gms | German Medical Science

Patient description and case history: A 16-year-old male refugee from the Ivory Coast presented to our outpatient department for a health check as an unaccompanied minor refugee. For many months, he had been complaining about suprapubic pain after micturition. Urine dipstick showed micro-hematuria without proteinuria. Laboratory evaluation revealed eosinophilia of 2.040/µl (normal value <500/µl). He reported contact to fresh water from lakes and rivers in the home country as well as during the central Mediterranean refugee route via Mali, Niger and Libya where he had spent several years.

Diagnostics: Because of hematuria, eosinophilia and the migration route along countries with endemic schistosomiasis, a schistosomiasis serology was performed and returned positive. Subsequently, urine was collected over 4 hours and by microscopy, multiple Schistosoma haematobium eggs were found. No parasites were found by stool microscopy. Ultrasound of the abdomen showed an altered bladder wall morphology and a cystoscopy was planned.

Therapy and additional follow-up: According to the current S1-guideline for Schistosomiasis (AWMF-Register Nr. 042-005), which was established under the guidance of the German Tropical Medicine Society (DTG), the patient was treated with Praziquantel (40 mg/kg/d for three following days). We expect that this cycle is sufficient and that long-term problems such as bladder cancer were averted. Follow-up visits were planned at 6, 12 and 24 months (urine status, urine microscopy, serology, ultrasound) to assess therapy success. Unfortunately, the patient was transferred and lost to follow-up before the cystoscopy or a first follow-up visit could be scheduled.

Conclusion: Our case highlights the need for a thorough screening for communicable and non-communicable diseases in minor refugees after arrival in Germany. A health assessment should be performed within days after arrival in Germany to prevent further spread of communicable infectious diseases (e.g., measles, varicella or tuberculosis) and to identify rare or tropical infectious diseases. We also advise to screen for non-infectious health complaints. In the light of growing migration and travelling, imported tropical illnesses, such as schistosomiasis, the second most frequent tropical disease worldwide, will be seen more often in our clinics and outpatient departments. Patients typically will be treated by doctors not fully trained in tropical or travel medicine. We therefore want to emphasize that the guideline for the care of refugees, such as AWMF Register Nr. 048-017 from the GTP and the DGPI, should be implemented.