Pulmonary Infiltrates and Eosinophilia in a 25-Year-Old Traveler

Jose Muñoz,Edelweiss Aldasoro,Joaquim Gascon,Pedro Arguis,Maria Jesús Pinazo

doi:10.1371/journal.pntd.0002201

Abstract

A 25-year-old Spanish male travelled to Senegal in September 2009, where he swam near the Dindefelo fresh-water falls. Five weeks later, he presented with fever, myalgia, and dry cough. His complete blood count showed a hemoglobin level of 157 g/L, platelet count of 123.000 platelets/mL, and a leukocyte count of 8.670 cells/mL, with 9% eosinophils. Malaria smear, blood cultures, and serologies for common viral and bacterial infections were negative. Titers of an indirect hemagglutination test for Schistosoma mansoni were 1:80. The patient was treated with a single dose of praziquantel (40 mg/kg) and prednisone (30 mg) for three days. After treatment, the dry cough increased and he developed moderate dyspnea, with increasing malaise and myalgia. A second blood sample revealed eosinophilia of 1.200 cells/mL. A chest Xray showed patchy infiltrates in both lungs (Figure 1), and a CT Editor: David Joseph Diemert (The George Washington University Medical Center, United States of America)

Highlights

Antibodies against Schistosoma species increased in a control blood sample six months later
Infection with Schistosoma species is acquired by exposure to fresh water that contains cercariae, the infective form of this trematode [1]
Acute schistosomiasis or Katayama syndrome is an early manifestation of the infection and may occur between two and 12 weeks after primary infection

Summary

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Jose Munoz1*, Edelweiss Aldasoro, Maria Jesus Pinazo, Pedro Arguis, Joaquim Gascon. A 25-year-old Spanish male travelled to Senegal in September 2009, where he swam near the Dindefelo fresh-water falls Five weeks later, he presented with fever, myalgia, and dry cough. He presented with fever, myalgia, and dry cough His complete blood count showed a hemoglobin level of 157 g/L, platelet count of 123.000 platelets/mL, and a leukocyte count of 8.670 cells/mL, with 9% eosinophils. Acute pulmonary schistosomiasis The patient was treated with prednisone (1 mg/kg/day) for seven days and became asymptomatic within 48 hours. A repeat chest X-ray 24 hours later showed no abnormalities. He was treated again with praziquantel (40 mg/kg/day) for three days, three months after initial diagnosis. Antibodies against Schistosoma species increased in a control blood sample six months later (titers 1:160). The patient remained asymptomatic up to 24 months after treatment

Discussion

Key Learning Points