From the Guidelines
To diagnose and treat Katayama syndrome, recognize the clinical presentation of fever, malaise, cough, and urticaria occurring 4-8 weeks after exposure to freshwater in endemic areas for schistosomiasis, and treat with prednisolone at 20 mg/day for 5 days, as well as praziquantel 40 mg/kg in a divided dose 4 hours apart, repeated 6-8 weeks later. The clinical presentation of Katayama syndrome is non-specific, but includes symptoms such as fever, lethargy, myalgia, arthralgia, cough, wheeze, headache, urticarial rash, diarrhoea, and hepatosplenomegaly 1. The diagnosis is likely in patients with a history of freshwater exposure 4-8 weeks previously, fever, urticarial rash, and eosinophilia, and empiric therapy should be given 1. Key points to consider in the diagnosis and treatment of Katayama syndrome include:
- The combination of freshwater exposure, fever, urticarial rash, and eosinophilia makes the diagnosis likely, and justifies empirical treatment 1
- Praziquantel should be given at the time of diagnosis and repeated 6-8 weeks later to kill mature and immature schistosomes 1
- A short course of steroids, such as oral prednisolone 20 mg/day for 5 days, may help alleviate acute symptoms with no known adverse effect on cure 1
- Other causes of eosinophilia, including helminths and non-infectious causes, should be considered 1. Given the unpredictability of Katayama syndrome, prompt recognition and treatment are crucial to prevent progression to chronic schistosomiasis.
From the Research
Diagnosing Katayama Syndrome
- Katayama syndrome is an acute manifestation of schistosomiasis, characterized by a hypersensitivity reaction to migrating larvae and early egg deposition 2.
- The syndrome can present with non-specific symptoms, including fever, myalgia, night sweats, gastrointestinal, and pulmonary complaints, making diagnosis challenging 3.
- A history of water contact in an endemic area, typically 14-84 days before the onset of symptoms, is a crucial diagnostic clue 3.
- Laboratory findings, such as eosinophilia, and the presence of schistosome eggs in stool or tissue samples, can support the diagnosis 2, 4.
Treating Katayama Syndrome with Corticosteroids
- Corticosteroids, such as prednisolone, can be used to suppress the hypersensitivity reaction associated with Katayama syndrome 2, 5.
- The use of corticosteroids in combination with schistosomicides, such as praziquantel, may have a synergistic effect, reducing egg excretion and tissue egg density 5.
- Treatment with corticosteroids and praziquantel can lead to complete resolution of symptoms and radiological abnormalities, as well as eradication of the parasite 2.
- The decision to use corticosteroids should be made on a case-by-case basis, considering the severity of symptoms and the potential risks and benefits of treatment 3, 5.