“This water is my drink. This water is my playground. This water is my bath. This water is my danger. From the snail, to the water, to me, it lives – a parasite. I am one of the 200 million infected. I am one of 600 million at risk. Yet, I feel no sickness.”
Bilharzia – schistosomiasis – is a water-borne disease caused by a parasitic flatworm, prevalent in over 75 countries around the world. There are five different species that infect humans and many others that infect other mammals. There are five species of the schistosomes (also known as flatworms or blood flukes). The five human parasites are S. mansoni, S. haematobium, S japonicum, S. intercalatum and S. mekongi. Their complex life cycle involves the primary host (man), an intermediate host (water snail) and two free swimming forms (miracidia and cercariae). This disease is disregarded and classified as a Neglected Tropical Disease (NTD).
Infection occurs when your skin meets contaminated fresh water in which certain types of snails that carry schistosomes are living. Fresh water becomes contaminated by Schistosoma eggs when infected people urinate or defecate in the water. The eggs hatch, and if certain types of snails are present in the water, the parasites grow and develop inside the snails. The parasite leaves the snail and enters the water where it can survive for about 48 hours. Schistosoma parasites can penetrate the skin of persons who are wading, swimming, bathing, or washing in contaminated water. Within several weeks, worms grow inside the blood vessels of the body and produce eggs. Some of these eggs travel to the bladder or intestines and are passed into the urine or stool. A fluke or schistosome parasite causes Bilharzia or Schistosomiasis, which spends part of its life cycle in a water snail and develops in humans.
When a person becomes infected, it is just a matter of seconds when the parasite has penetrated the person’s skin and continues its life cycle. After about 30 days, the parasite has grown into a long worm. A male and a female attach and copulate to produce from 200 to 2,000 eggs (depending on the species) per day over an average of five years. During normal activities such as swimming, bathing or fishing, people are infected because of the unawareness of the risks, lack of public health services, and extreme poverty.
Symptoms usually only shows once it has progressed into the chronic stages of the disease. Symptoms include itchy skin and rashes, fever, cough, and chills. Anaemia is a common symptom as well. The symptoms are a result of the body’s immune response rather than the actual organism; however, it may take months or even years for symptoms to show.
Bilharzia causes itching and rashes at the site of entry. If the flatworms invade the stomach and digestive tract, abdominal pain and bloody diarrhoea may result. If the kidneys, bladder or urinary tract are infested, frequent urination, painful urination and bloody urine are all common. A heavy infestation can cause chills, fevers and enlargement of the lymph nodes, liver and spleen. Some 200 million people are thought to suffer from this disease in the tropics, and 750,000 people a year die.
This parasitic infection can be treated by a single oral dose of generic biltricide – generic name Praziquantel; But the good news stops here, for Praziquantel is the only effective drug against schistosomiasis and has been so since the 1980s. That’s a dangerous and untenable position to be in and already, worrying reports have started to emerge about strains of blood-flukes that are resistant to the drug. Parasitic diseases can be difficult to diagnose because many parasites do not show up on the routine blood tests that doctors perform. In addition, people with parasites are prone to get bacterial infections as well, which may fool doctors into thinking that the bacteria alone are the cause of the illness. Research also shows a high occurrence in genital schistosomiasis resulting in infertility, miscarriage, ectopic pregnancies, erectile dysfunction and increased risk of acquiring sexually transmitted infections including HIV. Of special mention is that bilharzia, if not treated properly, can lead to bladder cancer later in life.
Tropical parasitic diseases may lack the headline-grabbing power of bird flu or SARS and they may fail to grab the pharmaceutical industry’s attention. But there is no doubt that they are a massive problem. Bilharzia, a disease that many people in Western countries will never have heard of, currently afflicts 3% of the world’s population.
There are no water testing methods for the parasite. Checking for snails, microscopic inspection of the water and testing with mice are some of the ways that have been tried, however there is no technique to definitively detect the condition of the water. If chronic bilharzia goes untreated, complications may arise that result in death. It is essential that this disease is no longer neglected, for what we do not know will hurt us
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