Title : A rare case of urogenital schistosomiasis in an African asylum seeker: Diagnostic and management challenges
Abstract:
Background: Schistosomiasis is a parasitic disease caused by trematode worms of the genus Schistosoma. Schistosoma haematobium is primarily responsible for urogenital schistosomiasis, commonly presenting with haematuria and bladder pathology. This case highlights the diagnostic and management challenges of a rare presentation of urogenital schistosomiasis in a non-endemic region.
Case Presentation: A 15-year-old male asylum seeker from Eritrea presented with intermittent haematuria for six months and intermittent per rectum (PR) bleeding for one year. His past medical history included pulmonary tuberculosis and chickenpox with scarring. Social history revealed he traveled through multiple endemic regions before arriving in the UK. Physical examination was generally unremarkable, with no visible haematuria on gross examination of the urine and no blood on digital rectal examination.
Investigations: Initial laboratory investigations, including FBC, CRP, and urine culture, were unremarkable. Stool pathogen PCR and microscopy were negative. Ultrasound of the urinary tract revealed focal bladder wall thickening without vascularity. Diagnostic cystoscopy under general anaesthetic showed sandy patches in the bladder but no other abnormalities. Definitive diagnosis was confirmed by the presence of Schistosoma haematobium ova in urine microscopy.
Management: The patient was treated with Praziquantel 1.2 g, the drug of choice for schistosomiasis, with an expectation of a curative outcome.
Discussion: Schistosomiasis is endemic in Eritrea and other parts of Africa. The patient's journey through multiple endemic regions increased his risk of infection. Haematuria and PR bleeding in this case indicated involvement of both the urinary and gastrointestinal tracts. The intermittent nature of symptoms and chronic timeline were consistent with a long-standing infection, rare in the UK but common in endemic areas.
Conclusion: This case underscores the importance of considering schistosomiasis in patients with compatible travel history and unexplained haematuria or PR bleeding. Prompt diagnosis and treatment are crucial to prevent long-term complications. This case also emphasizes the need for heightened clinical awareness and thorough history-taking for patients from endemic regions presenting with atypical symptoms in non-endemic areas.
Audience Take Away Notes:
- Recognize Clinical Presentations: Understand key symptoms of urogenital schistosomiasis, including haematuria and PR bleeding, and their relevance to travel history.
- Diagnostic Process: Learn the importance of comprehensive history-taking, laboratory tests, imaging, and cystoscopy in diagnosing schistosomiasis.
- Treatment Protocols: Gain knowledge about the use of Praziquantel for treating schistosomiasis and the importance of timely intervention to prevent complications.
- Clinical Awareness: Appreciate the need for heightened awareness and consideration of tropical diseases in patients from endemic regions, even in non-endemic settings.
- Case Significance: Recognize the complexities and challenges in managing rare tropical diseases in diverse healthcare environments, illustrated by this case.
