Bladder schistosomiasis in Italy: A case report.

INTRODUCTION: Human schistosomiasis is a snail-borne disease caused by parasitic blood-dwelling flukes. A long-term infection can lead to the risk of liver damage, kidney failure, infertility, or bladder cancer. The most common sign is hematuria with the blood first seen in the terminal urine, but in severe cases the whole urine sample can be dark colored. We analyze the case of a healthy African child living in Italy since birth, harboring a hidden debilitating disease that was picked up during ultrasonography. CASE REPORT: A 11-year-old African child was admitted to our emergency department with macroscopic hematuria, dysuria, and frequency for 2 months. Ultrasonography revealed a solid mass involving bladder's right wall. Non-contrast and contrast-enhanced scans of computerized tomography showed a mass of 45 mm x 15 mm on the right bladder wall. A bipolar transurethral resection of bladder was performed. The pathological examination showed findings consistent with Schistosoma haematobium. DISCUSSION: The clinical manifestations of schistosomiasis depend on the inflammatory response to the parasitic infection. In particular, it can manifest in the bladder as painless dysuria, urinary incontinence and urinary frequency, hematuria, or even urinary retention if the trigone is involved. Utilization of ultrasonography for diagnostic evaluation of schistosomiasis is mandatory. For treatment, the World Health Organization recommends praziquantel which has an efficacy of up to 90%.

[Testicular bilharzioma by Schistosomia haematobium: about two cases]. / Bilharziome testiculaire à Schistosomia haematobium: à propos de deux observations.

Bilharzioma are inflammatory pseudotumors, which often pose the problem of differential diagnosis with neoplastic processes. Using the keywords "testicular" and "schistosomiasis", there are only 14 cases of testicular bilharzioma identified on PubMed. The authors report two new cases in a 6-year-old child and an adult of 38 years, collected over a period of 5 years. In both cases, orchidectomy was performed and histological analysis of the surgical specimen was allowed to diagnose testicular bilharzioma by Schistosomia haematobium. The authors emphasize the need to evoke a bilharzioma before any testicular nodule in a patient living in an endemic area.

Unexpected urinary Schistosoma infection in a Belgian travel group returning from Malawi.

Urinary schistosomiasis, caused by Schistosoma haematobium, is a prevalent parasitic infection in certain areas of Africa and the Middle East. Humans can be infected by cercariae when they are in contact with contaminated freshwater. The adult worms reside in the veins of the vesical and pelvis plexuses. The urinary bladder, the seminal vesicles and the lower ends of the ureters are the most commonly affected organs. In this case report, we describe an unrecognised case of urinary schistosomiasis in a woman who was part of a Belgian travel group; two other patients out of eight were also infected. In Belgium, the number of reported cases of S. haematobium infection is limited. The aim of this report is to emphasize this parasitic infection should be suspected in patients who travel to endemic areas.

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.

Ureteric schistosomiasis with obstructive uropathy.

A 25-year-old male Nigerian undergraduate who had earlier been treated with praziquantel for schistosomal epidydymitis presented with clinical features of pyelonephritis, and radiological appearances of bilateral hydroureteronephrosis with fibrosis of lower ureters. Surgical resection of the ureters, Boari flap and Psoas hitch reconstruction were done. The histology of the resected ureters proved schistosomiasis. He was subsequently treated with praziquantel and artemether. This case highlights the insidious nature of schistosomiasis infection, possibility of progression of primary infection with complications or probable reinfection in a previously treated individual. In any case, surgical intervention may be necessary in those who present late with severe ureteric stricture and also to prevent progressive renal damage.

[A case report: Bilharzial schistosomiasis in the urinary bladder presented with gross hematuria].

A 31-year-old Japanese man who had been in Africa for two years presented with gross hematuria. He had been swimming in Lake Malawi during this period. Urinary specimen consisted of hematuria and pyuria. Cystoscopy showed tumors resembling Bilharzial tubercles located in the trigone, left lateral and posterior wall and dome. Further urine examination demonstrated eggs of schistosome haematobium. The patient was highly suspected of having Bilharzial schistosomiasis in the urinary bladder. Transurethral resection of bladder tumors was performed for diagnosis. Pathological examination revealed granuloma with many eggs of schistosome haematobium. He was diagnosed with Bilharzial schistosomiasis and was treated with 3,600 mg of praziquantel daily for two days. There have been no signs of recurrence during the one-year follow up except for excretion of degenerated eggs of schistosome haematobium in the urine specimens.

Appendicitis associated with presence of Schistosoma haematobium eggs: an unusual pathology for Europe. Report of three cases.

Three cases of appendicitis associated with presence of Schistosoma haematobium eggs in the appendix tissue are reported. The patients (two males and one female) were all from Ghana and had immigrated to Italy a few years previously. It is difficult to attribute the cause of the appendicitis to the parasite; it is more probable that the appendicular location of the eggs occurred accidentally many years earlier in an endemic zone of the country of origin, and that recently bacterial agents were able to provoke the present appendicitis. Since it is probable that with the increase in the number of immigrants to Europe from endemic countries (sub-Saharan Africa in particular) other similar cases may occur, it is important that the surgeon and the pathologist be aware of this pathology, which has so far been considered unusual.

[Pulmonary bilharziosis due to Schistosoma haematobium: pitfalls of species diagnosis. A case report from Libreville, Gabon]. / Bilharziose pulmonaire à Schistosoma haematobium: difficulté du diagnostic d'espèce. A propos d'un cas observe à Libreville.

The purpose of this report is to describe a case of pulmonary schistosomiasis treated at la Fondation Jeanne Ebori in Libreville, Gabon. This case is exceptional due to the rarity of the disease and the schistosomiasis agent involved. The patient was a 47-year-old woman who presented with recurrent right-sided pneumonia 6 months after initial hospitalization and nonspecific antimicrobial therapy. Her general status was altered by hyperthermia, right chest pain, and repetitive bouts of hemoptysia. Because etiological diagnosis could not be achieved and clinical condition was deteriorating, the decision was taken to perform exploratory thoracotomy. Based on operative findings, medial and lower lobectomy was performed. Histological examination demonstrated granulomatous inflammatory lesions due to bilharziosis. Infection was attributed to Schistosoma haematobium that is the most common agent in pulmonary localizations. However Ziehl coloration raised the possibility of involvement of Schistosoma intercalatum that has never been observed in the lung and of a hybrid species. Natural hybridization between S. haematobium and S. intercalatum and the presence of active transmission of the Schistosoma hybrid has been suspected in Gabon.

Analysis of fibronectin expression in the bilharzial granulomas and of laminin in the transformed urothelium in schistosoma haematobium infested patients.

UNLABELLED: The bilharzial granulomas and urothelial transformation are common findings in Schistosoma haematobium infested patients. We hypothesize that the distribution of extrinsic (fibronectin, FN) and intrinsic basement membrane (BM) proteins (laminin, LN) is altered during the evolution of these lesions. METHODS: To test this hypothesis, 70 cystectomy specimens, entailing variable associations of normal and dysplastic urothelium (all cases), and bilharzial granulomas were examined for FN and LN protein expression. RESULTS: The biharzial granulomas were formed of admixture of CD3+T cells, CD68+histiocytes and CD220B cells. The CD3+T cells and and CD68+histiocytes were the predominant cell populations. Increased deposition of FN occurred with the evolution from cellular (loose fibrillary network, 20 cases) to fibrocellualr (dense fibrillary network, 30 cases) to fibrotic (tight conglomerates, 20 cases) granulomas. Alternatively, BM staining for LN was linear and continuous underlying normal and metaplastic urothelium. In dysplastic urothelium (20 cases), it showed breaks in continuity. CONCLUSIONS: Alterations of FN and LN occur during the development of the bilharzial granuloma and urothelial transformation.

Schistosomal appendicitis in pregnancy.

Acute appendicitis is the most common acute surgical infection during pregnancy. Although usually pyogenic in origin, parasitic infections account for a small percentage of cases. Despite the relatively high prevalence of acute appendicitis in our environment, it is not commonly associated with schistosomiasis. We report here the association of pregnancy and appendicitis caused by Schistosoma haematobium. Schistosomiasis is very common complication of pregnancy in hyperendemic areas. Schistosome egg masses can lodge throughout the body and cause acute inflammation of the appendix, liver and spleen. Congestion of pelvic vessels during pregnancy facilitates passage of eggs into the villi and intervillous spaces, causing an inflammatory reaction. Tourism and immigration make this disease a potential challenge for practitioners everywhere.

Schistomiasis of the spinal cord: report two cases.

Schistosomiasis affects over 200 million people worldwide. Schistosomiasis of the spinal cord is a rare occurrence. In Africa, there have been recent reports from Egypt and South Africa. In Uganda, the last histological records were over two decades ago. Schistosomiasis of the spinal cord is commonly caused by Schistosoma mansoni although Schistosoma haematobium has been isolated. Two case reports are presented. In both patients, the diagnosis was made retrospectively. The first patient was a female patient with a lesion in the thoracic region. The second patient was a 21 year old male with a lesion in the conus. Apart from a block on the myelograms, all other laboratory investigations were negative. The diagnosis was made histologically in both cases with the identification of eggs of schistosoma in the spinal cord. The eggs could however, not be retrieved from the stool or urine samples. Both patients were treated with antischistosomal drugs and steroids. On follow up they had marked improvement in their neurological signs. We hope to renew attention in this rare but devastating neurological manifestation of a disease which affects many in our region and which if left untreated can lead to permanent neurological damage.

Therapeutic and operational profiles of metrifonate and praziquantel in Schistosoma haematobium infection.

A systematic analysis of the existing literature has been undertaken to compare the therapeutic and operational profiles of metrifonate (CAS 52-68-6), and praziquantel (CAS 55-268-74-1), two anti-schistosomal compounds. The criteria evaluated were therapeutic efficacy against Schistosoma haematobium and other helminths, impact on pathology commonly associated with S. haematobium infection, frequency, type and duration of adverse reactions, health risk associated with inadvertent overdosage, applicability and practicality of treatment in various medical settings, tolerance and resistance, pharmacological properties, toxicity and economic aspects. It is concluded that both medical and operational criteria indicate that praziquantel is superior to metrifonate for the treatment of schistosomiasis caused by S. haematobium. Since, compared to praziquantel, metrifonate has a number of disadvantages, future antischistosomal chemotherapy can do without this drug.

[Bilharziasis and bladder cancer. A case report]. / Bilharziasis y cáncer vesical. Aportación de un caso.

In our setting, the association between bilharziasis and bladder cancer is uncommon. However, the presence of recurrent haematuria in a patient from an endemic area of bilharziasis (east of Africa and Middle East), is highly suspicious of this disease. Lack of an adequate treatment by using anthelminthic drugs during the acute phase of disease, might lead to the onset of chronic bladder lesions and, on occasion, bladder cancer, of the epidermoid type in the majority of cases. Because of the high mortality and aggressivity of this type of cancer, an early diagnosis and appropriate treatment of acute lesions is mandatory. We report a 40-year-old black male from Senegal, presenting chronic bladder schistosomiasis and infiltrative epidermoid carcinoma of the bladder, diagnosed and treated in our department by palliative cystectomy.