What are the implications of finding Schistosoma (schistosome) in stool?

From the Guidelines

Schistosome eggs found in stool should be treated with praziquantel at a dose of 40 mg/kg as a single dose for S. mansoni, S. intercalatum, and S. guineensis infections, and 60 mg/kg in two divided doses for S. japonicum and S. mekongi infections, as recommended by the most recent guidelines 1. When diagnosing schistosomiasis, it's essential to consider the species of the parasite, as different species may have different treatments and presentations.

• The incubation period for schistosomiasis is typically 2-8 weeks 1.
• The clinical presentation of intestinal schistosomiasis can include chronic or intermittent abdominal pain, weight loss, and diarrhea, while very heavy infection can manifest as dysenteric illness or obstruction 1.
• Investigations for schistosomiasis include serology, microscopy of concentrated stool samples, abdominal ultrasound, and upper gastrointestinal endoscopy if portal hypertension is suspected 1.
• It's crucial to note that serology may remain positive for many years after treatment, so it cannot be used to assess the success of treatment 1.
• Treatment with praziquantel is effective against schistosomiasis, but the dose and administration may vary depending on the species of the parasite 1.
• Patients should be advised that praziquantel may cause temporary side effects, including abdominal pain, dizziness, and headache.
• Prevention of schistosomiasis involves avoiding contact with freshwater in endemic areas, as infection occurs when larval forms penetrate human skin during water contact.

From the Research

Schistosome in Stool

• Schistosomes can be detected in stool through the presence of eggs, which is a common method for diagnosing intestinal schistosomiasis 2
• The diagnosis of schistosomiasis is confirmed by finding eggs in stool or biopsy specimens 2
• Intestinal schistosomiasis is most often asymptomatic and presents with occult gastrointestinal bleeding, and the presence of eggs in stool can be an indicator of the infection 2
• Praziquantel is the schistosomicidal drug of choice for treating schistosomiasis, and its efficacy can be influenced by the presence of certain gut microbiome profiles, such as a higher abundance of Fusobacterium spp. 3
• The presence of schistosomes in stool can be an indicator of reinfection, and studies have shown that reinfection rates can vary widely, ranging from 13.9% to 63.4% within 8 to 28 weeks following praziquantel treatment 4

Detection and Diagnosis

• Antischistosome antibodies may identify infected individuals returning from endemic areas, and circulating schistosome antigens can distinguish current from past infections 2
• Diagnostic imaging can reveal hepatosplenomegaly and pericardial effusion, which can be complications of schistosomiasis 5
• Negative stool culture does not rule out the infection in patients with a history of travel to an endemic area with high clinical suspicion 5

Treatment and Management

• Praziquantel, with or without steroids, is the standard treatment for managing schistosomiasis and its complications 5
• Early recognition and management of complications, such as pericardial effusion, can improve patient outcomes 5
• The provision of potable water, toilet, and recreational facilities can reduce reinfection and egg reduction rates, and increase cure rates to expedite schistosomiasis elimination 4