Imported Katayama fever: clinical and biological features at presentation and during treatment

To investigate the characteristics of imported Katayama fever (acute schistosomiasis) as well as evolution and outcome under treatment.

Between April 2000 and September 2004, we included prospectively all patients with confirmed diagnosis of Katayama fever. Follow-up was maintained at least until 6 months after symptoms resolved. Praziquantel (PZQ) was given as soon as the diagnosis was probable, most of the time with steroids.

Twenty-three patients were diagnosed with Katayama fever by Schistosoma egg detection and/or by seroconversion. Clinical features were non-specific, with mainly respiratory and/or gastrointestinal symptoms. Diagnosis was confirmed at presentation in 17/23 (74%) patients, of whom 15 by serology. Immediate clinical exacerbation occurred in five of nine patients not given steroids concomitantly with PZQ. After initial resolution, fever recurred in five (22%) patients. When compiling initial and recurrent episodes (n=28), respiratory symptoms tended to occur at an earlier stage after exposure, while abdominal complaints were more frequent later. All patients were completely cured, sometimes after repeated treatments.

Clinical presentation of Katayama fever is non-specific and involves respiratory and abdominal symptoms. Recurrence of fever is not unusual despite anti-helminthic treatment. Optimal therapeutic strategy remains to be defined to prevent recurrence.