Environmental management

Bilharzia

What is Bilharzia?

Bilharzia is a human disease caused by parasitic worms called

Schistosomes. Over one billion humans are at risk worldwide
and approximately 300 million are infected. Bilharzia is
common in the tropics where ponds, streams and irrigation
canals harbor bilharzia-transmitting snails. Parasite larvae
develop in snails from which they infect humans, their definitive
host, in which they mature and reproduce.

Worms wriggling in your veins

Adult Schistosomes worms are about 1 cm long and hang out in

mesenteric veins (the small veins that carry blood from the
intestine to the liver). The worms feed on red blood cells and
dissolved nutrients such as sugars and amino acids. This can
cause anemia and decreased resistance to other diseases.
Schistosomes live in pairs, the male holding and protecting the
female inside his ventral groove. Once paired, the two remain in
constant copulation. The female lays hundreds of eggs each day,
which find their way out of the human body through the urine or
the faeces, depending on the species. The pathology is mostly
caused by the large number of eggs becoming stuck in various
body parts, in particular the liver (causing liver enlargement and
malfunction) and the kidneys (causing kidney damage,
detectable by blood in the urine).

Worms transmitted by snails

Schistosomes eggs are evacuated from the human body via

faeces or urine. When sanitation is poor, they can reach rivers or
lakes. They hatch into tiny swimming larvae called miracidia.
These swim about until they locate a snail and bore into its
body. Over a period of 3 to 4 weeks, miracidia develop into
hundreds of sporocysts, which each produce thousands of
cercariae, the next infective stage. A single snail can shed
thousands of cercariae each day.

Can I catch Bilharzia from someone infected?

No - unless you are a snail !

Schistosomes must alternate between humans and snails to
complete their life cycle. This means that Bilharzia can only
caught from snails.
Under the tropics, any body of water containing vegetation
could contain bilharzia-transmitting snails. Washing, swimming
or paddling in that water therefore exposes you to infection by
the parasite.
What are the symptoms?

In the case of urinary Bilharzia (found only in the Old World),

the victim passes red urine, tinted by blood lost through the
damaged kidneys. In some places such as Nigeria, this is
actually seen as "coming of age", after which boys are
considered men.

In the case of intestinal Bilharzia (Old and New World), blood

may be passed in the faeces but is not often recognized.

Both types of Bilharzia cause anemia and fatigue. They are

medically diagnosed by the presence of eggs in the urine or
feaces.

Is there a vaccine?

Not yet, although many medical scientists are working on it. The
problems involved in vaccine development are threefold:

Adult worms are about one thousand times larger than the
white blood cells responsible for the immune response.
Worms protect themselves with a tough tegument, protecting
them from chemical attack.
Worms mimic their host by coating themselves with host
molecules.
The good news is that there is a readily available treatment. A
drug called praziquantel is injected into the bloodstream and
disrupts the parasite's tegument. The parasite is then destroyed.

Should you have personal medical questions about bilharzia,

please contact consult your local specialist or the Center for
Disease Control.