Colonic bilharzioma - dramatic complication of schistosomiasis: report of ten cases

Bilharzioma implies a localized mass of fibrous and inflammatory tissue, which usually contains many eggs, frequently involving serosa and mesentery. Bilharzioma is probably caused by reaction to numerous eggs produced by one or more pair of worms in a single site. The aim of this study is to present the management of a group of patients had colonic bilharzioma presented with abdominal masses and intestinal obstruction. Ten patients presented with abdominal masses and intestinal obstruction. Complete blood count, urinalysis, stool analysis, and abdominal ultrasonography done in all the patients of the study. Barium enema done in 5 patients. Abdominal computed tomography done in 6 patients. All the patients of the study had been subjected to laparotomy. There were 7 males and 3 females, their ages ranged from 8 to 42 years [mean 14.2 years]. All the patients had abdominal pain [100%], 6 patients presented with abdominal mass [60%], and 4 patients presented with intestinal obstruction [40%]. There was microcytic hypochromic anemia in 9 patients [90%] and leukocytosis with eosinophilia in 7 patients [70%]. Abdominal US revealed presence of lymphoma versus teratoma in 6 patients [60%] and signs of intestinal obstruction in 4 patients [40%]. Barium enema revealed presence of multiple polyps throughout rectosigmoid colon, with loss of haustrations and spasm of descending colon in 3 cases. CoIonic wall thickening with narrowing and rigidity of the ascending colon in 2 cases. Abdominal CT revealed presence of colonic wall masses suggestive of lymphoma in 6 cases. In laparotomy, there were 4 rectosigrnoid bilharzioma, bilharzioma of the transverse colon down to the upper rectum in 3 patients and ascending colonic bilharzioma in 3 cases. Histopathology confirmed presence of bilharzial granuloma in all surgical specimens. Always consider bilharzioma in differential diagnosis of abdominal masses and intestinal obstruction, especially in countries where it is endemic. Rectal examination is an important and integral part of abdominal examination in such cases and biopsy is a must in presence of palpable nodules

Impact of national schistosomiasis control program in Kafr El-Sheikh Governorate, Nile Delta, Egypt: an independent evaluation

A longitudinal study has been conducted [1991-1997] to evaluate the impact of repeated selective chemotherapy on human transmission indices of Schistosoma mansoni infection. The study population included 8370 individuals inhabiting four villages and their satellites and representing high and low S. mansoni endemicity communities in Kafr El-Sheikh governorate. A parasitological survey was conducted for three successive years [1991-1992 and 1993]. Each time infected individuals received praziquantel [PZQ] chemotherapy. In 1997, a fourth parasitological survey was done. During the period from 1994-1996 only routine diagnosis and treatment of schistosomiasis offered by the Ministry of Health and Population [MOHP] was going on. Study results revealed a decrease in S. mansoni prevalence and intensity of infection in the first three years. The drop was marked after the first year. In 1997, after the cessation of active case finding and treatment by the project team, an upward trend was observed for both prevalence and geometric mean egg count [GMEC] especially for the high prevalence villages. However, all indices were kept at significant low levels as compared to base-line values in 1991

Evaluation of eosinophiluria in active schistosomiasis haematobium and its relation to morbidity changes in the urinary tract

Schistosoma hematobium was reported as a cause of eosinophiluria. In this study, evaluation of the relationship between eosinophiluria using Hansel's strain and urinary morbidity as detected by ultrasound in 75 patients with active S. hematobium infection. The control group included 91 subjects [20 normal, 20 had blood eosinophilia due to causes other than schistosomiasis and 51 had different renal diseases]. All patients received a single dose of praziquantel 40 mg/kg and were followed up after one and three months. The frequency of eosinophiluria was significantly more in patients with active S. hematobium than those with renal disease [46.7%], 12%. Eosinophiluria was not present in either normal controls or patients with eosinophilia due to causes other than S. hematobium. There was a significant positive correlation between the log of ova count and the eosinophil count in both urine and blood. However, there was no relation between either eosinophiluria or eosinophilia and urinary bladder or renal morbidity changes. The sensitivity of eosinophiluria as an indirect index for suggestion of S. Hematobium infection was 33%, the specificity was 93.8%, the positive predictive value was 88.6% and the negative predictive value was 49.2%

Effect of antischistosomal chemotherapy [praziquantel] on some immunochemical parameters in patients with hepatic schistosomiasis

Thirty male patients with active schistosomal hepatic fibrosis and splenomegaly without ascites were included in this study. They were divided into two groups: group I was treated with praziquantel [PZQ] in a single oral dose of 40 mg/kg body weight. Group II received PZQ in a total dose of 180 mg/kg body weight divided into 20 mg/kg body weight, three times daily for three consecutive days. Levels of circulating immune complexes [CIC's] as well as IgG and IgM were studied before treatment and 4 weeks after treatment. Although gamma-globulins, CIC's, IgG and IgM levels before treatment were all above the normal values, only IgM showed a significant decrease after treatment with the high dose of PZQ. PZQ in high split dose was more effective than in low single dose