Tropical Medicine in an Age of High Global Mobility: Schistosomiasis in a School Class after Travel to Rwanda

Abstract

Introduction: Schistosomiasis is one of the most common parasitic diseases worldwide. If left untreated, intestinal (Schistosoma mansoni, S. japonicum, S. mekongi) and urogenital (S. haematobium) chronic disease manifestations occur depending on the parasite load. The early phase however is characterized by fever and an immune-complex-mediated illness. Long-distance travel to tropical regions is on the rise, academic partnerships and humanitarian missions take even young people to developing countries. Methods: 12 students from a German secondary school had fresh water exposure during a 14-day school trip to Rwanda in Lake Kivu in the west of the country. After returning to Germany, one of the students fell ill with acute schistosomiasis (Katayama syndrome), which led to examination of the other students. WBC, differential blood count, serology for schistosomal antibodies and ova detection in urine and stool were performed on first presentation and 6 and 12 months after therapy. Results: Positive antibody results indicated infection in all students, eosinophilia was found in 9 patients, ova of S. mansoni were detected in 3 cases. At presentation in our outpatient department 11 of the 12 students were asymptomatic. All patients received therapy with praziquantel. Discussion: Tropical diseases will further increase due to high global mobility. For their prevention and diagnosis physicians need to be sensitized beyond subject specific units. We describe an outbreak of schistosomiasis in a school class to sensitize physicians outside endemic areas. Since the disease is often asymptomatic a high number of unrecognized infections and illnesses can be assumed. When suspecting or treating schistosomiasis, a specialized center should always be consulted.