614

A Case of Mixed Infection with Schistosoma haematobium and Trichinella sp..

Yasuhiro KUSUHARA1), Yoshimasa MAEN01), Keizo NAGASE1.3), Koki TANIGUCHI1),

Katsutaka TORIKAI2) and Yuzo TAKAHASHI4)1) Department

of Virology and Parasitology and

2) Departrent of Internal Medicine, Fujita Health University, School of Medicine3) Departrent of Medical Zoology, Fujita Health University, College4) Department

of Parasitology, Gifu University, School of Medicine

(Received: February12, 1999)

(Accepted: April2, 1999)

Key words: mixed infection, schistosomiasis, trichinellosis

Introduction

Schistosomiasis haematobia is a parasitic disease caused by the infection with Schistosoma haemato-

bium (S. haematobium) prevalent mainly in Africa and western Asia1), and is characterized by dysuria, pol-

lakisuria, and terminal hematuria with an insidious onset. Schistosomiasis haematobia is not endemic to

Japan. However, with increasing number of Japanese traveling or staying in tropical and subtropical ar-

eas where S. haematobium is endemic, a few Japanese patients have been reported in the 1990's2).

Trichinellosis is a disease caused by parasites of the genus Trichinella that humans acquire from eat-

ing the muscles of several kinds of wild animal or domestic pigs. Trichinellosis is one of the most common

parasitic zoonoses in the world, and may be found in the USA, Canada, and eastern Europe3). In Japan,

there have been some reports of outbreaks of trichinellosis associated with the ingestion of raw bear

meat4) and there is a case report of a patient infected with Trichinella from eating raw pork in Thailand5).

The disease is characterized by fever, myositis, gastrointestinal symptoms, eosinophilia, and swollen eye-

lids. We report here the first Japanese case to be coinfected with S. haematobium and Trichinella sp..

Case report

A33-year-old Japanese man traveled in South America, Egypt, South Africa, Malawi, Kenya, and Po-

land from February1993to July 1996. The patient had suffered from pain on micturition since April1995

after traveling in Egypt by motorcycle. Although the acute severe pain improved within a week, the pain

on micturition persisted. Furthermore, the patient developed diarrhea after ingestion of a half-cooked sau-

sage in Poland in November1995, but afterwards diarrhea subsided spontaneously without treatment.

After returning to Japan, the patient underwent some medical examinations at a local hospital and was

found to have eosinophilia, and was later hospitalized in Fujita Health University Hospital for further

close examination on April22, 1997.

Correspondence to: Yasuhiro KUSUHARA, Ph. D.Department of Virology and Parasitology, Fujita Health University School of Medicine. Toyoake, Aichi, 470-1192, Japan

感染症学雑誌 第73巻 第6号

Mixed infection with Schistosoma and Trichinella 615

Fig.1•@ S. haematobium eggs in stool (A) and urine (B). Scale bars represent20.ƒÊm

(A) and40gm (B).

Fig.2•@ Immunofluorescence staining of the mid gut of Trichinella spiralis using patient

serum. N shows nurse cell associated with encystation. Scale bar represents100gm.

On admission, he complained of myalgia from the scapular region to gluteal region and pain on mic-

turition. S. hnematobium eggs were detected in stool and urine after centrifugation (Fig.1). But no other

parasite eggs or larvae were detected. We suspected trichinellosis from his chief complaint and history of

eating insufficiently cooked sausage in Poland, and examined the reactivity of his serum with Trichinella

spiralis in experimentally infected mouse muscle by indirect fluorescent antibody technique. The fluores-

cent antibody assay showed a strong positivity for trichinellosis (Fig.2). His blood counts and biochemical

examination results including LDH and CK levels were normal, except for eosinophil count4,060/ƒÊl(nor-

mal70-400/ƒÊl) and IgE level2, 449IU/ml (normal<400 IU/ml). Thus, he was diagnosed as having a

mixed infection with S. haematobium and Trichinella sp.. The patient was treated first with praziquantel

600mg •~6for two days (Fig.3). Twenty-three days later, no schistosoma eggs were seen in his urine and

the pain on micturition disappeared. He was then treated with mebendazole100mg three times daily for

平成11年6月20日

616 Yasuhiro KUSUHARA et al.

Fig.3•@ Changes in the number of S. haematobium eggs, anti-T. spiralis antibody titers,

eosinophil count, and IgE levels during the clinical course of patient. Anti T. spiralis

antibody content was expressed as+(weak), 2+(intermediate), or3+(strong)

depending on the fluorescence strength.

four consecutive days. This treatment was repeated three times. Finally, the muscle pain from scapular

region to gluteal region was improved, and he was discharged from hospital on July5, 1997. He was well

at the last medical examination on December4, 1997and his blood eosinophil count and IgE level were

found to have decreased to almost normal levels (eosinophil count490/ƒÊl and IgE level 657IU/ml).

Discussion

Schistosomiasis haematobia arises from cutaneous infection with cercaria in fresh water6). In this

case, the patient appeared to be infected with S. haematobium during bathing in the Nile River, Egypt, an

endemic area of S. haematobium.We recognized S. haematobium60,000eggs in his24-hour specimen of

urine on admission, suggesting the presence of a lot of mature S. haematobium in this patient. In addition,

the detection of eggs in both stool and urine implied that female worms might have produced eggs not

only in the vessels of the lower part of the colon but also in the urogenital system.

Although detection of the larvae of Trichinella sp. is required for definitive diagnosis, it is generally

difficult to find larvae of Trichinella sp. in the muscle of the patients. Therefore, the clinical manifestations,

laboratory examinations and history of eating raw or insufficiently cooked meat of pigs or wild animals

often provide clues for the diagnosis of trichinellosis. In this case, the fluorescent antibody assay, eosino-

philia, high IgE value and history of the ingestion of a half-cooked sausage in Poland were sufficient evi-

dence for the diagnosis. The patient was thought to probably be infected with Trichinella britovi,which is

the prevalent Trichinella species in Poland7).

As the infection progresses, the penetration of larvae into a variety of tissues gives rise to symptoms

and signs mimicking different diseases such as polymyositis. This should alert the physician to consider a

diagnosis of trichinellosis8). In this case, successive examinations of the number of S. haematobium eggs in

urine, and antibody detection by the fluorescent antibody technique, eosinophil count, and IgE value were

感染症学雑誌 第73巻 第6号

Mixed infection with Schistosoma and Trichinella 617

good indexes in the follow-up of schistosomiasis and trichinellosis, respectively.

In recent years, the number of cases of parasitic infection have been increasing, as increasing num-

bers of Japanese visit or reside in tropical countries which are endemic for various parasites. Japanese

physicians and medical technologists should be aware of parasitic diseases when they encounter patients

who have returned from such areas. In particular, complicated cases with multiple parasitic infections as

reported here require careful diagnosis and relevant treatment.

References

1) Mahmound AAF: Schistosomiasis. In: Wyngaarden JB and Smith LC Jr ed. Cecil Textbook of Medicine. 18th ed. W. B.

Saunders Co., Philadelphia, 1988; 1890-1901.

2) Ohnishi K: Schistosomiasis haematobium: a case imported by a Japanese patient. Kansenshogaku Zasshi 1997; 71:

672-674.

3) Piekarski G: Trichinella spinals. In: Medical Parasitology. Springer-Verlag, Berlin, 1989; 209-213.

4) Yamaguchi T: Trichinella and Trichinellosis in Japan. In : Case reports from Japan after 1974. Nankodo, Tokyo, Japan,

1989; 8-20 (in Japanese).

5) Totani T, Maeno Y. Nagase K, Asano A: The first imported case of trichinellosis in Japan due to the ingestion of raw

pig meat. Bull Fujita Med Soc 1985; 9: 369-372 (in Japanese).6) Beaver PA, Jung RC, Cupp EW: Schistosomiasis of blood flukers. In : Clinical Parasitology. 9th ed. Lea & Febiger, Phila-

delphia, 1984; 415-448.

7) Poizo E, La Rosa G, Yamaguchi T, Saito S: Trichinella britovi from Japan. J Parasitol 1997, 82: 847-849.

8) Katz M. Despommier DD, Gwadz R: Trichinella spiralis. In : Parasitic Disease. 2nd ed, Springer-Verlag, New York,

1988; 28-35.

ビルハルツ住血吸虫 と旋毛虫に重複感染 した1症 例

藤田保健衛生大学医学部 ウイルス ・寄生虫学教室山,同 内科学教室2)

藤田保健衛生大学短期大学医動物学教室3),岐 阜大学医学部寄生虫学教室4)

楠 原 康 弘1)前 野 芳 正1)長 瀬 啓 三1)3)

谷口 孝 喜1)鳥 飼 勝 隆2)高 橋 優 三4)

要 旨

今回我々は世界一周旅行中にビルハルツ住血吸

虫と旋毛虫に重複感染 した 日本人の症例を経験 し

たので報告する.患 者は33歳 男性.人 院時検査で

顕著 な好酸球増多および著明なIgE値 の上昇を

認めたため,寄 生虫学的検索を行い,ビ ルハルツ

住血吸虫症 な らびに旋 毛虫症 と診 断 され た.

Praziquantei6錠/日,2日 間 の 投 与 に よ り尿 中 虫

卵 と排 尿 痛 が 消 失 し,さ ら にmebendazole3錠/

日,4日 間服 用/3ク ー ル に て 入 院 時 強 陽 性 を 示 し

た 抗 旋 毛 虫 抗 体 価 が 弱 陽 性 と な り,好 酸 球 数 と

IgE値 は ほ ぼ 正 常 値 まで 減 少 し た。

〔感染 症 誌73: 614～617, 1999〕

平成11年6月20日