This complex of diseases is caused by Schistosoma haematobium, S. intercalatum, S. japonicum, S. mansoni, and S. mekongi. Schistosomiasis is acquired from free-swimming freshwater cercariae that penetrate the skin or are swallowed with fecally contaminated water from snail-infested sources ( Schistosoma). As they penetrate the skin, cercariae lose their tails and become schistosomules. Growing couples of monogamous male and female migrate to intestinal (S. mansoni and S. japonicum) or urogenital (S. haematobium) venules where females lay hundreds to thousands of eggs per day. The great variety of lesions are superbly described and illustrated by McCulley et al. and Lichtenberg. The granulomatous response is subject to multiple immunologic mechanisms.
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