Schistosomiasis: Clinical Relevance to Surgeons in Australasia and Diagnostic Update

Abstract

All surgeons working in Australasia should be prepared to encounter imported cases of schistosomiasis. The disease should be considered when typical symptoms are present, and there is evidence of skin exposure to fresh water in an endemic area. Whether or not signs of urinary or intestinal tract schistosomiasis are present, ectopic ova can involve and produce symptoms in almost any structure including the liver, the lungs, the reproductive system and the central nervous system, sometimes producing puzzling clinical abnormalities decades after primary infection. Recovery of ova from urine, stool or their detection in a biopsy confirms diagnosis but, when this is unsuccessful, immunological tests support diagnosis. Imaging techniques (e.g. ultrasonography, standard radiology, computed tomography or magnetic resonance imaging scans) may indicate and define involvement of various organs and structures. The surgeon often has an important role to play in the management of the protean complications of schistosomiasis.

Schistosomiasis in Patients in the Sultanate of Oman

“…It is essential that the correct investigation is performed at different stages of the disease, in both schistosomiasis mansoni and haematobia. 9 The emphasis is on recovery of ova, and especially the use of rectal snips, 10,11 but in cases where they cannot be recovered, e.g., in early or very late infection, immunodiagnosis is helpful. Serology does not distinguish well between past and current infection, but single high titers in the IHA test, e.g., ≥1:320 (reference range for laboratory ≥1:80), suggests active infection.…”

“…[12][13][14][15] It is important that doctors in this part of the world be familiar with the main features of the disease and appropriate diagnostic methods. 9 All untreated patients, including seropositive, asymptomatic individuals, should receive praziquantel, to ensure destruction of all worms, including those in ectopic locations. In Arabian Peninsula countries where vector snails are endemic, surveillance for human schistosomiasis, and mollusciciding of freshwater habitats, should be continued indefinitely.…”

An unusual pedunculated polyp of the transverse colon associated with schistosomiasis

“…Colonic schistosomiasis is defined as a specific acute or chronic inflammatory reaction to Schistosoma ova, which are deposited mainly in the colorectal mucosa [1]. Worms trapped in the submucosa produce ova that stimulate an intense tissue reaction that further leads to development of polyposis and occasionally pericolic masses [2]. Schistosomal colonic polyps mainly occur in the distal colon in men living in heavily endemic areas and the presenting symptoms are bloody diarrhea, abdominal pain, and rectal bleeding [3].…”