Bilharzia in Grahamstown: travelling risks, and treatment

Professor Chris Appleton says he has yet to hear of a case of schistosomiasis in Grahamstown. Grocott’s Mail wrote to several Grahamstown medical practices and the most detailed response came from Dr Fred Oosthuizen. The questions GM asked were: 1. Have you had cases of haematuria in patients at your practice over the past two years? If so how many? 2. Have you diagnosed Bilharzia in any patient at your practice in the past two years? How many? 3. What would be your preferred treatment to prescribe for schistosomiasis and why? Dr Fred Oosthuizen responded as follows:

Bilharzia reportedly only occurs in South African rivers flowing eastwards. Due to the large number of students and private school scholars from north of our borders attending institutions in Grahamstown, we regularly screen for Bilharzia. The test results take 1014 days from the institute in Pretoria and are mostly requested in patients complaining of lassitude/tiredness and who are from an endemic area or been exposed to Bilharzia dams whilst holidaying in, for example, Zimbabwe or Zambia.

Haematuria is not a common presenting symptom ‒ and has many causes eg cystitis, kidney disease, kidney stones.

I am unaware of a problem south of Transkei. There was once a possible case reported in Jeffreys Bay (Kabeljous River).

The only treatment available for bilharzia is Biltricide at 40mg/kg in two divided doses. Biltricide is a 600mg tablet. The old treatment was a very painful injection called Acanthar.

We regularly have microscopic haematuria in the practice for other causes.

I have approximately three chronic Bilharzia carriers in the practice. No new cases have been proven in the past two years, but I have treated several patients empirically for Bilharzia based on the clinical settings. The Bilharzia tests are difficult to interpret clinically ‒ and need simplification and improvement.

The gold standard for diagnosis is a cystoscopic diagnosis by a urologist.

During the acute infestation, the patient presents with respiratory symptoms as the larvae migrate through the lungs (pulmonary eosinophilic infiltrate). I have had two such cases.

Bilharzia prostatitis is another form of presentation in males, especially those who swim in lakes like Lake Malawi. My message is, if one suspects Bilharzia in a susceptible/possibly exposed patient, treat empirically with Biltricide while awaiting test results. Easy, not too expensive and much cheaper than cystoscopic investigation.

•http://www.duct.org.za/index. php/paddlers-29/35-paddlerspage/water-quality-and-health/63bilharzia-are-you-safe-interviewwith-dr-richard-anderson.html •https://en.wikipedia.org/wiki/ Schistosomiasis http://www.who.int/tdr/ news/2008/praziquantel-dosing/ en/ •http://www.sajei.co.za/index.php/ SAJEI/article/viewFile/302/374