Page 69 - Journal of Special Operations Medicine - Fall 2016

these patients required multiple courses of praziquantel Appropriate follow-up when returning to home sta-
to achieve negative serologic test results. One patient re- tion is paramount. Medical personnel must maintain
quired five doses over 4 years. 23 a high index of suspicion in personnel who had fresh-
water contact in schistosomiasis-endemic areas, includ-
These reports suggest that nonimmune patients diag- ing AFRICOM, PACOM, and SOUTHCOM. Serologic
nosed with shistosomiasis require a more aggressive testing at least 9 weeks after last exposure is sufficient.
treatment regimen. This includes repeated doses of When the results are either indeterminate or positive,
prazi quantel, possibly in combination with artemisinin the patient should be treated with 20mg/kg praziquantel
derivatives. 15,23,24 Belgian military personnel with symp- twice a day for 3 days.
toms were treated with 40mg/kg/d praziquantel and
16mg/d methylprednisolone for 3 days. Corticosteroids This approach will not guarantee that all infections are
5
are sometimes administered as initiation of therapy can recognized and eradicated, but it is a start to protect
cause exacerbation of symptoms. 12,13 deployed persons as the medical community continues
to study this parasite. Special Operations Forces person-
Due to high rates of relapse, follow-up and retesting nel are willing to give everything to support the United
may be indicated up to 2 years after initial therapy. 15,23,24 States. Special Operations Medics must be prepared to
protect them in kind.
Conclusion
Schistosomiasis is a widespread disease in the tropics Disclosures
and particularly in Africa. It can have devastating effects
if untreated. Special Operations Medics must recognize The authors have nothing to disclose.
the consequences and assist deployed personnel with
education, prevention, and recognition. While there are
still many questions to answer with regard to preven- References
tion, diagnosis, and treatment in nonendemic popula- 1. Aerssens A, De Vos D, Pirnay J, et al. Schistosomiasis in Bel-
tions, the following is a reasonable approach (Figure 4). gian Military personnel returning from the Democratic Re-
public of Congo. Mil Med. 2011;176:1341–1346.
Figure 4 Schistosomiasis management. 2. Nicolls D, Weld L, Schwatz E, et al. Characteristics of schisto-
somiasis in travelers reported to the GeoSentinel Surveillance
Network 1997-2008. Am J Trop Med Hyg. 2008;79:729–734.
3. Baaten G, Sonder G, van Gool T, et al. Travel-related schis-
tosomiasis, strongyloidiasis, filariasis, and toxocariasis: the
risk of infection and the diagnostic relevance of blood eosino-
philia. BMC Infect Dis. 2011;11:84.
4. Centers for Disease Control and Prevention. Parasites: schis-
tosomiasis. Epidemiology & risk factors. http://www.cdc.gov
/parasites/schistosomiasis/epi.html. Accessed 8 June 2016.
5. Chitsulo L, Engels D, Montresor A, et al. The global status of
schistosomiasis and its control. Acta Tropica. 2000;77:41–51.
6. Inobaya M, Olveda R, Chau T, et al. Prevention and control
of schistosomiasis: a current perspective. Res Rep Trop Med.
2014;2014:65–75.
7. Salafsky B, Ramaswamy K, He Y, et al. Development and
evaluation of LIPODEET, a new long-acting formulation
of N, N-diethyl-m-toluamide (DEET) for the prevention of
schistosomiasis. Am J Trop Med Hyg. 1999;61:743–750.
8. Jackson F, Doherty J, Behrens R. Schistosomiasis prophylaxis
in vivo using N,N-diethyl-m-toluamide (DEET). Trans R Soc
To prevent infection, educate troops to avoid untreated Trop Med Hyg. 2003;97:449–450.
freshwater. When freshwater contact is unavoidable, the 9. Cooper E, Iqbal A, Bartlett A, et al. A comparison of topical
application of liposomal DEET to all skin beforehand formulations for the prevention of human schistosomiasis. J
Pharm Pharmacol. 2004;56:957–962.
or vigorous toweling and subsequent application of 10. Whitty C, Carroll B, Armstrong M, et al. Utility of history,
alcohol-based DEET to all skin after freshwater contact examination and laboratory tests in screening those returning
can prevent infection. to Europe from the tropics for parasitic infection. Trop Med
Int Health. 2000;5:818–823.
Treatment of acute schistosomiasis should be initiated at 11. Bierman W, Wetsteyn J, Gool T. Presentation and diagnosis
a medical facility capable of treating an exacerbation of of imported schistosomiasis: relevance of eosinophilia, micro-
scopy for ova, and serology. J Trav Med. 2006;12:9–13.
symptoms with corticosteroids. This might require the 12. Gray DJ, Ross AG, Li Y-S, et al. Diagnosis and management
troop to leave the fight until symptoms abate. of schistosomiasis. BMJ. 2011;342:d2651–d2651.

Schistosomiasis in Nonendemic Populations 51