Imported parasitosis as a diagnostic challenge in Primary Healthcare Clinic in the non-endemic region — a case study of schistosomiasis in English Division student

Abstract

Schistosomiasis is a parasitosis, most commonly caused by Schistosoma mansoni or Schistosoma haematobium, eventually by other species from the genus Schistosoma (blood flukes). This study presents a case of schistosomiasis in an African-origin student cured in the Primary Healthcare Clinic (PHC) in Lublin, Poland. The young adult male patient from Zimbabwe, studying in Poland, presented to the PHC, due to pain in the left down quadrant of the abdomen, bloody stools, and a single episode of drooling with a blood-stained jelly-like mass, without fever. In blood tests, there was neutropenia, lymphocytosis and eosinophilia. In a colonoscopy, numerous lymphoid nodules were observed with small regions of mucosal erythema, faded vascular drawing, and delayed small contact bleeding. The patient had an elevated level of IgE (329,5 IU/mL; N < 158) and minor abnormalities in the proteinogram. Abdominal CT showed calcification of intestinal walls, suggesting infection of flukes from the Schistosoma genus. The result of histopathological examination confirmed the presence of structures interpreted as parasite eggs in intestinal crypts, lamina propria and the lumen of mesenteric vessels. It is of great importance, that general medicine physicians working in schistosomiasis non-endemic regions are aware and pay attention to various risks as well as provide referrals to advanced imaging and endoscopic procedures in patients with unusual health problems. Keeping in mind, that early signs and symptoms of schistosomiasis, and results of blood tests may remain unspecific in contrast to a more complex gastrointestinal diagnostic approach, a chance of early diagnosis and successful therapeutic intervention may be facilitated.