A 26-Year-old Woman With Dysuria and Hematuria.

In this case, we present imaging findings characteristic of chronic genitourinary schistosomiasis. Schistosoma haematobium, a blood fluke endemic to Africa and the Middle East, is a prominent cause of hematuria and bladder cancer in regions lacking adequate water sanitation. Luminal calcifications of the genitourinary tract, that is, of the bladder and/or ureters, from deposition of fluke eggs are a classic sign of chronic S. haematobium infection and should raise suspicion for the disease even when urine or serological tests are negative. It is important to recognize these findings on CT or, in resource-limited settings, plain film to allow for prompt, effective treatment.

Chyluria with massive proteinuria: Do not reach for the biopsy gun!

We report on a patient presenting with persistent chyluria due to filariasis, whose clinical course was complicated by massive proteinuria and severe hypoalbuminemia. Treatment with dietary manipulation, antifilarials, and sclerotherapy resulted in successful reversal of the above abnormalities. It has been reported that chyluria is not associated with massive proteinuria, or that even in cases of massive proteinuria, hypoalbuminemia is not seen and implies a glomerular pathology. We argue that chyluria is always associated with proteinuria, which may be massive, and does not warrant a kidney biopsy unless proteinuria persists despite resolution of chyluria.

Salmonella enterica and Theileria co-infection in dromedary camels (Camelus dromedarius) in UAE.

Background: Despite a steady increase in camel husbandry worldwide, pathology of camel diseases is still relatively under-investigated. Clinical hematuria is generally indicative of either acute or chronic urogenital inflammations, traumatic calculous injuries, cancers, corrosive poisonings. Infectious agents are not typically implicated in urinary tract infection of camels. Aim: This study aims to explore possible causes in camels clinically suffered from acute febrile disease with severe hematuria. Methods: To achieve aims of the study culturing of urine samples, microscopic examination for detection of blood parasites, phenotypic and genotypic characterization for the identification of isolated bacteria were followed. Results: Conventional bacteriology enabled identification of Salmonella enterica subsp. enterica serovar typhimurium which further genotyped by 16S rRNA gene sequencing. Microscopic examination of Giemsa stained blood smears from both infected dromedary camels revealed the presence of pleomorphic Theileria piroplasms. The results suggest that the clinical symptoms were as coinfection induced by salmonellosis and theileriosis. Conclusion: Given these remarkable findings, further research should aim to better characterize the opportunistic pathogens associated with camel theileriosis, as well as to determine other possible infectious agents of the camel urinary tract.

Parasitic Hematuria: Six Cases in a Row in a Single Centre in Spain.

Most cases of urogenital parasitosis are registered in Africa. However, migration movements and travellers moving from developed to developing countries are responsible for leading to an increased incidence of genitourinary infections caused by parasites in the western world including Spain having serious economic and health implications. The importance of its early detection and treatment also results from its potential risk for infertility, susceptibility for HIV infection and the development of bladder cancer. The most common presentation symptom is terminal haematuria, and when diagnosed, praziquantel is the treatment of choice. We report a series of 6 cases of urinary schistosomiasis that happened in a single centre in Spain and reminds the importance of having the infection in mind in certain cases of haematuria study.

Sensitivity of the Point-of-Care Circulating Cathodic Antigen Urine Cassette Test for Diagnosis of Schistosoma mansoni in Low-Endemicity Settings in Côte d'Ivoire.

The sensitivity of a point-of-care circulating cathodic antigen (POC-CCA) urine cassette test for diagnosis of Schistosoma mansoni in low-endemicity settings is poorly understood. We conducted a cross-sectional survey in 14 villages in western Côte d'Ivoire and diagnosed children aged 9-12 years for schistosomiasis. Two stool samples were subjected to triplicate Kato-Katz thick smears each for diagnosis of S. mansoni, whereas a single urine sample was examined by POC-CCA for S. mansoni, filtration for Schistosoma haematobium, and reagent strip for microhematuria. According to the Kato-Katz technique, we found 45 out of 681 children positive for S. mansoni (6.6%) with a mean intensity among infected children of 72.2 eggs per gram of stool. Point-of-care circulating cathodic antigen revealed a prevalence of S. mansoni of 33.0% when trace results were considered positive and 12.5% when trace results were considered negative. Eggs of S. haematobium were found in eight participants (1.2%), whereas the prevalence of microhematuria was 13.5%. A single POC-CCA urine cassette test revealed a several-fold higher prevalence of S. mansoni than multiple Kato-Katz thick smears in this low-endemicity area. Our findings have important ramifications for choosing an appropriate diagnostic tool in low-endemic areas that might be targeted for elimination.

Polyparasitism of Rhabditis Axei and Enterobius Vermicularis in a Child from Beijing, China.

BACKGROUND: Rhabditis (Rhabditellae) axei is a common species in soil, which has been reported repeatedly in human urine and the digestive system. Humans exposed to sewage or mistakenly polluted sewage is the cause of larvae infecting the digestive tract or via the urethra. We reported a patient infected with Rhabditis axei and Enterobius Vermicularis. The migration of the nematodes caused true signs of hematuria, diarrhea, and high eosinophilia. METHODS: Stool and urine are collected to detect parasite eggs and genotype. Specimens are sent for polymerase chain reaction (PCR)-based species identification. Amplification of the 18S ribosomal RNA gene was performed by PCR as described [1]. RESULTS: Morphological features and PCR amplification of the 18S ribosomal RNA gene confirmed Rhabditis axei and Enterobius vermicularis as the pathogen of infection. CONCLUSIONS: Herein, we presented a case that confirmed Rhabditis axei and Enterobius vermicularis infection in humans can be associated with high eosinophilia.

An unusual case of hematuria in a French family returning from Corsica.

Urinary schistosomiasis caused by Schistosoma haematobium worms is endemic to tropical regions where it is the most common cause of hematuria. However, the intermediate snail hosts, Bulinus truncatus, have been described in Portugal, Spain, Sardinia, and Corsica. S. haematobium has long remained exotic to Europe, however, an outbreak of urinary schistosomiasis in Corsica started in 2011 with B. truncatus as the primary intermediate host. We describe the case of a 12-year-old French boy presenting hematuria and dysuria who was diagnosed with urinary schistosomiasis. Urine examination confirmed the presence of viable parasitic ova. He also had a positive serology. Since there was no history of travel to a schistosomiasis endemic region, the probable area of contamination was identified as the south of Corsica where the family had spent their summer holidays 7 months earlier. Two other family members had a positive serology without ova excretion in urine. The patients were treated with praziquantel. In light of these recent locally acquired cases in France, schistosomiasis should be considered in the differential diagnosis of hematuria, especially in patients who have recently visited Corsica.

Performance of three rapid screening methods in the detection of Schistosoma haematobium infection in school-age children in Southeastern Nigeria.

BACKGROUND: A cross-sectional study of primary school children was conducted to evaluate and compare the performance of some rapid screening methods in the detection of Schistosoma haematobium infection in Nigeria Cement Factory (NigerCem) and Nike Lake areas of Southeastern Nigeria. METHODS: Urine samples of school children were examined for macro-haematuria and tested for micro-haematuria and proteinuria using reagent strips followed by egg microscopy. Self-reported haematuria was assessed using simple questionnaire. The performances of these rapid diagnoses singly and in combination were calculated using egg microscopy as gold standard. RESULTS: The prevalence of the infection was 26·6% in NigerCem and 5·1% in Nike Lake area, classifying these areas as moderate- and low-prevalence areas (MPA and LPA); while in the subsample used for self-reported haematuria, the prevalence was 27·2 and 4·2% in MPA and LPA, respectively. The positive predictive value (PPV) of micro-haematuria was comparable in MPA (55·26%) and LPA (57·89%). Overall PPV of macro-haematuria was 87·50% in MPA and 66·70% in LPA while in the detection of heavy infection; PPV was higher in LPA (75%) than in MPA (66·67%). In LPA and MPA, combination of micro-haematuria and proteinuria, and concomitant presence of macro-haematuria, micro-haematuria, and proteinuria had PPV of 83·33 and 63·16%, and 100 versus 66·67%, respectively. Generally, the rapid screening tests had lower negative predictive values (NPVs) in MPA than in LPA. The use of simple questionnaire increased the PPV of heavy infection in MPA (77·78%). This was further increased to 80% when self-reported haematuria was combined with micro-haematuria. CONCLUSION: The result suggests that in MPA with chronic infections, combination of self-reported haematuria and micro-haematuria may reduce the chance of missing those who should be treated.

The unacknowledged impact of urinary schistosomiasis in children: 5 cases from Kumasi, Ghana.

Urinary schistosomiasis is a parasitic disease caused by Shistosoma haematobium. It is prevalent in several parts of Africa particularly in areas where there are large water bodies. In most affected communities, the condition is often accepted as normal since to them, all growing children pass blood in their urine and "grow out of it". Mass treatment of school children has been a regular exercise often undertaken by stake holders to decrease the disease burden and reduce transmission in selected communities. Urinary schistosomiasis can have devastating impact on the urinary tract which is often unacknowledged and unevaluated. Such omission could have implication for progressive renal damage which, if not detected and treated, could lead to end stage renal failure and death. We present five (5) cases of urinary schistosomiasis with severe obstructive uropathy seen at the paediatric nephrology/urology units of Komfo Anokye Teaching Hospital, Ghana. All five cases had some degree of anaemia and hypertension. Two of the five cases presented with end stage renal failure and died subsequently whilst two underwent successful surgery. One made a spontaneous recovery from the urinary obstruction though still has significant renal impairment. This potential devastating effect of urinary schistosomiasis on the kidneys calls for thorough evaluation and assessment of each confirmed case to include blood pressure measurement, full blood count, and ultrasonography of the urinary system. Mass screening programmes should be combined with portable ultrasonography of the kidneys, ureters and bladder.

Vesical schistosomiasis with terminal hematuria in sub-Saharan patients.

OBJECTIVES: To know the characteristics of vesical schistosomiasis caused by schistosoma hematobium in immigrant patients. MATERIAL AND METHODS: The retrospective study of 41 cases microbiologically diagnosed in our hospital over the last 16 years is presented. Data was collected on origin, age, presentation form, diagnostic tests and treatment. RESULTS: All were African patients whose ages ranged from 4 to 32 years and who had terminal macroscopic hematuria. Most of the patients (85%) were men. In all of the cases, diagnosis was by a urinary microbiological study and in one case, cystoscopy with a biopsy of a typical vesical lesion. Terminal hematuria is the most representative clinical sign. They were treated with praziquantel. CONCLUSIONS: The epidemiology and intermittent terminal hematuria in African patients should lead to the suspicion of vesical schistosomiasis as the first diagnostic option. Urinary microbiological study is a rapid, non-invasive, test with high diagnostic yield that would avoid performing invasive studies. Its simple treatment assures high level of compliance and consequent efficacy.

A rare case of urinary schistosomiasis in Turkey.

Schistosomiasis is a chronic, parasitic disease and is endemic in some countries, primarily in Africa, Latin America and Asia. In some regions, Schistosoma haematobium is one of the principal causes of haematuria. In Turkey, due to the increasing amount of travel to and from endemic regions, the number of cases is also rising. We report a case of a 22-year-old Nigerian male who was admitted to our hospital with haematuria. Direct microbiological examination revealed S. haematobium eggs in his urine specimen. Schistosomiasis was diagnosed by pathology testing. Schistosomiasis has not been seen frequently in Turkey, and we therefore discuss the epidemiology, treatment options and clinical importance of S. haematobium.

Efficacy of Praziquantel against Schistosoma haematobium in Dulshatalo village, western Ethiopia.

BACKGROUND: Praziquantel (PZQ) is the drug of choice for treatment of all human schistosomes. It is used in population based targeted or mass deworming strategies in several countries. The effect of PZQ on S. hematobium has not been studied in Ethiopia. The objective of this study was to determine the efficacy of PZQ against S. haematobium in Dulshatalo village, western Ethiopia. METHODS: A prospective study was conducted from October to December, 2007. Urine samples from 341 residents were collected and screened for haematuria and proteinuria using urinalysis dipstick. S. haematobium eggs were detected and quantified using filtration techniques. The participants who were positive for haematuria were treated with a standard dose of PZQ (40 mg/kg). Data on pre and 24 hours post treatment symptoms were collected via questionnaire. Urine samples were also collected 7 weeks after treatment and examined to assess the cure and the egg reduction rates. RESULTS: The prevalence of S. haematobium among the study participants was 57.8% (197/341). Haematuria was detected in 234 (68.6%) of the study participants. For PZQ efficacy asessment, 152 of the treated participants were considered. The presence of S. haemetaobium eggs showed statistically significant association (p < 0.05) with haematuria and proteinuria. Seven weeks post treatment, the extent of haematuria and proteinuria decreased from 100% to 40.8% and 94.07% to 48.7%, respectively. The cure and the parasitological egg reduction rates seven weeks post treatment were 86% and 85%, respectively. Post treatment symptoms revealed a wide range of side effects including straining, abdominal pain, nausea and headache. CONCLUSIONS: There were marked cure and egg reduction rates, together with mild and short lived side effects of PZQ for treatment of S. haematobium, in this study.

Schistosomiasis.

Schistosomiasis is a parasitic infection caused by flatworms (trematodes). It is second only to malaria in public health significance, with over 200 million people infected worldwide, leading to severe consequences in 20 million persons and 100,000 deaths, annually. There are four species that cause intestinal schistosomiasis: Schistosoma mansoni; Schistosoma japonicum, Schistosoma mekongi, and Schistosoma intercalatum. Schistosoma haematobium causes urinary schistosomias, and is endemic in Africa and the Middle East, with the greatest prevalence in poor rural areas. Fibrotic changes in the urinary tract can lead to hydroureter, hydronephrosis, bacterial urinary infections, and ultimately, kidney disease or eventually bladder cancer. A rare lesion can also arise in patients infected with Schistosomiasis haematobium, resulting in squamous and adenosquamous prostate cancers. Imported diseases, such as schistosomiasis, are entering the United States through immigration via illegal aliens, refugees, and travelers. Schistosomiasis is a neglected tropical disease, and its global health impact is grossly underestimated.

A rare parasitic infection in Turkey: schistosomiasis. Case report.

Schistosomiasis is a water-borne parasitic disease. It is endemic in tropical and subtropical countries mainly in Africa and the eastern Mediterranean region. We report a case of a 37-year-old male who attended our hospital for terminal hematuria and irritative voiding symptoms. Schistosoma haematobium eggs were found in his urine sediment. He underwent transurethral resection of the bladder. Pathological study confirmed the existence of vesical schistosomiasis. S. haematobium cases are rarely seen in Turkey. Epidemiological and clinical significance of S. haematobium has been discussed.

Performance of microhaematuria and proteinuria as measured by urine reagent strips in estimating intensity and prevalence of Schistosoma haematobium infection in Nigeria.

OBJECTIVE: To assess if microhaematuria and proteinuria as measured by reagent strips could estimate intensity of Schistosoma haematobium (S. haematobium) infection in endemic areas and evaluate their screening performance among children in Benue State, Nigeria. METHODS: A total of 1,124 urine samples were collected, screened for microhaematuria and proteinuria using reagent strips (Combi 9) and results were compared to filtration technique, the gold standard method. RESULTS: A significant correlation was observed between microhaematuria (rho= 0.66, P<0.01), proteinuria (rho = 0.71, P<0.01) and intensity of S. haematobium eggs. Proteinuria had sensitivity of 95.7% and specificity of 67.2%, while microhaematuria had sensitivity of 64.8% and specificity of 89.6%. The proportion of false positive diagnoses was higher in proteinuria (19.2%) than microhaematuria (6.0%). CONCLUSIONS: The findings suggest that use of urine reagent strips could potentially estimate intensity of S. haematobium infection and their performance to screen urinary schistosomiasis agreed with previous observations.

Clinical presentation and management of schistosomiasis at a hospital in a rural area in Nigeria.

BACKGROUND: Schistosomiasis is a parasitic infection affecting both adults and children. It occurs on contact with infected fresh water that harbours the intermediate host. It is a chronic disease and its urinary symptoms manifests as dysuria and haematuria. METHOD: This is a nine months prospective study of patients diagnosed and managed for urinary schistosomiasis at General Hospital Aliero, Nigeria from February to October 2006. The patients were followed up after presentation and commencement of therapy. RESULT: During the period of study, 35 patients were managed at the centre for urinary schistosomiasis. The patients presented with haematuria (13), dysuria (12), abdominal pain (4), fever (3), oliguria (2), polyuria (1), penile pain (1), and urethral discharge (1). The patients were managed with praziquantel. CONCLUSION: Haematuria and dysuria were the main symptoms of urinary schistosomiasis. There is need for mass treatment of schistosomiaisis in affected areas. Regular continuous education and campaign against schistosomiasis is necessary for control ofthe disease.