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Urinary schistosomiasis (bilharzia)
Schistosomiasis is the disease caused by the parasitic flukes, schistosomes.
Schistosomiasis affects 200 million people worldwide.
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.
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.
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.
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.
Praziquantel is the treatment of choice.
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