Page 65 - Journal of Special Operations Medicine - Fall 2016

Schistosomiasis

Travelers in Africa

Jeremy Strohmayer, DO; Ian Matthews, DO; Kurt Locke, IDMT

ABSTRACT
Schistosomiasis is a parasitic infection acquired through Figure 1 Geographic distribution of schistosomiasis,
freshwater exposure in the tropics. It is an infection that available at http://wwwnc.cdc.gov/travel/yellowbook/2016/
can have devastating implications to military personnel infectious-diseases-related-to-travel/schistosomiasis#4701.
if it is not recognized and treated, especially later in life.
While there is an abundance of information available
about schistosomiasis in endemic populations, the infor-
mation on nonendemic populations, such as deployers,
is insufficient. Definitive studies for this population are
lacking, but there are actions that can and should be
taken to prevent infection and to treat patients. This lit-
erary review presents a case study, reviews basic science,
and explores the information available about schisto-
somiasis in nonendemic populations. Specifically, the
authors provide recommendations for the prevention,
diagnosis, and postexposure management in military
personnel.

Keywords: Africa; schistosomiasis; disease, tropical; mili-
tary personnel; DEET; praziquantel; Schistosoma spp.
troops. The aims of this literature review are to increase
5
awareness, knowledge, and recognition of this infection
by Special Operations Forces Medics and to provide a
Introduction
reasonable guideline for managing the risk it poses to
Schistosoma is a blood fluke that resides in human the troops.
blood vessels. It causes an acute febrile condition as
1
well as severe chronic complications. While this fluke Case Presentation
1
can be found in tropical climates around the world, it is Two military pilots presented to an austere clinic and re-
particularly prevalent in Africa (Figure 1). The Geo- ported that they were kayaking in Lake Victoria 1 week
1,2
Sentinel Surveillance network reported that 88% of all earlier. They were concerned about exposure to para-
cases in travelers from 1997 through 2008 originated on sites in the lake water. They reported entering the kayaks
this continent. There are five species that cause schisto- from wet rocks without wading. They denied swimming
2
somiasis that infect humans, of which three are endemic in the lake but reported being splashed as they kayaked.
to Africa: Schistosoma mansoni, S. haematobium, and They denied any physical symptoms, and their physical
S. intercalatum. 1–3 While the incidence rate for schisto- examinations revealed no abnormalities. The initial pro-
somiasis is small at 1.6%, repeated travel to endemic vider gave the patients three 600mg tablets of praziqu-
areas leads to a significant cumulative risk for military antel as postexposure prophylaxis and instructed them
personnel. 4 to follow up with the flight surgeon at their deployed
location. On follow-up 3 days later, a telemed consult
Medical personnel in Africa must be aware of this risk, for infectious disease was placed. The consultant ad-
but most providers are unfamiliar with this disease. The vised that praziquantel should be held as it would not
Belgian military found that gaps in provider knowledge be effective and for the patients to follow up with the
contributed to a 2.1-year delay in diagnosis for their flight medicine clinic at home for schistosomiasis testing

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