Eosinophilic

leukocytosis was a marked feature in antibody-positive persons. Eosinophil counts were above 20% (normal range, 2%–6%) in 45/66 (68.2%) patients, with 19/66 (28.8%) of the antibody-positive patients having eosinophilia above 50%. The highest eosinophil count was 81% in a patient with a total WBC count of 47.1 × 109/L. Total WBC counts were therefore correspondingly high with 56% above 10 × 109/L. Of the 77 patients, 49 submitted stool samples for examination. Schistosoma mansoni eggs were found in five stools using the PI3K inhibitor formol-ether concentration method. Ten persons also provided urine samples for analysis, but none was positive for Schistosoma haematobium. During physical examination, various allergic reactions were seen or described by the patients as unexplained illnesses in the previous 1 month. They included periorbital edema, conjunctivitis, swollen lips, glossitis, blurred vision, itching with skin rashes, erythematic selleck lesions, and edema of fingers. Other generalized symptoms noted, which were perceived by patients to be similar to malaria, included fever, headache, low back pain, abdominal disturbances, and dizziness. More than 70% (54) of the patients

examined were children growing up in Nairobi who had never been exposed to schistosomiasis before. It is known that previously unexposed individuals with naive immunity are most likely to get heavy infections with accompanying severe allergic manifestations.2 The allergic reactions in the Mwanza group were therefore attributed to Katayama syndrome in acute schistosomiasis.1–3 However, the unusual eye reactions, for which Racecadotril there was no specific explanation, were atypical and had not been described before in the literature.1–5 Symptoms coincided with the production of schistosome eggs into the blood stream, from approximately 6 weeks after exposure to cercariae in the lake water. The high antibody titers and marked eosinophilia indicated a heavy infectious dose of cercariae on contact with the contaminated lake water. The yield of S. mansoni eggs in stool samples was low because the infection was still in a relatively early phase; therefore, a serological test was the

most appropriate at this stage.2 Antibodies are known to appear when the allergic manifestations are still present.6 The individual who tested negative for bilharzia antibodies despite swimming had grown up in the locality of Lake Victoria, suggesting a probable acquired immunity or innate resistance. All patients seen at CTTM and positive for bilharzia by stool or antibody tests were treated using praziquantel at a dose of 40 mg/kg daily for 4 days. Those with allergic manifestations were, in addition, treated with prednisolone at a dose of 0.5 to 0.8 mg/kg once daily for 4 days. The infection rate of nearly 100% (66/67) among those who had been in the lake justified the treatment of all the remaining individuals who had swum, even in the absence of laboratory testing.