Schistosomiasis in the United States

In endemic areas, dogs with chronic (>3 weeks) vomiting, diarrhea, and hematochezia and/or elevated alanine aminotransferase activity should be screened for HA with a fecal. To improve sensitivity, aliquots from 3 different stools should be pooled before submission. The possibility of HA infection should also be considered in dogs living elsewhere in the United States, particularly if the signs and findings listed above are accompanied by weight loss, anorexia, hyperglobulinemia, hypercalcemia, or a robust eosinophil count. Findings on abdominal US may be unremarkable. However, the combination of heterogenous small intestinal wall layering and pinpoint hyperechoic foci in small in-testine, liver, or mesenteric nodes is highly predictive with HA infection and should al-ways prompt testing for this infection.Treatment should include a combination of praziquantel and fenbendazole. The author recommends dosing praziquantel orally at 25 mg/kg (q8 hours for 2-3 days) in symptomatic dogs because the effect of the lower dose (5 mg/kg) has not been reported in this more vulnerable population. The response to treatment should be assessed with a follow-up PCR 1 to 2 months later. Prospective studies are needed to determine the optimal dose and duration of praziquantel because the cost of this drug can be considerable and affects owner compliance with treatment recommenda-tions. Other canine members of the household should always be tested, because infection may be asymptomatic, at least in the initial stages.The prognosis for clinically affected dogs is fairly positive, although sequelae such as acute kidney injury or cirrhosis may affect outcomes.