Urinary Schistosomiasis: A Rare Cause of Hematuria in the United States

By Fernandez, Nella C.; Mortensen, Joel | Journal of Continuing Education Topics & Issues, April 2012 | Go to article overview

Urinary Schistosomiasis: A Rare Cause of Hematuria in the United States


Fernandez, Nella C., Mortensen, Joel, Journal of Continuing Education Topics & Issues


Introduction

The popularity of "adventure vacations," along with the mobilization of the population of Asian and African countries due to armed conflict, has brought exotic infectious organisms into the United States. The clinical manifestations of these can sometimes be easily associated with the history of travel, but in some cases, the latency of these infectious diseases spans weeks, months or even years.

Schistosomiasis is one such disease, and is second to malaria in the world's parasitic diseases in terms of endemicity and the number of infected people. (1)

Following is the case of a patient diagnosed with urinary schistosomiasis and a brief review of the pathophysiology, diagnosis and current recommendations for treatment and prevention.

Case Report

Our patient is a 17-year-old male, born in the United States, who, at the age of 8 years old, moved with his parents to the African nation of Mali, where he stayed until one month before consulting our hospital.

For the previous 18 months, he observed persistent painless hematuria, with scant bright red blood at the end of each urination. The patient denied swimming in lakes or rivers in Mali. No family history of hematuria was elicited.

His blood count was within normal limits; however, the differential showed eosinophilia (23%, normal range 0-3%). Two tests for ova and parasites in the urine were negative for schistosomiasis; however, due to the strong suspicion, immunoglobulin G for schistosomas was ordered. The result was positive and treatment with praziquantel was prescribed.

[FIGURES 1 OMITTED]

The patient was referred to nephrology. An ultrasound showed echogenic polypoid lesions arising from the posterior and left lateral wall of the bladder with possible underlying bladder thickening, suggestive of chronic infection/inflammation with schistosomas.

A third sample of urine for ova and parasite was received and after concentration procedures, numerous ova consistent with Schistosoma haematobium were identified. (Figure 1A & 1B)

Discussion

Schistosomiasis or bilharzia is highly endemic in tropical and subtropical areas of the world, including most African countries and regions of Asia, South America, the Caribbean, and the Middle East. An estimated 200 million people are infected annually. (2)

The three main species causing infections in humans are S haematobium (urinary schistosomiasis), S japonicum and S mansoni (intestinal schistosomiasis). Two other species more localized geographically are S mekongi and S intercalatum (rectal schistosomiasis). (3,4)

Life cycle of the parasite

Schistosomes are 1-2 cm long white parasitic flatworms, belonging to the Trematoda class of parasites; they are referred to as trematodes or flukes. During adult life, the female is embedded in the gynecophoric canal of the male and the paired adult flukes live in the venules of the mesenteric or vesical plexus. (4) The infection is usually acquired via contact with freshwater that contains infectious, free-living, cercarial larvae. The cercariae penetrate the intact skin, shedding their forked tail to become schistosomulae. The schistosomulae then migrate into the blood and lymph vessels and are carried to the heart and lungs. After entering the arterial circulation via the left side of the heart, the schistosomulae settle in the liver where they mature into adults over a period of one to four weeks before reaching the vesical venous plexus. (Figure 2A, B and C)

[FIGURE 2 OMITTED]

The parasite remains in these blood vessels for the life of the patient, adhering to the wall of the blood vessels by a ventral and an oral sucker. After one to three months, the female worm produces eggs, which can travel hematogenously to other sites or can traverse from the vascular space through host tissues to the urinary bladder where they are excreted in the urine. …

The rest of this article is only available to active members of Questia

Sign up now for a free, 1-day trial and receive full access to:

  • Questia's entire collection
  • Automatic bibliography creation
  • More helpful research tools like notes, citations, and highlights
  • Ad-free environment

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Default project is now your active project.
Project items

Items saved from this article

This article has been saved
Highlights (0)
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

Citations (0)
Some of your citations are legacy items.

Any citation created before July 30, 2012 will labeled as a “Cited page.” New citations will be saved as cited passages, pages or articles.

We also added the ability to view new citations from your projects or the book or article where you created them.

Notes (0)
Bookmarks (0)

You have no saved items from this article

Project items include:
  • Saved book/article
  • Highlights
  • Quotes/citations
  • Notes
  • Bookmarks
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

1

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited article

Urinary Schistosomiasis: A Rare Cause of Hematuria in the United States
Settings

Settings

Typeface
Text size Smaller Larger Reset View mode
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Full screen

matching results for page

Cited passage

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited passage

Welcome to the new Questia Reader

The Questia Reader has been updated to provide you with an even better online reading experience.  It is now 100% Responsive, which means you can read our books and articles on any sized device you wish.  All of your favorite tools like notes, highlights, and citations are still here, but the way you select text has been updated to be easier to use, especially on touchscreen devices.  Here's how:

1. Click or tap the first word you want to select.
2. Click or tap the last word you want to select.

OK, got it!

Thanks for trying Questia!

Please continue trying out our research tools, but please note, full functionality is available only to our active members.

Your work will be lost once you leave this Web page.

For full access in an ad-free environment, sign up now for a FREE, 1-day trial.

Already a member? Log in now.