Confirmation of the presence of Trichobilharzia by examination of water samples and snails following reports of cases of cercarial dermatitis

In case of cercarial dermatitis after exposure to fresh water lakes, managers responsible for bathing water quality wish to confirm the presence of Trichobilharzia, which substantiates taking measures to protect bathers from further exposure. A novel approach, including concentration of suspected water samples by filtration and PCR detection of the parasite, is proposed. This approach has been applied to bathing sites with a history of cercarial dermatitis, sampled from 2005 to 2008. Examination of snails, the standard procedure for confirmation of the parasite's presence, and analysis of water samples, appear to be complementary procedures that enhance the chance of parasite detection in implicated bathing water. Water analysis is particularly valuable when snails cannot be found; it confirmed the presence of Trichobilharzia on 25% of sampling days with reported skin conditions and no snails found. PCR of the ToSau3A repeat directly confirmed the parasite in the water. The application of the combination of analysis of water samples and examination of snails is suggested when cases of (presumptive) cercarial dermatitis are reported or when lakes with a history of cercarial dermatitis are inspected prior to the bathing season, in order to guide interventions to prevent (further) cases of swimmers' itch.