Schistosomiasis: a case of severe infection with fatal outcome

Abstract

Schistosomiasis is one of the most common parasitic diseases, still
considered of public health significance. Acute schistosomiasis is of difficult
diagnosis and therefore has been overlooked, misdiagnosed, underestimated
and underreported in endemic areas. The delay between the exposure to
contaminated water and the initial symptoms may explain this challenging
diagnosis. Acute schistosomiasis is frequently reported in non-immune
individuals while reinfection cases occurring in endemic areas is scarcely
documented. The later usually shows a benign course but fatal cases do exist.
The authors report a case of a young female patient, in the late puerperium,
with a three-month history of weight loss, intermittent fever, cough, thoracic
and abdominal pain and increased abdominal girth. Physical examination
showed a tachycardia, tachypnea and hypotension. Laboratory tests showed
a mild anemia, eosinophilia, and a slightly elevation of liver enzymes. Thorax
and abdominal multidetector computed tomography evidenced a diffuse
and bilateral pulmonary micronodules and peritoneal and intestinal wall
thickening. The patient progressed rapidly to hepatic insufficiency, and death
after respiratory insufficiency. An autopsy was performed and the findings
were compatible with acute Schistosomiasis in a patient previously exposed
to Schistosoma mansoni.