Beware the swimming parasite

2008-04-11 00:00

WHEN eight-year-old Julia Soderlund unexpectedly tested positive for bilharzia recently her doctor was as surprised as her parents.

According to her mother, Susan Spencer, Julia had been prone to diarrhoea, was lacking an appetite and had been fatigued for a long time. Then she got very ill with a cough and a fever that lasted for about 10 days.

“She was so sick,” says Spencer, “I was carrying her around.”

The family doctor wanted to do a blood count to gain insight into Julia’s poor health and in desperation, remembering a comment by someone about the high prevalence of bilharzia in KwaZulu-Natal, Spencer requested a test for that too. It came back positive.

Julia was treated with a single dose of Biltricide.

“After a day or two of having nuked it, she was back to herself,” says the relieved mother.

Pietermaritzburg general practitioner and 15-times Duzi finisher Dr Richard Anderson says that bilharzia is a disease that should be taken seriously. He’s aware of at least three bilharzia-related deaths caused by either cerebral bilharzia, renal failure or liver failure.

According to Anderson, the most common symptom of bilharzia is fatigue, however, it can also lead to neural damage in the brain or spine, hepatitis and even appendicitis. It is becoming an increasingly common cause of appendicitis among young people, evident by extensive bilharzia found in the removed appendix.

Bilharzia is a parasite that uses humans and water snails as hosts during its life cycle. It enters the skin when a human enters a transmission area. According to Anderson, bodies of water that fall below rural populations are at risk.

“You can even catch bilharzia when trout fishing in the upper Kamberg,” he cautions.

If you feel extremely tired and have previously swum in fresh water, “it is worth testing for bilharzia”.

Anderson says it is very difficult to estimate how many people have this disease as “many people don’t get sick enough to be tested. They feel tired and might think they are depressed”.

He tests about 30 people a year for it, most of whom are paddlers.

Spencer thinks Julia may have contracted bilharzia about six months ago, indicated by “a furiously itchy skin”, known as swimmer’s itch, a symptom that usually occurs on the day of exposure and then subsides within a few days. Many of her other symptoms are consistent with Katayama syndrome which is the body’s allergic responses to the parasite. This presents with a fever, diarrhoea, a cough and swollen lymph nodes. Spencer confirms that Julia “had extremely swollen lymph nodes and all of those symptoms”. Katayama fever only presents with people who have never previously had bilharzia.

Spencer is not sure where her daughter became infected as she has played in a variety of bodies of water over the years, including the river and dam at the Botanical Gardens and a lagoon at Cintsa (near the Eastern Cape) last year.

Professor Chris Appleton of the University of KwaZulu-Natal says that in this province urinary bilharzia (S. haematobium) is widespread, while intestinal bilharzia (S. mansoni) is patchy along the coast. He says urinary bilharzia is prevalent at an altitude of 500 metres to 600 metres, but can also be found as high as Colenso in the midlands and around Pietermaritzburg, for example.

Asked about the common perception that bilharzia is not found in flowing water he says that it depends on the situation.

“Snails can’t tolerate flowing water, but if the water is flowing out of a pool or a weir and the cercariae are flowing down — yes they can penetrate the skin if they make contact.”

Temperature plays a role in the distribution of bilharzia.

“These animals — parasite and snail — are cold-blooded and entirely dependent on water temperature for development. They survive more successfully in warmer water,” says Appelton.

With regards to bilharzia in the Drakensberg, Appleton says, “One can never give a categorical no, but I would say that the low temperature of the water precludes transmission.” Anderson, however, reports that bilharzia is present in the cool waters of the Umzimkulu River in the Underberg area.

Appleton reports that there have been a few cases of Katayama syndrome in Duzi paddlers. The Duzi-uMngeni Conservation Trust website reports that Kirsten Oliver tested 500 Duzi paddlers’ urine at the UKZN in 2006.

“A total of 20 out of the 500 samples tested positive. Of these, five were from Gauteng and eight were from the Nagle Dam area. The incidence among the Nagle paddlers is 27%, which is nine times greater than that in the balance of the paddlers tested.”

On the website, paddlers are advised not to treat themselves with Biltricide yearly, unless they have bilharzia, as anti-bilharzials are “toxic and not without temporary side effects”.

As for Midmar, Wayne Ridden, the Midmar Mile organiser, says, “We’ve had no reports of bilharzia from anyone who has swum the Midmar Mile.”

Is bilharzia found in lagoons? According to Appleton, bilharzia will only infect low salinities. But a lot of lagoons and estuaries are “becoming shallower and fresher and can have a range of bilharzias”.

What is bilharzia and how does one contract it?

Bilharzia is a parasitic disease where the life cycle of the parasite depends on human and snail hosts. A fork-tailed lava emerges from a Bulinus snail and penetrates through the skin of a person immersed in fresh water. After infection, the eggs migrate to the liver where they mature into male and female adults. They mate and then migrate to the lower abdomen. Depending on the type of bilharzias, eggs are release either in urine or faeces and when released directly, or washed by rain into nearby surface waters, the ora can then enter a suitable snail and complete the cycle.


A rash or itchy skin which may be followed a month or two later by fatigue, fever, chills, cough, muscle aches, abdominal pain, diarrhoea, dysentery and blood in the urine.

How does one test for bilharzia?

"The easiest way to test for bilharzia is a blood test," says Dr Peter Appelt, a Maritzburg GP. Once tested positive, however, you will always test positive for bilharzia antibodies. This complicates matters for Duzi paddlers who may contract bilharzia more than once. "They need to then have a urine test, between one and three in the afternoon, in the heat of the day when the eggs are likely to be in the urine," says Appelt. "Sometimes they may need to jump up and down to get the eggs into the urine".

Alternately, Anderson finds it useful to check the IgM levels in blood. According to a DUCT website interview, Anderson says, "Blood tests measure two immunoglobulins _ one indicating recent exposure (IgM), and the other indicating past infection and consequent resistance to current exposures to bilharzia (IgG). Testing for levels of IgM are very relevant as they indicate the level of current infection from which the effectiveness of medication can be gauged and the individual"s resistance determined. Obviously the IgG remains positive and is less relevant".

Just to complicate things further, Appelt says, "The problem is, one can still get the rectal type (s. mansoni) and then they need to have a rectal biopsy or a cystoscopy which is invasive".

Can a person ascertain how long they have had bilharzia?

According to Appelt, "No, one can"t really. It can literally be in the blood for years and can cause chronic liver failure and organ damage. This is a late stage that I personally have never seen." Chronic infections can even cause cell change in the bladder that can lead to bladder cancer. Appelt says that persistent blood in the urine would indicate the need for a cystoscopy. Early detection certainly appears beneficial. Sue Spencer is emphatic, "I think people in Pietermaritzburg need to test more regularly."

Join the conversation! encourages commentary submitted via MyNews24. Contributions of 200 words or more will be considered for publication.

We reserve editorial discretion to decide what will be published.
Read our comments policy for guidelines on contributions. publishes all comments posted on articles provided that they adhere to our Comments Policy. Should you wish to report a comment for editorial review, please do so by clicking the 'Report Comment' button to the right of each comment.

Comment on this story
Comments have been closed for this article.

Inside News24

Traffic Alerts
There are new stories on the homepage. Click here to see them.


Create Profile

Creating your profile will enable you to submit photos and stories to get published on News24.

Please provide a username for your profile page:

This username must be unique, cannot be edited and will be used in the URL to your profile page across the entire network.


Location Settings

News24 allows you to edit the display of certain components based on a location. If you wish to personalise the page based on your preferences, please select a location for each component and click "Submit" in order for the changes to take affect.

Facebook Sign-In

Hi News addict,

Join the News24 Community to be involved in breaking the news.

Log in with Facebook to comment and personalise news, weather and listings.