Introduction
This infection is caused by a fluke, released from fresh water snails in Africa and South America (and less so in the Middle and Far East). Infected humans contaminate the water by their urine or stools. Snails usually live on weed and stones near the surface of water - but not exclusively. Currents can also spread the flukes to areas well away from the contaminated water.

Transmission occurs when an individual's skin comes into contact with infected water, for example, during activities such as swimming, washing or paddling.

The Illness
Initial infection is often asymptomatic but itching can occur at the site of entry. Two to four weeks later fever, diarrhoea, cough or a rash may develop. Long standing disease can lead to problems with the bladder, kidneys, bowel or liver.

Treatment
Oral medication can treat the infection, but travellers are advised to take precautions to prevent infection, rather than rely on treatment, because of the potential long-term effects of the disease.

Recommendations for Travellers

• Avoid skin contact with fresh water in endemic areas, e.g. ponds, lakes and river;
• Swim only in protected swimming pools or safe sea water;

Avoid drinking infected water;

source: Scottish NHS www.fitfortravel.scot.nhs.uk/General/