title: An outbreak of acute Schistosoma mansoni Schistosomiasis in a nonendemic area of Brazil: a report on 50 cases, including 5 with severe clinical manifestations.
abstract: BACKGROUND
  Acute schistosomiasis is a systemic hypersensitivity reaction against the migrating schistosomula and eggs. In this report, we describe an atypical outbreak of the disease with severe cases. Transmission occurred in a nonendemic area of Brazil, which became a new focus of transmission due to the in-migration of infected workers.
  
  
  METHODS
  From December 2009 to March 2010, the 50 patients with acute schistosomiasis (group 1) bathed in a swimming pool supplied by a brook on a country estate in the outskirts of São João del Rei, Brazil. Thirty other subjects (group 2) living in the same area, who denied having contact with the swimming pool, volunteered to participate in the study. All participants were submitted to clinical, laboratory, and ultrasound examinations.
  
  
  RESULTS
  Five of 50 (10%) patients were admitted to the hospital: 1 with myeloradiculopathy, 1 with diffuse pulmonary micronodules, and 3 with diarrhea and dehydration. All 5 had hypereosinophilia and prolonged fever. Group 1 patients more frequently had cercarial dermatitis (P = .01), blood in the stool (P = .04), and intra-abdominal lymph nodes (P = .001). All group 1 patients were treated with praziquantel; 1 patient with myeloradiculopathy also received oral prednisone (60 mg/day) for 6 months with complete recovery.
  
  
  CONCLUSIONS
  This report describes the first time that patients from an outbreak of acute schistosomiasis have been compared to controls. Five subjects (10%) had severe manifestations of schistosomiasis. Diagnosis of the disease and its severity was delayed because physicians did not consider that an epidemic of schistosomiasis might emerge in a nonendemic area.
authors.affiliation: Infectious Diseases Branch, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil. lamber@uai.com.br
authors.forename: José Roberto
authors.initials: JR
authors.lastname: Lambertucci
authors.forename: Sandra Costa
authors.initials: SC
authors.lastname: Drummond
authors.forename: Izabela
authors.initials: I
authors.lastname: Voieta
authors.forename: Leonardo Campos
authors.initials: LC
authors.lastname: de Queiróz
authors.forename: Pedro Paulo Nunes
authors.initials: PP
authors.lastname: Pereira
authors.forename: Bruna Assis
authors.initials: BA
authors.lastname: Chaves
authors.forename: Patrícia Passos
authors.initials: PP
authors.lastname: Botelho
authors.forename: Pedro Henrique
authors.initials: PH
authors.lastname: Prata
authors.forename: Alba
authors.initials: A
authors.lastname: Otoni
authors.forename: José Fagundes
authors.initials: JF
authors.lastname: Vilela
authors.forename: Carlos Maurício
authors.initials: CM
authors.lastname: Antunes
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D000871:Anthelmintics / Q000627:therapeutic use; D001938:Brazil / Q000453:epidemiology; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks; D005260:Female; D064368:Healthy Volunteers; D006801:Humans; D008297:Male; D008875:Middle Aged; D011223:Praziquantel / Q000627:therapeutic use; D012550:Schistosoma mansoni / Q000302:isolation & purification*; D012555:Schistosomiasis mansoni / Q000453:epidemiology* / Q000473:pathology* / Q000635:transmission; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000871:Anthelmintics; D011223:Praziquantel
keywords: acute schistosomiasis; fever of unknown origin; myeloradiculopathy; outbreak; pulmonary nodules