Schistosomiasis, also known as bilharzia, is caused by blood flukes (trematode worms). The larvae penetrate the skin and develop into adult worms inside the blood vessels.
The disease is especially prevalent in sub-Saharan Africa but is also found in parts of South America, the Middle East, and Asia. While it rarely causes death, it leads to chronic illness and disability, particularly in communities with limited access to clean water and adequate sanitation.
Early (acute) symptoms may include:
As the infection becomes chronic, ongoing symptoms may develop, such as:
Kidney damage and fibrosis of the bladder and ureter are sometimes diagnosed in advanced cases. Bladder cancer is another possible complication in the later stages. Women can develop genital lesions, vaginal bleeding, pain during sexual intercourse and nodules in the vulva. Complications can be life-threatening, particularly when multiple organs are affected.
The disease cycles between humans and freshwater snails, which carry the parasitic worm. Humans become infected when they come into direct contact with contaminated freshwater, for example while bathing, swimming, fishing, or washing clothes. The larvae burrow into the skin and migrate through the body to the blood vessels, where they mature into adult worms.
Praziquantel is the main treatment for all forms of schistosomiasis. It is effective, safe and inexpensive. Treatment kills the adult worms and stops the disease progressing and spread.
In areas where schistosomiasis is widespread, large-scale drug administration programmes are used to treat entire communities, particularly school-age children, who are most at risk.
If you are travelling to an area where schistosomiasis is present you should avoid contact with contaminated freshwater. You cannot pick the disease up in a chlorinated swimming pool.
In places where the disease is endemic improving access to clean water and sanitation is essential, as is educating communities about safe water. Preventative measures include snail control, use of protective footwear when in contact with water, and regular mass drug administration.
Schistosomiasis has affected humankind for thousands of years and some historians believe it may have killed Alexander the Great. It was first described by the German physician Theodore Maximilian Bilharz who, as chief of surgery at a hospital in Cairo, discovered the trematode worm during a post mortem. He initially called it Distomum haematobium but it was later renamed Schistosoma haematobium, from the Greek for ‘split body’.
who.int/fact-sheets/schistosomiasis
nhs.uk/conditions/schistosomiasis
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