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Eyal Leshem, Eyal Meltzer, Eli Schwartz, Reply to Jauréguiberry et al, Clinical Infectious Diseases, Volume 48, Issue 8, 15 April 2009, Pages 1164–1166, https://doi.org/10.1086/597498
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To the Editor—We appreciate the valuable comments of Jauréguiberry et al. [1] regarding our description of an outbreak of acute schistosomiasis in a group of travelers [2]. Jauréguiberry et al. [1] comment on 2 areas in the management of acute schistosomiasis: diagnosis and treatment. Both issues were extensively discussed in a previous report [3].
The diagnosis of acute schistosomiasis during the initial symptomatic period is based on clinical and epidemiologic grounds. Serologic evidence may support the diagnosis. However, because seroconversion often occurs after the onset of symptoms, initial diagnosis often relies solely on clinical evidence. In suspected cases, serologic tests should be repeated if initial results are negative, and acute schistosomiasis should only be ruled out if serologic test results remain negative ⩾3 months after exposure. This principle was demonstrated by 2 patients in the described group who presented with symptoms compatible with acute schistosomiasis but were initially seronegative (at weeks 5 and 8 after exposure). Repeated serologic testing revealed seroconversion in both patients (at weeks 7 and 10 after exposure, respectively). In addition, 8 of the 27 exposed travelers in the outbreak did not experience acute schistosomiasis symptoms or eosinophilia [2]. Serologic testing performed ⩾3 months after exposure (range, 94–186 days after exposure) revealed that 3 of the 8 were seropositive, and those 3 subsequently received a diagnosis of asymptomatic infection. Only the remaining 5 patients, who were seronegative long after exposure (a minimum of 3 months), were regarded to be not infected. We are unaware of any reports of very late seroconversions that occur even 6 months after exposure, which were mentioned by Jauréguiberry et al. [1]. There are very few case reports that describe patients who were repeatedly seronegative and subsequently received a diagnosis by use of ova detection [4, 5]. These few cases possibly illustrate the different sensitivities of various serologic tests or the pitfalls associated with use of locally produced worm antigen [6].
