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Schistosomiasis Japonica in American Military Personnel: Clinical Studies of 600 Cases during the First Year after Infection^1,2,

(1) An analysis was made of 315 electrocardiograms taken on 100 patients during various stages of treatment with tartar emetic and fuadin for schistosomiasis infection.

(2) Eleven per cent of the patients showed an increased amplitude of P-waves in leads II and III.

(3) Forty-five per cent of the patients showed a fusion of S-T segment and T-waves.

(4) Ninety-nine per cent of the patients showed varying degrees of decrease in amplitude of T-waves in all leads resulting in deep inversion in many cases. This change was more pronounced during tartar emetic treatment than during fuadin treatment.

(5) The Q-T interval was prolonged beyond the limits of normal in 27 per cent of the patients in this study.

(6) The etiology and significance of these changes is unknown. It is our opinion that they represent a transient side action of antimony not indicative of cardiac damage or serious impairment of cardiac function.

(7) Recent antimony therapy must be considered in evaluating abnormal EKG's found in veterans.

C) Effect of Treatment on the Intradermal Antigen Test. As previously noted, one of the main purposes in conducting tests with the intradermal cercarial antigen was an attempt to evaluate cases which had been previously diagnosed as having schistosomiasis and who had been treated before they reached this hospital. In a group of 57 men who had been reported to have positive stools overseas, but in whom repeated stool examinations were negative, 23 or 40 per cent had a positive skin test. In examining these cases an attempt was made to correlate this observation with the amount of treatment each group had received. It was found that the group with positive skin tests had had an average of 61 cc. of fuadin, while the negative group had an average of 48 cc., a difference of no statistical significance. The length of time which had elapsed between the last date of treatment and the skin test was of no significant difference either, it being an average of 6.6 months in the positives and 6.1 months in the negatives. This observation was of considerable interest in view of the statement made by Culbertson (78) that "positive skin reactions persist for years after the need for treatment is ended." In our experience, the skin test with 1:5000 dilution became negative in at least 60 per cent of proven cases within 6 months after completion of successful therapy. It is of interest in this connection that Alves and Blair (58) recently reported that 85 per cent of a group of 53 patients treated intensively for S. haematobium and S. mansoni infections developed negative skin tests to cercarial antigen two to three months after completion of successful treatment.

The proper evaluation of the treatment given patients with schistosomiasis japonica presents many difficulties in view of the fact that a single course o treatment is frequently found to be insufficient, and because of the necessity for repeated stool examinations to determine whether or not therapy has been adequate. It would, therefore, be of considerable value if a simple means could be found to determine the effectiveness of therapy. A number of patients with schistosomiasis were skin tested 30 days or more following completion of treatment in whom stools and skin tests were positive prior to therapy. Of 49 patients treated with 1.8 to 2.08 grams of tartar emetic, 25 still had positive skin reactions 30 to 90 days after completion of treatment, and 24 were found negative. Stools were examined at least 3 times weekly for 90 days or more after completion of treatment. No treatment failures, i.e. positive stools, were discovered in the 24 patients whose skin reactions had become negative, while in the 25 patients whose skin reactions remained positive, 4 treatment failures were subsequently discovered. Of 31 patients treated with 100 cc. of fuadin during 14 days, 20 still had a positive skin test 30 days or more after completion of treatment. Three treatment failures occurred in this group.

¹ From New York University-Bellevue Medical Center, New York City, and Moore General Hospital, Swannanoa, North Carolina.

² The cost of publication has been met in part by a grant from the Louis Livingston Seaman Fund of the New York Academy of Medicine.

³ 477 First Avenue, New York 16, New York.