Pulmonary manifestations of early schistosome infection among nonimmune travelers

Abstract

PURPOSE: The clinical aspects of acute pulmonary schistosomiasis among nonimmune patients have not been well characterized. METHODS: We evaluated 8 patients who presented with pulmonary symptoms and abnormal chest radiographs after recent travel to Africa. Diagnosis was based on the detection of schistosomal eggs or positive serology. RESULTS: Of 60 patients evaluated in our center for schistosomiasis during a 3-year period, 8 (6 with Schistosoma hematobium, 2 with S. mansoni) had pulmonary symptoms. These symptoms appeared 3 to 6 weeks after exposure and consisted of dry cough and shortness of breath without concurrent fever. The mean (± SD) eosinophil count was 4020 ± 1400 per μmL. Chest radiography revealed multiple small nodules in 7 patients; in 1 patient, a diffuse interstitial infiltrate was also seen. Computerized tomographic scans of the chest were obtained in 4 patients; the scans confirmed the nodular pattern and detected a greater number of nodules. A transbronchial biopsy in 1 patient revealed eosinophilic pneumonia without detection of larva or eggs. CONCLUSION: Pulmonary manifestations during the early stage of schistosomal infection may occur with either S. hematobium or S. mansoni infection. These manifestations may represent an immunologic process, as is thought to be responsible for the febrile systemic response (Katayama fever) to acute infection.