Infections with S mekongi are exceptional in travelers, and cluster cases are not unusual. It was diagnosed in 12 Israelis in 2002 to 2006, including 4 of a cluster, and in a Canadian traveler with neuroschistosomiasis who had swum in the Mekong River in Laos 2 years prior.
Khong Island (Si Pan Don, Four Thousand Islands) is a well-known endemic spot for S mekongi and an increasingly popular traveler destination. Just before crossing into Cambodia, the Mekong River splits into many branches, creating a multitude of islets and terminating in rapids of selleck products scenic beauty. Diagnosis of acute schistosomiasis was readily suspected because of the markedly raised eosinophil count and the exposure to a possible source of S mekongi 5 weeks prior. Diagnosis was confirmed both by microscopy and by detecting S mekongi-specific specific DNA in a stool sample. Contrary to what we observed in a cluster of travelers infected with S mansoni, DNA could not be detected in the patient’s serum during the acute phase. This may be owing to interspecies variation
in DNA sequences reactive with the chosen primer-probe set. The Sm1-7 PCR targeting DZNeP research buy the 121-bp tandem repeat sequence was proven successful in S mansoni diagnosis but not in Schistosoma haematobium infection (unpublished results). It has been evaluated for the first time in this study in a naturally acquired S mekongi infection. The poor performance of PCR for detection of schistosome species other than S mansoni illustrates the need for a genus-wide PCR protocol for clinical application that detects all human schistosome species with a similar level of sensitivity. Diagnostic workup during ioxilan the acute phase of the disease may occasionally be marred by serum antibodies cross-reacting with Trichinella antigen, and with sheep RBC, invalidating the IHA test result. Similarly the HRP-2 P falciparum antigen test showed a false positive reaction persisting for at least 2 months. When treating an asymptomatic patient during the acute phase of infection with praziquantel, it is not unusual to observe an exacerbation
of symptoms shortly after ingestion.[6, 12] This is thought to be the result of a sudden release of a vast amount of schistosome antigen. This may explain the substantial rise in eosinophil count. Symptoms may be spectacular, but subside readily with corticosteroid therapy.[6, 12] Caution has to be taken when considering praziquantel treatment during the acute symptomatic phase. This may in some circumstances lead to severe neurologic symptoms. Therefore, referring praziquantel treatment until after the acute symptoms have subsided (induced by corticosteroid treatment or spontaneously) is recommended. On the other hand, referring praziquantel treatment for too long may increase the risk of neuroschistosomiasis that may occur during the late acute phase. Confirming the diagnosis of schistosomiasis soon after exposure is still elusive.