Cytologic diagnosis of Schistosoma haematobium in routine cervicovaginal smear from an infertile woman

Abstract

Schistosomiasis is a worldwide parasitic infestation.The species, Schistosoma haematobium, is endemic in Africa and the Middle East. It predominantly affects the urinary system; the diagnosis of schistosomiasis is usually made through detection of ova in the urine. Observation of ova in cervical smears has occasionally been reported in endemic areas in Africa. 1-3 The diagnosis is rarely made by examination of cervicovaginal smears in nonendemic areas such as North America. In this communication we report such a rare case in a women who was evaluated for infertility.A 22-yr-old black Liberian woman presented to the gynecology clinic with the complaint of infertility for four years. She had been taking Clomiphene for 8 mo which was discontinued 6 mo prior to her current visit. Physical examination was unremarkable with the exception of a small pruritic fistula in the perianal region. A cervicovaginal smear and a urine specimen were obtained and the patient was referred to dermatology.Two urine specimens as well as stool samples were negative for parasites. The cervicovaginal smear stained by the Papanicolaou method revealed that scattered among the inflammatory cells were a number of Schistosoma haematobium ova in various stages of development similar to what has been previously described by Berry. The majority of the ova contained miracidium, showing an eosinophilic cytoplasm, abundant hematoxylin-stained granular material, and the pathognomonic terminal spine. One egg was found in which the miracidiurn appears to be hatching from the egg shell (Fig. 1). Occasional empty egg shells were present; they showed a light refractile morphology with crumpled edges and terminal spines (Fig. 2). A number of free miracidium were noted. They contained eosinophilic cytoplasm, prominent bull's-eye cells which are stained basophilic with hematoxylin stain, and cilia which were discernible by careful focusing (Fig. 3).A skin biopsy of the perianal fistula showed a granulom-atom reaction with a calcified structure suggestive of a schistosome ovum.The patient was treated with Praziquantel and is currently being monitored by the gynecology service.The incidence of schistosomiasis in the female genital tract ranks next to that of urinary and gastrointestinal systems. The vagina and cervix are most frequently involved. 4i5 The eggs can also be found in the subserosa of the uterus, ovary, and fallopian tubes, especially in cases where there is heavy infestation, which likely occurs as a result of communication between the pelvic venous plexuses.Negative urine examination in our patient, as has been reported in other cases, underscores the difficulty in making an accurate diagnosis by a single urine examination. This should not be surprising in view of the diurnal nature of egg excretion by the parasite^.^,^ In endemic areas, rectal biopsy is a well-recognized method of investigation in suspected cases with negative urine results. ' Infertility has been reported in association with pelvic schistosomiasis, and it appears not to be an un...

Significance of a Diagnosis of Microorganisms on Pap Smear

“…The organisms are most commonly S. hematobium. In a later case report, produced by DeMille et al [60] in 1995, a Liberian woman presented with infertility. On cervical smear stained by the Pap method, S. hematobium ova were scattered among the numerous inflammatory cells.…”

“…The bulk of the ova identified contained miracidium showing an eosinophilic cytoplasm, hematoxylin-stained granules, and, most importantly, the pathognomonic terminal spine. Occasionally empty egg shells were also present [60], but one must be mindful of the fact that, to document active infection, living organisms must be present inside the eggs if only eggs are present. A unique case was reported in 1998 by Mainguene et al [61] in which a European woman who had visited Senegal 9 years previously presented with S. hematobium on Pap stain.…”

Schistosomiasis of the abdominal cavity and infertility: a case report

“…Reports suggest the cervix is not an uncommon site of the disease and when present it can be diagnosed by cytology. The cervical smear shows that among inflammatory cells there are a number of S. haematobium ova in various stages of development 5,6 . Colposcopy usually reveals cream-coloured nodules within the squamous and metaplastic epithelium of the ectocervix.…”