Imported Katayama fever: Clinical and biological features at presentation and during treatment
Introduction
Katayama fever (or acute schistosomiasis) occurs as an early manifestation of infection with Schistosoma species, in non-immune individuals exposed to cercariae-infested water in endemic regions. This syndrome is characterized by an acute febrile stage, often associated with pulmonary and/or abdominal symptoms, and may develop 2–10 weeks after the initial infection. Because fever is not always present, some experts find more appropriate to call Katayama syndrome all clinical manifestations associated with acute schistosomiasis, including also angio-oedema, respiratory symptoms and even fatigue. The symptoms of Katayama are thought to be due to an allergic reaction to various antigens released during larval migration and early oviposition, with production also of circulating immune complexes.1, 2 Symptoms are often mild and transient, and the syndrome may go unrecognized in settings unfamiliar with tropical pathology.3 In some cases, the illness follows a more severe clinical course.4, 5, 6 Many outbreaks among tourists returning from endemic areas have been reported in the last decades, reflecting probably the increase of exposure to freshwater during outdoor activities. Most publications described clusters of patients with Katayama from a single location of infection.2, 4, 5, 6, 7, 8, 9, 10, 11, 12 Optimal therapy of Katayama fever remains controversial, and evolution and outcome under treatment are poorly documented. We report on all patients diagnosed with Katayama fever during a 4.5-year prospective study on imported fever.
Section snippets
Patients and methods
From April 2000 onwards, all patients presenting with fever (≥38 °C) and attending the in- or outpatient departments of the Institute of Tropical Medicine, Antwerp (ITMA) and of the University Hospital, Antwerp (UHA) are included in a prospective study investigating the aetiology of febrile diseases after a stay in the Tropics. All patients with a confirmed diagnosis of Katayama fever until September 2004 were further analysed for this presentation. Diagnosis of Katayama fever was confirmed when
Epidemiology
Among the 1640 fever episodes included during the study period, 28 (1.7%) were due to confirmed Katayama fever, and occurred in 23 patients (18 males and five females). Five episodes were due to recurrence of Katayama fever after the initial episode had subsided. All patients were native of European countries (22 travellers and one expatriate), with a mean age of 31 years (range: 18–52 years). Countries of infection were all located in sub-Saharan Africa (Table 1). Mean delay between exposure
Discussion
Most publications on imported Katayama fever have described outbreaks of schistosomiasis from a single source, in homogenous groups of travellers, where active tracing of patients was triggered by an index case.2, 9, 10, 12 This study presents prospective data on features and outcome of 28 confirmed Katayama fevers occurring in 23 travellers, being one of the largest series of sporadic imported cases.
As reported elsewhere, schistosomiasis is nowadays almost exclusively acquired in sub-Saharan
Acknowledgements
There is no potential conflict of interest with any of the authors. Financial support: None.
References (26)
- et al.
Pulmonary manifestations of early schistosome infection among nonimmune travelers
Am J Med
(2000) - et al.
Acute schistosomiasis (Katayama fever)—clinical deterioration after chemotherapy
J Infect
(1987) Praziquantel in acute schistosomiasis
Trans R Soc Trop Med Hyg
(1987)- et al.
Oral artemether for prevention of Schistosoma mansoni infection: Randomised controlled trial
Lancet
(2000) - et al.
Current concepts—schistosomiasis
N Engl J Med
(2002) - et al.
Outbreak of schistosomiasis among travelers returning from Mali, West-Africa
Clin Infect Dis
(1995) - et al.
Lesson of the week—Katayama fever: An acute manifestation of schistosomiasis
BMJ
(1996) - et al.
Acute pulmonary schistosomiasis in travelers returning from lake Malawi, sub-Saharan Africa
Clin Infect Dis
(1999) - et al.
Katayama fever in scuba-divers—A report of 3 cases
S Afr Med J
(1991) - et al.
Factors in the pathogenesis of acute schistosomiasis mansoni
J Infect Dis
(1979)
Outbreak of acute schistosomiasis among Israeli rafters on the Omo river in Ethiopia
Am J Trop Med Hyg
Acute schistosomiasis (Katayama fever) among British air crew
BMJ
Acute schistosomiasis in travelers returning from Mali
J Travel Med
Cited by (96)
Schistosomiasis
2023, Manson's Tropical Diseases, Fourth EditionSchistosomiasis in Malaysia: A review
2019, Acta TropicaEosinophilia in Infectious Diseases
2015, Immunology and Allergy Clinics of North AmericaCitation Excerpt :Although symptom onset varies slightly depending on the schistosome species, symptoms often begin 3 to 4 weeks (range 2–9) after infection18 that occurs through contact with cercarial-containing fresh water. The most common presenting complaints are a combination of malaise, myalgia, diarrhea, cough, abdominal pain, fevers, and/or headache.17–22 A minority of patients develop urticaria with the onset of symptoms.
Case report: Imported asymptomatic schistosomiasis among Belgian school travelers to Rwanda
2024, Frontiers in Tropical Diseases