Page 15 - Jan - March 2023 Edition

BILHARZIA

Article by Dr Dick Stockley
I get messages from people who left years
ago who are worried about ongoing health
issues. The most common reason is
undiagnosed and untreated Bilharzia. It is in
the WHO list of the 7 most neglected
diseases in Africa. There is a lot of research
going on, most of it in Entebbe. Visitors are
often told that they shouldn’t go in any fresh
water in Africa because of Bilharzia. Yet we
encourage tourists to come here, go
white-water rafting, the lake is right there,
there are sailing clubs, fishing, waterskiing. So,
what is the best advice? People ignore
medical advice anyway: they drink too Dr Dick Stockley
much, eat too much, smoke, and work on
weekends. And they’re going to go in the pumped into a tank, go down a pipe and
lakes and rivers. Water sports are healthy come out a tap. You can get bilharzia from
exercise: it’s difficult to smoke a cigarette a shower. Municipal water supplies are
when you’re waterskiing. The best advice is safe. Swimmers itch This is the itchy spotty
advice that people might follow: so I say go rash you get from cercaria penetrating the
sailing, fishing and waterskiing. Go out on a skin. Most swimmers itch is from other
boat trip, go for a dip if you’re hiking past a species of Bilharzia, most likely birds, avian
lake, watch out for crocodiles if you’re going schistosomiasis. You itch for a few hours or
skinny dipping at midnight; and take bilharzia days but they cannot infect you.
seriously. We have mostly S. Mansoni in However, the human schistosomes can
Uganda and everything I’m saying applies to also cause swimmers itch: there’s no way
Mansoni. of knowing, just get tested after 6 weeks.

ACUTE BILHARZIA
Katyama syndrome or conversion fever.
After wriggling through the skin, the cercaria
lose their tail and become schistosomula.
Somehow, they get to the liver, and the
boys and girls meet. No one knows how.
One theory is they whistle and burp. Or they
meet in intrahepatic discotheques. That’s
why the Nile river rafting guides hold parties
that play very loud music after rafting, in an
attempt to confuse the schistosomes and
prevent them meeting. They spend 3 to 6
weeks in the liver, they grow to about 2 cms
long. The male has muscles (don’t we all?)
The cercaria live up to a day but are most the female is just a long egg laying tube
active in the first few hours. Most infection is (no comment). He wraps himself round his
from actual immersion in water with the lady and they spend the next 15 years in
infected snails: however, they can be permanent copulation. No wonder we feel

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