While chronic schistosomiasis is pathologically well defined, the acute form of the disease is less well understood. It is generally agreed that early lesions, such as lung nodules and bladder polyps, are reversible, which impedes identification of the time elapsed since exposure. The intermediate stage between the acute and the chronic forms of schistosomiasis requires further investigation, as does the clinical stage due to lesions remaining after treatment. With current schistosomiasis control efforts gradually progressing to elimination, there is a need to focus on post-transmission schistosomiasis, which not only refers to remaining lesions from previous infections, but also accounts for the potential presence of surviving worms after treatment. This issue is particularly salient for migrants from endemic to non-endemic countries and should be kept in mind for returning expatriates from schistosomiasis-endemic countries. Negative stool examination or urine filtration are generally taken as indicative of cure since rectoscopy for Schistosoma mansoni infection, or cystoscopy for S. haematobium infection, are rarely performed. However, pathology of affected organs may persist indefinitely, while potentially remaining live worms could produce additional pathology. Hence, post-transmission schistosomiasis can prevail for years after elimination of the disease, and thus, warrant further attention.

Ingerod 407 545 30 Brastad Sweden

Institute of Parasitology Czech Academy of Science CZ 370 01 České Budějovice Czech Republic

Swiss Tropical and Public Health Institute CH 4123 Allschwil Switzerland

University of Basel CH 4003 Basel Switzerland

See more in PubMed

Bilharz T.M. Fernere Beobachtungen über das die Pfortader des Menschen bewohnende Distomum haematobium und sein Verhältnis zu gewissen pathologischen Bildungen, von Dr. Th. Bilharz in Cairo (aus brieflichen Mittheilungen an Professor v. Siebold vom 29 März 1852) Z. Wiss. Zool. 1853;4:72–76.

Leiper R.T. On the relation between the terminal spined and lateral-spined eggs of bilharzia. Br. Med. J. 1916;1:411. doi: 10.1136/bmj.1.2881.411. PubMed DOI PMC

Gönnert R., Andrews P. Praziquantel, a new broad-spectrum antischistosomal agent. Z. Parasitenkd. 1979;52:129–150. doi: 10.1007/BF00389899. PubMed DOI

Davis A., Wegner D.H. Multicentre trials of praziquantel in human schistosomiasis: Design and techniques. Bull. World Health Organ. 1979;57:767–771. PubMed PMC

Li Y.-S., Ross A.G.P. Acute schistosomiasis. In: Jamieson B.G.M., editor. Schistosoma: Biology, Pathology and Control. CRC Press; Boca Raton, FL, USA: 2016. pp. 352–359.

Clegg J.A., Smithers S.R., Terry R.J. “Host” antigens associated with schistosomes: Observations on their attachment and their nature. Parasitology. 1970;61:87–94. doi: 10.1017/S0031182000040889. PubMed DOI

Kanzaria H.K., Acosta L.P., Langdon G.C., Manalo D.L., Olveda R.M., McGarvey S.T., Kurtis J.D., Friedman J.F. Schistosoma japonicum and occult blood loss in endemic villages in Leyte, the Philippines. Am. J. Trop. Med. Hyg. 2005;72:115–118. doi: 10.4269/ajtmh.2005.72.115. PubMed DOI

Butler S.E., Muok E.M., Montgomery S.P., Odhiambo K., Mwinzi P.M., Secor W.E., Karanja D.M. Mechanism of anemia in Schistosoma mansoni-infected school children in western Kenya. Am. J. Trop. Med. Hyg. 2012;87:862–867. doi: 10.4269/ajtmh.2012.12-0248. PubMed DOI PMC

Skelly P.J., Da’dara A.A., Li X.H., Castro-Borges W., Wilson R.A. Schistosome feeding and regurgitation. PLoS Pathog. 2014;10:e1004246. doi: 10.1371/journal.ppat.1004246. PubMed DOI PMC

Bergquist R., van Dam G., Xu J. Diagnostic tests for schistosomiasis. In: Jamieson B.G.M., editor. Schistosoma: Biology, Pathology and Control. CRC Press; Boca Raton, FL, USA: 2016. pp. 401–439.

Ross A.G., Vickers D., Olds G.R., Shah S.M., McManus D.P. Katayama syndrome. Lancet Infect. Dis. 2007;7:218–224. doi: 10.1016/S1473-3099(07)70053-1. PubMed DOI

Corachan M. Schistosomiasis and international travel. Clin. Infect. Dis. 2002;35:446–450. doi: 10.1086/341895. PubMed DOI

Wu X.-H., Zhang S.-Q., Xu X.-J., Huang Y.-X., Steinmann P., Utzinger J., Wang T.-P., Xu J., Zheng J., Zhou X.-N. Effect of floods on the transmission of schistosomiasis in the Yangtze River valley, People’s Republic of China. Parasitol. Int. 2008;57:271–276. doi: 10.1016/j.parint.2008.04.004. PubMed DOI

Clerinx J., van Gompel A. Schistosomiasis in travellers and migrants. Travel Med. Infect. Dis. 2011;9:6–24. doi: 10.1016/j.tmaid.2010.11.002. PubMed DOI

Doenhoff M.J., Cioli D., Utzinger J. Praziquantel: Mechanisms of action, resistance and new derivatives for schistosomiasis. Curr. Opin. Infect. Dis. 2008;21:659–667. doi: 10.1097/QCO.0b013e328318978f. PubMed DOI

Bergquist R., Utzinger J., Keiser J. Controlling schistosomiasis with praziquantel: How much longer without a viable alternative? Infect. Dis. Poverty. 2017;6:74. doi: 10.1186/s40249-017-0286-2. PubMed DOI PMC

Colley D.G., Bustinduy A.L., Secor W.E., King C.H. Human schistosomiasis. Lancet. 2014;383:2253–2264. doi: 10.1016/S0140-6736(13)61949-2. PubMed DOI PMC

Bottieau E., Clerinx J., de Vega M., van den Enden E., Colebunders R., van Esbroeck M., Vervoort T., van Gompel A., van den Ende J. Imported Katayama fever: Clinical and biological features at presentation and during treatment. J. Infect. 2006;52:339–345. doi: 10.1016/j.jinf.2005.07.022. PubMed DOI

Jauréguiberry S., Paris L., Caumes E. Acute schistosomiasis, a diagnostic and therapeutic challenge. Clin. Microbiol. Infect. 2010;16:225–231. doi: 10.1111/j.1469-0691.2009.03131.x. PubMed DOI

Gobbi F., Tamarozzi F., Buonfrate D., van Lieshout L., Bisoffi Z., Bottieau E., TropNet Schisto Task Force New insights on acute and chronic schistosomiasis: Do we need a redefinition? Trends Parasitol. 2020;36:660–667. doi: 10.1016/j.pt.2020.05.009. PubMed DOI

Coltart C., Whitty C.J. Schistosomiasis in non-endemic countries. Clin. Med. 2015;15:67–69. doi: 10.7861/clinmedicine.15-1-67. PubMed DOI PMC

Roure S., Valerio L., Pérez-Quílez O., Fernández-Rivas G., Martínez-Cuevas O., Alcántara-Román A., Viasus D., Pedro-Botet M.L., Sabrià M., Clotet B. Epidemiological, clinical, diagnostic and economic features of an immigrant population of chronic schistosomiasis sufferers with long-term residence in a non-endemic country (North Metropolitan area of Barcelona, 2002–2016) PLoS ONE. 2017;12:e0185245. doi: 10.1371/journal.pone.0185245. PubMed DOI PMC

Marchese V., Beltrame A., Angheben A., Monteiro G.B., Giorli G., Perandin F., Buonfrate D., Bisoffi Z. Shistosomiasis in immigrants, refugees and travellers in an Italian referral centre for tropical diseases. Infect. Dis. Poverty. 2018;7:55. doi: 10.1186/s40249-018-0440-5. PubMed DOI PMC

Giboda M. Migration of the people and parasites: Facts from survey of 5511 foreigners. Cas. Lek. Cesk. 2018;157:373–379. PubMed

Paran Y., Ben-Ami R., Orlev B., Halutz O., Elalouf O., Wasserman A., Zimmerman O., Nahmani I., Rabinowich L., Finn T. Chronic schistosomiasis in African immigrants in Israel: Lessons for the non-endemic setting. Medicine. 2019;98:e18481. doi: 10.1097/MD.0000000000018481. PubMed DOI PMC

Salas-Coronas J., Vázquez-Villegas J., Lozano-Serrano A.B., Soriano-Pérez M.J., Cabeza-Barrera I., Cabezas-Fernández M.T., Villarejo-Ordóñez A., Sánchez-Sánchez J.C., Vivas-Pérez J.I., Vázquez-Blanc S., et al. Severe complications of imported schistosomiasis, Spain: A retrospective observational study. Travel Med. Infect. Dis. 2020;35:101508. doi: 10.1016/j.tmaid.2019.101508. PubMed DOI

Harris A.R., Russell R.J., Charters A.D. A review of schistosomiasis in immigrants in Western Australia, demonstrating the unusual longevity of Schistosoma mansoni. Trans. R. Soc. Trop. Med. Hyg. 1984;78:385–388. doi: 10.1016/0035-9203(84)90129-9. PubMed DOI

Vieira P., Helena P., Miranda H.P., Cerqueira M., de Lurdes Delgado M., Coelho H., Antunes D., Cross J.H., Correia da Costa J.M. Latent schistosomiasis in Portuguese soldiers. Mil. Med. 2007;172:144–146. doi: 10.7205/MILMED.172.2.144. PubMed DOI

Giboda M., Bergquist N. Post-transmission schistosomiasis. Parasitol. Today. 1999;15:307–308. doi: 10.1016/S0169-4758(99)01487-8. PubMed DOI

Giboda M., Bergquist N.R. Post-transmission schistosomiasis: A new agenda. Acta Trop. 2000;77:3–7. doi: 10.1016/S0001-706X(00)00120-0. PubMed DOI

Peters P.A., Mahmoud A.A., Warren K.S., Ouma J.H., Siongok T.K. Field studies of a rapid, accurate means of quantifying Schistosoma haematobium eggs in urine samples. Bull. World Health Organ. 1976;54:159–162. PubMed PMC

Katz N., Chaves A., Pellegrino J. A simple device for quantitative stool thick-smear technique in schistosomiasis mansoni. Rev. Inst. Med. Trop. São Paulo. 1972;14:397–400. PubMed

WHO . Bench Aids for the Diagnosis of Intestinal Parasites. 2nd ed. World Health Organization; Geneva, Switzerland: 1991. [(accessed on 31 December 2021)]. Available online: https://apps.who.int/iris/handle/10665/324883.

Giboda M., Loudová J., Shonová O., Boučková E., Horáček J., Numrich P., Ruppel A., Vitovec J., Lukeš S., Noll P. Efficacy of praziquantel treatment of schistosomiasis in a non-endemic country: A follow-up of parasitological, clinical and immunological parameters. J. Hyg. Epidemiol. Microbiol. Immunol. 1992;36:346–355. PubMed

Bärenbold O., Raso G., Coulibaly J.T., N’Goran E.K., Utzinger J., Vounatsou P. Estimating sensitivity of the Kato-Katz technique for the diagnosis of Schistosoma mansoni and hookworm in relation to infection intensity. PLoS Negl. Trop. Dis. 2017;11:e0005953. doi: 10.1371/journal.pntd.0005953. PubMed DOI PMC

Mosimann J.E., Malley J.D., Cheever A.W., Clark C.B. Size and shape analysis of schistomsome egg-counts in Egyptian autopsy data. Biometrics. 1978;34:341–356. doi: 10.2307/2530597. PubMed DOI

Danso-Appiah A., Utzinger J., Liu J., Olliaro P. Drugs for treating urinary schistosomiasis. Cochrane Database Syst. Rev. 2008:CD000053. doi: 10.1002/14651858.CD000053. PubMed DOI

Danso-Appiah A., Olliaro P.L., Donegan S., Sinclair D., Utzinger J. Drugs for treating Schistosoma mansoni infection. Cochrane Database Syst. Rev. 2013:CD000528. doi: 10.1002/14651858.CD000528.pub2. PubMed DOI PMC

Laurent G.F., Lamothe M., Develonx B., Sellin B., Mouchet F. Ultrasonographic assessment of urinary tract lesions due to Schistosoma haematobium after consecutive years of treatment with praziquantel. Trop. Med. Parasitol. 1990;21:130–142. PubMed

Junqueira L.C.U., Bignolas G., Brentani R.R. Picrosirius staining plus polarization microscopy, a specific method for collagen detection in tissue sections. Histochem. J. 1979;11:447–455. doi: 10.1007/BF01002772. PubMed DOI

Clegg J.A. In vitro cultivation of Schistosoma mansoni. Exp. Parasitol. 1965;16:133–147. doi: 10.1016/0014-4894(65)90037-8. PubMed DOI

Giboda M., Smith J.M. Schistosoma mansoni eggs as a target for praziquantel: Efficacy of oral application in mice. J. Trop. Med. Hyg. 1994;97:98–102. PubMed

Race G.J., Michaels R.M., Martin J.H., Larsh J.E., Jr., Matthews J.L. Schistosoma mansoni eggs: An electron microscopic study of shell pores and microbarbs. Proc. Soc. Exp. Biol. Med. 1969;130:990–992. doi: 10.3181/00379727-130-33706. PubMed DOI

Neill P.J., Smith J.H., Doughty B.J., Kemp M. The ultrastructure of the Schistosoma mansoni egg. Am. J. Trop. Med. Hyg. 1988;39:52–56. doi: 10.4269/ajtmh.1988.39.52. PubMed DOI

Ždárská Z., Giboda M., Zenka J. The ultrastructure of Schistosoma mansoni egg: The line of hatching. Helminthologia. 1992;29:63–65.

Giboda M., Ždárská Z. Alkaline phosphatase as marker of Schistosoma mansoni egg viability. Folia Parasitol. 1994;41:55–58. PubMed

Pan S.C.T. The fine structure of the miracidium of Schistosoma mansoni. J. Invertebr. Path. 1980;36:307–372. doi: 10.1016/0022-2011(80)90040-3. PubMed DOI

Xu Y.-Z., Dresden M.H. The hatching of schistosome eggs. Exp. Parasitol. 1990;70:236–240. doi: 10.1016/0014-4894(90)90104-K. PubMed DOI

Gu K., Li Y.-S., Driguez P., Zeng Q.-G., Yu X.-L., Sun H., Cai L., He Y.-K., Wang W.S.-Y., McManus D.P. Clinical diagnostic value of viable Schistosoma japonicum eggs detected in host tissues. BMC Infect. Dis. 2017;17:244. doi: 10.1186/s12879-017-2362-4. PubMed DOI PMC

WHO Factsheet Schistosomiasis. Dated 8 January 2022. [(accessed on 12 March 2022)]. Available online: https://www.who.int/news-room/fact-sheets/detail/schistosomiasis.

McManus D.P., Dune D.W., Sacko M., Utzinger J., Vernervald B.J., Zhou X.N. Schistosomiasis. Nat. Rev. Dis. Primers. 2018;4:13. doi: 10.1038/s41572-018-0013-8. PubMed DOI

Deol A.K., Fleming F.M., Calvo-Urbano B., Walker M., Bucumi V., Gnandou I., Tukahebwa E.M., Jemu S., Mwingira U.J., Alkohlani A., et al. Schistosomiasis—assessing progress toward the 2020 and 2025 global goals. N. Engl. J. Med. 2019;381:2519–2528. doi: 10.1056/NEJMoa1812165. PubMed DOI PMC

Khieu V., Sayasone S., Muth S., Kirinoki M., Laymanivong S., Ohmae H., Huy R., Chanthapaseuth T., Yajima A., Phetsouvanh R., et al. Elimination of schistosomiasis mekongi from endemic areas in Cambodia and the Lao People’s Democratic Republic: Current status and plans. Trop. Med. Infect. Dis. 2019;4:30. doi: 10.3390/tropicalmed4010030. PubMed DOI PMC

Rollinson D., Knopp S., Levitz S., Stothard J.R., Tchuem Tchuenté L.A., Garba A., Mohammed K.A., Schur N., Person B., Colley D.G., et al. Time to set the agenda for schistosomiasis elimination. Acta Trop. 2013;128:423–440. doi: 10.1016/j.actatropica.2012.04.013. PubMed DOI

Kokaliaris C., Garba A., Matuska M., Bronzan R.N., Colley D.G., Dorkenoo A.M., Ekpo U.F., Fleming F.M., French M.D., Kabore A., et al. Effect of preventive chemotherapy with praziquantel on schistosomiasis among school-aged children in sub-Saharan Africa: A spatiotemporal modelling study. Lancet Infect. Dis. 2022;22:136–149. doi: 10.1016/S1473-3099(21)00090-6. PubMed DOI PMC

Mao S.P., Shao B.R. Schistosomiasis control in the People’s Republic of China. Am. J. Trop. Med. Hyg. 1982;31:92–99. doi: 10.1590/S0074-02761987000800012. PubMed DOI

Utzinger J., Zhou X.-N., Chen M.-G., Bergquist R. Conquering schistosomiasis in China: The long march. Acta Trop. 2005;96:69–96. PubMed

Chen J., Xu J., Bergquist R., Li S.-Z., Zhou X.-N. “Farewell to the God of Plague”: The importance of political commitment towards the elimination of schistosomiasis. Trop. Med. Infect. Dis. 2018;3:108. doi: 10.3390/tropicalmed3040108. PubMed DOI PMC

Wang W., Bergquist R., King C.H., Yang K. Elimination of schistosomiasis in China: Current status and future prospects. PLoS Negl. Trop. Dis. 2021;15:e0009578. doi: 10.1371/journal.pntd.0009578. PubMed DOI PMC

Kajihara N., Hirayama K. The war against a regional disease in Japan: A history of the eradication of schistosomiasis japonica. Trop. Med. Health. 2011;39((Suppl. 1)):3–44. PubMed PMC

Khademvatan S., Salmanzadeh S., Foroutan-Rad M., Ghomeshi M. Elimination of urogenital schistosomiasis in Iran: Past history and the current situation. Parasitology. 2016;143:1390–1396. doi: 10.1017/S0031182016000883. PubMed DOI

Balahbib A., Amarir F., Bouhout S., Rhajaoui M., Adlaoui E., Sadak A. Review of the urinary schistosomiasis control in Morocco (1960–2018) Interdiscip. Perspect. Infect. Dis. 2020;2020:3868970. doi: 10.1155/2020/3868970. PubMed DOI PMC

Doumenge J.P., Mott K.E. Global distribution of schistosomiasis. CEGET/WHO Atlas. World Health Stat. Q. 1984;37:186–199. PubMed

Weller T.H., Dammin G.J. The incidence and distribution of Schistosoma mansoni and other and absence of helminths in Puerto Rico. P. R. J. Public Health Trop. Med. 1945;21:125–147. PubMed

Cline B.L., Rymzo W.T., Hiatt R.A., Knight W.B., Berríos-Duran L.A. Morbidity from Schistosoma mansoni in a Puerto Rican community: A population-based study. Am. J. Trop. Hyg. 1977;26:109–117. doi: 10.4269/ajtmh.1977.26.109. PubMed DOI

Giboda M., Malek A.E., Correa R. Human schistosomiasis in Puerto Rico: Reduced prevalence rate and absence of Biomphalaria gabrata. Am. J. Trop. Med. Hyg. 1997;57:564–568. doi: 10.4269/ajtmh.1997.57.564. PubMed DOI

File S., Francheschini A.B., Fernandez-Santiago B. A case of ectopic schistosomiasis in Puerto Rico with some observations on the biology of the parasite. Am. J. Trop. Med. Hyg. 1998;58:671–672. doi: 10.4269/ajtmh.1998.58.671. PubMed DOI

Hewitt R., Willingham A.L. Status of schistosomiasis elimination in the Caribbean region. Trop. Med. Infect. Dis. 2019;4:24. doi: 10.3390/tropicalmed4010024. PubMed DOI PMC

Karanja D.M., Hightower A.W., Colley D.G., Mwinzi P.N., Galil K., Andove J., Secor W.E. Resistance to reinfection with Schistosoma mansoni in occupationally exposed adults and effect of HIV-1 co-infection on susceptibility to schistosomiasis: A longitudinal study. Lancet. 2002;360:592–596. doi: 10.1016/S0140-6736(02)09781-7. PubMed DOI

Hayashi S., Ohtake H., Koike M. Laparoscopic diagnosis and clinical course of chronic schistosomiasis japonica. Acta Trop. 2000;77:133–140. doi: 10.1016/S0001-706X(00)00126-1. PubMed DOI

Hosho K., Ikebuchi Y., Ueki M., Nakamura K., Yashima K., Maeda N., Koda M., Murawaki Y., Suou T., Inoue M. Schistosomiasis japonica identified by laparoscopic and colonoscopic examination. Dig. Endosc. 2010;22:133–136. doi: 10.1111/j.1443-1661.2010.00935.x. PubMed DOI

Chen H.-Z., Chuang S.-C., Hsieh F.-C., Lin L.-J., Hung R.-M., Lee K.-T. Diagnosis of schistosomiasis japonica infection coincident with hepatocellular carcinoma by fine-needle aspiration. Diagn. Cytopathol. 2007;35:722–724. doi: 10.1002/dc.20725. PubMed DOI

Rodriguez-Molina R., Gonzalez J.O., De Sala A.R. The circumoval precipitin test in Schistosoma mansoni. A study of 300 patients. JAMA. 1962;182:1001–1004. doi: 10.1001/jama.1962.03050490025005. PubMed DOI

Salk J.E. Studies in human subjects on active immunization against poliomyelitis. 1. A preliminary report. J. Am. Med. Assoc. 1953;151:1081–1098. doi: 10.1001/jama.1953.13.1081. PubMed DOI

Sabin A.B. Characteristics and genetic potentialities of experimentally produced and naturally occurring variants of poliomyelitis virus. Ann. N. Y. Acad. Sci. 1955;61:924–938. doi: 10.1111/j.1749-6632.1955.tb42551.x. PubMed DOI

Van Dam G.J., Wichers J.H., Ferreira T.M., Ghati D., van Amerongen A., Deelder A.M. Diagnosis of schistosomiasis by reagent strip test for detection of circulating cathodic antigen. J. Clin. Microbiol. 2004;42:5458–5461. doi: 10.1128/JCM.42.12.5458-5461.2004. PubMed DOI PMC

Van Lieshout L., Polderman A.M., Deelder A.M. Immunodiagnosis of schistosomiasis by determination of the circulating antigens CAA and CCA, in particular in individuals with recent or light infections. Acta Trop. 2000;77:69–80. doi: 10.1016/S0001-706X(00)00115-7. PubMed DOI

Van Dam G.J., Xu J., Bergquist R., de Dood C.J., Utzinger J., Qin Z.-Q., Guan W., Feng T., Yu X.L., Zhou J., et al. An ultra-sensitive assay targeting the circulating anodic antigen for the diagnosis of Schistosoma japonicum in a low-endemic area, People’s Republic of China. Acta Trop. 2015;141:190–197. doi: 10.1016/j.actatropica.2014.08.004. PubMed DOI

Fung M.S., Xiao N., Wang S., Carlton E.J. Field evaluation of a PCR test for Schistosoma japonicum egg detection in low-prevalence regions of China. Am. J. Trop. Med. Hyg. 2012;87:1053–1058. doi: 10.4269/ajtmh.2012.12-0177. PubMed DOI PMC

Colley D.G., Binder S., Campbell C., King C.H., Tchuem Tchuenté L.-A., N’Goran E.K., Erko B., Karanja D.M., Kabatereine N.B., van Lieshout L., et al. A five-country evaluation of a point-of-care circulating cathodic antigen urine assay for the prevalence of schistosomiasis mansoni. Am. J. Trop. Med. Hyg. 2013;88:426–432. doi: 10.4269/ajtmh.12-0639. PubMed DOI PMC

Bergquist R. Good things are worth waiting for. Am. J. Trop. Med. Hyg. 2013;88:409–410. doi: 10.4269/ajtmh.12-0741. PubMed DOI PMC

Masong M.C., Wepnje G.B., Marlene N.T., Gamba V., Mengue M.-T., Kouokam E., Stothard J.R., Ekobo A.L.S. Female genital schistosomiasis (FGS) in Cameroon: A formative epidemiological and socioeconomic investigation in eleven rural fishing communities. PLoS Glob. Public Health. 2021;1:e0000007. doi: 10.1371/journal.pgph.0000007. PubMed DOI PMC

Szekeres C., Galletout P., Jaureguiberry S., Crickx E., Monsel G., Chabriat H., Jouvent E. Neurological presentation of schistosomiasis. Lancet. 2013;381:1788. doi: 10.1016/S0140-6736(13)60317-7. PubMed DOI