A simple approach improving the performance of urine reagent strips for rapid diagnosis of urinary schistosomiasis in Nigerian schoolchildren

In Nigeria, schistosomiasis, caused predominantly by the species Schistosoma haematobium, is highly endemic in resource-poor communities. We performed a school-based survey in two rural communities in Osun State (Southwestern Nigeria) and assessed macrohaematuria, microhaematuria and proteinuria as indirect indicators for the presence of disease. Urine samples were inspected macroscopically for haematuria and screened for microhaematuria and proteinuria using urine reagent strips. The microscopic examination of schistosome eggs was used as the gold standard for diagnosis. In total, 447 schoolchildren were included in this study and had a 51 percent prevalence of urinary schistosomiasis. The sensitivity of microhaematuria (68 percent) and proteinuria (53 percent) for infection with S. haematobium was relatively low. In patients with a heavy infection (>500 eggs/10 mL), the sensitivity of microhaematuria was high (95 percent). When the presence of macrohaematuria and the concomitant presence of microhaematuria and proteinuria were combined, it revealed a sensitivity of 63 percent, a specificity of 93 percent and a positive predictive value of 91 percent. Macrohaematuria also showed high specificity (96 percent) and a positive predictive value of 92 percent, while sensitivity was < 50 percent. These data show that combining urine reagent strip tests (presence of proteinuria and microhaematuria) and information on macrohaematuria increased the accuracy of the rapid diagnosis of urinary schistosomiasis in an endemic rural West African setting. This simple approach can be used to increase the quality of monitoring of schistosomiasis in schoolchildren.

Schistosomiasis haematobia: histopathological course determined by cystoscopy in a patient in whom praziquantel treatment failed / Esquistossomíase hematóbica: seguimento histopatológico determinado por cistoscopia em um paciente com falha terapêutica ao praziquantel

Schistosomiasis haematobia or urinary schistosomiasis is one of the main public health problems in Africa and the Middle East. A single dose of 40 mg praziquantel per kg body weight continues to be the treatment of choice for this infection. The aims of this follow-up were to study the post-treatment course of a patient infected with S. haematobium and not submitted to re-exposure, and to identify complications of the disease and/or therapeutic failure after praziquantel treatment by histopathological analysis. Treatments were repeated under medical supervision to ensure the correct use of the drug. In view of the suspicion of lesions in cystoscopy, the patient was submitted to bladder biopsy. The histopathological characteristics observed in biopsies obtained, after each treatment, indicated viability of parasite eggs and activity of granulomas.

A Esquistossomíase Hematóbica ou Esquistossomíase Urinária é um dos principais problemas de Saúde Pública na África e no Oriente Médio. Uma única dose de praziquantel 40 mg/kg de peso, continua sendo o tratamento de escolha para esta infecção. Os objetivos deste seguimento foram: avaliar o período pós-tratamento de um paciente infectado com Schistosoma haematobium e não submetido à re-exposição e, identificar as complicações da doença e/ou falha terapêutica, após o tratamento com praziquantel, por análise histopatológica de material obtido por biópsia vesical. O tratamento foi repetido sob supervisão médica para assegurar o uso correto do medicamento. Na presença de lesões suspeitas a cistoscopia, o paciente foi submetido a biópsia vesical. As características histopatológicas observadas nos materiais obtidos por biópsia, após cada tratamento, indicaram viabilidade de ovos e atividade dos granulomas.

Cystoscopy in the diagnosis and follow-up of urinary schistosomiasis in Brazilian soldiers returning from Mozambique, Africa

A avaliação de esquistossomose urinária em indivíduos procedentes de áreas endêmicas, freqüentemente requer recursos diagnósticos não usados nas áreas de exposição, para determinar as complicações ou estabelecer um critério de cura mais preciso. A cistoscopia e o exame de urina de 24 horas foram realizados, após tratamentos com praziquantel na dose de 40 mg/kg de peso, dose única, em 25 militares brasileiros que participaram de uma Missão de Paz pela ONU em Moçambique no ano de 1994. A idade média dos indivíduos foi de 29 anos e todos apresentavam exame parasitológico de urina positivo. As alterações detectadas pela cistoscopia foram hiperemia e granulomas na submucosa vesical em 59.1% dos indivíduos e somente granulomas em 40.9%. A biópsia vesical revelou granulomas em todos os pacientes e ovos viáveis em 77.3%, mesmo após um período durante o qual os pacientes não mais eliminavam ovos pela urina. Após o tratamento, a cistoscopia seguida por biópsia e avaliação histopatológica, realizada em áreas onde a evolução da doença pode ser monitorada melhor, demonstrou ser um critério mais seguro de cura parasitológica.

Eosinophilia as a diagnostic value in patients suffering from schistosomiasis haematobium comparing to eosinophiluria and egg count in the urine

Fifty-out of sixty cases [ranging in age between 18-30 years old] suffering from Schistosomiasis hematobium were selected from Inpatient and Outpatient Clinic of Theodore Bilharz Research Institute. Patients were divided into three groups: 20 infected and non treated, 20 infected and treated, then exposed again to infection and ten were completely treated. Also, a fourth group to serve as healthy control was included. Blood samples were collected to count eosinophil percentage and absolute eosinophil count. Urine samples were collected to study eosinophiluria by slide film staining with Leishman's stain and to count number of ova excreted in 10 ml urine by urine filtration technique. Eosinophilia and eosinophiluria >5% had diagnostic value for Schistosomiasis hematobium as well as the correlation between them and intensity of infection by number of ova in urine

Hematuria causada por Schistosoma haematobium / Hematuria caused by Schistosoma haematobium

Os autores descrevem 2 casos clinicos onde ocorreu hematuria macroscopia causada por Schistosoma haematobium. O diagnostico foi realizado a partir de dados epidemiologicos e clinicos. Sao comentados aspectos atuais relativos ao diagnostico e a conduta nestes casos.

Comparison between the excretion of some metallic elements in normal and parasitized human

Twenty four hours urine samples from a total of 50 normal healthy individuals [30 males and 20 unmarried females] and a total of 70 parasitized patients [40 urinary schistosomiasis males and 30 trichomoniasis females] were analysed for zinc, copper, iron, calcium, magnesium, potassium and sodium. The results showed that urinary schistosomiasis leads to increased zinc, iron, calcium, magnesium and potassium levels but decreases the excretion of sodium, where as trichomoniasis leads to increase the excretion of zinc and sodium but decrease the excretion of copper. No significant differences were found in the biochemical element excretion between filtered and unfiltered urine samples during both infections