Localized papular cutaneous schistosomiasis: two cases in travellers

Abstract

Schistosomiasis is endemic in many parts of the tropics and subtropics with an estimated 200 million people, at least, infected worldwide. The symptoms and signs of vesical and gastrointestinal forms are readily recognized but ectopic forms are rare even in endemic areas and present a greater diagnostic challenge, particularly when they are encountered in nontropical climes. We now report two cases of cutaneous schistosomiasis presenting in Edinburgh with subtle, but remarkably similar, skin lesions.

The Potential of Molecular Diagnosis of Cutaneous Ectopic Schistosomiasis

“…3,7,8,[10][11][12]16 In the described case no ova were observed in urine and in feces, which is in accordance with earlier reports. 3,8,9,12 Our patient presented with gastrointestinal complaints, but sequence analysis showed DNA of S. haematobium , which causes urinary schistosomiasis. Gastrointestinal complaints in a patient with CES caused by S. haematobium are uncommon, but have been reported previously by MacDonald and others.…”

“…This atypical presentation of schistosomiasis has only been described in 15 cases; 7 cases were caused by S. haematobium , 3, 7-11 7 cases caused by S. mansoni, 9, 12-16 and in one case species determination was not mentioned. 3 CES occurs 4 weeks to 2 years after infection and is characterized by grouped, erythematous, itchy papular lesions or nodules, with a diameter up to 1 cm. Often this is accompanied by eosinophilia.…”

“…In these cases the diagnosis is often difficult, and species determination by microscopy is sometimes impossible. 3 Here we report a patient with cutaneous ectopic schistosomiasis (CES) and describe the potential of molecular methods in this diagnosis.…”

Cutaneous schistosomiasis: Case report and literature review

“…[7] However, review of reports by Obasi [4] from Nigeria, Andrade Filho [5] from Brazil, and Leman [6] from the United Kingdom among others has shown papular presentation to be the predominant pattern, and similar to our index case, tends to appear in crops.…”

“…Its occurrence in the skin is however rare even in areas endemic for the disease. [6] Epidemiologically male preponderance and highest frequency in the second to third decades of life have been noted for cutaneous presentation of the disease. [5] These age and gender patterns, reflected in our index case, highlight the social risk factors at play whereby young adult males in our area visit bodies of water which may harbor Bulinus, the parasite vector, either for leisure or fishing.…”