REVIEW PAPER
Cercarial dermatitis: Clinical course and prevention
 
More details
Hide details
1
Department of Medical Biology, School of Public Health, Collegium Medicum, University of Warmia and Mazury in Olsztyn, Poland
 
 
Submission date: 2024-03-25
 
 
Final revision date: 2024-04-09
 
 
Acceptance date: 2024-04-10
 
 
Online publication date: 2024-07-02
 
 
Corresponding author
Joanna Korycińska   

Department of Medical Biology, School of Public Health, Collegium Medicum, University of Warmia and Mazury in Olsztyn, Żołnierska 14C, 10-561, Olsztyn, Poland
 
 
Pol. Ann. Med. 2024;31(2):129-134
 
KEYWORDS
TOPICS
ABSTRACT
Introduction:
Cercarial dermatitis (swimmer's itch) is a water-borne parasitic skin disease caused by larvae (cercariae) of a nonhuman species of schistosome. The prevailing symptoms are nodulopapular skin lesions accompanied by pruritus. The condition occurs virtually worldwide and is considered to be an emerging public health problem in Europe. In most cases, the symptoms are associated with cercariae of avian schistosomes of the genus Trichobilharzia spp.

Aim:
The aim of this review article is to present the most important information on the course of the disease, its diagnostics, treatment and epidemiology. Additionally, it offers an account of preventive measures targeted at reducing the risk of infection.

Material and methods:
A literature search was conducted using electronic databases such as PubMed, Google Scholar and Willey Online Library. Altogether, 40 articles were subject to analysis.

Results and discussion:
The data obtained from the literature survey process were systematised and presented in 5 sections. Clinically, effective control of swimmer’s itch should comprise measures from the fields of diagnostics, treatment, epidemiology and prevention.

Conclusions:
Swimmer’s itch poses diagnostic difficulties, primarily due to the low specificity of its symptoms. Owing to a lack of conclusive data on the fate of cercariae penetrating human skin and a growing number of documented cases of cercarial dermatitis worldwide, further intensive research into the matter is warranted.

FUNDING
None declared.
CONFLICT OF INTEREST
None declared.
 
REFERENCES (40)
1.
Kolářová L, Horák P, Skírnisson K, Marečková H, Doenhoff M. Cercarial dermatitis, a neglected allergic disease. Clin Rev Allergy Amp Immunol. 2012;45(1):63–74. https://doi.org/10.1007/s12016....
 
2.
Al-Jubury A, Bygum A, SusannaTracz E, Koch CN, Buchmann K. Cercarial dermatitis at public bathing sites (Region Zealand, Denmark): A case series and literature review. Case Rep Dermatol. 2021;13(2):360–365. https://doi.org/10.1159/000516....
 
3.
Loker ES, DeJong RJ, Brant SV. Scratching the itch: Updated perspectives on the schistosomes responsible for swimmer’s itch around the world. Pathogens. 2022;11(5):587. https://doi.org/10.3390/pathog....
 
4.
Horák P, Kolářová L, Adema CM. Biology of the schistosome genus Trichobilharzia. Adv Parasitol. 2002;52:155–233. https://doi.org/10.1016/s0065-....
 
5.
Soldánová M, Selbach C, Kalbe M, Kostadinova A, Sures B. Swimmer's itch: etiology, impact, and risk factors in Europe. Trends Parasitol. 2013;29(2):65–74. https://doi.org/10.1016/j.pt.2....
 
6.
Tracz E, Al-Jubury A, Buchmann K, Bygum A. outbreak of swimmer’s itch in Denmark. Acta Derm Venereol. 2019;99(12):1116–1120. https://doi.org/10.2340/000155....
 
7.
De Gentile L, Picot H, Bourdeau P, et al. Cercarial dermatitis in Europe: a new public health problem? Bull World Health Organ. 1996;74(2):159–163.
 
8.
Kerr O, Juhász A, Jones S, Stothard JR. Human cercarial dermatitis (HCD) in the UK: an overlooked and under-reported nuisance? Parasit Vectors. 2024;17(1). https://doi.org/10.1186/s13071....
 
9.
Skírnisson K, Kolářová L. Diversity of bird schistosomes in anseriform birds in Iceland based on egg measurements and egg morphology. Parasitol Res. 2008;103(1):43–50. https://doi.org/10.1007/s00436....
 
10.
Soleng A, Mehl R. Geographical distribution of cercarial dermatitis in Norway. J Helminthol. 2010;85(3):345–352. https://doi.org/10.1017/s00221....
 
11.
Hörweg C, Sattmann H, Auer H. Cercarial dermatitis in Austria: Questionnaires as useful tools to estimate risk factors? Wien Klin Wochenschr. 2006;118(S3):77–80. https://doi.org/10.1007/s00508....
 
12.
Caumes E, Felder-Moinet S, Couzigou C, Darras-Joly C, Latour P, Léger N. Failure of an ointment based on IR3535 (ethyl butylacetylaminopropionate) to prevent an outbreak of cercarial dermatitis during swimming races across Lake Annecy, France. Ann Trop Med Amp Parasitol. 2003;97(2):157–163. https://doi.org/10.1179/000349....
 
13.
Marszewska A, Cichy A, Heese T, Żbikowska E. The real threat of swimmers’ itch in anthropogenic recreational water body of the Polish Lowland. Parasitol Res. 2016;115(8):3049–3056. https://doi.org/10.1007/s00436....
 
14.
Korycińska J, Rybak-d'Obyrn J, Kubiak D, Kubiak K, Dzika E. Dermatological and molecular evidence of human cercarial dermatitis in North-Eastern Poland. Vector Borne Zoonotic Dis. 2021;21(4):269–274. https://doi.org/10.1089/vbz.20....
 
15.
Verbrugge LM, Rainey JJ, Reimink RL, Blankespoor HD. Prospective study of swimmer's itch incidence and severity. J Parasitol. 2004;90(4):697–704. https://doi.org/10.1645/ge-237....
 
16.
Soldánová M, Selbach C, Sures B. The early worm catches the bird? Productivity and patterns of Trichobilharzia szidati cercarial emission from Lymnaea stagnalis. Plos One. 2016;11(2):e0149678. https://doi.org/10.1371/journa....
 
17.
Selbach C, Soldánová M, Sures B. Estimating the risk of swimmer's itch in surface waters – A case study from Lake Baldeney, River Ruhr. Int J Hyg Environ Health. 2016;219(7):693–699. https://doi.org/10.1016/j.ijhe....
 
18.
Larsen AH, Bresciani J, Buchmann K. Increasing frequency of cercarial dermatitis at higher latitudes. Acta Parasitol. 2004;49(3):217–221.
 
19.
Cort WW. Schistosome dermatitis in the United States (Michigan). JAMA. 1928;90(13):1027. https://doi.org/10.1001/jama.1....
 
20.
Horák P, Mikeš L, Lichtenbergová L, Skála V, Soldánová M, Brant SV. Avian Schistosomes and outbreaks of cercarial dermatitis. Clin Microbiol Rev. 2015;28(1):165–190. https://doi.org/10.1128/cmr.00....
 
21.
Haas W, Haeberlein S. Penetration of cercariae into the living human skin: Schistosoma mansoni vs. Trichobilharzia szidati. Parasitol. Res. 2009;105(4):1061–1066. https://doi.org/10.1007/s00436....
 
22.
Chamot E, Toscani L, Rougemont A. Public health importance and risk factors for cercarial dermatitis associated with swimming in Lake Leman at Geneva, Switzerland. Epidemiology Infect. 1998;120(3):305–314. https://doi.org/10.1017/s09502....
 
23.
Macháček T, Turjanicová L, Bulantová J, Hrdý J, Horák P, Mikeš L. Cercarial dermatitis: a systematic follow-up study of human cases with implications for diagnostics. Parasitol Res. 2018;117(12):3881–3895. https://doi.org/10.1007/s00436....
 
24.
Horák P, Kolářová L. Bird schistosomes: do they die in mammalian skin? Trends Parasitol. 2001;17(2):66–69. https://doi.org/10.1016/s1471-....
 
25.
Lichtenbergová L, Horák P. Pathogenicity of Trichobilharzia spp. for vertebrates. J Parasitol Res. 2012;2012:1–9. https://doi.org/10.1155/2012/7....
 
26.
Chao-Hwei W, Chung-Hsing Ch. Cercarial Dermatitis. Tzu Chi Med J. 2002;20 (1): 63–66.
 
27.
Gordy MA, Cobb TP, Hanington PC. Swimmer’s itch in Canada: a look at the past and a survey of the present to plan for the future. Environ Health. 2018;17(1):73. https://doi.org/10.1186/s12940....
 
28.
Schets FM, Lodder WJ, De Roda Husman AM. Confirmation of the presence of Trichobilharzia by examination of water samples and snails following reports of cases of cercarial dermatitis. Parasitology. 2009;137(1):77–83. https://doi.org/10.1017/s00311....
 
29.
Horák P, Schets L, Kolárová L, Brant SV. Trichobilcharzia. In: Liu D, editors. Molecular detection of human parasitic pathogen. Boca Raton: CRC; 2012: 455–466.
 
30.
Tremaine AM, Whittemore DE, Gewirtzman AJ, et al. An unusual case of swimmer's itch. J Am Acad Dermatol. 2009;60:174-176. https://doi.org/10.1016/j.jaad....
 
31.
Lichtenbergová L, Kolbeková P, Kouřilová P, et al. Antibody responses induced by Trichobilharzia regenti antigens in murine and human hosts exhibiting cercarial dermatitis. Parasite Immunology. 2008;30(11–12):585–595. https://doi.org/10.1111/j.1365....
 
32.
Fraser SJ, Allan SJR, Roworth M, Smith HV, Holme SA. Cercarial dermatitis in the UK. Clin Exp Dermatol. 2009;34(3):344–346. https://doi.org/10.1111/j.1365....
 
33.
Burkhart CG, Burkhart CN. Swimmer’s itch: An assessment proposing possible treatment with ivermectin. Int J Dermatol. 2003;42(11):917–918. https://doi.org/10.1046/j.1365....
 
34.
Nowak DA, Yeung J. Diagnosis and treatment of pruritus. Can Fam Physician. 2017;63(12):918–924.
 
35.
Directive 2006/7/WE of the European Parliament and of the Council of 15 February 2006 concerning the management of bathing water quality (Dz. Urz. UE L 64 z 04.03.2006).
 
36.
Lévesque B, Giovenazzo P, Guerrier P, Laverdière D, Prud'homme H. Investigation of an outbreak of cercarial dermatitis. Epidemiol Infect. 2002;129(2):379–386. https://doi.org/10.1017/s09502....
 
37.
Leighton BJ, Zervos S, Webster J. Ecological factors in schistosome transmission, and an environmentally benign method for controlling snails in a recreational lake with a record of schistosome dermatitis. Parasitol Int. 2000;49(1):9–17. https://doi.org/10.1016/s1383-....
 
38.
Wulff C, Haeberlein S, Haas W. Cream formulations protecting against cercarial dermatitis by Trichobilharzia. Parasitol Res. 2007;101(1):91–97. https://doi.org/10.1007/s00436....
 
39.
‌De Liberato C, Berrilli F, Bossù T, et al. Outbreak of swimmer’s itch in Central Italy: Description, causative agent and preventive measures. Zoonoses Public Health. 2019;66(4):377–381. https://doi.org/10.1111/zph.12....
 
40.
Kolarova L. Schistosomes causing cercarial dermatitis: a mini-review of current trends in systematics and of host specificity and pathogenicity. Folia Parasitol. 2007;54(2):81–87. https://doi.org/10.14411/fp.20....
 
Journals System - logo
Scroll to top