“Swimmer’s itch: incidence and risk factors”. Verbrugge, LM, Rainey, JJ, Reimink, RL, Blankespoor, HD. (Detailed review article discussing background, disease, biology, diagnosis, and treatment.) “Cercarial dermatitis: the swimmer’s itch”. (Short review article focusing on life cycle, epidemiology, and clinical presentation.)īaird, JK, Wear, DJ. “Swimmer’s itch: a cercarial dermatitis”. (General overview of the biology of cercarial dermatitis and frequently asked questions for patients and healthcare professionals.) Parasites – Cercarial Dermatitis (also known as Swimmer’s Itch). While dissemination of non-human schistosomes has not been reported in humans, studies in murine models have reported migration of avian schistosomes past the epidermis and into the lungs. It is widely accepted that non-human schistosomes die in human epidermis. Anti-schistosomal antibodies may also be evident on serological testing. This is highly suspect if the patient’s history includes recent travel to endemic areas.ĭiagnosis of systemic schistosomiasis is supported by the presence of eggs in urine or stool samples. The clinician must contemplate the possibility of swimmer’s itch as an early sign of systemic schistosomiasis caused by human schistosomes. When evaluating swimmer’s itch in a patient, one must also consider other more treacherous culprits. Unusual Clinical Scenarios to Consider in Patient Management One should check with the local health department regarding reported cases of water-borne illnesses, including swimmer’s itch, prior to water activity. If one has swum in a high-risk environment, the person should remove swimsuits, towel dry the exposed skin, and shower immediately after water exposure to potentially reduce risk of parasite penetration into the skin. One should also avoid shallow, marshy areas where exposure to snails and schistosomes is likely. People in endemic areas should avoid prolonged activity in areas where swimmer’s itch has been reported. Patient and community education is paramount in the prevention of swimmer’s itch. Patients should be followed days to weeks after initial presentation to monitor possible complications and assess response to symptomatic therapy. Treatment options are summarized in the Table I.ġmg/kg daily orally for 1 week, followed by 0.5mg/kg daily for 1 week, followed by 0.25mg/kg daily for 1 week Standard treatment is topical or oral antibiotics. Patients are at an increased risk when lesions are excoriated or manipulated.
SWIMMERS ITCH SYMPTOMS SKIN
Possible complications include secondary bacterial skin infections. Cercarie die upon penetration into human skin, thus halting the schistosome life cycle. Miracidia mature within snails and produce free-swimming cercariae, which either reinfect birds or infect humans. The eggs hatch and liberate ciliated miracidia into the water, which infect snails (intermediate host). Adult worms then produce eggs that are passed in avian feces. The life cycle begins as cercariae infect birds (definitive host), maturing into adult worms within blood vessels. Swimmer’s itch occurs when free-swimming cercariae penetrate the skin of humans (incidental host) and cause an allergic skin reaction (types I and IV hypersensitivity).
Human schistosomes may additionally cause systemic schistosomiasis. Cases are less often due to human schistosomes (e.g., Schistosoma haematobium, Schistosoma japonicum, Schistosoma mansoni, Schistosoma mekongi, Schistosoma intercalatum). The Trichobilharzia genus is commonly implicated. Swimmer’s itch is most often caused by non-human schistosomes (over 20 species), particularly avian schistosomes. What is the Cause of the Disease? Etiology Children may be at a higher risk due to more exposure to shallow water and they may be less likely to towel dry. Resident or migratory birds (definitive hosts), snails (intermediate host), and humans (incidental host) must all be present in order for a person to contract swimmer’s itch. Presence of hosts is also an important factor. Warm months may increase intermediate host snail populations leading to increased transmission.
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