Urinary Schistosomiasis: Review

Abstract

In this review, the clinical manifestations of urinary schistosomiasis are displayed from a pathogenetic perspective. According to the prevailing host’s immune response profile, urinary schistosomiasis may be broadly categorized into cell-mediated and immune-complex-mediated disorders. The former, usually due to Schistosoma haematobium infection, are attributed to the formation of granulomata along the entire urinary tract. As they heal with excessive fibrosis, they may lead to strictures, calcifications and urodynamic abnormalities. The main impact is lower urinary, the site of heaviest ovi-position. Secondary bacterial or viral infection is common, any may be incriminated in secondary stone formation of the development of bladder malignancy. Immune-complex mediated lesions are usually associated with hepatosplenic schistosomiasis due to Schistosoma mansoni infection. Circulating complexes composed of schistosomal gut antigens and different classes of immunoglobulins deposit in the kidneys leading to several patterns of glomerular pathology. The latter have been categorized under six classes based on the histological and immunofluorescence profile. These classes have been linked to respective clinical manifestations and depend on the stage of evolution of the host’s immune response, extent of associated hepatic fibrosis and co-infection with salmonella or hepatitis C. Secondary amyloidosis develops in 15% of such patients, representing a critical impairment of macrophage function. Conclusion: The wide clinicopathological spectrum of urinary schistosomiasis mirrors the evolution of the host’s immune response according to chronicity of infection, bacterial or viral co-infection and, in the case of glomerulonephritis, to the extent of hepatic co-morbidity.

Urinary schistosomiasis among preschool-age children in an endemic area of Kinondoni municipality, Dar es Salaam, Tanzania 2016

“…The sample size for estimating the prevalence of S. haematobium among Class I pupils was calculated using a prevalence of 50.0% (since there was no previous figure) that was the largest sample size [16]; thus using the formula for estimating sample size in a single cross-sectional survey: N = (z/d) 2 × p (1-p) where, N is the desired sample size; z is SD (1.96) which corresponds to 95% confidence interval; p is estimated prevalence of S. haematobium in preschool children in the study area (50.0%); d is marginal error (5%). N = (1.96/0.05) 2 ××0.5 (1 -0.5) = 385 Adding 10% for non-responses, drop outs and missing data (0.1 ××385), the sample size was 424 in Class I pupils.…”

“…Infection with Schistosoma haematobium (S. haematobium), a parasitic dioecious trematode, transmitted by snails of the Bulinus species, causes urinary schistosomiasis whose common early signs include microscopic and visible haematuria that precede the development of urological abnormalities such as urinary bladder calcification, deformed ureters and kidneys in the form of hydronephrosis [1,2]. The control of schistosomiasis in sub-Saharan Africa, including Tanzania, have focused primarily on schoolaged children, excluding preschool-age children and adults [3,4].…”

Efficacy and Safety of Arachidonic Acid for Treatment of Schistosoma mansoni-Infected Children in Menoufiya, Egypt

“…2 Schistosomes show unsurpassed precision in laying eggs near the conduit for egg passage to the external environment to complete the life cycle. 3,4 Accordingly, massive numbers of eggs daily exit from the blood capillaries to the lumen of the gut or urinary bladder, where they may be detected by analysis of stool or urine samples, respectively. Large numbers of eggs are retained in the tissues of the intestinal and urinary bladder walls and the liver and responsible for the disease's clinical manifestations by releasing egg antigens that provoke intense immunological reactions.…”

Prevalence of Urinary Schistosomiasis among School Aged Children in Khelawa Village, River Nile State, Sudan, 2017

“…The wide clinic pathological spectrum of urinary schistosomiasis mirrors the evolution of the host's immune response according to chronicity of infection, bacterial or viral co-infection and, in the case of glomerulonephritis, to the extent of hepatic co-morbidity [4].…”