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tired. He swims down the hepatic veins to found her ascending colon stuck to the
the terminal venules of the bowel, they get posterior abdominal wall. Sounds like
jammed in the narrow vessel and she starts Bilharzia we said: finally diagnosed 5 years
laying eggs. They are hidden from our after leaving.
immune system by the tegument, think The good news is most of this is rare! Most
Harry Potter and his invisibility cloak, but the people just feel vaguely unwell, never quite
eggs cause a big immune response, local right, bad guts and tired all the time. The
and systemic and this causes the acute bad news is how many are never
fever of katayama syndrome. You may diagnosed? How many expats with Bilharzia
have diarrhea, a rash, cough, nausea and go home, continue to see their chosen
feel rather unwell. Or nothing at all. It’s specialist, get diagnosed with IBS,
rarely diagnosed. In the tropics any fever is endometriosis, chronic PID, recurrent uti or
called malaria. The clue is high eosinophil depression, and only get better when the
count and a negative malaria rapid. It schistosomes die of old age after 15
goes away on its own. years?

CHRONIC BILHARZIA DIAGNOSIS
The loving schistosome couple live for at The symptoms are vague, and are usually
least 15 years causing no problem other diagnosed as something else because few
than laying eggs. The eggs are supposed doctors think Bilharzia. So first of all, think
to get through the tissue into the bowel Bilharzia! Take it seriously. It probably isn’t
lumen, get washed into the lake, hatch but it might be. Our advice is after any
and go and torment a snail for 2 years. exposure, get tested. Any vague symptoms
Instead most get stuck. They provoke an get tested. When you leave the country
immune response that causes a get tested. Any long lasting vague unwell
granuloma. This may not cause much after being in Africa think “what if it’s
damage in the large bowel, but ectopic bilharzia.” Any sudden neurological
couples migrate into the surrounding tissue symptoms such as headaches, dizziness,
such as ovaries, tubes, or prostate if you tingling or numbness get tested. Vague
have one. They can get completely lost rather annoying tingling in the fingers on
and finish up in the spinal canal or into the Monday can be paralysed from the neck
brain. This was considered rare or even down in ICU on a ventilator on Thursday.
denied 20 years ago but is now a Please be wary of advice from those who
recognised cause of epilepsy, paralysis and are not up to date. We have mostly
death. Mansoni at our end of the lake that doesn’t
Over the years chronic inflammation turns present with hematuria or eggs in the urine.
into permanent fibrosis. Fibrosis of the You might find eggs in the stool: if there are
bowel causing chronic inflammatory bowel enough to find and use special
disease, fibrosis of the tubes or ovaries concentration techniques. In most patients
causing infertility and pain, fibrosis of the if you find an egg it’s a bit of a fluke. *
prostrate causing obstruction, or pipe stem Blood tests for antibody are low sensitivity
fibrosis in the liver. We have seen it all. We and specificity: many cases do not have
used to find that the commonest cause of detectable antibodies. Even PCR can miss
chronic gynecological problems in expats it.
was Bilharzia. We have seen boys in their So, what to do?
late teens with prostate problems, needing The cathodic antigen point of care tests
dilation and surgery before they are 30. We are excellent screening tests. It’s a quick
have seen patients with spinal cord lesions simple very cheap urine dip stick.
causing very sudden onset of progressive Schistosomes burp: the antigen is burped
paralysis. One email was a lady who had out into the blood and can be detected in
seen 4 gynecologists in USA with chronic the urine. The test can be strong positive,
pain, finally had a laparotomy where they weak or negative depending how many

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