Bilharzial Granuloma Research Articles

Urinary schistosomiasis: report of case diagnosed in bladder biopsy

BackgroundUrinary schistosomiasis is a common parasitic disease in endemic countries.Case presentationWe report the case of a patient who was on a working trip to Mauritania. This parasitosis, suspected in the presence of hematuria and the notion of stay in an endemic zone, was confirmed by the presence of Schistosoma heamatobium eggs during the histological examination of the bladder biopsy performed after cystoscopy, highlighting a bilharzial granuloma and of course, the diagnosis was confirmed by the presence of eggs during the direct examination of the freshly collected urine.ConclusionsIt should be pointed out that the diagnosis of schistosomiasis must be evoked with the association of hematuria and the particular inflammatory aspect of the vesical mucosa and, of course, the notion of stay in an endemic zone.

Identification of parasitic infections in appendectomy specimens using histopathological and faecolith examinations

Background Appendicitis is the most common acute surgical condition of the abdomen, and appendectomy constitutes one of the most common surgical operations worldwide. Gender, age, seasonal variation and leucocytic count have been investigated in many studies, however, causative parasitic agents of appendicitis are the most important. They differ from country to country. Objective The present study aimed to investigate parasitic infections as causes of appendicitis among patients attending Minia University Hospital, Minia Governorate, EL Minia, Egypt. Methodology This descriptive study was carried out during the period between October 2013 and March 2014. Among 100 patients treated by appendectomy with a prediagnosis of appendicitis, 55 were males and 45 were females. All patients with clinically prediagnosed appendicitis were subjected to an open appendectomy, in which a right Macberny incision was made, followed by delivery of the caecum, devascularisation of the appendix, base ligation and appendectomy. Removed appendices were preserved in 10% formalin, fixed, sectioned, stained with H & E and examined for histopathological changes and presence of parasites. The faecolith contents of the remaining portions of appendices were evacuated. A wet mount preparation from each specimen was subjected to light microscopic examination for detection of parasites. Results Parasitic infection was detected in nine appendectomy specimens. The presence of Enterobius vermicularis worms was confirmed in three cases by both histopathological and faecolith examinations. Eggs of Ascaris lumbricoides , Ancylostoma duodenale and Hymenolepis nana were detected in one case each by faecolith examination. Bilharzial granulomas were detected in three cases by histopathology. Interestingly, E. vermicularis and the eggs of A. lumbricoides , A. duodenale and H. nana were found to be associated with obstructive acute appendicitis, whereas bilharzial granulomas were observed in chronic appendicitis. Conclusion The study concluded that parasitic infections constitute only 9% of the surgically removed appendices. Schistosoma spp . and E. vermicularis were the most common parasitic recorded. The association of H. nana with acute appendicitis appears to be a novel finding. A combination of histopathology and faecolith examinations is necessary for detection of parasitic causes of appendicitis.

Evidence of intra-hepatic vascular proliferation remodeling early after cure in experimental schistosomiasis mansoni: An immunohistochemical descriptive study

Experimental studies have demonstrated the occurrence of angiogenesis, blood vessels formation from pre-existing vessels, in the initial phase of bilharzial granuloma formation and during fibrosis progression in chronic hepatic schistosomiasis. Paradoxically, a recent work demonstrated an occurrence of angiogenesis during fibrosis regression months after curative treatment. Studies regarding the in situ kinetics of blood vessels in the phase of granuloma resolution and liver tissue healing early after treatment are lacking. The current work compared the kinetics of blood vessels by immunohistochemical staining using CD34, vascular endothelial growth factor (VEGF) and actin in the livers of normal control mice, Schistosoma mansoni infected mice and mice 2weeks after curative treatment. The present study demonstrated a process of angiogenesis remodeling in the liver in the curative phase of hepatic schistosomiasis during the stage of granuloma resolution. Such finding raises the evidence of the importance and potential beneficial effect of vascular proliferation in the process of healing and restoration of liver tissue functions. Thus, blocking of angiogenesis may not represent the appropriate therapeutic target for the early treatment of schistosomal liver fibrosis.

Bilharzial granuloma of the gastro-intestinal tract.

Thirty-four patients with bilharzial granuloma of the gastro-intestinal tract were analysed. The commonest site was the rectosigmoid, Bilharzial "appendicitis" was also common but the exact relation between bilharzial granuloma and acute inflammation remains unclear. Preoperative diagnosis is bilharzial granuloma is occasionally difficult and histological proof is necessary. Surgical treatment with polypectomy in the case of a solitary polyp and excision of the affected segment of bowel when there are multiple polps are recommended. There is no evidence that the condition is premalignant.

Analysis of fibronectin expression in the bilharzial granulomas and of laminin in the transformed urothelium in schistosoma haematobium infested patients

The bilharzial granulomas and urothelial transformation are common findings in Schistosoma haematobium infested patients. We hypothesize that the distribution of extrinsic (fibronectin, FN) and intrinsic basement membrane (BM) proteins (laminin, LN) is altered during the evolution of these lesions. METHODS: To test this hypothesis, 70 cystectomy specimens, entailing variable associations of normal and dysplastic urothelium (all cases), and bilharzial granulomas were examined for FN and LN protein expression. RESULTS: Increased deposition for FN occurred with the evolution from cellular (loose fibrillary network, 20 cases) to fibrocellualr (dense fibrillary network, 30 cases) to fibrotic (tight conglomerates, 20 cases) granulomas. Alternatively, BM staining for LN was linear and continuous underlying normal and metaplastic urothelium. In dysplastic urothelium (20 cases), it showed breaks in continuity. CONCLUSIONS: Alterations of FN and LN occur during the development of the bilharzial granuloma and urothelial transformation.

SECONDARY MALIGNANT INVOLVEMENT OF GYNECOLOGIC ORGANS IN RADICAL CYSTECTOMY SPECIMENS IN WOMEN: IS IT MANDATORY TO REMOVE THESE ORGANS ROUTINELY?

We report the incidence of concomitant secondary malignancy of gynecologic organs (uterus, ovaries and vagina) and the incidence of benign lesions affecting these organs in female radical cystectomy specimens. Between January 1983 and December 2001, 2,055 radical cystectomies were performed, including 609 in females. Pathological findings in gynecologic organs in female cystectomy specimens were reviewed. These data were correlated with different tumor characteristics. Mean age of the female patients +/- SD was 47 +/- 9 years (range 20 to 73). Mean followup was 4.3 +/- 4.2 years (range 0.5 to 19). Of these women 390 (64%) had squamous cell bladder carcinoma. Gynecologic organ involvement was documented in 16 of 609 patients (2.6%). Benign ovarian lesions (49 cases or 8%), a simple serous cyst (31), a dermoid cyst (1), a hemorrhagic cyst (3), bilharzial granuloma (6) and corpus albicans (8) were detected. Benign uterine lesions (30 cases or 5%), endometrial hyperplasia (20), endometriosis (4) and fibroids (6) were diagnosed. No primary genital cancers were detected in this study. Gynecologic organ involvement was more frequent in high grade tumors and the transitional cell cancer type than low grade tumors and the squamous cell type (p = 0.01 and 0.05, respectively). Posterior wall tumors were more frequently associated with genital involvement than other sites, although the difference was not statistically significant. Evidence is provided that the risk of secondary malignant involvement of genital organs in female cystectomy specimens is low. This low risk together with the low risk of primary cancers of genital organs in this group of patients does not strongly support the routine removal of uninvolved gynecologic organs during radical cystectomy in women.

Effect of Androgen and Schistosomicide In Murine Schistomiasis Mansoni: An Experimental Study

Background: Impotence is a consistent inability to sustain an erection sufficient for sexual intercourse. Testosterone administration in men with liver cirrhosis improves the sense of well-being, increase serum proteins and reduces edema without serious adverse effects. Oral, alkylated forms of testosterone can create a situation of liver toxicity. There is little evidence that other methods of administration cause liver dysfunction. Most doctors be indecisive on prescribing androgen preparations in patients with liver disease, so this work was designed to study the effect of androgen replacement (injectable form) on the murine diseased liver, and subsequently whether it can be used safely in men with chronic liver disease or not. Objective: To evaluate the effect of exogenous injectable androgen and praziquantel on the diseased liver of mice. Setting: National Hepatology and Tropical Medicine Research Institute (NHTMRI). Materials and methods: Forty male mouse (weighing 25-30 g) were infested subcutaneously with Schistosoma mansoni (100 cercariae/animal), and then they were divided into four groups. Mice in the first group were infected only and used as infected control group. Mice of group II and IV were given the Schistosomicide, praziquantel in a dose of 0.3mg/mouse. Androgen (Sustanon) was injected intramuscularly in a dose of 0.125 mg/mouse, (three doses, 3 weeks apart) in group III and IV. At the end of the trial all animals were then sacrificed to study histopathologically the possible effects of androgen on the liver tissue. Liver function tests were done in animals of group I, III, and IV, first prior to study and finally by the end of study. Results of assayed liver function tests and histopathological examination were tested for statistical significant association. Results: there were marked elevation of the liver enzymes in mice of group IV compared to the corresponding control (p 0.05) compared to group I. There was a reduction of granulomas diameter in group III and IV (animals injected with androgen) in comparison to group I (P>0.05 and P<0.01) respectively. Also comparison between the four groups as regards the type of bilharzial granulomas, it is clearly evident that the predominant type of granulomas in the androgen treated groups is the cellular type (38% and 57.1%) in group III and IV respectively and this may reflect the possible beneficial effect of androgen on the diseased liver. 72

Effect of Androgen and Schistosomicide In Murine Schistomiasis Mansoni: An Experimental Study

Background: Impotence is a consistent inability to sustain an erection sufficient for sexual intercourse. Testosterone administration in men with liver cirrhosis improves the sense of well-being, increase serum proteins and reduces edema without serious adverse effects. Oral, alkylated forms of testosterone can create a situation of liver toxicity. There is little evidence that other methods of administration cause liver dysfunction. Most doctors be indecisive on prescribing androgen preparations in patients with liver disease, so this work was designed to study the effect of androgen replacement (injectable form) on the murine diseased liver, and subsequently whether it can be used safely in men with chronic liver disease or not. Objective: To evaluate the effect of exogenous injectable androgen and praziquantel on the diseased liver of mice. Setting: National Hepatology and Tropical Medicine Research Institute (NHTMRI). Materials and methods: Forty male mouse (weighing 25-30 g) were infested subcutaneously with Schistosoma mansoni (100 cercariae/animal), and then they were divided into four groups. Mice in the first group were infected only and used as infected control group. Mice of group II and IV were given the Schistosomicide, praziquantel in a dose of 0.3mg/mouse. Androgen (Sustanon) was injected intramuscularly in a dose of 0.125 mg/mouse, (three doses, 3 weeks apart) in group III and IV. At the end of the trial all animals were then sacrificed to study histopathologically the possible effects of androgen on the liver tissue. Liver function tests were done in animals of group I, III, and IV, first prior to study and finally by the end of study. Results of assayed liver function tests and histopathological examination were tested for statistical significant association. Results: there were marked elevation of the liver enzymes in mice of group IV compared to the corresponding control (p 0.05) compared to group I. There was a reduction of granulomas diameter in group III and IV (animals injected with androgen) in comparison to group I (P>0.05 and P<0.01) respectively. Also comparison between the four groups as regards the type of bilharzial granulomas, it is clearly evident that the predominant type of granulomas in the androgen treated groups is the cellular type (38% and 57.1%) in group III and IV respectively and this may reflect the possible beneficial effect of androgen on the diseased liver. 72

Bilharzial Granuloma of the Conus

Schistosomiasis of the central nervous system is uncommon. Schistosoma mansoni is the most common cause of a spinal cord lesion, although Schistosoma haematobium is sometimes responsible. The conus medullaris is the primary site for spinal lesion. The spinal lesion of schistosomiasis may be in the form of a mass lesion or acute necrotizing myelitis, or it may be silent and symptomless. Diagnosis of spinal cord schistosomiasis is commonly retrospective but may be suggested by laboratory and radiological studies. We were confronted with a case of bilharzial granuloma of the conus in a 7-year-old boy. This patient sought treatment for sphincteric disturbance. Myelography showed an intradural lesion in the area of the conus (opposite L1-L2). The mass proved pathologically to be S. haematobium granuloma. There was no previous history of bilharzial infestation. The neurological deficits improved markedly after surgery and antibilharzial treatment.

Prevalence of Hepatitis B Surface Antigenemia among Patients with Schistosoma Mansoni

This case-control study was designed to determine the prevalence of persistent hepatitis B surface antigenemia (HBsAG) among patients with schistosoma mansoni and to rationalize their vaccination against hepatitis B virus (HBV) infection. Seventy consecutive patients with a confirmed diagnosis of schistosoma mansoni were matched for age, sex, nationality, and residence (for Saudis only) with 70 healthy controls. Despite identical mean ages, sex, and nationality distribution, 18 schistosomiasis patients (26%) had positive HBsAg as compared with only three of the controls (4%). The odd ratio for HBsAg antigenemia among patients as compared to controls was 7.73 (95% confidence interval (CI) = 2-35.01, P = 0.0004. Neither sex nor nationality had any influence on the positive rate for HBsAg found in schistosomiasis patients. Patients with schistosomiasis and a concomitant positive HBsAg had significantly more derangement of their hepatic enzymes (14 out of 18; 78%) as compared with those without this viral serological marker (22 out of 52; 42%) (odd ratio - 4.77; 95% CI=1.22-20.11; P = 0.009). I have concluded that patients with schistosoma mansoni are exposed to a higher risk of acquiring HBV infection and that concomitant schistosomiasis and HBV infection has a deleterious effect on hepatic enzymes as well as other liver functions. Prospective evaluation of the preventive role of HBV vaccine among these patients is warranted.

Leiomyosarcoma of the Inferior Vena Cava: Report of Two Cases and Review of the Literature

Leiomyosarcoma of the Inferior Vena Cava: Report of Two Cases and Review of the Literature

Schistosomiasis (Bilharzia) of the Spinal Cord: Case Reports and Clinical Profile

Eight cases of schistosomiasis of the spinal cord are described. These fall into two groups. Four patients had clinical and myelographic evidence of lesions in the conus medullaris and were found to have bilharzial granulomas at operation. Four patients had normal or equivocal myelographic appearances, but the coincidence of unexplained lower cord or cauda equina lesions with evidence of bilharzia led to the presumed diagnosis of spinal cord bilharzia. These patients, together with data from 39 cases reported in the world literature since 1969, have been used to compile a clinical profile of this condition. The clinical picture is the product of two types of reaction to bilharzial infestation, granuloma and necrotic myelitis, affecting the lower cord and cauda equina in varying proportions. Granuloma is the better defined entity because it is diagnosed following operation and biopsy. Myelitis is seldom proved and its diagnosis depends on circumstantial evidence. Both S. mansoni and S. haematobium may be responsible for either type.

Female Genital Schistosomiasis Mimicking other Gynecologic Disease: Two Case Reports

Female Genital Schistosomiasis Mimicking other Gynecologic Disease: Two Case Reports

Bilharzial granuloma of the conus medullaris and cauda equina.

Although 200 million people are infested with bilharziasis all over the world, few reports of involvement of the spinal cord, conus medullaris and cauda equina by schistosoma worms or ova appear in the literature. During a period of three years, the authors came across five patients with involvement of the conus medullaris and cauda equina that were operated upon and thus verified pathologically. Case summaries of these are presented.Clinically, the patient is generally a boy in his second decade who develops low back pain and sciatic pains and profound sphincteric disturbances. Paraparesis soon follows and often progresses rapidly to inability to walk within a few days or weeks. Examination of urine, stool and a rectal biopsy, the usual laboratory procedures to discover bilharzia ova, are much more frequently negative than positive.Serological tests (circumoval and precepitin) of the C.S.F., especially if the titre is compared to that of the blood serum, are likely to give a specific indication of involvement of the central nervous system.In the authors' opinion, the myelographic appearance is specific. The bilharzial granuloma produces an abrupt intramedullary block, the length of one vertebral body, strictly located opposite T12 and L1 with irregular and often trifid edges.Bilharzial myelitis and early granuloma of the conus medullaris and cauda equina, the former rarely seen and the latter rarely diagnosed at such a stage, may be cured by antibilharzial chemotherapy (the authors used potassium antimony tartarate).Advanced granulomas are best managed by a combination of wide surgical decompression in addition to chemotherapy.

Acute intestinal obstruction from a granuloma due to Schistosoma haematobium in the large intestine

2 patients developed intestinal symptoms due to bilharzial granuloma in the large gut. Although each passed ova of S. mansoni in the stool, the lesions were caused by the ova of S. haematobium.

Thirteenth Annual Report of the Memorial Ophthalmic Laboratory, Giza, Cairo, 1938.

The report covers in detail the activities of the laboratory for the year 1938 and offers a wealth of interesting case reports illustrated by photographs and drawings, some of which are in color. The cases are examples of such conditions as lipoid degeneration of the cornea and of the palpebral conjunctiva, episcleral abscess, bilateral inflammatory pseudotumor of the orbit, leproma of the limbus, adenoid epithelioma of the eyelid, bilharzial granuloma of the bulbar conjunctiva and adenocarcinoma of the lacrimal gland. Mention is made of the occurrence of small xerotic patches on the bulbar conjunctivas of 2 young adults with advanced pellagra. In 30 cases of pellagra of long duration in adults who had been previously examined by El-Tobgy, nothing abnormal was found in the eyes except senile cataract in 2 instances. The efficacy of sulfanilamide and its derivatives in the treatment of gonococcic ophthalmia and trachomatous keratitis is also noted.