42432. Exotic Waterfalls: Beauty and the Beast
Session: Poster Abstract Session: Medical Student Poster Session
Friday, October 4, 2013
Room: Yerba Buena Ballrooms
Background:  Illness in a returning traveler presenting with non-specific symptoms leads to a broad differential diagnosis. We present a case of Katayama fever in a Peace Corps volunteer who was returning from Madagascar.

Methods:  Case Report

Results:  A 25-year-old woman presented with several days of fatigue, headaches, fever, and mucous-like diarrhea with “stringy red objects” after returning from Madagascar. She noticed shortness of breath, palpitations and decreased appetite. When questioned, she recalled swimming in a waterfall in Madagascar. She appeared ill but not toxic with minimal abdominal tenderness. Initial evaluation included a WBC-12.5 with 24.3% eosinophils, negative blood cultures, and a negative stool smear for ova & parasites. Empiric treatment with ciprofloxacin and metronidazole failed. Repeat stool samples were sent to the same laboratory with specific instructions to look for “shistosoma eggs” which were then confirmed. Serum antibodies for Schistosoma IgG were elevated at 1.36 (range, 0.00-0.19 units). She was treated with praziquantel, 1200mg x 2 doses, and noted the onset of tachycardia and higher fevers. Symptoms resolved within 48 hours with the administration of methylprednisolone. She required retreatment with both methylprednisolone and praziquantel 7 days later.

Conclusion:  Katayama fever, acute schistosomiasis, occurs as an early manifestation of Schistosoma infection when non-immune individuals are exposed to cercariae-infested waters. The syndrome is characterized by an acute febrile stage with respiratory and abdominal symptoms developing 2-10 weeks after the initial infection. It is hypothesized that the symptoms may be due to an allergic reaction and subsequent immune complex formation caused by the release of antigens during larval migration. The gold standard for diagnosis is microscopic detection of eggs in stool. This test can be of limited sensitivity, particularly in travelers who may have fewer organisms or when the lab is not alerted to look for the specific parasite as was seen in our case initially. Praziquantel is the treatment of choice. Up to 50% of patients may require adjunctive steroids to control the immunologic flaring seen with death of the parasites. Subsequent treatment 2-3 months later is required to ensure clearance of all organisms.

Neha Maheshwari, University of Cincinnati College of Medicine, Cincinnati, OH and Carl Fichtenbaum, MD, University of Cincinnati, Cincinnati, OH; Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH


N. Maheshwari, None

C. Fichtenbaum, None

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