Schistosomiasis has acute and chronic phases. Days after the infection the cercarial dermatitis appears at the site where the worm penetrated the skin. In one or two months the acute phase begins and fever, cough, muscle pain and nausea occur but soon disappear; in some people this phase may not manifest. In the chronic phase of the disease the worm infestation can affect the bowels, causing diarrhea, bloody feces, tiredness and hepatosplenomegaly (enlargement of the liver and spleen). The excessive pressure upon the hepatic portal vein produces varix (collateral circulation) in the esophagus and the patient may have hemorrhages and bloody vomiting that may even cause death.