Sonographic Manifestation of Urinary Bilharziasis in School Children in Rahad, Sudan

Abstract

Background: Urinary bilharziasis is endemic to more than 70 countries, mostly in sub-saharan Africa, including Sudan. It poses a significant burden in terms of morbidity, economic and public health consequences. The disease is usually diagnosed clinically and by urine examination. Imaging plays an important role in demonstrating morbid anatomy and complications. Rahad town is located near a small fresh-water lake and is known for high prevalence of the disease. Objective: The aim of this study was to investigate the sonographic manifestations of urinary bilharziasis among school children in Rahad town in North Kordofan state, Sudan. Methods: Seventy-five school children, who complain of burning micturition, red urine and/or urgency were included in the study. At least 10 ml urine were collected from each child in a sterile, tightly closed container. Ultrasound scanning of the abdomen was carried out by a radiologist, using a 3.5 MHz abdominal probe and a portable ultrasound scanner. The liver, spleen, kidneys, ureters and urinary bladder were scanned and documented. The urine was examined by a senior pathologist, who recorded the finding of microscopic hematuria and/or bilharzial ova in each sample. Data were analyzed using a statistical package (PSPP) to calculate frequencies and mean values. Results: The study included 75 children in classes 1-4. Mean age was 9.36 years, range 7-14 years. Males were 59 (78.67%). More than one quarter (n= 20, 26.7%) have positive urine for S. hematobium ova. More than half (n= 42, 56%) have positive sonographic findings in the urinary bladder, including a third (n= 27, 36%) with bladder mucosal polyps. Only one child (1.3%) had dilated ureter and renal collecting system. Conclusion: Sonographic manifestations of urinary bilharziasis among school children in Rahad are mainly found in the urinary bladder, seen as wall thickening and irregularity, polyp formation and occasionally, calcification. Ultrasound could be used for mass screening and further follow up of urinary bilharziasis in children, as it can detect lesions even in patients with negative urine test for schistosomal ova.