Joachim Richter

The WHO expert group for echinococcosis recommends percutaneous treatment for the treatment of unilocular echinococcal cysts. In the rare case a hyperergic reaction occurs, it occurs as a type I immediate allergic reaction immediately after the cyst wall puncture. A 6-year-old boy with a unilocular echinococcal cyst in the left hepatic lobe, was treated with cyst puncture / drainage via the right hepatic lobe and falciform ligament under coverage with praziquantel and albendazole. No allergic reaction occurred during the procedure, but three hours later an acute severe hyperergic reaction occurred. Patients who have undergone an invasive therapy or suffered an acute leakage of an echinococcal cyst must be closely surveilled with the possibility of intensive care for at least 24 h after intervention.

Schistosoma japonicum infection can cause severe hepatic complications associated with portal hypertension, which may lead to death by bleeding from esophageal varices. Ultrasonography (US) enables the identification of two different types of liver fibrosis characteristic for S. japonicum infection: interseptal fibrosis (ISF) and portal fibrosis (PF). To date, these two forms of liver fibrosis have not been sufficiently investigated with regard to their potential to cause portal hypertension. Among the 121 reports published, only 56 (46.3%) distinguish between ISF and PF. In 31/56 (55.4%) of these publications, patients with only ISF, two (3.6%) with only PF, as well as 23 (41.1%) with concomitant ISF and PF, are reported. US signs of portal hypertension are reported in 10/25 (40.0%) of publications reporting PF, of which 2/2 (100%) of publications report PF alone and 8/23 (34.8%) of publications report concurrent PF and ISF. Also, 2/31 (6.5%) of publications report that ISF alone is associated with portal hypertension. Thus, PF appears to be the main risk factor for portal hypertension. Future studies need to assess the exact nature of liver fibrosis caused by S. japonicum in a standardized way to clarify the individual contributions of PF and ISF to morbidity.

Schistosoma (S.) haematobium is a widespread tropical helminthic zoonosis. Schistosomiasis was endemic in some foci in Southern Europe until the sixties of the last century. Autochthonous transmission of human schistosomiasis was first reported in the French island of Corsica in 2014, and the schistosome responsible for this emergence was also linked to partial hybridisation between S. haematobium and the bovine schistosome species S. bovis. Transmission has recently been retrospectively confirmed in southern Spain as well. The distance between southern Corsica and northern Sardinia is 12 km. The freshwater snail Bulinus (B.) truncatus, one of the intermediate mollusc hosts of S. haematobium, is known to be endemic in some regions of southern Europe, including Corsica, Spain, and Portugal, where it transmits the zoonotic S. bovis. B. truncatus appears still to be endemic in Sardinia and possibly also in Sicily. Furthermore, schistosomiasis of ungulates caused by S. bovis, transmitted by the same vector snail, also appears to be endemic in Sardinia. Migrant populations and returnees to Italy have been found to be infested with schistosomes, and tourism to local freshwater bodies is increasing. There is a considerable potential risk of autochthonous schistosomiasis being introduced to Italy. Therefore, surveillance has to be intensified to prevent the establishment of an autochthonous transmission cycle of human schistosomiasis in Italy. Systematic screening strategies for individuals who have been possibly exposed to endemic areas need to be established. Curative treatment of identified cases is mandatory. Praziquantel, the drug of choice, needs to be readily available throughout Italy. Malacological surveillance of snail populations focusing on potential transmission sites is recommended. A one-health approach is recommended to verify the actual epidemiological situation of autochthonous S. bovis infestation and, thereby, to investigate the risk of establishing a zoonotic reservoir. Clinicians should be aware that, in some circumstances, schistosomiasis may occur in individuals who have never travelled to known endemic areas before.

The online version contains supplementary material available at 10.1186/s40249-025-01359-9.

Asian hepatointestinal schistosomiasis due to Schistosoma japonicum is prevalent in the Philippines and in Indonesia, while it is close to elimination in China. The second Asian schistosome, S. mekongi, is found in Cambodia and Laos. The main pathology caused by both species is liver fibrosis, which can cause significant morbidity and mortality, mainly due to portal hypertension leading to bleeding from esophageal varices. Ultrasonography was introduced several decades ago as a safe, fast, non-invasive, and relatively inexpensive technique for assessing chronic schistosomiasis-related hepatic pathology in the clinical and field settings. A standardized ultrasound protocol had been established by experts at a WHO-chaired meeting in Cairo, Egypt, in 1990. The peculiarities of sonomorphologic abnormalities caused by S. japonicum and S. mekongi were not sufficiently covered in the Cairo protocol and not addressed at all in the subsequent WHO chaired meeting in Niamey 1996. At a follow-up WHO-chaired meeting in Phnom Pehnh, Cambodia, in 2002, an attempt was made to develop a protocol for Asian schistosomiasis, but a protocol resulting from this meeting has never been published. Although several studies investigated the use of ultrasonography to assess S. japonicum- and S. mekongi-related sonomorphological morbidity across endemic areas the lack of a standardized protocol hampered the characterization of sonomorphologic abnormalities with regard to progression, reversibility, prognosis, and correlation to morbidity. In addition, the comparison of data from different endemic areas and populations remained difficult. Therefore, a WHO-chiared expert meeting took place in Basel, Switzerland in September 2024 with the aim to establish a standardized ultrasound protocol for reporting the pathology caused by S. japonicum and S. mekongi. The proposed protocol is described in this article. Graphical Abstract

We present four cases of male genital schistosomiasis (MGS) within children and adolescents opportunistically encountered as part of a wider screening programme for imported schistosomiasis in Germany and community outreach screening in Mali. Such genital manifestations in young children and adolescents are often overlooked but can include hydrocele, hypogonadism, varicocele, cutaneous granulomata on the penis and scrotum, echogenic spots in the prostate and the epididymis, alongside testicular masses. Though these cases appear sporadic, from our scoping literature review, they draw fresh attention on MGS in young children and highlight wider confusion with other congenital, neoplastic and infectious disease. These might include an insufficient closure of the tunica vaginalis, malignancies or lymphatic filariasis. Frequently haematuria is not present. One typical sign indicating MGS in adults, i.e. haematospermia is not present before puberty. Another reason of missing MGS cases may be that screening with scrotal or transabdominal ultrasonography are not easily accepted unless the reason for it is not extensively explained beforehand and that transabdominal ultrasonography is less sensitive for revealing prostatic lesions than transrectal ultrasonography.

Background: Schistosome egg deposition in pregnant women may affect the placenta of infected mothers and cause placental schistosomiasis (PS). Histopathological examination of placental tissue is an inadequate detection method due to low sensitivity. So far, there has not been any systematic review on PS. Methods: We conducted a systematic literature search on PubMed, EMBASE, and Medline and included all publications that reported microscopically confirmed cases of PS, as well as the relevant secondary literature found in the citations of the primarily included publications. Results: Out of 113 abstracts screened we found a total of 8 publications describing PS with a total of 92 cases describing egg deposition of dead and/or viable eggs and worms of S. haematobium and S. mansoni in placental tissue. One cross-sectional study investigating the prevalence of PS and its association with adverse birth outcomes, found 22% of placentas to be infested using a maceration technique but only <1% using histologic examination. Additionally, no direct link to deleterious pregnancy outcomes could be shown. Conclusions: PS is a highly unattended and underdiagnosed condition in endemic populations, due to a lack of awareness as well as low sensitivity of histopathological examinations. However, PS may play an important role in mediating or reinforcing adverse birth outcomes (ABO) such as fetal growth restriction (FGR) in maternal schistosomiasis, possibly by placental inflammation.

Background: Schistosome egg deposition in pregnant women may affect the placenta of infected mothers and cause Placental Schistosomiasis (PS). Histopathological examination of placental tissue is an inadequate detection method due to low sensitivity. So far, there has not been any sys-tematic review on PS. Methods: We conducted a systematic literature search on PubMed and in-cluded relevant secondary literature found in the citations of the primarily included publications. Results: We found a total of 8 publications describing PS with a total of 92 cases, describing egg deposition of dead and/or viable eggs and worms of S. haematobium and S. mansoni in placental tissue. One cross-sectional study investigating the prevalence of PS and its association to adverse birth outcomes, found 22% of placentas to be infested using a maceration technique but only < 1% using histologic examination. Additionally, no direct link to deleterious pregnancy outcomes could be shown. Conclusions: PS is a highly unattended and underdiagnosed condition in en-demic populations, due to a lack of awareness as well as low sensitivity of histopathological examinations. However, PS may play an important role in mediating or reinforcing adverse birth outcomes (ABO) such as fetal growth restriction (FGR) in maternal schistosomiasis, possibly by placental inflammation.