Urinary Schistosomiasis

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This is a water-borne disease caused by penetration of the skin or mucous membranes by the early stages of the causative organism (Schistosoma haematobium), which in the adult form settles in the blood vessels of the urinary bladder resulting in the common presentation of haematuria.  

This disease is common in Ghana with several endemic areas along the lakes, slow-flowing rivers and irrigation systems. The commonest body sites affected are the bladder, ureters and pelvic organs. Prevention entails avoiding contact with infested water.

Chronic infestation may lead to severe anaemia, ureteric stricture and hydronephrosis as well as carcinoma of the bladder.

Cause

  • Schistosoma haematobium

Symptoms

Initial

  • Itching and redness of skin at site of penetration of parasite
  • Fatigue, low grade fever, malaise, lassitude, excessive sweating, headache and backache

Later

  • Terminal haematuria
  • Painful urination (dysuria)
  • Lower abdominal pain (bladder pain)

Signs

  • Pallor
  • Palpable kidney from hydronephrosis due to ureteric stricture
  • Palpable bladder from bladder cancer or retention of urine due to clots or bladder neck stenosis
  • DRE may reveal a fibrosed prostate, enlarged seminal vesicle or thickened bladder base

Investigations

  • FBC
  • Urine for red blood cells, pus cells, and schistosoma ova (mid-day urine specimen preferably taken after physical exercise is ideal)
  • Midstream urine for culture in associated urinary tract infections
  • Imaging: Ultrasound scan; Intravenous Urogram (IVU) may show calcification of bladder, ureters, hydronephrosis and hydroureters 

TreatmentTreatment Objectives

  • To eliminate the causative organism
  • To manage the complications

Non-pharmacological treatment

Avoid repeated exposure to infested water bodies if possible

Pharmacological treatment

Evidence Rating: [A]

  • Praziquantel, oral, 

Adults and Children

40 mg/kg as a single dose

  • Treat anaemia if present

Referral Criteria

  • Refer patient after adequate treatment if: haematuria and/ or symptoms of urinary infection persist or if complications like hydronephrosis, bladder mass, retention of urine, severe wasting and severe anaemia are present