Pulmonary manifestations of early schistosome infection among nonimmune travelers

PURPOSE: The clinical aspects of acute pulmonary schistosomiasis among noni mmune 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 bas ed 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 p ulmonary symptoms. These symptoms appeared 3 to 6 weeks after exposure and consisted of dry cough and shortness of breath without concurrent fever. Th e mean (+/- SD) eosinophil count was 4020 +/- 1400 per mu mL. Chest radiogr aphy revealed multiple small nodules in 7 patients; in 1 patient, a diffuse interstitial infiltrate was also seen. Computerized tomographic scans of t he chest were obtained in 4 patients; the scans confirmed the nodular patte rn and detected a greater number of nodules. A transbronchial biopsy in 1 p atient 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. The se manifestations may represent an immunologic process, as is thought to be responsible for the febrile systemic response (Katayama fever) to acute in fection. Am I Med. 2000;109:718-722, (C) 2000 by Excerpta Medica, Inc.