Associations between infection intensity categories and morbidity prevalence in school-age children are much stronger for Schistosoma haematobium than for S. mansoni.

BACKGROUND: World Health Organization (WHO) guidelines for measuring global progress in schistosomiasis control classify individuals with Schistosoma spp. infections based on the concentration of excreted eggs. We assessed the associations between WHO infection intensity categories and morbidity prevalence for selected S. haematobium and S. mansoni morbidities in school-age children. METHODOLOGY: A total of 22,488 children aged 6-15 years from monitoring and evaluation cohorts in Burkina Faso, Mali, Niger, Uganda, Tanzania, and Zambia from 2003-2008 were analyzed using Bayesian logistic regression. Models were utilized to evaluate associations between intensity categories and the prevalence of any urinary bladder lesion, any upper urinary tract lesion, microhematuria, and pain while urinating (for S. haematobium) and irregular hepatic ultrasound image pattern (C-F), enlarged portal vein, laboratory-confirmed diarrhea, and self-reported diarrhea (for S. mansoni) across participants with infection and morbidity data. PRINCIPAL FINDINGS: S. haematobium infection intensity categories possessed consistent morbidity prevalence across surveys for multiple morbidities and participants with light infections had elevated morbidity levels, compared to negative participants. Conversely, S. mansoni infection intensity categories lacked association with prevalence of the morbidity measures assessed. CONCLUSIONS/SIGNIFICANCE: Current status infection intensity categories for S. haematobium were associated with morbidity levels in school-age children, suggesting urogenital schistosomiasis morbidity can be predicted by an individual's intensity category. Conversely, S. mansoni infection intensity categories were not consistently indicative of childhood morbidity at baseline or during the first two years of a preventive chemotherapy control program.

Occurrence of human urogenital myiasis due to neglected personal hygiene: a review.

Myiasis, the infestation of tissues or organs of vertebrate animals with dipteran larvae, is a common parasitic problem among domestic and wild mammals. The condition, which is also witnessed in humans, is relatively frequent in rural areas where people are in close contact with domestic animals. It is a subject of medical and veterinary importance, particularly in tropical and subtropical regions of the world. Human myiasis is generally encountered in open neglected wounds but can also affect body orifices with foetid discharge, such as the oral cavity, eyes, ears, anus and urogenital tract. Urogenital myiasis involves infestation of the urinary tract, as well as genital organs such as vaginal or penile orifices, with fly larvae. The condition is a rare among humans inhabiting developed countries but relatively more common in patients of low socio-economic status with poor hygienic conditions in developing countries. Damage varies from superficial to massive infestation, which may result in severe problems or even death of the individual. In the present study, the authors reviewed the past literature describing the cases of human urogenital myiasis, causative fly species and risk factors. The aim of the present article is to document the predisposing risk factors and provide guidelines for prevention and control of urogenital myiasis among humans. Besides poor genital hygienic conditions, other factors leading to urogenital myiasis include psychiatric disorders, the use of urinary catheters and uterine prolapse. Prevention of the condition is of utmost importance and involves the dressing and covering of open wounds, maintaining proper personal hygiene and control of fly populations.

Ortholinea concentrica n. sp. (Cnidaria: Myxozoa) from the Patagonian seabass Acanthistius patachonicus (Jenyns, 1840) (Perciformes: Serranidae) off Patagonia, Argentina.

The Patagonian seabass Acanthistius patachonicus (Jenyns, 1840) (Serranidae) is a marine fish valued for commercial and sport fisheries from Argentina. We report a new myxosporean (Cnidaria: Myxozoa) infecting the urinary system of the Patagonian seabass from San Antonio Bay, San Matías Gulf, on the Atlantic Ocean. The mature myxospores were subspherical, 8.2-11.0 µm × 7.9-11.0 µm and 7.7-9.0 µm in thickness; two subspherical polar capsules, 2.4-3.8 µm × 2.3-3.6 µm, with 3 to 4 turns of the polar tubule; openings on different valves in almost opposite directions. Ornamented shell valves exhibited 17-20 concentrically organized surface ridges. SSU rDNA phylogenetics analyses placed the new species in the freshwater urinary tract clade, clustering in a clade formed by Myxobilatus gasterostei (Parisi, 1912), Acauda hoffmani Whipps, 2011, and other Ortholinea spp. Based on spore morphology, site of infection, and molecular data, we described this myxozoan as Ortholinea concentrica n. sp.

Urogenital schistosomiasis and hybridization between Schistosoma haematobium and Schistosoma bovis in adults living in Richard-Toll, Senegal.

Since the construction of the Diama Dam (1985), the epidemiology of schistosomiasis along the Senegal River Basin (SRB) has been extremely dynamic with outbreaks of both intestinal and urogenital schistosomiasis. In the early 2000s, technicians reported cases of suspected urogenital schistosomiasis in adults from the local hospital in Richard-Toll, Lower SRB. The genetic analysis of schistosome miracidia isolated from 11 patients in 2012 from two neighbourhoods (Campement and Gaya) of Richard-Toll confirmed infection with Schistosoma haematobium but also S. haematobium/S. bovis hybrids. Thirty-seven per cent of the miracidia were S. bovis/S. haematobium hybrids and 63% were pure S. haematobium. The data are discussed in relation to the ongoing dynamic epidemiology of the schistosomes in Senegal and the need to treat non-target individuals.

Ultrasound findings and associated factors to morbidity in Schistosoma haematobium infection in a highly endemic setting.

OBJECTIVE: To evaluate the usefulness of the WHO classification of ultrasound pathological changes and to establish risk factors for morbidity in a highly endemic setting. METHODS: One hundred and fifty-seven ultrasounds were performed on school-aged children previously diagnosed with urinary schistosomiasis in Cubal, Angola. The findings were analysed according to the WHO guidelines. Factors for morbidity were studied. RESULTS: Mean age of the children was 8.7 (SD 3.2) years. Pathological changes were found in 85.3% (84.7% in the bladder, 34.4% the ureter and 6.3% kidney lesions). The global score according to the WHO classification was 5.74. Male gender [OR 2.61 (1.04-6.58); P 0.043] and older age [OR 2.96 (1.17-7.46); P 0.023] were associated with a higher risk of developing any kind of urinary abnormality. Proteinuria was present in 61.7% of the children. Macroscopic haematuria [OR 2.48 (1.11-5.58); P = 0.02)] and a high level of proteinuria > 300 mg/dl [OR 5.70 (2.17-14.94); P 300 mg/dl)] were associated with abnormalities of the upper urinary tract and showed good positive and negative predictive values for the detection of pathology in the upper urinary tract (65.5% and 71.1%, respectively). CONCLUSIONS: Severe urinary tract pathology was found in a high percentage of the children in our setting. Microhaematuria and proteinuria were good markers of morbidity, proteinuria being more precise for severe alterations of the upper urinary tract. We suggest initial and evolutive ultrasound in children diagnosed with schistosomiasis, and close monitoring including periodic controls. As schistosomiasis control efforts are currently focused on reducing morbidity, tests that detect the presence or degree of morbidity are essential for targeting treatment and tracking the progress of control campaigns.

Prevalence and factors associated with urogenital schistosomiasis among primary school children in barrage, Magba sub-division of Cameroon.

BACKGROUND: The purpose of this study was to determine the prevalence and intensity as well as the factors associated with urogenital schistosomiasis (US) in Barrage, a rural community around the Mape΄ dam, in the West region of Cameroon not previously documented for transmission. METHODS: In this cross sectional parasitological survey, 382 children were enrolled from three primary schools in the study area between March and May 2016. A semi-structured questionnaire was used to collect information on demographics, clinical and predisposing factors. The syringe filtration technique was used to analyse urine samples. Samples with visible or gross haematuria were recorded prior to filtration. The Pearson chi-square, the student T-test and logistic regression were all performed as part of the statistical analyses. RESULTS: The overall prevalence of US was 41.1% (95% CI: 36.1-46.2). Infection was more common in children below 10 years (p = 0.009), in males (p = 0.029), and in children who frequently come into contact with water from the dam (p < 0.001). Furthermore, US was more common in children attending Ecole Public (EP) Manbonko Bord (81.1%, p < 0.001) which is very close to the dam and in children from a fishing background (80.9%, p < 0.001). On the contrary, knowledge about schistosomiasis was not observed to be associated with prevalence. In this study, the intensity of infection was observed to be higher in children below 10 years (p < 0.001), in males (p = 0.001), and in children attending EP Manbonko Bord (p < 0.001). The intensity of infection was also highest in children presenting with haematuria (p < 0.001). Frequent contact with water from the dam and having parents whose occupation was fishing were identified as the associated factors for US. CONCLUSION: A high prevalence of US was observed in school-aged children in the study area especially in those attending EP Manbonko Bord. Limiting contact with water from the dam, control of the snail intermediate host, provision of portable water and mass treatment of the entire population are proposed as some of the measures to reduce and eventually eliminate transmission in the area.

Case-Control Study of Posttreatment Regression of Urinary Tract Morbidity Among Adults in Schistosoma haematobium-Endemic Communities in Kwale County, Kenya.

Previous population-based studies have examined treatment impact on Schistosoma-associated urinary tract disease among children, but much less is known about longer-term treatment benefits for affected adult populations in areas where risk of recurrent infection is high. In communities in Msambweni, along the Kenya coast, we identified, using a portable ultrasound, 77 adults (aged 17-85) with moderate-to-severe obstructive uropathy or bladder disease due to Schistosoma haematobium. Treatment response was assessed by repeat ultrasound 1-2 years after praziquantel (PZQ) therapy and compared with interval changes among age- and sex-matched infected/treated control subjects who did not have urinary tract abnormalities at the time of initial examination. Of the 77 affected adults, 62 (81%) had improvement in bladder and/or kidney scores after treatment, 14 (18%) had no change, and one (1.3%) had progression of disease. Of the 77 controls, 75 (97%) remained disease free by ultrasound, while two (3%) had apparent progression with abnormal findings on follow-up examination. We conclude that PZQ therapy for S. haematobium is effective in significantly reducing urinary tract morbidity from urogenital schistosomiasis among adult age groups, and affected adults stand to benefit from inclusion in mass treatment campaigns.

Estrogen-like metabolites and DNA-adducts in urogenital schistosomiasis-associated bladder cancer.

An estrogen-DNA adduct mediated pathway may be involved in the pathogenesis of the squamous cell carcinoma of the bladder associated with infection with the blood fluke Schistosoma haematobium. Extracts from developmental stages of S. haematobium, including eggs, induce tumor-like phenotypes in cultured cells. In addition, estrogen-derived, reactive metabolites occur in this pathogen and in sera of infected persons. Liquid chromatography-mass spectrometry analysis was performed on urine from 40 Angolans diagnosed with urogenital schistosomiasis (UGS), half of who also presented UGS-associated squamous cell carcinoma and/or urothelial cell carcinoma. The analysis revealed numerous estrogen-like metabolites, including seven specifically identified in UGS cases, but not reported in the database of metabolites in urine of healthy humans. These schistosome infection-associated metabolites included catechol estrogen quinones (CEQ) and CEQ-DNA-adducts, two of which had been identified previously in S. haematobium. In addition, novel metabolites derived directly from 8-oxo-7, 8-dihydro-2'-deoxyguanosine (8-oxodG) were identified in urine of all 40 cases of UGS. These metabolites can be expected to provide deeper insights into the carcinogenesis UGS-induced bladder cancer, and as biomarkers for diagnosis and/or prognosis of this neglected tropical disease-linked cancer.

Urinary estrogen metabolites and self-reported infertility in women infected with Schistosoma haematobium.

BACKGROUND: Schistosomiasis is a neglected tropical disease, endemic in 76 countries, that afflicts more than 240 million people. The impact of schistosomiasis on infertility may be underestimated according to recent literature. Extracts of Schistosoma haematobium include estrogen-like metabolites termed catechol-estrogens that down regulate estrogen receptors alpha and beta in estrogen responsive cells. In addition, schistosome derived catechol-estrogens induce genotoxicity that result in estrogen-DNA adducts. These catechol estrogens and the catechol-estrogen-DNA adducts can be isolated from sera of people infected with S. haematobium. The aim of this study was to study infertility in females infected with S. haematobium and its association with the presence of schistosome-derived catechol-estrogens. METHODOLOGY/PRINCIPAL FINDINGS: A cross-sectional study was undertaken of female residents of a region in Bengo province, Angola, endemic for schistosomiasis haematobia. Ninety-three women and girls, aged from two (parents interviewed) to 94 years were interviewed on present and previous urinary, urogenital and gynecological symptoms and complaints. Urine was collected from the participants for egg-based parasitological assessment of schistosome infection, and for liquid chromatography diode array detection electron spray ionization mass spectrometry (LC/UV-DAD/ESI-MSn) to investigate estrogen metabolites in the urine. Novel estrogen-like metabolites, potentially of schistosome origin, were detected in the urine of participants who were positive for eggs of S. haematobium, but not detected in urines negative for S. haematobium eggs. The catechol-estrogens/ DNA adducts were significantly associated with schistosomiasis (OR 3.35; 95% CI 2.32-4.84; P≤0.001). In addition, presence of these metabolites was positively associated with infertility (OR 4.33; 95% CI 1.13-16.70; P≤0.05). CONCLUSIONS/SIGNIFICANCE: Estrogen metabolites occur widely in diverse metabolic pathways. In view of the statistically significant association between catechol-estrogens/ DNA adducts and self-reported infertility, we propose that an estrogen-DNA adduct mediated pathway in S. haematobium-induced ovarian hormonal deregulation could be involved. In addition, the catechol-estrogens/ DNA adducts described here represent potential biomarkers for schistosomiasis haematobia.

Vesical paragonimiasis diagnosed by histopathology: a case report.

Vesical paragonimiasis is an extremely rare form of ectopic infestation caused by Paragonimus spp. We reported a case of vesical paragonimiasis associated with urinary symptoms but without history of respiratory symptoms or cercarial dermatitis. The diagnosis was made by histopathological examination of the surgical specimens of the vesical masses. Identification of the species by morphometric analysis of the fluke body sections indicated that the vesical lesion was caused by Paragonimus. Postsurgical medication with the antiparasitic drug praziquantel was applied regularly, and the patient experienced a stable recovery.

Life cycle of Renylaima capensis, a brachylaimid trematode of shrews and slugs in South Africa: two-host and three-host transmission modalities suggested by epizootiology and DNA sequencing.

BACKGROUND: The life cycle of the brachylaimid trematode species Renylaima capensis, infecting the urinary system of the shrew Myosorex varius (Mammalia: Soricidae: Crocidosoricinae) in the Hottentots Holland Nature Reserve, South Africa, has been elucidated by a study of its larval stages, epizootiological data in local snails and mammals during a 34-year period, and its verification with mtDNA sequencing. METHODS: Parasites obtained from dissected animals were mounted in microscope slides for the parasitological study and measured according to standardized methods. The mitochondrial DNA cox1 gene was sequenced by the dideoxy chain-termination method. RESULTS: The slugs Ariostralis nebulosa and Ariopelta capensis (Gastropoda: Arionidae) act as specific first and second intermediate hosts, respectively. Branched sporocysts massively develop in A. nebulosa. Intrasporocystic mature cercariae show differentiated gonads, male terminal duct, ventral genital pore, and usually no tail, opposite to Brachylaimidae in which mature cercariae show a germinal primordium and small tail. Unencysted metacercariae, usually brevicaudate, infect the kidney of A. capensis and differ from mature cercariae by only a slightly greater size. The final microhabitats are the kidneys and ureters of the shrews, kidney pelvis and calyces in light infections and also kidney medulla and cortex in heavy infections. Sporocysts, cercariae, metacercariae and adults proved to belong to R. capensis by analysis of a 437-bp-long cox1 fragment, which was identical except for three mutations in metacercariae, of which only one silent. Epizootiological studies showed usual sporocyst infection in A. nebulosa and very rare metacercarial infection in A. capensis, which does not agree with high prevalences and intensities in the shrews. CONCLUSIONS: The presence of monotesticular adult forms and larval prevalences and intensities observed suggest that R. capensis may use two transmission strategies, a two-host life cycle by predation of A. nebulosa harbouring intrasporocystic cercariae may be the normal pattern, whereas a second mollusc host is just starting to be introduced. In shrews, a tissue-traversing, intraorganic migration followed by an interorganic migration to reach and penetrate the outer surface of either of both kidneys should occur. For first slug infection, the fluke takes advantage of the phenomenon that M. varius always urinate during defaecation. Consequently, in Brachylaimidae, the second intermediate mollusc host should evolutionarily be seen as a last addition to the cycle and their present adult stage microhabitat restricted to digestive tract and related organs as a loss of the tissue-traversing capacity of the metacercaria.

Urologic complications of genitourinary schistosomiasis.

OBJECTIVES: To provide systematic review of the literature on the long-standing complications of genitourinary schistosomiasis. MATERIALS AND METHODS: The PubMed literature database was searched from inception to December 2010. The following keywords were used: schistosomiasis, bilharziasis, and genitourinary. Only English language publications were utilized. RESULTS: Variable tissue reactions to bilharzial eggs with subsequent healing or progression and complications in the urinary tract mainly affect the urinary bladder and pelvic segments of the ureters. These lesions may assume an atrophic, proliferative, or neoplastic pattern. Although the pathology is usually extensive in the submucosal, all layers from the mucous membrane through deep to the perivesical or periureteral tissues may be involved. Main fixed bilharzial urologic sequelae include chronic bladder ulcers, leucoplakia, vesical granuloma, contracted bladder, bladder neck contracture, stricture ureters, and bladder carcinoma. These sequelae may lead to marked morphologic and functional changes of the urinary tract, and ultimately, mortality can follow from renal failure or bladder cancer. CONCLUSIONS: Urinary schistosomiasis is a preventable disease through nationwide snail control and mass therapy with oral antibilharzial drugs. If not properly treated, long-standing urinary complications may result in serious sequelae that may lead to mortality from renal failure or bladder cancer.

Learning curve of vesico-urinary ultrasonography in Schistosoma haematobium infection with WHO practical guide: a "simple to learn" examination.

In developing countries, it is difficult to rally a radiologist to conduct field studies. Here, we report how a radiologist taught a clinician to carry out the ultrasound examination as defined by the World Health Organization (WHO) record sheet for Schistosoma haematobium related lesions. In a population infected with S. haematobium, the learner and teacher performed two ultrasound exams and the results were compared. One hundred thirty-two children were prospectively included, during 8 ultrasonography sessions split over 23 days. After 51 examinations the learner's sensitivity was above 90%. After the fifth session the specificity reached 100% (results remained stable until the end of the study period). This study shows that a clinician can quickly learn how to carry out a simple ultrasound examination to gather the items needed for the follow-up of S. haematobium related lesions, suggesting that clinicians could implement networks of ultrasound-based surveillance on the field.

Renylaima capensis n. gen., n. sp. (Trematoda: Brachylaimidae) from the urinary system of the shrew Myosorex varius Smuts, 1832 (Insectivora: Soricidae).

A trematode species belonging to the family Brachylaimidae was found in the kidneys and ureters of the forest shrew Myosorex varius (Insectivora: Soricidae: Crocidosoricinae) in a restricted, very damp area of the Hottentots Holland Mountain range, near Cape Town, South Africa. The adult stage is described anatomically and histologically. The relative frequency of monotesticular forms is highlighted. A comparison is made with other brachylaimid species known to infect shrews and other peculiar brachylaimids from poikilothermic invertebrates and vertebrates with which the South African species shares several aspects. Peculiar characteristics such as absence of a cirrus pouch and cirrus and presence of a genital atrium that can be evaginated to produce a prominent ventral extention of the body, as well as the fact that the urinary system of a mammal host is an extraordinary microhabitat for a trematode, indicate that this digenean represents a new genus and species for which the name Renylaima capensis n. gen., n. sp. is proposed.

Risk factors for Schistosoma haematobium infection and morbidity in two villages with different transmission patterns in Niger.

A better control of major neglected tropical diseases such as schistosomiasis is urgently needed to reduce their impact on public health in developing countries. To optimize the efficiency of intervention campaigns, we assessed the influence of individual human factors on the level of Schistosoma haematobium infection and morbidity in a typical Sahelian country (Niger). Random samples of 246 and 257 individuals were selected from general census in two villages with distinct patterns of schistosome transmission. One village (Lossa) is located in an area of perennial transmission whereas transmission is seasonal in the other village (Tara). Despite comparable levels of both egg excretion and lower tract pathology in the two villages, the inhabitants of Lossa had a higher risk (OR: 2.1, 95% CI: 1.1-3.9) of developing upper tract lesions compared to those living in Tara. In both villages, bladder lesions were more serious in males than in females. Children between 7 and 15 years old were the most at risk to experience heavy infections (OR: 3.4, 95% CI: 2.1-5.7), bladder (OR: 4.5, 95% CI: 2.6-7.8) and upper tract (OR: 10.4, 95% CI: 2.4-45.0) lesions, independently of gender and village. These results confirm that targeted intervention campaigns should include foci regardless of their schistosome transmission pattern and focus on the school-aged population.

A comparison of urinary tract pathology and morbidity in adult populations from endemic and non-endemic zones for urinary schistosomiasis on Unguja Island, Zanzibar.

BACKGROUND: Renal tract involvement is implicated in both early and late schistosomiasis leading to increased disease burden. Despite there being good estimates of disease burden due to renal tract disease secondary to schistosomiasis at the global level, it is often difficult to translate these estimates into local communities. The aim of this study was to assess the burden of urinary tract pathology and morbidity due to schistosomiasis in Zanzibar and identify reliable clinical predictors of schistosomiasis associated renal disease. METHODS: A cross-sectional comparison of Ungujan men and women living within either high or low endemic areas for urinary schistosomiasis was conducted. Using urine analysis with reagent strips, parasitological egg counts, portable ultrasonography and a qualitative case-history questionnaire. Data analysis used single and multiple predictor variable logistic regression. RESULTS: One hundred and sixty people were examined in the high endemic area (63% women and 37% men), and 101 people in the low endemic area (61% women and 39% men). In the high endemic area, egg-patent schistosomiasis and urinary tract pathology were much more common (p = 1 x 10-3, 8 x 10-6, respectively) in comparison with the low endemic area. Self-reported frothy urine, self-reported haematuria, dysuria and urgency to urinate were associated with urinary tract pathology (p = 1.8 x 10-2, p = 1.1 x 10-4, p = 1.3 x 10-6, p = 1.1 x 10-7, respectively) as assessed by ultrasonography. In a multi-variable logistic regression model, self-reporting of schistosomiasis in the past year, self-reporting of urgency to urinate and having an egg-positive urine sample were all independently associated with detectable urinary tract abnormality, consistent with schistosomiasis-specific disease. Having two or more of these features was moderately sensitive (70%) as a predictor for urinary tract abnormality with high specificity (92%). CONCLUSION: Having two out of urgency to urinate, self reporting of previous infections and detection of eggs in the urine were good proxy predictors of urinary tract abnormality as detected by ultrasound.

Parasites of urological importance.

With the world increasingly becoming a global village, transnational and transcontinental migration has become the order of the day. It is expected that migrants will take with them some diseases (including parasites) which are normally endemic in their countries of origin, to their host countries. Similarly, environmental changes that result from development of water resources, global warming, growth and migration of population can facilitate the spread of parasites. In this review we describe the epidemiology, presentation, diagnosis and treatment options of parasites that urologists may encounter. Notably among these parasites are Schistosoma haematobium, Echinococcus granulosus, Wuchereria bancrofti and Onchocerca volvulus.

Urinary tract pathology in Schistosoma haematobium infected rural Nigerians.

Parasitological investigation assessing the ova of Schistosoma haematobium in the urine of 138 volunteers in Ihieve-Ogben, Edo State, Nigeria revealed 43 positive results (31.2%). Children had a higher prevalence of urinary schistosomiasis 30 (41.1%) than their adult counterparts 13 (20.0%) and this difference was statistically significant (t = 8.89, p > 0.01). More volunteers had light intensity of infection 27 (19.6%) than heavy infection 16 (11.6%) and this difference was statistically significant (chi2 = 22.90, p>0.05). Ultrasonographic investigations carried out on these 43 S. haematobium infected volunteers revealed ten pathological conditions, including abnormal wall thickness 24 (55.8%), abnormal shape 30 (69.8%), irregular bladder wall 12 (27.9%), masses 10 (23.3%), pseudopolyps 2 (4.7%), echogenic particles 30 (69.8%), residual volume 12 (27.9%), calcifications 24 (55.8%), hydroureter 10 (23.3%) and hydronephrosis 8 (18.6%) when compared to control subjects which lacked bladder and kidney abnormalities. These pathological conditions were slightly more common in the volunteers with heavy infection than those with light infection, but this difference was not statistically significant (t = -2.19, p < 0.02). More pathological conditions were found in children than in adults; this finding was statistically significant (t = 3.23, p > 0.03). Hydronephrosis and hydroureter were not found in the volunteers with light intensity of infection.

Surgical pathology of schistosomiasis.

Schistosomiasis remains an important health problem in many tropical countries and is being seen with increasing frequency in immigrant populations and tourists in developed countries. The pattern of organ involvement and clinical presentation of schistosomiasis in 80 patients (male: female, 9:1) during a five-year period (2001-2005) was examined from archival histopathology records. The urinary bladder was the most common organ affected [50 (62.5%)]. Gastrointestinal, male and female genital schistosomiasis were detected in 12 (15%), eight (10%) and five (6.1%) cases, respectively. Hematuria was the most common presenting symptom [34 (42.5%)], and bladder cancer was the only malignancy found to be associated with the infection. A high clinical index of suspicion usually allows for a preoperative diagnosis where indicated and avoidance of radical surgery. While research for the development of an effective vaccine continues, a plea is made for the expansion of multinational control programs in sub-Saharan Africa.