Laboratory diagnosis of schistosomiasis and Katayama syndrome in returning travellers

The gold standard for laboratory diagnosis of schistosomiasis is the presence of typical eggs in stool or urine. The laboratory diagnosis of schistosomiasis and Katayama syndrome in returning travellers is difficult because the number of excreted eggs is often very limited. In early infections and in patients with only a few contacts with contaminated water, the total number of parasites, migrating larvae or schistosomulae, and adult worms, is very low. Eggs can only be found in faeces or urine when there is at least one pair of adult worms at the final location. The number of parasites increases as a function of the number of contacts with infected water. The exact latency between contamination and egg production is unknown. It is estimated that excretion of eggs starts after 40-50 days. The specific diagnosis of early schistosomiasis and Katayama fever relies essentially on serologic tests or preferably on PCR (if available). These assays are much more sensitive (up to four times) in the early phase of schistosomiasis than microscopic examination for typical eggs. Eosinophilia (sometimes exceeding 50%) is often present in patients with acute schistosomiasis (Katayama fever), but may be limited or absent in late fibrotic manifestations of the disease.