Urinary schistosomiasis in childhood

Abstract

,omiasis comprises a group of chronic dised by blood flukes. Three species of schisre clinically important: Schistosoma man~onicum, and S. haematobium. S. mansoni )nicum colonize portal circulation and estinal schistosomiasis. S. haematobium veins of bladder and distal ureter :s urinary schistosomiasis (bilharziasis). 1 estimated that 200 to 300 million people :d with schistosomiasis worldwide. Eighty lion people are infected by S. haemato: vast majority of these cases are found in Memic regions, s. haematobium is found through~t African continent, including islands of i~dagascar and Mauritius. In southwest Asia, it is ~nd in Yemen, Saudi Arabia, Lebanon, Syria, rkey, Iraq, and Iran. ~ S. haematobium is not transited in United States because appropriate itermediate host snail necessary for asexual repro~ tion of parasite is absent. However, ret increase in immigrant populations from enicrnic countries has introduced into United ;ates a population of patients infected with S. iematobium Urologists in United States are !~reasingt_y diagnosing and treating patients with :rtnary schistosomiasis. Between December 1991 ndJanuary 1994 we have diagnosed and treated 7 Nldren with schistosomiasis at Children's Hospital !d Health Center, San Diego. The age at presenta!~n was 6 to 12 years of age. All patients presented !th a his tory of gross hematur ia . Urinalysis bowed 15 to 20 red blood cells (RBC) per high~ower field in all patients and ova with, terminal ipines in all but 1 patient (Fig. 1). This patient reiuired a. bladder biopsy to detect ova (Fig. 2). U1~sonography demonstrated bladder wall thicken}ng (Fig. 3) in 5 c h i l d r e n and mi ld r igh t hydronephrosis in 1 child. All patients were treated :~th praziquante140 mg/kg and showed resolution fhematuria and absence of ova from their urine at { month follow-up. The main focus of this review NIl be on S. haematobium infection in childhood. HISTORY Schistosomiasis is one of oldest known diseases. Calcified S. haematobium ova have been discovered in Egyptian mummies from 20th dynasty, 1200 to 1090 BC. Many of Napoleon's troops, the menstruating men, during Egyptian invasion are believed to have been infected with S. haematobium. In 1851, Theodore Bilharz first identified S. haematobium as agent responsible for Egyptian endemic hematuria. In 1921 Cristol described cystoscopic findings of schistosomiasis. McDonough introduced first effective chemotherapy, tartar emetic (antimony potassium tartrate) in 1918. 2,3 Recent advances in control and treatment of schistosomiasis have been based on a better understanding of life cycle of S. haematobium.