Wüstenschiff

Die Gefahr aus tropischem Süßwasser
Schwere Organschäden teils bis zum Tod drohen
14.08.2007

Die Tropenkrankheit Bilharziose bedroht Einheimische in Afrika, Südamerika und Asien – und auch Touristen, die in dortigen Ländern in Naturgewässern baden, oder auch nur die Füße kühlen. Denn die Erreger tummeln sich dort in Flüssen und Seen: Zunächst dringen die Larven der Pärchenegel (Schistosma) binnen Minuten durch die Haut in den menschlichen Körper ein. Dabei bildet das Männchen mit den Seitenrändern seines Körpers eine Art Rinne, in der die fadenförmigen Weibchen eingeschlossen werden.

Die Saugwürmer gelangen durch Blut- und Lymphgefäße in die Leber. Inzwischen auf zehn bis 20 Millimeter Länge angewachsen, paaren sich die Parasiten, die sich im Menschen von den roten Blutkörperchen ernähren. Einen Teil der dabei entstehenden Eier scheidet der Befallene durch Urin und Kot aus. Da aber nicht alle Eier den Körper verlassen, kann es zu Komplikationen kommen. Das Leiden fängt oft harmlos an: Jucken und Errötung an den Hautstellen, wo die Larven eingedrungen sind – diese Symptome klingen nach einigen Tagen ab. Doch nach drei- bis zehnwöchiger Inkubationszeit beginnt die akute Phase der Bilharziose. Die Betroffenen leiden unter Fieber, Kopf- und Gliederschmerzen, Husten sowie Juckreiz. Zudem schwellen Leber, Milz und Lymphknoten an. Nach Monaten, sogar noch nach Jahren können sich allmählich chronische Schäden an den Organen zeigen, beispielsweise als Leberzirrhose.

Die vom deutschen Arzt Theodor Bilharz (1825-1862) entdeckte Krankheit ist in den Industriestaaten nicht verbreitet. Bilharziose gilt als typische Geißel der Entwicklungsländer. Wie Statistiken zeigen, führt dort die dauerhafte Ablagerung von Wurmeiern auch zu Epilepsie, Erblindung und Krebs. So hat etwa das Krebsforschungsinstitut „International Agency for Reasearch of Cancer“ ermittelt, dass die Erkrankungsrate an Blasenkrebs in einigen Gebieten Afrikas dreiundzwanzigmal höher ist als in den USA. Bilharziose gilt nach Malaria als die häufigste Tropenkrankheit. Nach Angaben der Weltgesundheitsorganisation (WHO) sind etwa 200 Millionen Menschen mit Bilharziose infiziert. Davon betroffen sind besonders junge Menschen. In Gebieten mit hohen Infektionsraten sind es Personen bis zu einem Alter von 35 Jahre, die am häufigsten erkranken. Zu den Risikogruppen gehören Schwangere, Bauern und Fischer. Da eine Vielzahl von Erreger-Formen existiert, gilt eine Impfung bisher als kaum praktikabel.

Unbehandelt kann Bilharziose bis zum Tod führen. Etwa 15 000 Betroffene sterben jährlich an den Folgen der Infektion. Gute Heilungschancen bestehen, wenn die Krankheit rechtzeitig erkannt und behandelt wird. Einige Wochen nach Kontakt mit den Larven lassen sich Wurmeier in den Exkrementen nachweisen. Auch in Gewebsproben (Biopsien) aus der Darm- oder Harnblasenwand können Eier ermittelt werden. Endgültige Gewissheit liefert eine Blutanalyse, die untersucht, ob das Immunsystem Antikörper gegen die Schistosomen gebildet hat.

Als wirksames Mittel gegen den Schistosma-Befall hat sich seit den Achtzigern das Medikament Praziquantel bewährt. Die darin enthaltenen Wirkstoffe verursachen bei Pärchenegeln spastische Lähmungen – dadurch getötete Würmer werden mit dem Stuhl ausgeschieden. Einwände, wonach Praziquantel gegen junge Würmer in den ersten Wochen nach der Infektion noch nicht helfe, kontert Andreas Ruppel, Professor am Institut für Tropenhygiene des Klinikums der Universität Heidelberg: „Schistosma-Parasiten werden meist nicht unmittelbar nach der Infektion entdeckt, sie reifen erst“. Deshalb sei der Einsatz von Praziquantel „absolut empfehlenswert“.

Für Menschen aus Industrieländern sei „die beste Maßnahme gegen die Krankheit“ Aufklärung über die Infektionsrisiken, sagt Ruppel. Dies betreffe besonders „all die Last-Minute-Urlauber, die spontan und oft zu sorglos in gefährdete Gebiete aufbrechen“. Für sie wie für Bewohner der Dritten Welt gilt die Devise: Nicht in Naturgewässern baden, Wasser vor Gebrauch stets abkochen. Mit chemischen Mitteln den Zwischenwirt der Pärchenegel, eine Süßwasserschneckenart, zu bekämpfen ist eine weitere, eher langfristige Maßnahme.

Das Darmstädter Pharma-Unternehmen Merck, Hersteller des praxisbewährten Medikaments Praziquantel, hat der WHO zugesagt, in den kommenden zehn Jahren kostenlos 200 Millionen Praziquantel-Tabletten nach Afrika zu liefern, weil die Bilharziose „eine der größten Gesundheitsgefahren für den Kontinent darstellt“, sagt Elmar Schnee vom Konzernvorstand.

Quelle: echo online

Und hier ein aktueller Fall aus Tansania, Nähe Lake Eyasi.
Lake Eyasi ist ein Salzwassersee und damit Bilharziose-frei.
Stark kontaminiert dagegen ist der Süßwasserpool der Kisima Ngeda
Tented Lodge. Es wird vermutet, dass sich weitere Touristen dort infiziert
haben. Wer also zufällig in der Region war, und dort ein Bad genommen
hat, sollte sich umgehend ärztlich untersuchen lassen, auch wenn bisher
keine Symptome zu beobachten waren.


SCHISTOSOMIASIS - TANZANIA (Lake Eyasi)
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Date: Tue 4 Sep 2007
Source: GeoSentinel [edited]
<geosentinel@geosentinel.org>


Schistosomiasis outbreak in safari camp
--------------------------
GeoSentinel, the global surveillance program of the International
Society of Travel Medicine, wishes to report on an ongoing
significant point source outbreak of acute travel-related
schistosomiasis apparently localized to an artificial swimming pond
at a small tented camp hotel near to Lake Eyasi, Tanzania.

As the small man-made pool seems heavily contaminated, there may be
still undiagnosed returned travelers out there worldwide either with
non-specific illnesses of unknown origin or without symptoms. Once
diagnosed a simple course of praziquantel will cure most infections.

--
From Eli Schwartz, MD (ISR Geosentinel Site):
28 Israelis in 2 separate groups went on a safari trip to Tanzania.
They spent 1 day (in April 2007) at the Kisima Ngeda tented lodge
near Lake Eyasi which itself is salt water (schistosomiais is not
possible in salt water). The freshwater pond at the hotel has
vegetation and according to the ill travelers also snails. Except for
3 people, everyone swam in the pond for 0.5-1 hour only once. No one
had other freshwater exposure during the trip and none had previous
travel to Africa except for 2 Israeli guides.

The first case came to our emergency room about 4 weeks after return
with several days of fever, urticaria, and later cough and
eosinophilia was documented. A clinical diagnosis of acute
schistosomiasis was made and the rest of the group was investigated.
23/25 people who swam in the pool are infected by serology. Serology
was confirmed by the US CDC, and western blot shows S. mansoni mostly
but also 2 patients are positive for both S. mansoni and S. hematobium.

17/23 (74 percent) are symptomatic. According to the 2 guides (who
both were severely ill), they had several previous visits to the
hotel over a number of years with no problems. There is another
family of 6 people who visited the hotel 1 week earlier, 3 of whom
are similarly ill who are currently under investigation.

--
Prof. Dr. Frank von Sonnenburg (MUC GeoSentinel Site at the
University of Munich) reports:
A journalist was seen in Munich in March 2007 after a 2 month Africa
trip. She had a high fever at one point during travel which was
treated with routine antibiotics after a negative malaria smear. When
she presented to us she was clinically healthy but had an
eosinophilia of 17 percent and many eggs of Schistosoma mansoni on
rectal scrapings. She recalls no other fresh water exposure during
the trip except at the pool at the Kisima Ngeda camp. We are
presently investigating exposure histories in several of the
abnormally large number of German travelers to Tanzania presenting in
Munich in the past few weeks.

A review of the hotel website indicates that the camp is located on a
former farm and that the toilets drain into some sort of septic
system. One wonders if there is a flaw in the design of the drainage system.

The lesson is likely that there is really no safe fresh water in
Africa and that the advice of most travel medicine advisors to avoid
any fresh water exposure in Africa is sound. It is hard to track
acute changes in some environmental factor, perhaps in this case, a
new drainage pattern for fecal waste. The safari camp has been
contacted and we understand they have now ceased all bathing activity
in the artificial pool.

GeoSentinel advises clinicians to consider schistosomiasis in ill
travelers from Tanzania especially those with an eosinophilia. Any
traveler with exposure that may be linked to this focal outbreak
should be screened with serology for schistosomiasis even if
clinically well and with no abnormalities in other blood tests.
GeoSentinel would appreciate hearing of further suspected cases so as
to be able to prepare comprehensive documentation for formal publication.

--
David O. Freedman, MD,
University of Alabama at Birmingham, United States
Eli Schwartz,
Sheba Medical Center, Tel Hashomer, Israel
Frank von Sonnenburg, University of Munich, Germany
for GeoSentinel
<http://www.geosentinel.org>
<geosentinel@geosentinel.org>

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[Outbreaks of schistosomiasis in tourists exposed to the same
infected water source have been reported before (see, for instance:
Fuller et al. Schistosomiasis in Omo National Park of southwest
Ethiopia. Am J Trop Med Hyg 1979;28:526-30; Harries et al.
Schistosomiasis in expatriates returning to Britain from the tropics:
a controlled study. Lancet 1986;i:86-8; Schwartz E et al. Schistosome
infection among river rafters on Omo River, Ethiopia. J Travel Med
2005;12:3-8; Meltzer E et al. Schistosomiasis among travelers: new
aspects of an old disease. Emerg Infect Dis 2006;12:1696-700).

Most infections will be asymptomatic, but can be found by detecting
Schistosoma-specific antibodies supported in some cases by
eosinophilia and an elevated total IgE level. Specific antibodies may
take some months to develop, which mean that antibody tests performed
a few weeks after return should if negative be repeated after at
least 2 months. - Mod.EP]

SCHISTOSOMIASIS - DEMOKRATISCHE REPUBLIK KONGO (NORTH KATANGA)
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Date: 11 Oct 2007
Source: Eurosurveillance Weekly Release, Vol 12 Issue 10 [edited]
<http://www.eurosurveillance.org/ew/2007/071011.asp#2>


Although schistosomiasis is a widespread infection in the tropics,
travellers are almost exclusively infected in sub-Saharan Africa, through
exposure to freshwater infested with cercariae of either _Schistosoma
mansoni_ (intestinal schistosomiasis) or _Schistosoma haematobium_ (urinary
schistosomiasis) [1]. Primary infection may cause a febrile
hypersensitivity reaction occurring 3 to 12 weeks post-exposure, with
fever, cough and/or abdominal pain when schistosomules ma ture to
egg-producing adult worms, the so called "Katayama fever".
Hypereosinophilia is its early diagnostic hallmark. Definite diagnosis
requires antischistosomal antibody detection and/or demonstrating
schistosomal eggs in stools, urine, or rectal mucosa to be found on microscopy.

The mapping of schistosomiasis in the Democratic Republic of the Congo
(DRC) was extensively compiled during the colonial period [2,3].
Thereafter, only few studies have examined outbreaks or new foci of
infection [3,4,5], and, apart from occasional reports, there are no recent
comprehensive data on schistosomiasis in travellers returning from the DRC
[1,6].

From 1 Jan 2006 to 31 Aug 2007, as part of a larger ongoing study spanning
10 years of active schistosomiasis seen at our policlinic, we conducted a
retrospective study on clinical presentation and associated biologic
features on active intestinal schistosomiasis in all persons attending the
Institute for Tropical Medicine in Antwerp, Belgium's outpatient clinic who
had returned from the DRC and in whom _S. mansoni_ eggs were detected in a
faecal sample using a concentration method for ova and parasites.

Our cases from 2006 were incorporated in the latest TropNetEurop report on
schistosomiasis [7]: of the 102 cases reported as being imported into
Europe in 2006, the highest number was from Belgium (33), with the United
Kingdom the next highest (10). Of a total of 25 persons included in our
study, 24 (96 per cent) were of Caucasian origin, 20 (80 per cent) were
male, and 20 (80 per cent) were European. Most of the Europeans were
Belgian expatriates, of whom 12 (60 per cent) were children younger than 18
years old. Applying the World Health Organization's 1993 criteria,
infection was light to moderate (mean EPG 100, range 10 to 710) [8]. Three
presented with symptoms of Katayama fever. All other persons were asymptomatic.

Three major sources of exposure were identified. Bathing in Kalemie, Lake
Tanganyika (North Katanga province) (Google Earth: Kalemie, Congo) infected
3/25 (12 per cent), of whom 2 were Belgian military personnel who developed
Katayama fever after bathing near the area where the Kalemie river flows
into the lake. The northern shore of Lake Kivu, near Goma (Google Earth:
Goma, Kivu), was the source of infection in 4/25 (16 per cent), all of them
Belgian expatriates. Bobandana Bay, east of Goma city, has been a
well-known focus since colonial times [2].

But most acquired the infection in south Katanga (17/25, 68 per cent). Lake
Katebe was the stated source of infection in 11/17 (65 per cent), all of
them expats. Lake Katebe and Lake Wasela are the upstream and downstream
part of a large artificial lake complex on the upper course of the Lualaba
river, the lake Nzilo (formerly Lake Delcommune). The lake complex is
situated northeast from the main Kolwezi mining sites (Google Earth:
Kolwezi, Congo, or Google Maps: Kolwezi, Katanga). Despite an obvious
effluent from a copper mine midstream, schistosomiasis seems to thrive in
the lake complex, which is a popular weekend spot for water sports among
the expatriate community. Systematic mollusciciding of the Lualaba river
basin with copper sulphate was practiced in the 1950s but has declined
since independence [3]. A new influx of international expatriates recently
arrived in sizeable numbers in the Kolwezi area to restart the moribund
mining industry. One might thus expect an upsurge of schistosomiasis in
that community in the near future.

Since the old-hand expatriate community in the DRC is well aware of the
problem, it is likely that the widely practiced intermittent self-treatment
with praziquantel keeps worm loads down. This probably accounts at least
partially for the low fecal egg counts observed. Of course, this treatment
policy will not prevent Katayama fever among hitherto non-infected
expatriates (praziquantel does not eliminate the immature schistosomules)
nor will it be able to prevent neuroschistosomiasis entirely.

Many travellers are unlikely to forgo the pleasures of aquatic sports in an
inviting freshwater environment, even when schistosomiasis is all too
present, so there is a need for an evidence-based prevention and treatment
policy for this specific community to minimise the morbidity associated
with schistosomiasis. A combination of physical measures (thoroughly
rubbing down the skin after bathing) and medications active against both
the immature (artemisinin derivatives) and ma ture worms (praziquantel) at a
given time after exposure might achieve this. However, the optimal
treatment schedule still needs to be established [9].

References:
1. Jelinek T, Nothdurft HD, Loscher T. Schistosomiasis in Travelers and
Expatriates. J Travel Med 1996; 3(3): 160-4.
2. Gillet J, Wolfs, J. [Bilharziosis in the Belgian Congo and in
Ruanda-Urundi.] Bull World Health Organ 1954; 10(3): 315-419.
3. Doumenge JP, Mott KE. Atlas of the global distribution of
schistosomiasis. CGET/WHO atlas. World Health Stat Q 1984; 171-182.
<https://login.exserver.dk/exchweb/bin/r ... urundi.pdf>.
4. Ripert C, Carteret P, Gayte MJ. [Epidemiologic study of intestinal and
urinary bilharziosis in the reservoir area of La Lufira (Katanga).
Prevalence of infestation according to the study of eggs elimination in the
excreta]. Bull Soc Pathol Exot Filiales. 1969 May-Jun;62(3):571-81.
5. Polderman AM. Schistosomiasis in a mining area: intersectoral
implications. Trop Med Parasitol 1986;37(2): 195-9.
6. Bengtsson E, Pellegrino J. Bilharziasis in Swedish military personnel
returning from the Democratic Republic of the Congo. Bull World Health
Organ 1966; 34(2): 273-6.
7. TropNetEurop Sentinel Surveillance Report: Schistosomiasis in 2006. June
2007.
8. The control of schistosomiasis: second report of the WHO expert
committee. WHO Technical Report Series N 830, 1993.
9. Utzinger J, Xiao SH, Tanner M, Keiser J. Artemisinins for
schistosomiasis and beyond. Curr Opin Investig Drugs 2007; 8(2): 105-16.

[Reported by: J Clerinx <jclerinx@itg.be> Department of Clinical Sciences,
Institute for Tropical Medicine Antwerp, Belgium]

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[Outbreaks of schistosomiasis in tourists and expatriates were discussed in
our comment to the report of schistosomiasis in tourists in Tanzania
(Schistosomiasis - Tanzania (Lake Eyasi) 20070904.2912). The use of
artemisinin as a prophylactic drug for schistosomiasis has recently been
reviewed (Utzinger J, et al. Artemisinins for schistosomiasis and beyond.
Curr Opin Investig Drugs 2007; 8(2): 105-16.). Both drugs reduce eggs
counts, but praziquantel is more efficient
<http://www.ncbi.nlm.nih.gov/sites/entre ... d_RVDocSum>.

(De Clercq D, et al. Efficacy of artesunate and praziquantel in Schistosoma
haematobium infected schoolchildren. Acta Trop 2002; 82(1): 61-6). However,
the possible use of artemisinins as a immediate, post exposure prophylaxis
still needs further studies. - Mod.EP]

Kamerun - Schistosomiasis (Bilharziose)
16.06.2008

Die durch Saugwürmer verursachte Erkrankung von Darm und/oder Blase mit Komplikationen an Inneren Organen und Nervensystem ist in Kamerun weit verbreitet. Das gilt nicht nur für ländliche Gebiete. In den letzten Jahren wird ein Anstieg der Fallzahlen auch aus Yaounde gemeldet. In einzelnen Stadtteilen sind bis zu einem Drittel der Einwohner infiziert. Das betrifft nicht nur Armenviertel sondern auch Wohngebiete mit höherem Standard. Die Übertragung erfolgt durch Larven, die im Süßwasser leben und durch die gesunde Haut eindringen können. Kontakt mit Binnengewässern ist überall meiden. / Quelle: crm

Moin moin,

kann man der Sache nicht vorbeugen? Soviel ich weiß, halten sich die Biester nur im Ufergegend oder Seichte Stellen auf.
Wie sieht es mit Malawisee aus? Der soll ja früher bilharziafrei gewesen sein.

Gruß

Steve

Hallo Schwimmer und Badende!

Gefahr in seichten Gewässern und ufernah vor allem deshalb, weil wie in den Texten nachzulesen ist, eine dort lebende Schnecke als unabdingbarer Zwischenwirt fungiert.

Im Niger (Fluss) also nicht lange zögern, rein ins Wasser dort wo es tief ist. Falls wieder mal jemand nach Timia/Rep. Niger reisen sollte: Auch die Wasserstellen unterhalb des Ortes sind verseucht.

Gerhard Göttler

pantoffelos hat geschrieben:Wie sieht es mit Malawisee aus? Der soll ja früher bilharziafrei gewesen sein.

Hallo Steve,

der Malawisee ist heute nicht mehr bilharziafrei, wurde mir - auch von der lokalen Bevölkerung - gesagt. Aber ich denke an den "Strand- und Baderegionen" des Sees kann man ruhig das kühle Nass genießen, ich war Ende 2005 in Senga Bay auch schwimmen und schnorcheln ... problematisch sind wohl eher die bewachsenen und sumpfigeren Uferstellen.

Gruß
Birgitt

SCHISTOSOMIASIS, KENYA: (COAST), REQUEST FOR INFORMATION
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Date: Thu 25 Sep 2008
Source: All Africa, The Nation (Nairobi) report [edited]
<http://allafrica.com/stories/200809250172.html>


An outbreak of suspected schistosomiasis has been reported in Ganze
constituency, Kilifi District.

Health officials said residents relied on contaminated water from a
local pan [shallow, flat, body of water that goes dry seasonally] near
Malomani primary school in Malomani sub-location, which they shared
with their livestock.

An official at Ganze Health Centre, who requested anonymity, told
Kilifi district commissioner [DC] John Elungata that there had been
an upsurge in the number of cases of diarrhoea.

"At least 30 cases have been reported at the health centre after
residents of Malomani, Mitsenzini, Ganze, Migodomani, and Dungicha
villages came to seek treatment," he said. "People are coming from
different villages for treatment complaining of diarrhoea and stomach
pains.

"A majority of affected youths have been passing urine mixed with
blood, indicating they are suffering from bilharzia
[schistosomiasis]," the officer said. The DC urged the Ministry of
Health to dispatch a medical team to investigate the cases before the
situation worsens. He also advised residents to boil water before
drinking it. "I am asking the Ministry of Public Health to supply
purification tablets as well as chlorine powder to treat drinking
water in the affected areas," Mr Elungata said.

The DC said the Department of Arid and Semi-Arid Lands would dig
separate water pans for the residents and their livestock in various
parts of the constituency.

Ganze constituency is a semi-arid area in Kilifi District, and has
been experiencing perennial water shortages. Residents mostly depend
on water pans and ponds that collect water during the rainy season.

[Byline: Walker Mwandoto]

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[A recent survey of schistosomiasis in Kilifi District found eggs of
_Schistosoma haematobium_ in urine, as identified by microscopy in 8
percent of children aged 1 to 6 years (Bejon P, Mwangi TW, et al.
PLoS Negl Trop Dis. 2008; 2(2): e164). However an earlier study found
prevalence rates of _S. haematobium_ between 2 percent and 85 percent
in the east and southeastern part of the district (Kombe Y et al. Afr
J Health Sci. 1995; 2(3): 338-43).

The presence of haematuria in the report above suggests that it may be
due to _S. haematobium_, but _S. haematobium_ does not infect
livestock. Furthermore, we have no information about incubation time,
but long-term exposure to the water seems reasonable. The suggestion
that most cases are in youths is intriguing. In Egypt, young boys are
most at risk because they swim in infected water bodies, getting whole
body exposure to the infection compared to most people who only get
hands and feet wet when using the water.

Further information is needed and if the haematuria is caused by _S.
haematobium_, eggs should be easily demonstrated in urine samples. -
Mod. EP/JW]

The Coast Province of Kenya can be seen on the map at
<http://www.ogiek.org/photo-gallery/kenya-map-big.jpg>.
Kilifi District is located north and northwest of Mombasa, the capital
of the province.
The HealthMap/ProMED-mail interactive map of Kenya can be accessed at
<http://healthmap.org/promed?g=3D197794&v=3D0.5,37.9,6>. - CopyEd.MJ]

SCHISTOSOMIASIS - ANGOLA: (NZETO)
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Date: Sun 16 Nov 2008
Source: Xinhua Net [edited]
<http://news.xinhuanet.com/english/2008- ... 360566.htm>


Schistosomiasis -- which broke out in Kindeje, Nzeto district,
northern Ziare province, Angola in October 2008 -- has killed at
least 9 people, a local health official said on Friday [14 Nov 2008].

Paulo Seixas Nelembe, head of the Nzeto District Health Bureau, told
reporters that since October 2008, more than 300 cases of the illness
have been diagnosed.

According to him, the cause of the expansion of the disease is the
poor quality of the water consumed by local people from rivers,
lagoons and wells.

He said more medical workers have been dispatched to the Kindeje area
to carry out awareness campaigns on how to treat water before
drinking it and to distribute anti-parasite medicine to the sick.

Schistosomiasis or bilharziosis is a serious and common disease in
Africa caused by several species of flukes of the genus _Schistosoma_
and which affects internal organs.

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[There are no recent published data on schistosomiasis in Angola, but
the WHO country collaboration report on Angola mentions a
schistosomiasis control program but without any data on prevalence
and geographical distribution
<http://www.who.int/countryfocus/coopera ... ago_en.pdf>.

Schistosomiasis has been described in Cuna soldiers serving in
Angola: Martinez Rodriguez R et al. Schistosomiasis mansoni in Cuban
patients. A clinical study of the first 4 cases imported from the
People's Republic of Angola. Rev Cubana Med Trop. 1986;38:135-9
(Spanish); and in literature from the previous colonial power,
Portugal: Ferreira and Gomes. Bilharziasis. The focus of Malanje
(Angola). (Aid for the study of bilharziasis in Angola). An Inst Med
Trop (Lisb). 1959;16:407-32 (Portugese).

A map of Angola showing the location of Kindeje can be found at:
<http://www.maplandia.com/angola/zaire/nzeto/kindeje/>. - Mod.EP]

SCHISTOSOMIASIS - DEMOCRATIC REPUBLIC OF CONGO (NZETE DISTRICT)
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Date: Fri 16 Jan 2009
Source: Agencia AngolaPress [edited]
<http://www.portalangop.co.ao/motix/en_u ... 429a4.html>

Schistosomiasis outbreak worries government
-------------------------------------------
Bilharzias outbreak affecting Kindege locality since September last year
[2008], is worrying the government of the northern Zaire province, calling
for measures to stem the disease.

Addressing an opening session of the II broad consultative council of the
provincial health department, the deputy-governor for the organisation and
technical services, Rogerio Zabila, [expressed concern about] the current
situation.

"The commune of Kindege, Nzeto district, has been going through, since late
last year, a situation which requires special attention by all of us,"
stressed the vice governor referring to the disease. Rogerio Zabilia
appealed to the health authorities in the region to coordinate efforts to
contain the spread of the disease.

In his turn, the head of the public health division of Nzeto district,
Boaventura Justina, noted that since September last year to 10 Jan 2009,
the commune of Kindege has recorded 354 cases of bilharzias, which resulted
in 15 deaths.

The disease attacks both children and adults, and is caused mainly by
contact with water.

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[Schistosomiasis is endemic in the Democratic Republic of Congo. A recent
report found infections rates in another district between 4 per cent and 8
per cent. (Baluku B, Bagalwa M, Bisimwa B. Parasitologic survey of
schistosomiasis due to Schistosoma mansoni in Katana, Democratic Republic
of Congo. Med Trop 2000; 60(2): 163-6). The report has very little
information on the means of diagnosis and previous infection in the area,
but the fact that people are very sick with several deaths suggest that the
infection is newly introduced into a population without preexisting
immunity. This could be related to irrigation or other farming projects
with increased contact to water. ­ Mod.EP]

SCHISTOSOMIASIS - CONGO DR: (NZETE DISTRICT), NOT
*************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Wed 28 Jan 2009
From: Tullia Marcolongo <tullia@iamat.org>


ProMED-mail recently posted a report of an outbreak of
schistosomiasis in the Democratic Republic of the Congo. This is
incorrect. The source is from Agencia Angola Press (Angola) and
N'Zeto district is located in Zaire province, northern Angola.

--
Tullia Marcolongo
IAMAT
(International Association for Medical Assistance to Travellers)
<tullia@iamat.org>

[ProMED apologizes for the error. Please find below a link to a map
showing the correct location of N'Zeto. For a discussion of
schistosomiasis in Angola, please refer to the 2008 post listed below.

For a map, see:
<http://www.maplandia.com/angola/zaire/n ... earth.html>.
- Mod.EP]

Gibt es dagegen nicht ein einfaches Medikament dass man auch vorbeugend einnehmen kann?
Wir haben damals nach unserer LKW Tour durchs sumpfige Botswana (in der Regenzeit) vorbei am wundervollen Malawisee in Dar es Salaam für wenig Geld je zwei dieser Pillen in der Apotheke erworben und eingenommen...

LG, Tobi

Es gibt eine Behandlung gegen Schistosomiasis (Bilharziose). Der Wirkstoff ist Praziquantel (Biltrizid ist der Markenname). In Europa ist das Medikament nur sehr schwierig zu bekommen. In Afrika aber problemlos in grösseren Apotheken erhältlich (nur Orginalmedikamente kaufen wegen den vielen gefälschten Produkten).

Sollte man Kontakt mit Süsswasser gehabt haben, empfehle ich grundsätzlich ca. 2 Monate später einen Bluttest (AK gegen Schisto) machen zu lassen. Der Test ist sehr gut. Wichtig ist, dass man den Test erst 2 Monate nach letztem Süsswasserkontakt macht, da nach Infektion mit Larven die Entwicklung zu ausgewachsenen Würmern 6-8 Wochen dauert und der Test auch erst dann positiv wird.

Eine vorbeugende Behandlung würde ich nur machen, wenn man sehr lange herumreist oder im Land selber wohnt und somit nicht in nächster Zeit einen Bluttest machen kann. Auch dann muss man das Medikament 2 Monate nach letztem Kontakt mit Süsswasser einnehmen, da Praziquantel nur gegen die ausgewachsenen Würmern wirksam ist.

Einfach so das Medikament schlucken, empfehle ich wegen möglichen Nebenwirkungen nicht.

SCHISTOSOMIASIS - ZAMBIA
************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Tue 21 Apr 2009
Source: Lukasatimes.com [edited]
<http://www.lusakatimes.com/?p=11194>


About 2 million Zambians have bilharzias
----------------------------------------
The government [of Zambia] has disclosed that about 2 million people are
currently affected with bilharzia in the country. The minister of
education, Geoffrey Lungwangwa, said that the bilharzia prevalence rate is
currently estimated at 90 per cent in some communities, a situation that
has affected the performance of pupils and growth of children.

Professor Lungwangwa disclosed this today when he officially opened a
training workshop for teachers on bilharzia and soil transmitted infections
in Lusaka. He said it is important to treat bilharzia and intestinal worms
at an early stage because it could affect fertility in women and kidney
damage in men. Professor Lungwangwa noted that bilharzia was found in all
the provinces and districts in Zambia, particularly those found near lakes
and rivers.

He added that infections such as intestinal worms are very common
throughout the country, which might result in children and pregnant women
having anemia. Professor Lungwangwa said the training of teachers will go a
long way in fighting the prevalence of the disease at the source among
communities. He said at the end of the training workshop, the teachers will
have the capacity to assist in fighting the diseases in the country.

And speaking at the same occasion, Egyptian Ambassador to Zambia, Nuri
Betel Mal expressed happiness at the turnout of teachers and urged them to
ensure that they disseminate information in their communities and schools.

Mr Mal said that the training has been sponsored by the Arab League Fund,
which is aimed at providing technical assistance to African countries in
fighting diseases such as bilharzia.

--
communicated by:
ProMED-mail rapporteur Susan Baekeland

[The data cited come from a report from a workshop held on 22-25 Jan 2009
in Lusaka "Schistosomiasis, HIV and Reproductive Health". The prevalence
data on schistosomiasis in Zambia are probably correct but the prevalence
is very uneven with areas with a very high rate of infection and other
areas with a low rate of infection.

At present WHO recommends 2 indicators for schistosomal morbidity -- namely
gross haematuria and ultrasound detectable changes in affected organs. WHO
recommends management of cases and to regularly treat school aged children
and other high-risk groups.

One of the conclusions from the workshop was that there is a lack of
information on co-morbidity and co-infections in, for instance,
schistosomiasis and HIV (human immunodeficiency virus). Further studies are
needed to find out whether schistosomiasis increases the risk of HIV
transmission and whether HIV infection increases pathology of
schistosomiasis. ProMED-mail wishes to thank Dr Birgitte Vennervald and
Thomas Kristensen from the Danish Center for Health Research and
Development for commenting on the report.

Further information on schistosomiasis can be found on the CDC website:
<http://www.cdc.gov/ncidod/dpd/parasites ... efault.htm> - Mod.EP]