Introduction

Schistosomiasis, or bilharzia, is a parasitic flatworm infection.

Pathophysiology

Schistosoma haematobium

These worms deposit egg clusters (pseudopapillomas) in the bladder, causing inflammation. The calcification seen on x-ray is actually calcification of the egg clusters, not the bladder itself.


Schistosoma mansoni and Schistosoma japonicum

These worms mature in the liver and then travel through the portal system to inhabit the distal colon. Their presence in the portal system can lead to progressive hepatomegaly and splenomegaly due to portal vein congestion.

These species can also lead to complications of liver cirrhosis, variceal disease and cor pulmonale.


Schistosoma intercalatum and Schistosoma mekongi

These are less prevalent than the other three forms, but are both attributed to intestinal schistosomiasis.

Clinical features

Schistosoma haematobium

Depending on the site of these pseudopapillomas in the bladder, they can cause an obstructive uropathy and kidney damage.

This typically presents as a 'swimmer's itch' in patients who have recently returned from Africa. Schistosoma haematobium is a risk factor for squamous cell bladder cancer.

  • Frequency
  • Haematuria
  • Bladder calcification

Management

  • Single oral dose of praziquantel