A Family Case Report of Schistosoma haematobium Infection in Italian Travelers.

Abstract

Schistosoma haematobium infection is endemic in 53 countries and is confined to Africa and the Middle East.1,2,3 It is estimated that about 90 million persons are infected and that at least 180 million persons are exposed to the risk of infection.1 Fortunately, the morbidity caused by S. haematobium infection is probably low, even though it is still difficult to define and evaluate this morbidity with any precision. S. haematobium infection is not a significant cause of death in most endemic areas.1,2 In fact, this particular parasitic infection is mild and often without symptoms. In some cases, the only clinically relevant symptom is recurrent, painless hematuria.2 Among people living in endemic areas, almost all children are infected by the parasite and, in some cases, complications develop, such as chronic renal infection, bladder abnormalities, and carcinoma.2 The seriousness of the disease is related to the rate of infection, since the active disease is more frequently detected among children aged 5-15 years.1,3,4 In developing countries, strategies for the control and prevention of the increasing diffusion of the S. haematobium infection are mainly aimed at the following: (1) education of the population to avoid contamination of fresh water with urine, possibly containing viable eggs of the parasite; (2) education to avoid bathing in or contact with, contaminated water; (3) control of irrigation systems and snails; and (4) use of noninvasive diagnostic techniques and treatment of infected subjects.2,3 In industrialized countries, S. haematobium infection is a rare, imported disease. In most cases, it exhibits only mild symptoms related to the urinary tract. The disease is often frequently unsuspected and misdiagnosed. In fact, S. haematobium infection is usually suspected only in patients immigrating from endemic areas and suffering from urinary tract symptoms, whereas correct diagnosis is often delayed in most cases of infected patients returning from a visit to an endemic area with similar symptoms. In addition, only a few laboratories can perform the correct diagnostic procedures. One such procedure is urine filtration, which can detect the presence and determine the number of S. haematobium eggs in urine samples obtained from infected subjects. In Italy, the number of reported cases of S. haematobium infection has increased in recent years. The increase is due to the increasing presence of immigrants from endemic African countries (unpublished data). The aim of this work was to describe the case report of an Italian family, which was infected by S. haematobium while vacationing in Malawi, and to emphasize that, in addition to immigrants from endemic areas, this parasitic infection should be suspected in patients who travel to these areas and who return, suffering from urinary tract symptoms.