Image 42: While swimming in a pond below a waterfall in the Dogon region of Mali, this young woman felt itchy, as did her travelling companion, left the pond and spent 20 minutes washing herself with soap and water. Her companion washed without soap for 5 minutes. During the subsequent night she awoke with these itchy lesions all over her body and took this picture. They persisted for 4 days. Her companion developed no rash. A screening examination 8 weeks after the swim revealed 2500 eosinophils/µl. Her companion, 5 weeks after the swim developed a fever, cough and diarrhea and was hospitalized twice in Ghana without a diagnosis before being shipped back to Canada where he was found to have 8000 eosinophils/µl. What was her rash?

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Image 42: This was a cercarial dermatitis (swimmer's itch). Despite positive schistosoma serologies, stool and urine examinations for schistosoma ova were negative (10 weeks after the swim). She received praziquantel and her eosinophilia had resolved 2 months later. Her travelling companion's illness suggested a Katayama syndrome and he was treated as such with praziquantel and prednisone. She received praziquantel alone.