Bilharzia - Water Born Disease In Thailand

[phallang]

don't want to create panic,

but after a couple of weeks of abdominal pain and very high eosinophilic blood levels, i was diagnosed Bilharzia / Schistosomiasis today. (Well, diagnosis is made upon a slightly positive result on a test targeting Schistosoma mansoni, but they don't have a specific test for Schistosoma japonicum here in Germany.)

So, why am i telling you all this sh...?

6 weeks ago, i was digging (enlarging) some pond at my wife's house in Amphoe Chawang, Nakorn Sri Thammarat. Two days later, i had some strange itchy marks on my feet, but i attributed it to some jellyfish-contact another 2 weeks before.

But from todays point of view, it is almost 100% sure that i got this shit while working on the pond - google or wikipediate for Schistosomiasis and you will understand why it is *not* a good idea to work in a freshwater pond in an area where there is Bilharzia.

The fact is (well i first have to twell you that all this unfortunately happened during my 5-weeks "holiday" in Germany, normally i use to live in southern Thailand) that when i initially met the doc (university department of tropical diseases) they ruled out Schistosomiasis because the told me that there is no such thing in Thailand.

Just last week, i came across some references in the web by chance:

http://stinet.dtic.mil/oai/oai?verb=getRec...ifier=AD0711968

http://zoeken.dokterdokter.nl/reisadvies/thailand/ (in dutch language)

(and a few more)

and a few others, that indicate that there was and IS in fact a chance of getting Bilharzia in the very south, especially in Nakhorn Sri Thammarat Province.

After telling my doc about this they immediately did a serology with above results.

So finally my question to all of you living in NST and surroundings: Did you hear of anybody else getting Bilharzia in your Neighborhood? (btw. in thai it "payad bai mai nai luad" - i.e. something like "leaf-shaped parasite in the blood" - a blood fluke).

That's because i might well refrain from digging ponds in this area, however i like to do canoeing/kayaking on the local rivers and , although literature says the risk is highest in ponds, lakes or "slow-running" streams, I'm wondering how much risk it will be to continue kayaking / canoeing in those "faster" klongs or creeks.

Regards,

P.

[klikster]

don't want to create panic,

but after a couple of weeks of abdominal pain and very high eosinophilic blood levels, i was diagnosed Bilharzia / Schistosomiasis today. (Well, diagnosis is made upon a slightly positive result on a test targeting Schistosoma mansoni, but they don't have a specific test for Schistosoma japonicum here in Germany.)

So, why am i telling you all this sh...?

6 weeks ago, i was digging (enlarging) some pond at my wife's house in Amphoe Chawang, Nakorn Sri Thammarat. Two days later, i had some strange itchy marks on my feet, but i attributed it to some jellyfish-contact another 2 weeks before.

But from todays point of view, it is almost 100% sure that i got this shit while working on the pond - google or wikipediate for Schistosomiasis and you will understand why it is *not* a good idea to work in a freshwater pond in an area where there is Bilharzia.

The fact is (well i first have to twell you that all this unfortunately happened during my 5-weeks "holiday" in Germany, normally i use to live in southern Thailand) that when i initially met the doc (university department of tropical diseases) they ruled out Schistosomiasis because the told me that there is no such thing in Thailand.

Just last week, i came across some references in the web by chance:

<a href="http://stinet.dtic.mil/oai/oai?verb=getRecord&metadataPrefix=html&identifier=AD0711968" target="_blank">http://stinet.dtic.mil/oai/oai?verb=getRec...ifier=AD0711968</a>

<a href="http://zoeken.dokterdokter.nl/reisadvies/thailand/" target="_blank">http://zoeken.dokterdokter.nl/reisadvies/thailand/</a> (in dutch language)

(and a few more)

and a few others, that indicate that there was and IS in fact a chance of getting Bilharzia in the very south, especially in Nakhorn Sri Thammarat Province.

After telling my doc about this they immediately did a serology with above results.

So finally my question to all of you living in NST and surroundings: Did you hear of anybody else getting Bilharzia in your Neighborhood? (btw. in thai it "payad bai mai nai luad" - i.e. something like "leaf-shaped parasite in the blood" - a blood fluke).

That's because i might well refrain from digging ponds in this area, however i like to do canoeing/kayaking on the local rivers and , although literature says the risk is highest in ponds, lakes or "slow-running" streams, I'm wondering how much risk it will be to continue kayaking / canoeing in those "faster" klongs or creeks.

Regards,

P.

This is pretty scary. I remember studying about Schistosomiasis in my army medic training about 45 years ago. Maybe I'm wrong, but I believe those flukes really like your liver.

What's scary is that this can get always get into other waterways and spread.

I also recall that swimming in the Nile is strongly discouraged because of these blood flukes .. and the Nile is definately a flowing stream.

Does you doctor see any ongoing problems for you?

[LaoPo]

What kind of treatment did the doctor(s) advise ?

Maybe this helps ?

http://www.itg.be/itg/DistanceLearning/Lec...somiasisp11.htm

LaoPo

[phallang]

I was already treated with Biltricide (Praziquantel) and everything should be fine now, just to be sure since the treatment might have been a liitle to early, i was advised to repeat it in a couple of weeks. I'm feeling fine right now and there souldn't bee any ongoing problems.

I'd just like to avoid reinfection (since it seems like there is no acquired immunity) and besides from earth filling that f+++ing pond and not travelling to africa ;-), i'd like to asses the risk of swimming in creeks / waterfalls in the Nakhorn Sri Thammarath Mountain Range.

[klikster]

I was already treated with Biltricide (Praziquantel) and everything should be fine now, just to be sure since the treatment might have been a liitle to early, i was advised to repeat it in a couple of weeks. I'm feeling fine right now and there souldn't bee any ongoing problems.

I'd just like to avoid reinfection (since it seems like there is no acquired immunity) and besides from earth filling that f+++ing pond and not travelling to africa ;-), i'd like to asses the risk of swimming in creeks / waterfalls in the Nakhorn Sri Thammarath Mountain Range.

The health department needs to do some serious testing of the streams in that area. Was officialdom notified of the infestation? If not, they should be made aware .. maybe a health oriented NGO or 2 as well.

Glad you are okay.

Edited November 5, 2007 by klikster

[seonai]

Phallang I am going to move this to Health as I think more people should be aware of it - if there's any problem for you with this PM me

Cheers and good luck,

Seonai

[phallang]

Afaihg (as far as i have googled) Bilharzia in Thailand is in fact a very local problem. Most places in Thailand seem to be not affected.

According to this abstract

http://stinet.dtic.mil/oai/oai?verb=getRec...ifier=AD0711968

at least some 40 years ago there was a problem with Bilharzia in (our) Amphoe Chawang of Nakhn Sri T., and at the Mekong in Ubon and Nakhon Phanom.

Yesterday i had my wife checked in a Hospital in NST, and according to a blood test there is some high possibility that she has some parasite (although it might be some "common" stuff) but still the doc advised us to have it thoroughly checked in Bangkok. And he didn't know of any kind of Bilharzia in his Hospital, but said that there is indeed a problem at the Mekong in the NorthEast.

So back to my initial question and before creating too much panic:

Did someone hear of anybody else getting Bilharzia in your neighborhood? (btw. in thai it's "payad bai mai nai luad" - i.e. something like "leaf-shaped parasite in the blood" - a blood fluke).

[MrSquigle]

Just wondering.....a few years ago after swimming in a Los river, I started to get very itchy, particulalry on the legs and almost always after getting wet, ie shower or swim and sweating, it would start to itch again.

This went on for a long long time and was kinda annoying. Still to this day it sometimes happens but not anywhere as often as before or as bad.

Also this was the only symptom, no other sicknes, pains, sores etc at all.

Any idea what this might have been ? I tried to research it, but nothing came up that I could find anyway.

[Sheryl]

It has long been kn own that there is schistosomiasis in Thailand, Cambodia, Laos and Viet Nam in areas areas around the Mekong. In fact there is a specific subspecies of the parasite called s. mekongi., and in some villages mass treatment has been done.

However OP had s. mansoni and apprently got it in a fresh water pond in Southern Thailand. S. mansoni has a wider distribution (has been identified in rice paddies....a good reason for farmers to wear boots rather than sandals), altho this is the first time I've heard of it in the South....

[pampal]

does it happen from drinking the water, or can it also be from contact(swimming) in the water?

[meadish_sweetball]

Billharzia enter through your skin, so swimming or wading in infested areas is not safe.

[stevenjm]

I had Bilharzia too from a province near phnom penh (on the river). I kept coming back to Australia and being mis-diagnosed by doctors, I had the high eosenophile levels also with kidney pains and liver problems and finally was hospitalised when I got down to 64 kilos in weight and even then was mis-diagnosed for wrong parasite ( I got a private room to myself though as they put me in isolation thinking maybe I had TB).

Finally another doctor prescribed me biltricide and have been putting on weight ever since. Think I may still have some liver problems though as I seem to get excema sort of things now every time I have any medications.

Glad you started this thread because more people, doctors included, should be aware that it is a real problem in some areas.

[phallang]

According to these maps

http://www.path.cam.ac.uk/~schisto/Backgro...stribution.html

http://www.ilgirodelmondo.it/malattie/schistosomiasi.html

i most likely didn't have S. mansoni but rather S. japoncium. (See the small red/purple areas in souther thailand - Nakhon Sri Thammarath that is)

This coincides with the fact that the ELISA -Test done with my blood where just about 40% reactive, with S. mansoni it would have been more than 90%.

Oh, and talking about boots and sandals, my brother in law was planting rice today, barefeet. Just some 30 meters away from "the" pond. All people i have spoken to here aknowledge that there are "Payad Bai Mai Nai Luad" problems, but all do think i'm crazy when i tell them that these creepers penetrate through healthy skin - they think you just get it from eating /drinking dirty things. (which is also true, because they will penetrate the skin of the gullet)

[ClaytonSeymour]

For what it's worth I've swam in the river Nile dozens of times and never caught bilharzia. Extremely common ailment in Egypt though all the same; the locals insist that the Nile itself isn't a problem, especially in Summer when the water level is high and the current is stronger; they assert that canals, ponds etc are the problem.

I've done my share of freshwater swimming, paddling & fishing in Thailand yet so far, no problems & hopefully it''ll remain that way. I guess you can buy Praziquantel over the counter in the pharmacy?

[thedi]

Did someone hear of anybody else getting Bilharzia in your neighborhood? (btw. in thai it's "payad bai mai nai luad" - i.e. something like "leaf-shaped parasite in the blood" - a blood fluke).

My wife and many people take a medicine which is supposed to kill payad bai mai nai luad once every year. It is supplied by the doctors here in their clinics. The doctor checks the wight of the patient first and calculates the dose. It seems to be very strong stuff, because the people are usually out of circulation for two or three days.

They take it preventive. There are no actual cases of Bilharzia known in our region (Khon Kaen, Isarn).

Regards Thedi

[ClaytonSeymour]

Did someone hear of anybody else getting Bilharzia in your neighborhood? (btw. in thai it's "payad bai mai nai luad" - i.e. something like "leaf-shaped parasite in the blood" - a blood fluke).

My wife and many people take a medicine which is supposed to kill payad bai mai nai luad once every year. It is supplied by the doctors here in their clinics. The doctor checks the wight of the patient first and calculates the dose. It seems to be very strong stuff, because the people are usually out of circulation for two or three days.

They take it preventive. There are no actual cases of Bilharzia known in our region (Khon Kaen, Isarn).

Regards Thedi

There's no vaccine for Bilharzia; your post appears to suggest they take Praziquantel just in case they have got it, rather than testing & treating on an individual basis. Maybe not a bad idea given that many wouldn't seek treatment if left to their own devices. I can't comment on potential side effects of this drug, which aside from Bilharzia is essentially a veterinary worming treatment.

Here's an interesting article on Bilharzia: http://student.bmj.com/issues/03/12/life/472.php

[thedi]

a few years ago after swimming in a Los river, I started to get very itchy, particulalry on the legs and almost always after getting wet, ie shower or swim and sweating, it would start to itch again.

This went on for a long long time and was kinda annoying. Still to this day it sometimes happens but not anywhere as often as before or as bad. Also this was the only symptom, no other sicknes, pains, sores etc at all.

This is one of the heu kan snails: , more pictures are here: http://members.aol.com/Mkohl2/Planorbidae.html

This itching is not Bilharzia. It is harmless, but very annoying. There are many kinds of flatworms. One of them may cause Bilharzia, most others are absolutely harmless for humans, but this one causes itching:

Swimmer's itch, also called cercarial dermatitis, is a skin rash caused by an allergic reaction to an infestation with certain parasites of birds and mammals. Immature larval forms (cercariae), of parasitic flatworms (schistosomes), are released from infected snails into fresh and salt water, such as lakes, ponds, and lagoons. Swimmer's itch develops on exposed areas of the skin after contact with these larval forms when they mistakenly penetrate the person's skin (rather than its usual host, a duck).

Full article see http://dermnetnz.org/arthropods/swimmers-itch.html

I the full article you can see, that the mistake of penetrating the skin of a human is bad for both: the flatworm dies, but the human suffers itching...

Regards Thedi

PS: Give credit where credit is due: I got the above links from Farma (a thaivisa forum member) about 2 years ago

[MrSquigle]

Tanks thedi

[stevenjm]

It seems to be very strong stuff, because the people are usually out of circulation for two or three days.

Good point - the biltricide made me feel no good for a couple of days too (really lethargic, headaches etc) but thought maybe it was unrelated.

[MrSquigle]

After reading it, I doubt it is what I experienced.

When I swam, it was in the river Kwai, very strong fast flowing clear water.

Secondly, the itching lasted for a long time, over a year or more, in fact still get it a little now and I did not get any red lumps and it really only itched after a shower, or more swimming, or sweating, anything that got the areas wet again.

[ClaytonSeymour]

After reading it, I doubt it is what I experienced.

When I swam, it was in the river Kwai, very strong fast flowing clear water.

Secondly, the itching lasted for a long time, over a year or more, in fact still get it a little now and I did not get any red lumps and it really only itched after a shower, or more swimming, or sweating, anything that got the areas wet again.

I've never known/considered the Kwai to be a problem.; if it was you'd see a lot of farangs going down with this.

If you're still worried you could always treat yourself. Nobody answered but, I'm sure you'll be able to obtain Praziquantel at the pharmacy (Thailand). The standard dosage is 40mg per kilo of bodyweight, trials appear to suggest that it is most effective when taken in a single dose however, it's not often so simple as that; the worms can spread throughout the body, including the brain. There is also a risk of the drug killing worm cysts in the eyes. The following link has further info for Praziquantel if anyone is still tempted to self treat; I wouldn't recommend it.

http://www.rxlist.com/cgi/generic/praziquantel.htm

What they are doing in Thedi's area is effectively the same as a worming routine with a dog; carry it out on a regular basis irrespective of whether they are showing symptoms. The fact that this is happening would suggest that it is incorrect of him to say there is no bilharzia, although it can be used to treat other parasites. Unless you're going to adopt such a "worming routine" yourself, it suggests that staying out of freshwater, certainly still or slow moving, would be sound advice.