Why does this matter?
Schistosomiasis, although the commonest cause of haematuria worldwide, often remains undiagnosed and is yet easily treated.
What happened in this case?
In a recent case report in the NEJM (Kara, 2023), A 13-year-old boy from Mali was referred to a paediatric urology clinic in Turkey, with a 3-month history of macroscopic haematuria. He reported no fevers, flank pain, or dysuria. A physical examination was normal.
Laboratory studies showed normal kidney function, an absolute eosinophil count of 2660 per cubic millimetre (reference range, 40 to 200). A urinalysis (dipstick) showed haematuria and pyuria, and a urine culture (MSU) was negative.
On microscopic examination of the urine, there were oval-shaped parasite eggs with a terminal spine, a finding consistent with Schistosoma haematobium (Picture A above, arrow; 0 to 1 eggs per high-powered field).
Subsequent cystoscopy showed polypoid masses extruding into the bladder lumen (Picture B). Pathological examination of a bladder-biopsy specimen (under a microscope) showed numerous schistosome eggs, acute and chronic papillary and polypoid cystitis (Picture C).
A diagnosis of urinary schistosomiasis due to S. haematobium was made. Treatment with praziquantel was administered. Two weeks after initiation of treatment, the patient’s haematuria resolved. One month after initiation of treatment, urine studies showed no microscopic haematuria or schistosome eggs.
How does this affect you?
S haematobium is found mainly in Africa and the eastern Mediterranean region. So, if you go on holiday to these areas, you can become infected and get urinary schistosomiasis – which sometimes shows itself months (or even years) later. This is why swimming in the Nile is not recommended. Fortunately this infection is rare, and most holidays don’t end in this way.
Last Reviewed on 10 September 2023