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A 33-year-old refugee from Nigeria, who had been living in Germany for 1 year, was admitted to the hospital due to pelvic pain, peranal hemorrhage, and an unexplained increase in transaminase levels. As the liver screening tests, sonography findings, and colonoscopy were normal, a liver biopsy was performed that revealed Schistosoma mansoni worm eggs as an unexpected diagnostic finding. Serological tests for specific antibodies and parasitological egg detection in the stool confirmed the diagnosis. After only temporary response to a short-term and low-dose treatment with praziquantel, a 3-day high-dose (40 mg/kg body weight) treatment with praziquantel finally led to long-lasting symptom relief.

Background: Schistosomiasis and hepatitis B are both tropical diseases with more than 200 and 350 million people infected worldwide respectively, but are rare in western countries. Worldwide a high rate of coinfections can be expected., Case Report: A 34-year-old African patient was referred to our clinic with known hepatitis B/D-coinfection for evaluation of antiviral treatment., Results: Surprisingly, liver biopsy showed a granuloma with the egg of Schistosoma in addition to virus induced alterations. Subsequent examination of the stool allowed to classify the parasite as Schistosoma mansoni. Thus, before initiation of an antiviral treatment, an antischistosomal therapy with praziquantel leading to elimination of schistosomiasis was started., Conclusion: Patients from tropical countries suffering from chronic viral hepatitis may present with additional coinfections which can be earily overlooked in daily clinical routine. Screening of African patients from endemic areas for schistosomiasis should include examinations for tropical diseases by specialists.

Neurocysticercosis, caused by Taenia solium larvae (cysticerci), is the most common parasitic infection of the human CNS Worldwide. In Germany its appearance is rare. Here we report two cases of neurocysticercosis which we followed over a period of 4-6 years. The first patient acquired neurocysticercosis in Germany. On admission he suffered from papilledema, partial seizures and a mild psychotic disorder. MR-tomography showed an internal hydrocephalus and multiple contrast enhancing parenchymal cysts. In the course of the disease a giant cyst within the left temporal pole developed and was exstirpated neurosurgically. The persistent internal hydrocephalus required ventriculoperitoneal shunting. Therapy with Praziquantel led to a clinical improvement, however, repeated analysis of the cerebrospinal fluid documented persistent inflammation. With the aid of a contrast enhanced three-dimensional (3D) ultrasound imaging technique we demonstrated increased cerebral perfusion surrounding one cyst. This may be interpreted as evidence for persistent disease activity. The second patient presented with repeated episodes of cysticercotic encephalitis, which is rarely described in the literature (incidence 1%). Clinical features, laboratory findings, diagnosis, and therapy of neurocysticercosis will be presented together with the pitfalls of the two described cases. Our cases will be compared to previous reports on clinical findings in neurocysticercosis.

Cases of swimmer's itch caused by cercariae of the genus Trichobilharzia have spread during the last years in Southwestern Germany and increased in intensity. The only consequence was to forbid swimming because no effective strategies are known which would be ecologically or financially acceptable. In this examination we therefore tried, by means of medication of ducks, the possible final hosts, to kill the different stages of Trichobilharzia in patency and prepatency in order to interrupt the parasitic cycle. For this the effectiveness of praziquantel on the parasitic stages in the final host (preadults, adults, eggs or fully developed miracidia) was tested in experimentally infected dwarf mallards (Anas platyrhynchos, hemerot.) and mallards (Anas platyrhynchos platyrhynchos). During therapy of ducks with patent Trichobilharzia infection, onefold or twofold application of this drug (1 x 500 mg/duck, 1 x 300 mg/duck, 2 x 200 mg/duck) only prevented the releasing of eggs with hatchable miracidia for up to 24 h. Only a threefold application of 200 mg/duck in 24 h intervals led to a permanent reduction of detectable miracidia. Application of praziquantel in low doses (30 or 40 mg per duck and day) did not reduce the number of released miracidia. Medication with praziquantel led to a strong shift of adult worms located in the enteric veins of the ducks to the liver veins in a little as 3 h; examinations by scanning electron microscopy revealed changes in the worms' surface and damage of the tegument. During prepatency doses of 22.5 mg praziquantel per duck and day, given continuously for one week, were sufficient to completely stop the release of miracidia. In this low dosage, a special preparation of the bitter drug was voluntarily swallowed by the ducks, thus providing in principal a simple, cheap and ecologically sound method of controlling cercarial dermatitis.

Two of three members (a 29-year-old man [case 1] and a 26-year-old woman [case 2]) of a tourist party to the tropics (Mali) developed a high fever (less than or equal to 40 degrees C), headache, cough, weight loss (less than or equal to 5 kg) and tiredness 3-4 weeks after returning to Germany. In case 1, acute schistosomiasis was tentatively diagnosed as the cause because he reported an attack of dermatitis after exposure to fresh water in an endemic schistosomiasis region and had marked eosinophilia (2118/microliters; 28%) on admission. Serological tests were positive (ELISA with adult antigen, O.D. 0.65 [normal less than 0.15]; with egg antigen O.D. 1.73 [normal less than 0.30], antibody titre in the immunofluorescence test 1:320 [normal less than 1:80]) supported the diagnosis and it was confirmed by demonstrating the parasite, Schistosoma mansoni, in stool but not urine. Findings in case 2 were similar. The third member of the group [case 3], a 58-year-old woman, was symptom-free, but tests revealed schistosomiasis. All three patients were treated with a single dose of Praziquantel (40 mg/kg). A second course of praziquantel (single dose of 40 mg/kg as well as 20 mg/kg three times daily for 3 days) became necessary in case 1, while in case 3 a further single dose of 40 mg/kg was given to ensure a parasite-free state. A follow-up scheme is suggested: clinical examination with white cell and differential counts 1, 3, 6 and 12 months after treatment; three stool and/or urine examinations 3, 6 and 12 months after treatment.

A 33-year-old patient with AIDS, and a history of episodes of Pneumocystis carinii pneumonia and cerebral toxoplasmosis, developed a subcutaneous paravertebral infiltrate, which at first resembled a haematoma. Over a period of several weeks, the lesion spread to cover almost the entire back. Initially, numerous investigations failed to reveal the aetiology. His general condition worsened progressively, and intermittent bleeding into the soft tissue of the back occurred, requiring transfusion. This was associated with the development of an isolated deficiency of clotting factor V and a fall in Quick values to 10%. On the 22nd day after admission, the infiltrate ruptured spontaneously, releasing blood and a large number of whitish spherical masses 2-3 mm in diameter. These were identified as Cysticerci longicolles, the larval form of Taenia crassiceps, a tapeworm occurring in Canidae. The blood clotting values returned to normal within two days of incision of the infiltrate and commencement of therapy with mebendazole (6 g/day) and praziquantel (3.6 g/day). The infiltrate subsequently regressed almost completely. After combination treatment for 2 weeks, treatment was continued with praziquantel alone, which, however, the patient stopped himself after 10 weeks. A recurrence at the same site 4 months later was successfully treated with a further course of mebendazole and praziquantel.

Urogenital schistosomiasis was confirmed in four patients, three Egyptians and one from Guinea. They were admitted with typical complaints, some chronic some acute, and successfully treated with praziquantel (Biltrizide). Since a single oral dose is sufficient, this is a greatly simplified form of treatment, without significant side effects.

A 49-years old female patient was admitted to the hospital with abdominal pain and symptoms of a shock. Four months before she had been sick and been an outpatient with slight pain in the upper abdomen and remarkable weight loss. The suspicion of perforated gall bladder was the indication to a laparotomy. A tumor on the right lobe of the liver was found. The histological diagnosis was: eosinophilic portal hepatitis with multiple eosinophilic abscesses in the liver. The parasitologic serology showed a positive test for Fasciola (liver fluke). Praziquantel in high doses was promptly effective and cured the patient. The sheep liver fluke is a common parasite of the biliary tract of herbivores all over the world, but rarely leads to a human disease. The patient had lived many decades in the South Pacific. The differential diagnoses was manifold because of the traveling habits, the clinical symptomatic and the course of the disease. The biology of the sheep liver fluke implies an infection acquired in Europe some weeks before the first symptoms of the disease.