Genitourinary Schistosomiasis: Life Cycle and Radiologic-Pathologic Findings

Abstract

Genitourinary schistosomiasis is produced by Schistosoma haematobium, a species of fluke that is endemic to Africa and the Middle East, and causes substantial morbidity and mortality in those regions. It also may be seen elsewhere, as a result of travel or immigration. S haematobium, one of the five fluke species that account for most human cases of schistosomiasis, is the only species that infects the genitourinary system, where it may lead to a wide spectrum of clinical symptoms and signs. In the early stages, it primarily involves the bladder and ureters; later, the kidneys and genital organs are involved. It rarely infects the colon or lungs. A definitive diagnosis of genitourinary schistosomiasis is based on findings of parasite ova at microscopic urinalysis. Clinical manifestations and radiologic imaging features also may be suggestive of the disease, even at an early stage: Hematuria, dysuria, and hemospermia, early clinical signs of an established S haematobium infection, appear within 3 months after infection. At imaging, fine ureteral calcifications that appear as a line or parallel lines on abdominopelvic radiographs and as a circular pattern on axial images from computed tomography (CT) are considered pathognomonic of early-stage schistosomiasis. Ureteritis, pyelitis, and cystitis cystica, conditions that are characterized by air bubble-like filling defects representing ova deposited in the ureter, kidney, and bladder, respectively, may be seen at intravenous urography, intravenous ureteropyelography, and CT urography. Coarse calcification, fibrosis, and strictures are signs of chronic or late-stage schistosomiasis. Such changes may be especially severe in the bladder, creating a predisposition to squamous cell carcinoma. Genital involvement, which occurs more often in men than in women, predominantly affects the prostate and seminal vesicles.

The WHO ultrasonography protocol for assessing hepatic morbidity due to Schistosoma mansoni. Acceptance and evolution over 12 years

“…The non-occurrence of pyelon fibrosis is futher confirmed by a case series and a review on kidney pathology due to schistosomiasis where kidney pyelon fibrosis was also not reported (Barsoum 2003, Shebel et al 2012). On the other hand, 5 classes of glomerulonephritis have been reported to be related to not only to S. haematobium but more frequently to S. Searches for ultrasonography AND schistosomiasis or S. haematobium AND calcifications retrieved only 7 publications, of which only 3 were published after 2001, only 2 of them were eligible (Nmorsi et al 2007;Salas-Coronas et al 2013).…”

Female Genital Schistosomiasis: A Neglected Tropical Disease

“…Female genital schistosomiasis may cause abnormal malodorous vaginal discharge, contact bleeding, dysmenorrhoea, menorrhagia 9,11-13 dysuria and haematuria. 3 In the vulva patients may complain of lumps or chronic itching. Patients may present with chronic pelvic pain.…”

“…The complications of this infection include ureteritis, pyelitis and cystitis. 3 There could be calcification, fibrosis and strictures in the urinary system. Genital tract infection may cause chronic pelvic inflammatory disease 17 and subfertility as the ova are lodged in the Fallopian tubes (Figure 1).…”

“…Computed tomography, intravenous urography, computed urography may all reveal bubble-like filling defects representing ova deposited in ureters, kidneys and bladder. 3 Directed punch biopsies obtained cystoscopically, hysteroscopically and colposcopically sent for histopathological examination can be diagnostic.…”

“…It is endemic in riverine areas of the world such as Africa, Eastern Mediterranean, Central America, East Asia and the Middle East. 2,3 Travellers to these areas can be affected. The majority of genito-urinary infections are caused by Schistosoma haematobium, Schistosoma japonica and Schistosoma mansoni that is found in Brazil.…”