Emmanuel Bottieau and Joannes Clerinx, from the Antwerp GeoSentinel® site, report acute schistosomiasis in a cluster of 33 Belgian travelers who returned from South Africa. They were exposed on one to three occasions in the period December 26th, 2016 to January 5th, 2017 at the Witrivier (White River), near the Mimi Moya Eco Lodge. This is situated in the north of Kwazulu-Natal, South Africa, close to the Swazi border. At Day 28-34 post-exposure, about 80% had symptoms compatible with acute schistosomiasis but only circa 30% had a raised eosinophil count. Egg detection in feces and urine were negative in all and only one person showed a weak reaction to the schistosome antibody test. However, two schistosome PCR tests on a serum sample of 5 persons with a raised eosinophil count were performed and all five had a positive signal with the Dra-1 primer, specific for S.haematobium. One sample reacted also with the sm1-7 primer, more sensitive in S.mansoni infection. This may indicate that the infective species is possibly a S.haematobium-S.bovis hybrid, but that needs to be substantiated with genomic sequencing once an egg is obtained. The cluster remains under close observation and follow-up. At present, 18 persons were seen again at day 45 – day 50 after exposure. Of these, 13 have experienced at least one day of fever since day 26 after exposure, and the eosinophil count was raised > 750/µL in 10 of the 18 patients. No schistosome ova were seen in urine samples from any of the 18 patients. Further follow-up is pending. A malacological survey will soon be conducted. Has your site seen such cases? Please be alert for urinary schistosomiasis in returning travelers who stayed in the Mimi Moya Lodge, and who bathed in the Witrivier during the last year. Intending travelers to this area should be advised regarding the risks of fresh water bathing. A ProMed posting is in preparation.
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Emmanuel Bottieau and Joannes Clerinx, from the Antwerp GeoSentinel® site, report acute schistosomiasis in a cluster of 33 Belgian travelers who returned from South Africa. They were exposed on one to three occasions in the period December 26th, 2016 to January 5th, 2017 at the Witrivier (White River), near the Mimi Moya Eco Lodge. This is situated in the north of Kwazulu-Natal, South Africa, close to the Swazi border. At Day 28-34 post-exposure, about 80% had symptoms compatible with acute schistosomiasis but only circa 30% had a raised eosinophil count. Egg detection in feces and urine were negative in all and only one person showed a weak reaction to the schistosome antibody test. However, two schistosome PCR tests on a serum sample of 5 persons with a raised eosinophil count were performed and all five had a positive signal with the Dra-1 primer, specific for S.haematobium. One sample reacted also with the sm1-7 primer, more sensitive in S.mansoni infection. This may indicate that the infective species is possibly a S.haematobium-S.bovis hybrid, but that needs to be substantiated with genomic sequencing once an egg is obtained. The cluster remains under close observation and follow-up. At present, 18 persons were seen again at day 45 – day 50 after exposure. Of these, 13 have experienced at least one day of fever since day 26 after exposure, and the eosinophil count was raised > 750/µL in 10 of the 18 patients. No schistosome ova were seen in urine samples from any of the 18 patients. Further follow-up is pending. A malacological survey will soon be conducted. Has your site seen such cases? Please be alert for urinary schistosomiasis in returning travelers who stayed in the Mimi Moya Lodge, and who bathed in the Witrivier during the last year. Intending travelers to this area should be advised regarding the risks of fresh water bathing. A ProMed posting is in preparation.