Urinary Schistosomiasis
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Introduction
- A common parasitic infection of the urinary tract caused by a body fluke, Schistosoma haematobium.
- Acquired while bathing/wading in infected water.
- Endemic in many parts of Africa and gets to the urinary tract through the blood vessels after penetrating the skin
Clinical features
Soon after penetration of the skin:
- Pricking sensation and itching (cercarial dermatitis)
Four weeks later:
- Intermittent fever, malaise, urticaria and cough
6 - 24 months later:
- Intermittent, painless terminal haematuria (may be total)
- Symptoms of bladder irritability: dysuria, frequency, urgency, strangury
Differential diagnoses
- Tuberculous cystitis
- Abacterial cystitis
- Bladder carcinoma
Complications
- Bladder fibrosis and contracture
- Ureteral stricture
- Urethral stricture
- Bladder calculi
- Bladder cancer
Investigations
- Urine examination for schistosomal ova
- Cystoscopy: tubercles, sandy patches, nodules, ulcers
- Plain abdominal radiograph (KUB)
- Intravenous urogram
- Serological tests
- Full Blood Count
Treatment goals
- To eradicate the fluke and ova
- Prevent complications
Drug treatment
Praziquantel
Adult: Single oral dose of 50 mg/kg
Child over 4 years: 20 mg/kg orally, repeated after 4 – 6 hours
In S. japonicum infection, 20 mg/kg 3 times daily for one day after initial dose
Notable adverse drug reactions, complications, and caution
- Nausea, epigastric pain, pruritus, headache, dizziness
Prevention
- Provision of and access to pipe-borne water
- Improvement in socio-economic conditions
- Mass chemotherapy in endemic areas
- Eradicating the intermediate hosts (water snails)