[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.

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%.

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.

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.

[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.

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.

[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.

Bilharzial granuloma of the conus: case report.

Schistosomiasis of the central nervous system is uncommon. Schistosoma mansoni is the most common cause of a spinal cord lesion, although Schistosoma haematobium is sometimes responsible. The conus medullaris is the primary site for spinal lesion. The spinal lesion of schistosomiasis may be in the form of a mass lesion or acute necrotizing myelitis, or it may be silent and symptomless. Diagnosis of spinal cord schistosomiasis is commonly retrospective but may be suggested by laboratory and radiological studies. We were confronted with a case of bilharzial granuloma of the conus in a 7-year-old boy. This patient sought treatment for sphincteric disturbance. Myelography showed an intradural lesion in the area of the conus (opposite L1-L2). The mass proved pathologically to be S. haematobium granuloma. There was no previous history of bilharzial infestation. The neurological deficits improved markedly after surgery and antibilharzial treatment.

Rectosigmoid bilharzioma causing intestinal obstruction.

Schistosomiasis is an infection caused by flukes (trematodes) of any species of the genus Schistosoma whereas bilharzioma implies a localized mass of fibrous and inflammatory tissue, which usually contains many eggs, frequently involving serosa and mesentery. Bilharziomas are probably caused by a reaction to numerous eggs produced by one or more pair of worms in a single site, although altered host reactivity may also be a factor. Bilharziomas, even in endemic areas are quite uncommon lesions in adults. So far they have not been reported to cause intestinal obstruction in children. Herein we present a case masquerading as large bowel malignancy in a child. Management and follow up are also mentioned.

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.

Retrovesical rare tumor: the schistosomial spermatocyst.

A case of large retrovesical tumor in a 50 year-old man is reported here. The diagnosis of schistosomial spermatocyst was made by histopathology. The authors underline the difficulty of the topographic diagnosis in large retrovesical masses.

[Appendiceal localization of bilharziasis: value of extemporaneous histological examination]. / Localisation appendiculaire de la bilharziose: valeur de l'examen histologique extemporané.

The association of appendicitis with schistosomiasis in the appendix is extremely rare in France. We report herein a new case in which the diagnosis was made, in the presence of pseudo-tumoral appendicitis, by frozen section biopsies. The patient presented with a typical acute appendicitis, without urinary symptoms, and with granulocytosis (14000 white cells/mm3, without eosinophilia). At laparotomy, the appendix was voluminous, with necrotic abscess, and lymph node masses were noted on the greater omentum. Frozen section biopsies of an omental tumor showed schistosoma eggs, without malignant cells. Appendicectomy and partial omentectomy were performed. Postoperative course was uneventful. Pathologic examination of the resected specimen showed schistosoma eggs in all layers of the appendix, and in the omentum. Final diagnosis was established by positive serology and by findings Schistosoma haematobium eggs in the urine. The patient was treated postoperatively by praziquantel. In conclusion, in case of acute appendicitis, with pseudotumorous appendix and lymph node masses, even with poor epidemiological findings on the clinical history, frozen section biopsies can sometimes establish the diagnosis of schistosomiasis with appendicitis, and avoid unjustified bowel resection.

Pregnancy following infertility due to pelvic schistosomiasis--a case report.

A case of infertility due to bilateral tubal blockage secondary to pelvic schistosomiasis in a Nigerian woman is presented. Intra uterine pregnancy followed treatment by peritubal adhesiolysis and the use of niridazole.

The use of small intestinal segments to replace diseased bilharzial ureters--a prospective study.

Five male patients mean age 31.8 years with lower ureteric obstruction from urinary tract schistosomiasis have been treated by bilateral uretero-ileocystoplasty. All the 5 patients had bilateral hydroureters and hydronephrosts and 3 had reversible chronic renal failure whilst one patient presented with anuria and acute renal failure. Fibrosis of lower 1/4th to 1/3rd of the Ureters was present in the 5 patients. Four patients survived the operation for a mean of 3.4 years (range 1-7 years). The post-operative complications were hypernatraemic hyperchloraemic metabolic acidosis in 3 and incisional hernia in one. There was one death from septicaemia complicating infected bilateral nephrostomies performed before ureteroileocystoplasty. Ureteroileocystoplasty is recommended for replacement of damaged ureters where the extent of the damage precludes ureteroneocystostomy or where previous ureteroneocystostomy has failed.

[Tubal bilharziasis]. / Bilharzoise tubaire.

We report a case of tubular bilharziosis discovered on a surgical specimen after salpingectomy. Tubular bilharziosis is not exceptional in endemic zones but is rarely found in Europe. The species most often isolated is Schistosoma haematobium. Contamination occurs via vascular anastomoses between the bladder and the genital organs. Bilharziosis has been shown to be a cause of extra-uterine pregnancy although its effect on fertility is yet to be established.

[A case of a schistosomal bladder polyp]. / Bir sistozomal mesane polibi olgusu.

A 67 year old patient who had transürethral resection because of previous diagnosis of bladder tumor and schistosomal polyp was detected on the histopathologic and the microbiologic examinations were presented.

[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.

[An unusual case of macroscopic hematuria in pediatric age]. / Un caso insolito di ematuria macroscopica in età pediatrica.

An unusual case of macroscopic hematuria in a 14 year old boy is presented. At the time of the first hospital admission, no urinary tract infection could be demonstrated, in spite of the associated symptoms of stranguria and dysuria. At ultrasound examination, only a mild thickening of the upper bladder wall was detected, and cystoscopy showed a huge oedema and inflammation of the mucosal layer. The biopsy of the bladder was characterized by a definite eosinophilic infiltration; due to this particular hystologic pattern, the diagnosis of eosinophilic cystitis was made. In the following months, the boy did not improve. Recurrent hematuria occurred, and a pseudo-polypoid mass in the inner bladder wall was detected at ultrasonography. A limited resection of the vesical dome was performed, to remove completely the mass. The hystologic examination showed Schistosoma Haematobium eggs in the bladder wall, with a typical granulomatous reaction. The post-operative course was uneventful, and the child was completely cured after Praziquantel treatment. The Authors underline the need to take into account Schistosomiasis in cases of hematuria, particularly when this symptom affects boys coming from countries where Bilharziasis is endemic.

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.