Indian Journal of Pathology and Microbiology
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Year : 2017  |  Volume : 60  |  Issue : 4  |  Page : 614-615
Urinary schistosomiasis: Schistosoma haematobium infection diagnosed by histopathology

1 Department of Urology, E-DA Hospital, I-Shou University, Kaohsiung, Taiwan
2 Department of Urology, E-DA Hospital, I-Shou University; School of Medicine for International Students, I-Shou University, Kaohsiung, Taiwan
3 Department of Pathology, E-DA Hospital, I-Shou University; School of Medicine for International Students, I-Shou University, Kaohsiung, Taiwan

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Date of Web Publication12-Jan-2018

How to cite this article:
Lin YY, Lin VC, Chang IW. Urinary schistosomiasis: Schistosoma haematobium infection diagnosed by histopathology. Indian J Pathol Microbiol 2017;60:614-5

How to cite this URL:
Lin YY, Lin VC, Chang IW. Urinary schistosomiasis: Schistosoma haematobium infection diagnosed by histopathology. Indian J Pathol Microbiol [serial online] 2017 [cited 2022 Jan 20];60:614-5. Available from: https://www.ijpmonline.org/text.asp?2017/60/4/614/222954

Schistosomiasis is an infectious disease caused by parasitic blood flukes. The disease is rare in developed countries, but still prevalent in less developed ones, especially in Africa, part of Asia, and South America.[1]Schistosoma haematobium, one of Schistosoma species, primarily infects the urinary tract. Therefore, urinary schistosomiasis is usually manifested by microscopic or macroscopic hematuria or pyuria. The blood usually appears at the end of micturition, hence, termed “terminal hematuria.” The late complication includes ulceration, granulomatous inflammation, and fibrosis. Microscopic examination of urine to find the eggs of S. haematobium is the gold standard for the diagnosis of schistosomiasis. Histopathological examination of urinary bladder specimen through cystoscopic biopsy is also an alternative diagnostic method. Herein, we described a case of urinary schistosomiasis with identified parasitic ova in the histopathological examination.

A 26-year-old African male from Swaziland presented to our hospital with intermittent terminal gross hematuria for years. He denied any systemic disease. Cystoscopy revealed multiple reddish patches over bladder wall. Cup biopsy was done for the pathologic examination. Microscopically, there were many parasitic ova in the lamina propria of urinary bladder mucosa [Figure 1]a. The nuclei of miracidia [Figure 1]b and terminal spines were also noted in the ova [Figure 1]c. No obvious tissue reaction except a few lymphocytic infiltrates was seen. The morphology of the parasitic ova was consistent with S. haematobium. After diagnosis, the patient was treated by oral praziquantel.
Figure 1: Pathological features. (a) There were clusters of parasitic eggs in the lamina propria of bladder mucosa (H and E, ×100), (b) The nuclei of miracidia (H and E, ×400), and (c) characteristic terminal spines (center) were also discernible (H and E, ×400)

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The genus Schistosoma is a kind of trematodes, including dozens of species. Among them, only five infect human being, that is, Schistosoma mansoni, Schistosoma japonicum, S. haematobium, Schistosoma mekongi, and Schistosoma intercalatum. The former three are the majority. The only one principally infects urinary tract is S. haematobium, causing urinary schistosomiasis. S. haematobium is firstly discovered by a German physician, Theodor Bilharz, during an autopsy in Egypt in 1851.[2] Therefore, schistosomiasis has a synonym, bilharziasis. To date, S. haematobium infection is still prevalent in sub-Saharan Africa and part of the Middle East [1] The life cycle of S. haematobium is as follows: ova shed from the urine of affected patients; the miracidia hatch out from the ova and penetrate the intermediate hosts – snails; the development of cercariae and release from the snails into water; the cercariae penetrate human skin and migrate through the venous circulation into the liver, where the flukes mature; the adult flukes keep moving to the venous plexus of urinary bladder, where the female worms lay the eggs; finally, the eggs migrate toward the urinary bladder mucosa and complete and life cycle.[3] The gold standard for the diagnosis of urinary schistosomiasis is the identification of the ova of S. haematobium in the urine. Biopsy of suspected bladder lesion is also an alternative diagnostic tool. The ova of S. haematobium have characteristic “terminal spines” as demonstrated in the present case. The most important long-term complication of urinary schistosomiasis is the susceptibility of bladder cancer.[4] The most common histological type of schistosomal bladder cancer is squamous cell carcinoma, but not urothelial carcinoma.[5] Therefore, S. haematobium has been listed as one of the Group 1 carcinogens by International Agency for Research on Cancer.[6]

In summary, we have reported a case of urinary schistosomiasis with typical histopathologic features. In spite of limited prevalent areas in sub-Saharan Africa and a portion of the Middle East, the disease can be encountered in developed countries with the population moving.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

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Conflicts of interest

There are no conflicts of interest.

   References Top

Chitsulo L, Engels D, Montresor A, Savioli L. The global status of schistosomiasis and its control. Acta Trop 2000;77:41-51.  Back to cited text no. 1
Jordan P. Schistosomiasis. Cambridge: Cambridge University Press; 1985.  Back to cited text no. 2
Gryseels B, Polman K, Clerinx J, Kestens L. Human schistosomiasis. Lancet 2006;368:1106-18.  Back to cited text no. 3
Mostafa MH, Sheweita SA, O'Connor PJ. Relationship between schistosomiasis and bladder cancer. Clin Microbiol Rev 1999;12:97-111.  Back to cited text no. 4
Ghoneim MA, Abdel-Latif M, el-Mekresh M, Abol-Enein H, Mosbah A, Ashamallah A, et al. Radical cystectomy for carcinoma of the bladder: 2,720 consecutive cases 5 years later. J Urol 2008;180:121-7.  Back to cited text no. 5
Anwar W, Armstrong BK, Correa P, Forman D, Gentile JM, Haswell-Elkins M, et al. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans: Schistosomes, Liver Flakes and Helicobacter pylori. Lyon: IARC; 1994.  Back to cited text no. 6

Correspondence Address:
I-Wei Chang
Department of Pathology, E-DA Hospital, No. 1, Yi-da Road, Yanchao District, Kaohiusng 824
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/IJPM.IJPM_182_16

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