Case Report of Urinary Schistosomiasis in a Returned Traveler in Korea.

A 23-year-old Korean woman with a residence history in Kenya and Malawi for about 2 years presented with gross hematuria for 1 month. Blood tests were within normal range except eosinophilia. Asymmetrically diffuse wall thickening and calcification were observed at the urinary bladder on CT. Multiple erythematous nodular lesions were observed in the cystoscopy and transurethral resection was done. Numerous eggs of Schistosoma haematobium with granulomatous inflammation were observed in the submucosal layer of the bladder. The patient was diagnosed with schistosomiasis-related cystitis and treated with praziquantel (40 mg/kg/day) twice before and after transurethral resection. This case suggests that S. haematobium infection should be considered as a cause of hematuria in Korea when the patient had a history of traveling endemic areas of schistosomiasis.

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.

Diagnosis and Clinical Management of Schistosoma haematobium-Schistosoma bovis Hybrid Infection in a Cluster of Travelers Returning From Mali.

Ten Belgian travelers returned from Mali with a Schistosoma haematobium-Schistosoma bovis hybrid infection, confirmed by DNA sequencing from eggs. Clinical symptoms and laboratory findings resembled those of classic acute schistosomiasis, but the detected eggs were morphologically unusual.

Testicular Schistosomiasis Mimicking Malignancy in a Child: A Case Report.

Schistosomiasis is an important communicable disease in the developing world. However, testicular schistosomiasis is an extremely rare condition. We report a case of testicular schistosomiasis mimicking testicular tumour in a 13 year old who presented with huge unilateral testicular mass. The dilemma encountered in the diagnosis and treatment of this child is presented to highlight the need for high index of suspicion of this pathology in children with testicular mass presenting from schistosomiasis-endemic areas.

[Clinical manifestations and treatment of schistosomiasis hematobia].

Schistosomiasis hematobia is one major human schistosomiasis. The disease is endemic in Africa and Mediterra- nean region, and is the main cause of urogenital diseases. Although only Schistosoma japonicum is spreading across the Mainland China, now more schistosomiasis hematobia cases are reported among aid projects and migrant workers to Africa, with the economy development and the increasing degree of foreign exchanges. Meanwhile, the relevant clinical data of.schistosomiasis hematobia are rare in China. This article reviews the clinical manifestations and progress in diagnosis and treatment of the disease.

Schistosomiasis-an endemic parasitic waterborne disease.

Schistosomiasis (or bilharzia) is a chronic waterborne disease caused by parasitic worms or schistosoma in the tropics and sub tropics. Five main species exist, and common to all is its transmission to humans as a result of exposure to infested fresh water, into which the cercariae of the parasite are released by freshwater snails. With the rise of tourism and travel, more people are travelling to countries where schistosomiasis is a risk. Schistosoma haematobium is responsible for urogenital schistosomiasis, in which manifestations range from acute hypersensitivity reactions to bladder disease in the detection of which the nurse cystoscopist can have a significant role. Treatment is highly effective, and the diagnosis should be considered in individuals with possible clinical illness who have travelled to or lived in endemic areas.

Protective immunity to Schistosoma haematobium infection is primarily an anti-fecundity response stimulated by the death of adult worms.

Protective immunity against human schistosome infection develops slowly, for reasons that are not yet fully understood. For many decades, researchers have attempted to infer properties of the immune response from epidemiological studies, with mathematical models frequently being used to bridge the gap between immunological theory and population-level data on schistosome infection and immune responses. Here, building upon earlier model findings, stochastic individual-based models were used to identify model structures consistent with observed field patterns of Schistosoma haematobium infection and antibody responses, including their distributions in cross-sectional surveys, and the observed treatment-induced antibody switch. We found that the observed patterns of infection and antibody were most consistent with models in which a long-lived protective antibody response is stimulated by the death of adult S. haematobium worms and reduces worm fecundity. These findings are discussed with regard to current understanding of human immune responses to schistosome infection.

[A western cohort of urinary schistosomiasis]. / Bilharziose urinaire : une série française.

UNLABELLED: Urinary schistosomiasis is very frequent, but there are few data upon its epidemiology in western countries. We wanted to describe the cohort from Tenon hospital, in Paris, France, near a big subsaharian community. METHODS: We searched in our clinical files database for "urinary schistosomiasis" encoding. RESULTS: The cohort comprised 207 men and 34 women seen for the first time at the mean age of 34, mainly for haematuria or LUTS. Patients were mainly native from subsaharian Africa. The lost to follow up rate was 54%. Diagnosis was made on sole endoscopic finding in half of the cases. For non-tumor pathology, were made seven cystoplasties et 12 ureteral dilations. Tumoral pathology was frequent and severe (15/81 from the same age range), mainly represented by urothelial histology (8/14). Imported cases were rare (five cases). CONCLUSION: Despite its limitations, different characteristics from this cohort seemed noticeable: frequency of sole lower urinary tract symptoms, frequency and severity of tumoral diseases, mainly with urothelial carcinoma as histology.

Safety and immunogenicity of rSh28GST antigen in humans: phase 1 randomized clinical study of a vaccine candidate against urinary schistosomiasis.

BACKGROUND: Treatment of urinary schistosomiasis by chemotherapy remains challenging due to rapid re-infection and possibly to limited susceptibility to praziquantel treatment. Therefore, therapeutic vaccines represent an attractive alternative control strategy. The objectives of this study were to assess the safety and tolerability profile of the recombinant 28 kDa glutathione S-transferase of Schistosoma haematobium (rSh28GST) in healthy volunteers, and to determine its immunogenicity. METHODOLOGY: Volunteers randomly received 100 µg rSh28GST together with aluminium hydroxide (Alum) as adjuvant (n = 8), or Alum alone as a comparator (n = 8), twice with a 28-day interval between doses. A third dose of rSh28GST or Alum alone was administered to this group at day 150. In view of the results obtained, another group of healthy volunteers (n = 8) received two doses of 300 µg of rSh28GST, again with a 28-day interval. A six-month follow-up was performed with both clinical and biological evaluations. Immunogenicity of the vaccine candidate was evaluated in terms of specific antibody production, the capacity of sera to inhibit enzymatic activity of the antigen, and in vitro cytokine production. PRINCIPAL FINDINGS: Among the 24 healthy male participants no serious adverse events were reported in the days or weeks after administration. Four subjects under rSh28GST reported mild reactions at the injection site while a clinically insignificant increase in bilirubin was observed in 8/24 subjects. No hematological nor biochemical evidence of toxicity was detected. Immunological analysis showed that rSh28GST was immunogenic. The induced Th2-type response was characterized by antibodies capable of inhibiting the enzymatic activity of rSh28GST. CONCLUSIONS: rSh28GST in Alum did not induce any significant toxicity in healthy adults and generated a Th2-type immune response. Together with previous preclinical results, the data of safety, tolerability and quality of the specific immune response provide evidence that clinical trials with rSh28GST could be continued in humans as a potential vaccine candidate against urinary schistosomiasis.

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.

Testicular schistosomiasis: a case report.

AIMS AND OBJECTIVES: To report a case of testicular Schistosomiasis with a suspicion of testicular cancer. PATIENT AND METHODS: Hospital record of a 16 year old patient with histopathology confirmation of testicular Schistosomiasis was reviewed and summarised. The patient who had painless testicular nodules and ultrasound features of heterogenous echotexture and hypoechoic focus was diagnosed as testicular cancer and treated with radical orchidectomy. Histopathology confirmed testicular Schistosomiasis and the patient had additional praziquantel therapy. RESULTS: Patient was followed up for over 26months post-operative. CONCLUSIONS: Testicular Schistosomiasis can mimick malignant testicular tumour. Hard nodular testicular mass in a patient with recent past history of schistosomiasis should arouse suspicion of testicular Schistosomiasis. Awareness and early presentation will prevent unwarranted orchidectomy.

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.

[Bilharziasis and urinary lithiasis: a study of 23 cases at the Gabriel Toure Hospital]. / Bilharziose urinaire et lithogenese: etude de 23 cas au CHU Gabriel Toure.

AIMS: Describe the clinical and therapeutic aspects of urinary stone on bilharziosis in the teaching hospital Gabriel Toure. METHOD: It was about a prospective study done from January 1st to December 31, 2007 on all patients presenting a urinary stone with history of bilharziosis treated in the service of urology at the teaching hospital Gabriel Toure. Lost patients during the study were not included. RESULTS: We brought together 23 cases of urinary stone on history of urinary bilharziosis. The mean age of our patients was 31 years with extreme of 10 and 64 years. Sex-ratio was 22 for men. Renal colic was the most frequent motive of consultation (30.4%). Fiver has been detected in 56.5% of cases.Stone has a renal localisation in 10 patients (43.5%), ureteral in 9 patients (39.1%) and vesical in 4(17.4%). Urine analysis has found following germs: Schistosoma haematobium (4 cases), positive cocci gram (3 cases), Enterococcus faecalis (1 case) and negative cocci gram (1 case). Moderate renal insufficiency has been detected in 4 patients (17.4%). Treatment has been surgical in 21 patients(91.3%). Nephrolithotomy was done in 7 patients (33.3%), ureterolithotomy in 7 others, cystolithotomyin 3 patients (14.3%), nephrectomy in 2 patients (9.5%), uretero-vesical reimplantation in 2 others. CONCLUSION: The assessment of bilharziosis may decrease the frequency and prevent numerous and disastrous complications of urinary bilharziosis.

Increased iron stores correlate with worse disease outcomes in a mouse model of schistosomiasis infection.

Schistosomiasis is a significant parasitic infection creating disease burden throughout many of the world's developing nations. Iron deficiency anemia is also a significant health burden resulting from both nutritional deficit as well as parasitic infection in these countries. In this study we investigated the relationships between the disease outcomes of Schistosoma japonicum infection and iron homeostasis. We aimed to determine if host iron status has an effect on schistosome maturation or egg production, and to investigate the response of iron regulatory genes to chronic schistosomiasis infection. Wild-type C57BL/6 and Transferrin Receptor 2 null mice were infected with S. japonicum, and sacrificed at the onset of chronic disease. Transferrin Receptor 2 null mice are a model of type 3 hereditary hemochromatosis and develop significant iron overload providing increased iron stores at the onset of infection. The infectivity of schistosomes and egg production was assessed along with the subsequent development of granulomas and fibrosis. The response of the iron regulatory gene Hepcidin to infection and the changes in iron status were assessed by real-time PCR and Western blotting. Our results show that Hepcidin levels responded to the changing iron status of the animals, but were not significantly influenced by the inflammatory response. We also show that with increased iron availability at the time of infection there was greater development of fibrosis around granulomas. In conclusion, our studies indicate that chronic inflammation may not be the primary cause of the anemia seen in schistosomiasis, and suggest that increased availability of iron, such as through iron supplementation, may actually lead to increased disease severity.

Height as a Surrogate for Bodyweight for Estimating the Dosage of Praziquantel and Artesunate in theTreatment of Urinary Schistosomiasis in School-Age Children

World Health Organization recommends mass treatment of all school children in areas where the prevalence of schistosomiasis is greater than 50. Praziquantel and artesunate are reported to display broad-spectrum antischistosomal activities. Since the susceptibilities of the different stages of schistosomes to the two drugs are distinctively different; it has been established that the use of these two drugs in combination will be beneficial for the treatment of urinary schistosomiasis. Dosage is determined by weight; which can be difficult to determine in field conditions. The use of calibrated height meter with height-based dosage calibration will make the work less cumbersome in field settings. Data on age; weight; and height from 264 school children who were screened and found to be infected with Schistosoma haematobium; diagnosed by the presence of the ova in their urine; were used to predict an alternative to bodyweight and thus the dosage of praziquantel and artesunate required to treat this disease. A very strong positive correlation (r = 0.8) was obtained for the height of treated children measured against weight while a moderately positive correlation coefficient (r = 0.6) was obtained for weight against age measurements; depicting that height can be used in lieu of weight for correct dose determination. A height meter calibrated with the equivalent number of tablets of praziquantel and artesunate could thus be used as a simple measurement to determine the dosage of praziquantel and artesunate needed to treat children in the field. This calibrated height will expedite treating large population of children in mass treatment campaigns in an endemic community