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Nature Reviews Disease Primersvolume 4, Article number: 13 (2018) | Download Citation


Schistosomiasis (bilharzia) is a neglected tropical disease caused by parasitic flatworms (blood flukes) of the genus Schistosoma, with considerable morbidity in parts of the Middle East, South America, Southeast Asia and, particularly, in sub-Saharan Africa. Infective larvae grow in an intermediate host (fresh-water snails) before penetrating the skin of the definitive human host. Mature adult worms reside in the mesenteric (Schistosoma mansoni and Schistosoma japonicum) or pelvic (Schistosoma haematobium) veins, where female worms lay eggs, which are secreted in stool or urine. Eggs trapped in the surrounding tissues and organs, such as the liver and bladder, cause inflammatory immune responses (including granulomas) that result in intestinal, hepato-splenic or urogenital disease. Diagnosis requires the detection of eggs in excreta or worm antigens in the serum, and sensitive, rapid, point-of-care tests for populations living in endemic areas are needed. The anti-schistosomal drug praziquantel is safe and efficacious against adult worms of all the six Schistosoma spp. infecting humans; however, it does not prevent reinfection and the emergence of drug resistance is a concern. Schistosomiasis elimination will require a multifaceted approach, including: treatment; snail control; information, education and communication; improved water, sanitation and hygiene; accurate diagnostics; and surveillance-response systems that are readily tailored to social-ecological settings.

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Nature Reviews Disease Primers thanks P. M. Z. Coelho, J. Friedman, N. Midzi, E. Secor and the other anonymous referee(s) for their contribution to the peer review of this work.

Author information


  1. Immunology Department, QIMR Berghofer Medical Research Institute, Herston, Brisbane, Queensland, Australia

    • Donald P. McManus
  2. Department of Pathology, University of Cambridge, Cambridge, UK

    • David W. Dunne
  3. Department of Diagnostic and Biomedical Research, Institut National de Recherche en Santé Publique, Bamako, Mali

    • Moussa Sacko
  4. Swiss Tropical and Public Health Institute, Basel, Switzerland

    • Jürg Utzinger
  5. University of Basel, Basel, Switzerland

    • Jürg Utzinger
  6. Department of Veterinary and Animal Science, University of Copenhagen, Copenhagen, Denmark

    • Birgitte J. Vennervald
  7. National Institute of Parasitic Diseases, Shanghai, People’s Republic of China

    • Xiao-Nong Zhou


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Introduction (D.P.M. and J.U.); Epidemiology (X.-N.Z. and J.U.); Mechanisms/pathophysiology (B.J.V., D.W.D. and M.S.); Diagnosis, screening and prevention (B.J.V., M.S., D.W.D. and D.P.M.); Management (D.P.M.); Quality of life (J.U.); Outlook (D.P.M. and B.J.V.); Overview of Primer (D.P.M.).

Competing interests

The authors declare no competing interests.

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Correspondence to Donald P. McManus.

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