improved water and sanitation. Travelers without further exposure rarely relapse.
Is schistosomiasis found outside Africa?▾▴
Yes. S. mansoni is endemic in Brazil, Venezuela, Suriname, parts of the Caribbean, and the Arabian peninsula. S. japonicum persists in China, the Philippines, and Indonesia. S. mekongi is restricted to the Mekong basin in Laos and Cambodia. Imported cases occur worldwide via travel and migration.
Does swimming in the ocean cause schistosomiasis?▾▴
No. Human schistosome species require a freshwater snail intermediate host and cannot survive in saltwater. Cercarial dermatitis (swimmer's itch) caused by bird schistosomes can occur in fresh or brackish water but does not progress to systemic infection.
What follow-up is needed after schistosomiasis treatment?▾▴
Repeat urine and stool microscopy at 4-12 weeks confirm parasitological cure; a second dose of praziquantel is given if eggs persist. Abdominal and pelvic ultrasound at 6 and 12 months tracks organ recovery. Travelers without re-exposure usually need no further follow-up after cure is confirmed.
Is praziquantel safe in pregnancy?▾▴
Yes. WHO 2006 expert consultation and subsequent reviews concluded that praziquantel is safe in pregnancy and breastfeeding, and pregnant women in endemic regions are now included in mass drug administration. Untreated maternal schistosomiasis is associated with anemia, low birth weight, and poorer infant growth.
05Fever, urticaria, generalized myalgia, fatigue, marked eosinophilia (often >20%), hepatosplenomegaly, and cough 4-8 weeks after first exposure in non-immune travelers — the Katayama syndrome.
06Progressive abdominal distension with a firm enlarged spleen and prominent abdominal collateral veins in late hepatosplenic disease.
07Hematemesis, melena, or syncope from ruptured esophageal varices secondary to schistosomal portal hypertension.
08Postcoital bleeding, contact bleeding from cervical lesions, infertility, dyspareunia, and chronic pelvic pain in women with female genital schistosomiasis.
09Hemospermia, scrotal swelling, prostatitis-like pain, and infertility in men with seminal vesicle or prostatic involvement.
10Seizures, focal neurological deficits, or back pain with lower-limb weakness and bladder dysfunction in rare neuroschistosomiasis.
early warning signs
•Pruritic papular eruption developing within 24 hours of swimming or wading in fresh water in an endemic region
•Visible blood in the urine of a school-age child in an endemic village, often accepted locally as a normal sign of puberty in boys
•Unexplained peripheral blood eosinophilia above 500/µL in a returning traveler from sub-Saharan Africa, the Nile basin, the Mekong, or northeast Brazil
•Fever, myalgia, and dry cough 4-8 weeks after freshwater exposure during an African or Asian trip
•Recurrent urinary tract symptoms in an endemic-region child or adolescent without classic bacterial culture findings
● emergency signs
•Massive hematemesis or melena from bleeding esophageal varices — requires immediate resuscitation and endoscopic band ligation
•Acute urinary retention with painful bladder distension and bilateral flank pain suggesting bilateral ureteric obstruction
•New seizure, paraparesis, urinary retention, or sensory level in a patient from or recently returned from an endemic region — exclude neuroschistosomiasis with urgent MRI and lumbar puncture
•High fever with respiratory distress, hypoxia, and infiltrates on chest imaging during Katayama syndrome — pulmonary schistosomiasis or superimposed infection
•Acute severe hypersensitivity (anaphylaxis, angioedema) after a first dose of praziquantel — uncommon but reported
04
Point-of-care urine CCA testDetects circulating cathodic antigen produced by living worms — indicates active infection
05
Abdominal and pelvic ultrasoundGrades hepatic periportal (Symmers') fibrosis, splenomegaly, portal hypertension, bladder wall thickening, calcifications, and hydronephrosis
06
Cystoscopy with bladder biopsyEvaluates persistent hematuria, sandy patches, polyps, and excludes bladder cancer in chronic S. haematobium infection
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MRI brain or spine with gadoliniumEvaluates suspected neuroschistosomiasis with seizures, focal deficits, or spinal symptoms
Outlook
Outlook depends on the stage at diagnosis. Recently acquired light infections treated with praziquantel have an excellent prognosis: more than 80% achieve parasitological cure, eosinophilia normalizes within 3-6 months, and structural sequelae are uncommon. Chronic urogenital disease shows substantial regression of bladder-wall thickening and hydronephrosis on ultrasound within 12 months of treatment in roughly 60% of patients, especially in children. Established hepatic periportal fibrosis does not reverse fully, but progression usually halts, and portal pressure may fall enough to reduce variceal bleeding rates. Untreated heavy chronic infection over 10-20 years carries a mortality risk dominated by variceal hemorrhage, end-stage renal disease from bilateral hydronephrosis, and squamous-cell bladder cancer; the latter develops in roughly 2-14 per 100,000 person-years in heavily infected populations. Female genital schistosomiasis recognized early responds to praziquantel with improvement in lesions and fertility outcomes, but advanced cervicovaginal damage may be permanent.
Occupational and recreational water contact
Fishermen, rice farmers, washerwomen, sand miners, and children who play in water carry the highest risk. Among travelers, white-water rafting, freshwater swimming, and missionary or aid work account for most imported cases. Saltwater and chlorinated swimming pools do not transmit infection.
risk factors
Residence or travel in a transmission areaenvironmental
Sub-Saharan Africa accounts for over 90% of global cases. Other foci: Egypt, Yemen, Brazil, eastern Mediterranean, and the Mekong, Yangtze, and Lake Malawi basins. Risk persists in many areas despite mass drug administration.
Age 5-15 yearsnon-modifiable
Children spend more time in water and acquire heavier worm burdens before partial immunity develops. Peak egg excretion occurs at age 10-14 in most endemic communities.
Male sex (urogenital)non-modifiable
Men have roughly 1.3-2× higher prevalence than women in many African foci because of occupational water exposure (fishing, irrigation). Female genital schistosomiasis is, however, common and under-recognized in women.
Occupational freshwater contactmodifiable
Fishing, rice cultivation, irrigation-canal maintenance, brick-making, and laundry by hand in natural water all sustain repeated exposure. WHO classifies fishing communities along Lake Victoria as among the highest-risk populations in the world.
Recreational freshwater exposure in travelersmodifiable
Swimming, rafting, kayaking, or wading in lakes or rivers during travel to endemic regions is the dominant exposure for imported cases. Lake Malawi, the Omo River, and the Nile are well-documented tourist exposures.
Inadequate sanitation and water accessenvironmental
Open defecation and lack of piped water maintain transmission. Provision of latrines and protected water sources reduces incidence by 30-77% in cluster-randomized trials.
HIV co-infectionmodifiable
HIV infection does not increase schistosomiasis prevalence but increases the risk of female genital schistosomiasis progression and may decrease praziquantel cure rates by approximately 10-20%. Female genital schistosomiasis itself increases HIV acquisition risk roughly 3-fold.
Vitamin-C-rich foods (citrus, peppers, guava) eaten with iron sources to improve absorption
•Adequate protein intake (1-1.2 g/kg/day) during convalescence and in growing children
•Folate-containing foods (legumes, leafy greens) to support erythropoiesis
foods to avoid
•Alcohol, especially with established hepatic fibrosis or variceal disease
•Unwashed raw produce irrigated with contaminated freshwater
•Untreated freshwater for drinking or food preparation
•Iron from supplements without medical advice in patients with active hepatic fibrosis
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Neuroschistosomiasis (seizures, transverse myelitis, cauda equina) — rare but disabling; urgent MRI and combined treatment.
choosing the right hospital
01Access to schistosome serology (ELISA) and PCR within the country
02Availability of praziquantel in adequate stock for treatment courses
03Endoscopy unit for variceal band ligation
04Urology service experienced in bladder reconstruction and oncology
05Tropical medicine outpatient clinic or travel medicine service
Essential facilities
WHO-collaborating tropical medicine centresTravel and tropical medicine outpatient clinicsReference parasitology laboratoriesTertiary hepatology units with endoscopic bandingReconstructive urology services
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02Monitor for transient post-treatment side-effects (nausea, headache, abdominal pain, dizziness) and rest for 24 hours.
03Drink at least 2 L of water daily to support clearance of dying parasites and any heme load.
04Track urine color and any visible blood; report new or persistent hematuria.
05Attend follow-up parasitology and ultrasound appointments at 3, 6, and 12 months.
06Keep an exposure diary (water contact dates and locations) to inform clinicians on any future presentation.
Exercise
Light to moderate aerobic activity is safe during and after treatment. Patients with hepatosplenic disease and significant splenomegaly should avoid contact sports because of splenic rupture risk; once portal hypertension is controlled, walking, cycling, and swimming in chlorinated pools are encouraged.