title: Schistosomiasis presenting in travellers: a 15 year observational study at the Hospital for Tropical Diseases, London.
abstract: BACKGROUND
  Schistosomiasis in returning travellers is one of the most common imported tropical infections with potentially serious complications, which are preventable if diagnosed early.
  
  
  METHODS
  A review was undertaken of consecutive cases of schistosomiasis presenting at the Hospital for Tropical Diseases, London, UK from 1997 to 2012.
  
  
  RESULTS
  All 1020 schistosomiasis cases were from Africa and Schistosoma haematobium was the predominant species in those with microscopy confirmed schistosomiasis (74.2%, 204/252). The number of cases of imported schistosomiasis is decreasing steadily as a proportion of travellers seen. The majority of cases were in travellers originating from non-endemic settings (81.8%, 707/864). The most common symptom was of genitourinary complaints (22.6%, 230/1020), predominantly haematuria (17.8%, 181/1020); 36.1% (368) of cases were asymptomatic. Overall 42% had eosinophilia, and 62% of ova positive S. haematobium cases had haematuria on urine dip. Thus, no single screening tool was sufficient to identify or rule out schistosomiasis when used alone. Serology testing was a more sensitive tool in travellers than in other patients (p=0.007).
  
  
  CONCLUSIONS
  The prevalence of schistosomiasis in presenting travellers is decreasing. The predominant presenting species has shifted from S. mansoni to S. haematobium. No single test can reliably diagnose schistosomiasis, with eosinophilia and urine dip having low sensitivity. Clinicians need to continue to undertake a wide spectrum of diagnostic tests to ensure cases of schistosomiasis are not missed.
authors.affiliation: The Hospital for Tropical Diseases, UCLH, Capper Street, London WC1E 6JB, UK The London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK cordelia.coltart@ucl.ac.uk.
authors.forename: Cordelia E M
authors.initials: CE
authors.lastname: Coltart
authors.affiliation: The Hospital for Tropical Diseases, UCLH, Capper Street, London WC1E 6JB, UK.
authors.forename: Anastasia
authors.initials: A
authors.lastname: Chew
authors.affiliation: The Hospital for Tropical Diseases, UCLH, Capper Street, London WC1E 6JB, UK.
authors.forename: Neill
authors.initials: N
authors.lastname: Storrar
authors.affiliation: The Hospital for Tropical Diseases, UCLH, Capper Street, London WC1E 6JB, UK.
authors.forename: Margaret
authors.initials: M
authors.lastname: Armstrong
authors.affiliation: The Hospital for Tropical Diseases, UCLH, Capper Street, London WC1E 6JB, UK.
authors.forename: Natalie
authors.initials: N
authors.lastname: Suff
authors.affiliation: University College London Medical School, Gower Street, London, WC1E 6BT, UK.
authors.forename: Leila
authors.initials: L
authors.lastname: Morris
authors.affiliation: The Hospital for Tropical Diseases, UCLH, Capper Street, London WC1E 6JB, UK The London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
authors.forename: Peter L
authors.initials: PL
authors.lastname: Chiodini
authors.affiliation: The Hospital for Tropical Diseases, UCLH, Capper Street, London WC1E 6JB, UK The London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
authors.forename: Christopher J M
authors.initials: CJ
authors.lastname: Whitty
mesh_terms: D000293:Adolescent; D000328:Adult; D000818:Animals; D005260:Female; D006801:Humans; D008131:London / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012548:Schistosoma haematobium / Q000302:isolation & purification; D012550:Schistosoma mansoni / Q000302:isolation & purification; D012553:Schistosomiasis haematobia / Q000453:epidemiology*; D012555:Schistosomiasis mansoni / Q000453:epidemiology*; D013997:Time Factors; D014195:Travel; D055815:Young Adult
keywords: Diagnosis; Schistosoma haematobium; Schistosoma mansoni; Schistosomiasis; Screening; Travellers