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Chapter: Medicine and surgery: Genitourinary system

Urinary schistosomiasis (bilharzia) - Urinary tract infections

Schistosomiasis is the disease caused by the parasitic flukes, schistosomes. - Definition, Incidence, Aetiology, Pathophysiology, Clinical features, Complications, Investigations, Management, Prognosis.

Urinary schistosomiasis (bilharzia)

 

Definition

 

Schistosomiasis is the disease caused by the parasitic flukes, schistosomes.

 

Incidence/prevalence

 

Schistosomiasis affects 200 million people worldwide.

 

Geography

 

Urinary schistosomiasis occurs in Africa, the Middle East, Spain, Portugal, Greece and the Indian Ocean, particularly in rural areas where the snail vectors are present. Travellers may pick up the infection, even with brief exposure to contaminated water.

 

Pathophysiology

 

The eggs of S. haematobium are excreted through the bladder wall into the urine causing haematuria. Eggs that are trapped in tissue cause local inflammation, scarring and fibrosis in the bladder and ureters, which can lead to obstruction, calcification and hydronephrosis.

 

Clinical features

 

Patients with S. haematobium may be asymptomatic, or have frequency, dysuria, haematuria (microscopic or macroscopic) and incontinence. Secondary anaemia may occur. Complications include hydronephrosis and renal failure, and chronic inflammation predisposes to squamous cell carcinoma of the bladder. S. mansoni and japonicumcan cause proteinuria and nephrotic syndrome by immune complex deposition and may cause other systemic features.

 

Investigations

 

Dipstick urine to look for blood. Urine microscopy to look for eggs with a terminal spine. Anti-schistosomal antibodies can be measured, although these take a month to become positive.

 

Managment

 

Praziquantel is the treatment of choice.

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Medicine and surgery: Genitourinary system : Urinary schistosomiasis (bilharzia) - Urinary tract infections |


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