Schistosomiasis in Travelers and Expatriates

Background: Several outbreaks of schistosomiasis among travelers, expatriates, and military serviceman have been reported in recent years. Methods: The travel histories and anamnestic and clinical features of 62 patients with schistosomiasis, who presented to a German outpatient clinic specializing in infectious and tropical diseases, were investigated to identify risk factors that could lead to infection in travelers and expatriates. Results: All patients remembered incidents that led to a likely exposure to cercariae of Schistosoma sp. Fifty nine patients (95%) acquired infection in Africa, two (3%) in South America, and one each (2% each) in Iraq and the Mekong River, respectively. The highest proportion of infection (45%) was imported from West Africa. Patients returning from West Africa reported either contact with tributaries of the Niger (including freshwater pools in the Dogon country, Mali) or with waters of the Volta River, notably Lake Volta and/or its delta. Six patients (10%) acquired infection in little-visited areas such as Central Africa and the Congo Basin. East Africa (especially Lake Victoria) and Lake Malawi contributed 14 patients (22%) to our study group; a further nine patients (14%) became infected after contact with waters of the Zambezi River. Conclusions: The most sensitive method for detection of possible infection with schistosomiasis appeared to be a combination of thorough travel history and serologic testing by indirect hemagglutination (IHA), immunofluorescence antibody test (IFAT), and enzyme-linked immunosorbent assay (ELISA). Most infections were acquired by travelers on lengthy and adventurous journeys or by expatriates venturing outside their normal areas of activity. Most patients knew that they had traveled in an area endemic for schistosomiasis, but were uninformed about behavioral risks they had taken in specific settings.