Colonic Schistosomiasis Research Articles

Colorectal Cancer Complicated with Chronic Schistosoma Japonicum Infected: A Case Report.

Colonic schistosomiasis is a significant health issue in endemic areas, presenting diagnostic challenges due to its nonspecific clinical symptoms and radiographic features. This case report highlights a patient with concomitant colorectal cancer and chronic Schistosoma japonicum infection, emphasizing the need for a comprehensive diagnostic approach. A 67-year-old male from an endemic region presented with a six-month history of intermittent hematochezia. Initial colonoscopy revealed multiple mucosal elevations in the sigmoid colon and rectum. Subsequent investigations, including CT scans and endoscopic ultrasonography, indicated high echogenic changes and multiple lesions. The patient underwent endoscopic submucosal dissection (ESD), revealing adenocarcinoma of the rectal mucosa and tubular adenoma in the sigmoid colon, both with extensive deposition of Schistosoma japonicum eggs. Postoperative pathology confirmed the diagnosis of moderately differentiated adenocarcinoma with chronic schistosomiasis. This case underscores the diagnostic complexity of colonic schistosomiasis, particularly when coexisting with malignancy. The integration of colonoscopy, histopathology, and auxiliary tests is crucial for accurate diagnosis. Clinicians should maintain a high index of suspicion for schistosomiasis in patients from endemic areas presenting with gastrointestinal symptoms. Regular screening and detailed medical histories are essential for early detection and treatment, improving patient outcomes and reducing the risk of misdiagnosis.

A Rare Case of Huge Schistosomiasis-Associated Cecal Polyp Mimicking Colon Carcinoma

Schistosomiasis is a parasitic infection caused by Schistosoma species, commonly found in tropical and subtropical regions. It affects millions of people worldwide and can lead to different clinical presentations like abdominal pain, weight loss, anemia, and chronic colonic schistosomiasis. In rare cases, chronic infection can result in the development of polyps, which can mimic colon carcinoma, posing a diagnostic challenge. Here, we present a rare case of a huge Schistosomiasis-associated cecal polyp in a patient initially suspected to have colon cancer. The patient's clinical history and the histopathological analysis confirmed the diagnosis, emphasizing the importance of considering parasitic infections in the differential diagnosis of gastrointestinal polyps in Schistosomiasis-endemic areas. This case report highlights the need for increased awareness among healthcare professionals of the potential for Schistosomiasis-associated polyps and the importance of multidisciplinary management in such cases.

Colonic Schistosomiasis Presenting with Findings of Inflammatory Bowel Disease

Colonic Schistosomiasis Presenting with Findings of Inflammatory Bowel Disease

Persistent Colonic Schistosomiasis among Symptomatic Rural Inhabitants in the Egyptian Nile Delta.

Background and AimsHuman schistosomiasis is one of the most important and unfortunately neglected tropical diseases. The aim of the current study was to investigate the prevalence and characteristics of colonic schistosomiasis among symptomatic rural inhabitants of the Middle Northern region of the Egyptian Nile delta.Patients and MethodsThis study recruited 193 inhabitants of the rural community in the Egyptian Nile Delta referred for colonoscopy because of variable symptoms. After giving written informed consent, they were exposed to thorough history, clinical examination, stool analysis, abdominal ultrasonography, and pan-colonoscopy with biopsies.ResultsTwenty-four cases out of the 193 patients had confirmed active schistosomiasis with a prevalence rate of 12.4%. Bleeding with stool was the predominant manifestation of active Schistosoma infection among the cases either alone or in combination with abdominal pain. On clinical examination, most patients (n=17; 70.8%) did not have organomegaly, and 25% had clinically palpable splenomegaly as far as 75% of them had sonographically detected hepatic periportal fibrosis. Also, 66.6% of patients have significant endoscopic lesions (polyps, ulcers, mass-like lesions), and 16.6% of them had colonic affection beyond the recto-sigmoid region.ConclusionColonic schistosomiasis is still prevalent among the Egyptian Nile Delta’s symptomatic rural inhabitants at a rate of 12.4%. Of them, 66.6% had significant endoscopic colorectal lesions. This persistent transmission of schistosomiasis in the Egyptian Nile Delta’s rural community sounds the alarm for continuing governmental efforts and plans to screen the high-risk groups. The prevalence rate reported in the current study is lower than the actual prevalence rate of schistosomiasis due to focusing only on a subgroup of individuals.

S1802 Colononic Schistosomiasis

INTRODUCTION: Schistosoma infection is endemic to certain tropical areas with water beds. It usually affects the liver or the bladder (depending on the species). We present a rather unique case of Schistosoma affecting the colon. CASE DESCRIPTION/METHODS: A 19 years old male presented to a hospital in Addis Ababa (Ethiopia) with an 8-month history of recurrent abdominal pain and occasional blood in the stool. Tenesmus and loss of appetite were present but there was no significant weight loss. Physical and basic laboratory exams, including liver enzymes, were unremarkable. Stool exam was positive for blood but negative for ova and parasite. Abdominal ultrasonography was normal. A colonoscopy was performed with a working diagnosis of inflammatory bowel disease (IBD). The exam showed a patchy mucosal erythema with scattered nodularity and multiple vascular lesions in ascending colon, sigmoid and rectum. Colon biopsies showed multiple schistosoma eggs with surrounding eosinophilic inflammation. It was noted that the patient resides in Bahir Dar, a lakeside city in Northern Ethiopia endemic for schistosomiasis. Upon inquiring, the patient reported frequent swimming in the lake and washing clothes in the river. The patient was treated with Praziquantel 40mg/Kg one dose orally and reported complete resolution of symptoms during a clinic visit 2 weeks later. DISCUSSION: Schistosomiasis is a common helminth-related disease that frequently affects the liver or bladder depending on the species. Colonic schistosomiasis occurs as eggs migrate through the intestinal wall, provoking mucosal granulomatous inflammation. Lesions that occur in rectum and sigmoid are usually secondary to S. Mansoni. Suspicion of Schistosoma colitis is often low, despite a reported association between colonic schistosomiasis and colon cancer. Biopsies specifically aimed at the mucosal alterations are important as they will provide higher yield for egg identification. In our case, the presentation and demographics of the patient were compatible with IBD and this was the main suspected diagnosis. In individuals originating from endemic areas infection such as Schistosoma should be clearly ruled out, as initiation of immunosuppressive regimens upon suspicion of IBD can be detrimental.

Mucinous Rectal Adenocarcinoma in a Background of Chronic Schistosomiasis: A Case Report and Review of the Literature

Reports have revealed the existence of colonic cancer with chronic bowel schistosomiasis. The specie most frequently involved is Schistosoma japonicum. Few cases have, however, shown Schistosoma mansoni as the involved specie. There seems to be an association between rectal cancer and Schistosoma mansoni infestation. Despite earlier studies that refuted any association between schistosomiasis and colonic cancer, more reports are lending credence to the claim that chronic colonic schistosomiasis, especially with S. Japonicum, may induce colonic cancer and the case with are reporting also point to the fact that S. Mansoni may also be implicated. We report a case of a 35-year-old man with a rectal cancer (pT3N0M0) associated with Schistosoma mansoni. He presented with intestinal obstruction and operation revealed a cirrhotic liver with hepatic schistosomiasis.

Mucinous Rectal Adenocarcinoma in a Background of Chronic Schistosomiasis: A Case Report and Review of the Literature

Reports have revealed the existence of colonic cancer with chronic bowel schistosomiasis. The specie most frequently involved is Schistosoma japonicum. Few cases have, however, shown Schistosoma mansoni as the involved specie. There seems to be an association between rectal cancer and Schistosoma mansoni infestation. Despite earlier studies that refuted any association between schistosomiasis and colonic cancer, more reports are lending credence to the claim that chronic colonic schistosomiasis, especially with S. Japonicum, may induce colonic cancer and the case with are reporting also point to the fact that S. Mansoni may also be implicated. We report a case of a 35-year-old man with a rectal cancer (pT3N0M0) associated with Schistosoma mansoni. He presented with intestinal obstruction and operation revealed a cirrhotic liver with hepatic schistosomiasis.

1516 A Rare Cause of Diarrhea in the U.S.: Schistosomiasis Colitis Case Report and Literature Review

INTRODUCTION: Schistosomiasis is one of the neglected tropical diseases and is endemic in more than 70 countries. Herein, we present a case of schistosomiasis colitis in the USA. CASE DESCRIPTION/METHODS: A 21-year-old man born in Libya, resident in USA for more than 9 years, was referred to the Gastroenterology consultation for chronic diarrhea (8 bowel movements per day of liquid feces), intractable diffuse abdominal pain, associated with subjective fevers, chills, nausea, vomiting (nonbloody), and decreased oral intake. Laboratory workup was negative for leukocytosis; stool cultures were negative. Computed Tomography (CT) abdomen and pelvis showed diffuse colitis with bowel wall thickening. Patient was treated with ciprofloxacin and metronidazole. Given no improvement in symptoms, Colonoscopy was performed showing diffusely congested and hyperemic mucosa. Random colonic biopsies were positive for parasitic infection associated with non-necrotizing granulomas most consistent with schistosomiasis. This was followed by a positive serology test for Schistosoma. He was started on praziquantel (40 mg/kg) with improvement in diarrhea frequency prior to discharge to follow up in clinic. DISCUSSION: Colonic schistosomiasis is common in endemic areas (Africa, South America and Asia) and the endoscopic findings can be confounded with inflammatory bowel disease with just a few reports published in these countries and very rare in the USA. The most common presentation is a form of symptomatic chronic active colitis with diarrhea and abdominal pain. The diagnostic gold standard is the histology. Even though new cases have not occurred recently in USA, we should remain aware of schistosomiasis colitis for patients who came from foreign epidemic areas.

A rare cause of diarrhea in the occident: A case of colonic schistosomiasis

A rare cause of diarrhea in the occident: A case of colonic schistosomiasis

Acute Schistosomal Colitis Preceded by Katayama Syndrome

ABSTRACTSchistosomiasis is prevalent in tropical and subtropical areas. It manifests as an acute or chronic illness caused by the body’s reaction to the worms’ eggs. In view of its clinical similarity to various other diseases, the disorder may cause diagnostic errors. We present a case of a Sudanese man, who presented with fever, headache, fatigue, myalgia, excessive sweating, abdominal cramps, and a high eosinophil count on blood testing. He was diagnosed with a connective tissue disorder and was started on prednisolone, but 3 weeks later, he presented with rectal bleeding. Colonoscopy showed features of moderate distal colitis. Colonic biopsies revealed several viable schistosome ova associated with aggregates of eosinophils, compatible with active colonic schistosomiasis.

Upregulation of Toll-like receptor 2 and nuclear factor-kappa B expression in experimental colonic schistosomiasis

Role of different mediators was described in the development of the granulomatous response and fibrosis observed in intestinal schistosomiasis. However, both Toll-like receptor 2 (TLR2) and nuclear factor kappa B (NF-κB) have not yet been investigated in intestinal schistosomiasis. This study aimed to characterize the role of TLR2 and NF-κB in the pathogenesis of intestinal schistosomiasis. Experimental animals were divided into two groups; group I: non-infected control group and group II: mice infected subcutaneously with S. mansoni cercariae. Colon samples were taken from infected mice, every two weeks, starting from the 6th week postinfection (PI) till 18th week PI. Samples were subjected to histopathological and immunohistochemical studies. Colon of S. mansoni infected mice showed histopathological changes in the form of mucosal degeneration, transmural mononuclear cellular infiltration and granulomas formation. Immunostained sections revealed significant increase in TLR2 and NF-κB positive cells in all layers of the colon, cells of the granuloma and those of the lymphoid follicles 10weeks PI. All these changes decreased gradually starting from 12weeks PI onward to be localized focally at 18weeks PI. In conclusion, recruitment and activation of inflammatory cells to the colonic mucosa in intestinal schistosomiasis are multifactorial events involving TLR2 that can trigger the NF-κB pathways. Hence, down-regulation of both TLR2 and NF-κB could be exploited in the treatment of colonic schistosomiasis.

A Rare Case of Chronic Schistosomiasis Occurring within a Tubular Adenoma Eight Years Following Infection

Purpose: Schistosomes infect about 200 million people annually. Schistosoma mansoni is endemic to South America, Africa, and the middle east. Found in fresh water, the parasite makes use of snails as an infective reservoir. Schistosomiasis may persist if untreated. Chronic schistosomiasis may cause hepatic complications, including periportal fibrosis and portal hypertension. We present the only reported case in the U.S. of incidental colonic schistosomiasis within a tubular adenoma eight years following infection. A 56-year-old man presented for colonoscopy for polyp surveillance. He was in good health and free of any gastrointestinal or constitutional complaints. Colonoscopic exam revealed diverticulosis and two small sessile polyps, one in the cecum and one in the rectum. Both polyps were tubular adenomas with epitheloid granulomata. Within the cecal polyp, a schistosome egg was noted. The appearance was consistent with Schistosoma mansoni. On subsequent questioning, the patient reported wading in Lake Eyasi in the Great Rift Valley of Tanzania during an excursion that occurred eight years prior. Pathology slides from his index colonoscopy were reviewed, and showed epithelioid granuloma. He was treated with a one-day course of praziquantel, and his travel companions were referred for serologic testing for schistosomiasis. We present a case of chronic schistosomiasis. Each year, approximately 200 million people are infected with schistosome species worldwide. Free-swimming cercariae leave the snail and penetrate mammalian skin. The parasites migrate to the portal venous system, where they mature. Early symptoms, if present, include a rash at the site of skin penetration. A less common syndrome of fever, myalgia, hepatomegaly, and eosinophilia is also well established. The patient's travel history established a time of infection approximately eight years ago. The endoscopic findings of mucosal congestion and polyps were far from specific. Therefore, the histologic findings of epitheliod granuloma, eosinophilic infiltration of the laminal propria, and schistosoma ova were key to the diagnosis. Both hyperplastic and adenomatous polyps have been associated with schistosomes. A relationship between Schistosoma japonicum and cancer of the large intestinal have been proposed. However, Schistosoma mansoni does not appear to be related to the development of colonic neoplasm. This case represents an unusual finding of chronic schistosomiasis in a patient living in the United States.

Schistosomiasis Combined with Colorectal Carcinoma Diagnosed Based on Endoscopic Findings and Clinicopathological Characteristics: A Report on 32 Cases

To improve understanding of the relationship between schistosome-related enteropathy and colorectal carcinoma with particular focus on endoscopic findings and clinicopathological characteristics of colonic schistosomiasis. All cases of intestinal schistosomiasis diagnosed at West China Hospital, Chengdu, China, between October 2006 and October 2012 were included in this study. A total of 179 cases of colonic schistosomiasis diagnosed through colonoscopy and pathological examinations were collected for analysis and the demographics, symptoms, endoscopic findings and clinicopathological characteristics were retrospectively evaluated. Of the 179 colonic schistosomiasis patients, 32 combined with colorectal cancer (CRC) were found, between the ages of 44 and 85 years (24 males, 75%). These 32 lesions were classified as 12 endophytic/ulcerative (37.5%), 10 exophytic/fungating (31.2%), 4 annular (12.5%), 3 giant polypus (9.4%), and 3 IIc (superficial depressed type) (9.4%). The segments of rectum and sigmoid colon were involved in 19 patients (59.4%) and 6 patients (18.8%), respectively. The histopathologic types were classified as follows: 30 well- differentiated adenocarcinomas, one mucinous adenocarcinoma and one poorly differentiated adenocarcinoma. The pathological findings suggest colorectal malignancy with deposited schistosome ova. Chronic schistosomal infestation has a probable etiological role in promoting genesis of colorectal neoplasms.

Evaluation of WGA and Concanavalin A (Con A) lectin as biomarkers of hepatosplenic schistosomiasis in human biopsies with no evidence of egg-granuloma system

Colonic lesions are predominant in patients with schistosomiasis. However, carbohydrate alterations in colonic schistosomiasis remain unclear. Lectin-ligands allow us to identify changes in the saccharide patterns of cells. Biopsies of descending and rectosigmoid colon of patients were submitted to WGA and Con A lectin histochemistry. WGA stained stroma and gland cells of descending colon and rectosigmoid tissues in a granular strong cytoplasmatic pattern in schistosomiasis specimens differing from normal control and Con A failing to recognize all samples analyzed. WGA ligands are expressed differently in patients with hepatosplenic schistosomiasis and no evidence of egg-granuloma system.

Gastrointestinal: Schistosomiasis—Diagnosis by colonoscopy

A 69-year-old Liberian female with no significant past medical history was referred for screening colonoscopy. Notably, she immigrated from Liberia to the United States 7 years prior to presentation, since which time she has had regular primary care visits and has been asymptomatic. On presentation, she had a negative review of systems and her physical examination was normal. Colonoscopic examination was notable for patchy areas of pale, nodular appearing mucosa in the transverse and descending colon with no features of polypoid tissue under narrow band imaging (Figure A). Targeted biopsies were obtained, the histology of which revealed numerous eggs of schistosome organisms (Figure B). Figure 1 Subsequent laboratory testing revealed peripheral eosinophilia (1700/cm3) and thrombocytopenia (130,000/cm3). Serum hemoglobin, aminotransferases, human immunodeficiency virus (HIV) 1 and 2 antibodies, viral hepatitis serologies as well as urinalysis were all unremarkable. An abdominal sonogram was also normal. She was ultimately treated with Praziquantel 60mg/kg in 3 divided doses with good response. Schistosomiasis is a common communicable disease endemic in Africa, the Middle East, Asia, and South America. Approximately 200 million are infected and 700 million are at risk of schistosomiasis. Colonic schistosomiasis comprises a small fraction of these cases.1 Though the prevalence is unknown, the majority of infections are caused by Schistosoma species mansoni, hematobium, and japonicum.2 Clinical manifestations and endoscopic findings of colonic schistosomiasis vary widely and reflect the host’s immune response to deposition of schistosoma eggs leading to granulomatous reaction in the colon as the disease progresses through the acute, chronic and advanced stages.2–4 Inflammation caused by colonic schistosomiasis has been suggested as a risk factor for colorectal cancer although the relationship has not been well established.4,5 Nonetheless, effective management requires an integrated approach of chemoprophylaxis, treatment, education and improved sanitation conditions in endemic areas. This case highlights a rare and often incidental finding discovered by colonoscopy in the US for which a high clinical suspicion (based on travel and migrant history) and histology ultimately led to the diagnosis.

Colonic Schistosomiasis and Associated Cecal Neuroma

Schistosomiasis remains a major health threat in many resource-poor countries and is being seen with increasing frequency in developed countries among immigrants and tourists who have a history of freshwater exposure in endemic areas. We report a case ofa 56-year-old male with no significant past medical history, who presented for a routine screening colonoscopy, which revealed two polyps in the cecum, and multiple petechiae in the rectum. Histologic evaluation showed presence of Schistosoma mansoni eggs. One of the polyps, where eggs were also present, was diagnosed as neuroma/ Schwann cell hamartoma. This is the first reported casewhere colonic schistosomiasis is associatedwith cecal neuroma.

Colonic Schistosomiasis as Incidental Finding in a Pedunculated Colonic Polyp

Colonic Schistosomiasis as Incidental Finding in a Pedunculated Colonic Polyp

Efficiency of diagnostic biomarkers among colonic schistosomiasis Egyptian patients

The schistosomal parasite plays a critical role in the development of malignant lesions in different organs. The pathogenesis of cancer is currently under intense investigation to identify reliable prognostic indices for disease detection. The objective of this paper is to evaluate certain biochemical parameters as diagnostic tools to efficiently differentiate between colonic carcinoma and colonic carcinoma associated with schistosomal infection among Egyptian patients. The parameters under investigation are interleukin 2 (IL-2), tumour necrosis factor alpha (TNF-α), carcinoembryonic antigen (CEA) levels, tissue telomerase, pyruvate kinase (PK), glucose-6-phosphate dehydrogenase (G-6-PD) and lactate dehydrogenase (LDH) enzyme activities. The results revealed a significant elevation in the level of the tumour markers IL-2, TNF-α and CEA as well as the activities of LDH, telomerase and G-6-PD among non-bilharzial and bilharzial colonic cancer groups, with a more potent effect in bilharzial infection-associated colonic cancer. A significant inhibition in PK activity was recorded in the same manner as compared to normal tissues. The efficacy of this biomarker was also evaluated through detecting sensitivity, specificity, negative and positive predictive values. In conclusion, schistosomal colonic carcinoma patients displayed more drastic changes in all parameters under investigation. The combination of the selected parameters succeeded in serving as biomarkers to differentiate between the two malignant types.

Endoscopy detected gastrointestinal mucosa macula is helpful in diagnosis of schistosomiasis

Objective To evaluate the specificity and clinical value of endoscopy detected gastroin- testinal mucosa macula in diagnosis of schistosomiasis. Methods The findings of routine gastroscopy and eolonoscopy performed in 8,000 subjects, including characteristic mucosal changes of schistosomiasis, detection of macula and results of biopsy, were retrospectively analyzed. Results Mucosal changes caused by schistosomiasis were detected in 702 cases （8.8%）. Among 6,421 cases of gastroscopy, 516 （8.0%） were diagnosed as schistosomiasis, with mucous macula found in 6 （0. 1% , 6/6421 ） , which accounted for 1.2% （6/516） of gastric schistosomiasis. Of the 1,579 cases of colonoscopy, 186 （ 11.8% ） were diagnosed as schistosomiasis, with mucous macula detected in 177 （ 11.2% , 177/1579） , which accounted for 95.2% （177/186） of colonic schistosomiasis. Conclusion Detection of mucous macula through gastroscopy and colonoseopy, accompanied with biopsy, plays an important role in diagnosis of schistosomiasis. Key words: Schistosomiasis; Endoscopy, digestive system ; Gastrointestinal mucosa macular

Colonic polyposis due to Schistosoma intercalatum

Schistosomiasis polyps induced by Schistosoma mansoni and S. japonicum have been reported from pathological observations but this is not the case for colonic schistosomiasis infection by S. intercalatum which has always been associated with mild clinical presentations. We report the case of a 17-year-old man, native from Equatorial Guinea, with colonic polyposis associated with infection by S. intercalatum.