Esquistosomiasis vesical urinaria: caso anatomoclínico diagnosticado en Chile / Urinary bladder schistosomiasis: a case report diagnosed in Chile

Resumen La esquistomiasis urinaria es producida por Schistosoma haematobium. Es una enfermedad endémica en muchas regiones del mundo, no existente en Chile. Se presenta el caso de un hombre joven que viajó a Malawi, en África meridional, y que a su regreso al país, años después, presentó un síndrome miccional con hematuria macroscópica. La biopsia de vejiga mostró una cistitis granulomatosa y eosinofílica con huevos de Schistosoma haematobium.

Urinary schistosomiasis is produced by Schistosoma haematobium. It is an endemic disease in many regions of the world, non-existent in Chile. We report a case of a young man who traveled to Malawi, in southern Africa, and who returned to Chile. Few years later, he presented a urinary syndrome with macroscopic hematuria. The bladder biopsy showed a granulomatous and eosinophilic cystitis with eggs of Schistosoma haematobium.

Bilharzial endocervical polyp.

Schistosomiasis still represents a major threat to women's health in many developing countries. The frequency in developed countries is increasing among immigrants and tourists who have a history of freshwater exposure in endemic areas. This is a case of 43-year-old immunocompetent Egyptian woman presented by abnormal vaginal bleeding. The gynecological examination revealed an endocervical polyp measuring 3 x 2 x 1 cm. Polypectomy was done. Histopathological examination revealed several granulomas containing viable eggs of Schistosoma hematobium. Schistosomiasis is rarely presented with endocervical polyp. In developing countries, schistosomiasis may be considered in differential diagnosis of patient with endocervical polyp.

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.

Therapeutic failure of praziquantel in the treatment of Schistosoma haematobium infection in Brazilians returning from Africa

Several cases of therapeutic failure of praziquantel used for the treatment of urinary schistosomiasis have been reported. Alternative drugs, like niridazol and metrifonate, have shown a lower therapeutic effect and more side effects than praziquantel. Twenty-six Brazilian military men (median age of 29 years) with a positive urine parasitological exam who were part of a United Nation peace mission in Mozambique in 1994 were treated with 40 mg/kg body weight praziquantel, single dose. They swimmed in Licungo river (Mocuba city, Mozambique) during the weekends. After this, they presented haematuria, dysuria, polakiuria, and lumbar pain. Control cystoscopy examinations carried out between 6 and 24 months after each treatment (including two additional treatments at a minimum interval of 6 months) revealed the presence of viable eggs. Granulomas in the vesical submucosa were observed in 46.2 percent (12/26) of the individuals. A vesical biopsy confirmed the presence of granulomas in all of these patients and the presence of viable eggs in 34.3 percent (9/26) of individuals who no longer excreted eggs in urine. The eggs filled with miracidia showed characteristics of viability. Histopathological examination using different strains demonstrated therapeutic failure and the need for repeated treatment. In this study, we demonstrated a low efficacy of praziquantel in the treatment of schistosomiasis haematobia, and the necessity of the urinary bladder biopsy as criterion of cure.

Studies on experimental mixed infection of schistosoma haematobium and schistosoma mansoni

Swiss albino mice have been infected with S. hematobium and challenged four weeks later with S. mansoni. Parasitological, pathological and ultrastructural studies were done. The results revealed cross mating between the two species. A reduction in S. mansoni worm load, egg count, hepatic granuloma number and size was noticed. The presence of heterologous immunity was suggested

Effect of colchicine on schistosoma induced hepatic amyloidosis in Syrian golden hamsters

This study comprised 80 Syrian Gold hamsters, 70 of them were infected with Schistosoma mansoni and 10 uninfected hamsters served as negative controls. Of the schistosome infected hamsters, 10 served as positive controls [infected but untreated] and the rest [60 hamsters] received treatment for 9-week duration. In 30 hamsters treatment was given early [9 weeks after infection], before the appearance of hepatic amyloidosis, and in the other 30 hamsters treatment was given late [15 weeks after infection] after the appearance of hepatic amyloidosis. Each treatment group was subdivided into three subgroups [ten hamsters each], in which treatment was either colchicine alone, combined colchicine and praziquantel, or praziquantel alone. All hamsters were sacrificed nine weeks after treatment, liver biopsies were taken and evaluated semiquantitatively for amyloid deposits. In the group with combined therapy there is significant reduction in hepatic amyloid deposits, together with reduction of proteinuria serum bilirubin, SGPT with an increase of total serum protein and serum albumin. This improvement was nearly complete with early treatment and only partial when treatment was given late. When colchicine was given alone, a partial, but insignificant reduction of hepatic amyloid deposits was documented. It was concluded that, colchicine is effective for the prevention and reduction of schistosome induced hepatic amyloidosis in Syrian Gold hamsters

Transurethral neodymium YAG laser photocoagulation on benign bilharzial lesions of urinary bladder

Two hundred patients with benign bilharzial lesions of the urinary bladder were treated by transurethral photocoagulation using neodymium- yttrium-aluminium-garnet [Nd: YAG] laser. These lesions were different types of benign bilharzial ulcers and granulomata. Laser energy was applied using quartz-glass fiber delivery system via a rigid cystoscope. Technique of photocoagulation of papillary tumors of urinary bladder described in the literature was modulated to suit the bilharzial lesions. Optimal parameters of photocoagulation were obtained in 86% out of 182 patients followed for one year

Beta-glucuronidase enzyme in bladder cancer associated with bilharziasis [Histochemical and biochemical study]

To understand the status of beta-glucuronidase enzyme in bilharzial bladder cancer, the enzyme was evaluated histochemically in tissue specimens taken from 70 bilharzial patients suffering from bladder cancer and treated by total cystectomy. Specimens were taken from three different sites; apparently non-tumor area, edge of the tumor and center of the tumor deep to the necrotic tissue. Twenty of these patients were selected for biochemical evaluation of the enzyme in the tissue and serum. In addition, ten patients had benign bilharzial lesions were included for histochemical evaluation of the enzyme in the benign ulcer and biochemical estimation of the enzyme in the serum and these benign lesions. Seven non-bilharzial healthy persons were selected for serum estimation of the enzyme as control group

Immunohistochemical study of benign bilharzial lesions of the urinary bladder in schistosoma haematobium infested patients

The distribution of laminin [LM] [a basement membrane glycoprotein] and fibronectin [FN] [an extracellular matrix glycoprotein] were studied in different types of bilharzial lesions in 60 cystoscopic specimens. This was done by immunoperoxidase methods. The distribution of FN in cellular, fibrocellular and fibrotic granulomas showed increasing progressive dense FN network expression, respectively. FN expression was presented in late or fibrotic granuloma functions as a mediator and indicator of healing. The distribution of LM is characterized by continuous band-like reactivity. It was present in benign, hyperplastic urothelial lesions. In contrast, complete loss of this band-like staining was constantly observed in metaplastic urothelial lesions, so laminin might be an important indicator for premalignant and malignant changes which needs further studies

HLA in schistosoma haematobium [Sh]: a special pattern in cancer bladder and hepatosplenomegaly

Estimation of HLA [ABC] antigen frequency was done in 65 patients with various manifestations of SH, in a trial to a possible association of these genetic markers and disease susceptibility to SH and/or in the development of various complications of the disease. It was concluded that, the close association between HLA antigens and S. hematobium infestation can provide some evidence that susceptibility or resistance to schistosomiasis is determined by genetic factors. Susceptibility of individuals may be based on the presence of A11, B21 contributes to resistance to infection. Individuals possessing A30, Cw4 may be prone to the development of the hepatosplenic form of the disease while A30, B35 and CwS more prone to the development of malignant bladder

Staging of carcinoma in schistosomal urinary bladder comparative computed tomographic and pathological studies

Seventy patients with carcinoma of schistosomal urinary bladder were investigated by computed tomography [CT] and the results were compared with those of pathological staging. There was over-staging in 3 out of 16 [18.75%] intramural tumors and under-staging in 3 [5.5%] out of 54 extramural tumors. CT demonstrated 5 patients out of 22 with enlarged pelvic lymph nodes [22.7%] with 2 false positive and one false negative results