Geographical distribution of cercarial dermatitis in Norway.

Bird schistosomes can cause a disease called cercarial dermatitis, or swimmer's itch, in humans. The disease occurs when people have direct contact with fresh water or sea water containing the free-swimming cercariae of the flukes. The symptoms are well known, and include intense itching, maculae, papulae, urticariae and, in some cases, local oedema with enlarged lymph nodes and fever. In this study, we present the geographical distribution of freshwater cercarial dermatitis in Norway. The study is based on random reports obtained from both individuals and physicians treating patients with itching skin rash after freshwater bathing. The first case of cercarial dermatitis in Norway was reported in 1980 and was traced to a lake near Trondheim in the central part of Norway. In the following years, an increasing number of cases were reported, especially in southern Norway. However, case reports are distributed almost all over the country, even from lakes in northern Norway. As far as we know, these are the northernmost case reports in Europe. So far, only one fluke species (Trichobilharzia franki) from a single infected snail (Radix auricularia) has been identified in Norway. However, unidentified schistosomatid ocellate cercariae have been found on several occasions in snails collected from six lakes where swimmer's itch is frequently reported. Future studies should be performed to identify the fluke species, as well as the most important snail and bird hosts, in Norwegian lakes.