Early Detection of Schistosoma Egg–Induced Pulmonary Granulomas in a Returning Traveler

Abstract

Abstract. We report the case of a French traveler who developed acute pulmonary schistosomiasis 2 months after visiting Benin. He presented with a 1-month history of fever, cough, and thoracic pain. Initial investigations revealed hypereosinophilia and multiple nodular lesions on chest computed tomography scan. Lung biopsies were performed 2 months later because of migrating chest infiltrates and increasing eosinophilia. Histological examination showed schistosomal egg-induced pulmonary granulomas with ova exhibiting a prominent terminal spine, resembling Schistosoma haematobium. However, egg shells were Ziehl-Neelsen positive, raising the possibility of a Schistosoma intercalatum or a Schistosoma guineensis infection. Moreover, involvement of highly infectious hybrid species cannot be excluded considering the atypical early pulmonary oviposition. This case is remarkable because of the rarity of pulmonary schistosomiasis, its peculiar clinical presentation and difficulties in making species identification. It also emphasizes the need to consider schistosomiasis diagnosis in all potentially exposed travelers with compatible symptoms.

Restaging Pulmonary Schistosomiasis

“…The lesion of the latter patient was very similar to the lesions described previously, 10 were schistosome eggs were found in the biopsies, so we now think that in the previous cases 10 praziquantel only sped up the clearance of the lungs lesions. These findings are similar to those observed in the acute phase of schistosomiasis, with well-defined or ground glass nodules that resolve spontaneously 11 ; only, we did not observe the pulmonary infiltrates that are also common in the acute phase. In view of these findings, we postulate the presence of an "intermediate" phase of schistosomiasis occurring in the lungs that can be defined as an "early chronic phase," and presents analogies to the acute phase.…”

Pulmonary nodules in African migrants caused by chronic schistosomiasis

“…Katayama syndrome is usually diagnosed either by serology or, less frequently, by detecting schistosome eggs in urine or stool (depending on the species). 11 Moreover, Coron and colleagues 19 reported eggs of S haematobium in a pulmonary biopsy from a French traveller with Katayama syndrome. Schwartz 20 considered three diff erent possible scenarios for acute pulmonary schistosomiasis: symptomatic cases with radiological fi ndings (either by chest radiograph or CT scan) evident at presentation; symptomatic patients without radiological fi ndings (probably with small lesions, not visible by chest radiograph); or asymptomatic cases with radiological fi ndings, with an unknown incidence, because radiology is usually not performed in the absence of symptoms.…”

New Insights on Acute and Chronic Schistosomiasis: Do We Need a Redefinition?

“…Worthy of note, another four cases of pulmonary nodules in CS were afterwards detected in the same center [34]; moreover, a case series of 17 cases [35] and other single cases were reported [36][37][38]. Second, the characteristics of the lung lesions in these patients with CS resembled those described by other groups during AS: transient macronodules, micronodules [11,39,40], and nodules with 'ground-glass' attenuation areas [6,7,9,[41][42][43][44][45]. These were obviously very different from the lung manifestations described in some patients with advanced-stage CS, that is, irreversible pulmonary arterial hypertension but no lung nodules [13,46,47].…”

“…Trends Trends in in Parasitology Parasitology 6 months earlier, just as the case described by Ryan et al [25]. Based on these two additional cases, it was postulated that, in the previous case series, the treatment with PZQ only accelerated the clearance of the lung lesions that otherwise would have disappeared spontaneously [50], similar to what is known for pulmonary lesions diagnosed during AS [44]. Since chest imaging is routinely offered for tuberculosis screening to asymptomatic migrants at the center, this allowed detection of pulmonary nodules that usually would go unrecognized when imaging is performed only in case of respiratory complaints, or in low-resource settings where imaging is usually not available.…”