Title: Hepatosplenomegaly, Papular Rash, Fever and Headache in a Traveler
题目：出现肝脾肿大、斑丘疹，发热及头疼症状的旅行者
Author 作者: Andrea Tenner
翻译：步涨 校对：陈都，肖锋

Clinical Presentation:
病史陈述：
A 35-year-old female presents to your emergency department complaining of fever, malaise, myalgias, headache and an urticarial rash.  Her physical exam reveals a papular rash and hepatosplenomegaly. You also find out that she traveled to Sudan 6 weeks earlier. She stayed mostly in Kharotum, but while there, she swam in the Nile. You send a smear for malaria, which is negative.  What other major parasite should you consider?
一名35岁的女性被送至急诊，主诉发热不适，肌肉酸痛，头疼及荨麻疹。查体示斑丘疹及肝脾肿大。该患者6周前曾赴苏丹旅行。她主要住在喀土穆（苏丹首都）；但在那里，她曾经在尼罗河中游泳。入院后行血涂片找疟原虫，结果是阴性。还有其他哪些寄生虫病应该考虑和怀疑的？
Diagnosis 诊断:
•Schistosomiasis, also know as bilharzia, is a disease caused by parasitic worms.
•血吸虫病是一种由寄生性蠕虫感染所导致的疾病。
•While not found in the US, it impacts more than 200 million people globally, and is second only to malaria as a major parasitic infection.
•尽管在美国没有疫源地，但全球有超过200万人口感染该疾病，是仅次于疟疾的全世界第二大寄生虫病。

Discussion 讨论:
While the acute presentation is generally non-specific, chronic complications may be more serious. Many organ systems can be impacted and symptoms of chronic infection can include liver dysfunction, including portal hypertension and esophageal varacies or hematuria and renal failure.
尽管血吸虫病在急性感染期的症状没有特意性，但其慢性感染所致的并发症则会引起更加严重的后果。许多器官及身体系统会受累，包括肝功能障碍，门脉高压及胃底食管静脉曲张以及血尿甚至肾衰。
Treatment 治疗:
1.Treatment is a one-day course of Praziquantel but must be initiated 6-8 weeks after infection. (It's most effective against the adult worm so timing is key!)

治疗主要是使用吡喹酮驱虫，但是治疗必须在感染后6-8周内开始。（吡喹酮是对成人蠕虫感染的最有效药物，因此时间是最关键的）

Bottom Line 要点:
Consider a broader differential in travelers. There are many infectious killers that can be easily treated.
对旅游者的鉴别诊断要广。有许多致死性的传染病，但其治疗实很简单。
References 参考文献：
http://www.cdc.gov/parasites/schistosomiasis/
http://emedicine.medscape.com/article/228392-clinical#a0256