The emerging threat of schistosomiasis spread in Pakistan

Schistosomiasis is among the thirteen neglected tropical diseases of the world. While prevalent in a number of countries, it has only rarely been reported in Pakistan. Here we report a 25 year old male who acquired the infection during travel to Malawi and presented with haematuria and dysuria. He was successfully treated with praziquantel. The possibility of schistosomiasis becoming endemic in the country is discussed. A number of risk factors are present including dams, irrigation, increased travel and geographical proximity to endemic countries. The local presence of at least one snail species of potential hosts for Schistosoma mansoni is confirmed. We see that schistosomiasis endemicity is a possible threat in Pakistan. Solutions to prevent this include reducing travel to endemic areas, prompt recognition and treatment of cases, and health education.

Diagnosis of Schistosoma haematobium on voided urine cytology: a case report with radiologic correlation

BACKGROUND

Infection with schistosomal species is becoming a more frequent finding in hospitals throughout the United States. Some causes that can be attributed to the rise include increased immigration from and travel to endemic areas.

CASE

We report a case of urinary schistosomiasis diagnosed on urine cytology in a 7-year-old Nigerian boy. Infection was suspected after review of the clinical history and correlation with radiologic images.

CONCLUSION

The rise in incidence has made it necessary for cytopathologists to be increasingly aware of these infections, in particular, Schistosoma haematobium, because it is the most frequent agent to be encountered on a cytology specimen, particularly urine. Similar cases have been published, one with specimen concentration and one without. However, no cases of cytology diagnosis with radiologic correlation are seen in the English literature.

Diagnostic value of a miracidium in urinary sediment

Although rarely encountered in the United States, urinary tract schistosomiasis occurs commonly in many countries in the eastern hemisphere. Travel and immigration may contribute to imported cases of schistosomiasis. Excessive morbidity and increased mortality, including the development of urinary-tract squamous-cell carcinoma, are associated with untreated Schistosoma haematobium infection. Therefore, in the appropriate clinical context, all efforts should be made to rule out infectious and readily treatable causes of chronic hematuria. The presence of characteristic eggs in the urinary sediment is the usual means of diagnosing a S. haematobium infection. Additionally, the small and less commonly encountered miracidium stage of S. haematobium may also be present in the urine, which is another means of diagnosing urinary tract schistosomiasis. The present report describes a case in which a miracidium was detected in a fresh, unstained urine specimen. As detection of miracidia can be made in specimens also processed by routine cytologic methods, it behooves cytologists to be aware of this entity for the diagnosis of schistosomiasis.

[Paleoparasitology: presumption of a case with bilharzia of the 15th century at Montbéliard (Doubs, France)]

On the archeological site of Montbéliard, paleoparasitological and sedimentological analysis of cesspit deposits led to the detection of well preserved parasitological forms (remains of helminths with associated eggs). The morphology and morphometry of these forms point to a plausible case of bilharzia transmitted by Schistosoma haematobium. The chance of ancient or recent contamination of the sample is discussed.

Speed of skin penetration and initial migration route of infective larvae of Schistosoma haematobium in Meriones unguiculatus

The kinetics of skin penetration of Schistosoma haematobium (Bilharz, 1852) (Trematoda, Schistosomatidae) cercariae is reported for the first time, Meriones unguiculatus (Rodent, Gerbillidae) being used as experimental model. It has been demonstrated that the cercariae cross the epidermis of their hosts either directly or through hair follicles culs-de-sac from 3 to 5 min. The corresponding schistosomulae slide into the superficial part of the dermis or move along the base of hair follicles. Six minutes after, schistosomulae are found in the lumen of lymphatic vessels running alongside blood capillaries. One hour post-infestation, the dermis presents acute inflammatory reaction with edema, infiltration of neutrophil and eosinophil leukocytes. Conversely, dilated blood capillaries do not contain any schistosomula. Thus, the initial migration path of infective larvae of S. haematobium in M. unguiculatus is lymphatic.

A study of the biological characteristics of a hybrid line between male Schistosoma haematobium (Dar es Salaam, Tanzania) and female S. intercalatum (Edea, Cameroun)

The viability of a hybrid between male Schistosoma haematobium (Dar es Salaam, Tanzania) and female S. intercalatum (Edea, Cameroun) was studied for up to the F7 hybrid generation and the biological characteristics of the hybrid were compared with those of each of the parental species. Using the total cercarial production/100 exposed snails/5 weeks value (TCP) as an index the hybrid miracidial infectivity to Bulinus forskalii (Kinshasa, Zaire), the host snail for S. intercalatum, remained comparable to that of S. intercalatum for up to at least the F5 generation and the TCP values for the hybrid/B. wrighti combination remained for up to the F7 generation intermediate between those of the parental species in B. wrighti. The hybrid also retained the infectivity for up to at least the F5 generation to B. globosus (Mazeras, Kenya), the host snail for S. haematobium, but the TCP values for the hybrid/B. globosus combination remained consistently lower than that of the S. haematobium/B. globosus combination. The hybrid cercarial infectivity to hamsters was for up to the F7 generation comparable to that of both parental species and the egg production capacity/worm pair/day of production of the F1 hybrid generation exceeded in both hamsters and mice that of both parental species. However, the egg production capacity subsequently decreased with that of the F3 to F6 generations in hamsters and with that of the F2 and F5 generations in mice being comparable to that of S. intercalatum. The pattern of distribution of eggs in tissue of hamsters of the F1 and F2 generations resembled that of S. haematobium and S. intercalatum, respectively, but the distributional pattern of the F3 to F6 generations deviated markedly from that of both the parental species and the preceding hybrid generations. The hybrid cercarial infectivity to mice and the pattern of egg distribution corresponded to that of S. intercalatum. The egg morphology of the P1 generation corresponded to that of S. intercalatum while that of the F1, F2 and F3 hybrid generations exhibited great polymorphism with a range of shapes through those of the parental species but with most eggs being intermediate in shape. However, the eggs of the F4 to F7 hybrid generations exhibited less polymorphism and resembled those of S. bovis in both size and shape.

A comparative study of the vitelline cell in Schistosoma mansoni, S. haematobium, S. japonicum and S. mattheei

A comparison is given of the ultrastructure of the vitelline cell in Schistosoma mansoni, S. haematobium, S. japonicum and S. mattheei. Four stages in development of the vitelline cell have been categorized as follows: Stage 1, the undifferentiated cell; Stage 2, the developing cell showing the beginning of synthetic activity; Stage 3, the developing cell showing active protein synthesis; Stage 4, the fully mature vitelline cell. These stages in development have been defined morphologically and Stages 1, 2 and 3 are very similar in all 4 species. Lipid is present in the Stage 4 cells of all species but appears earlier at Stage 3 in S. haematobium and S. mattheei. There are several differences as to the intercellular inclusions of the Stage 4 cells, the most marked of these being the absence of calcareous corpuscles from S. japonicum as compared with the other 3 species.

Multispecies schistosomal infections of the female genital tract detected in cytology smears

Egg morphology of Schistosomes affecting man in Africa is described and illustrated with particular reference to the appearance of the ova of S. haematobium, S. mansoni and S. mattheei in Papanicolaou stained smears.

The timing of reproductive cell development and movement in Schistosoma mansoni, S. japonicum, and S. haematobium, using techniques of autoradiography and transplantation

Tritiated thymidine was incorporated into gonial and vitelline cells of male and female Schistosoma mansoni, S. japonicum, and S. haematobium after 2 hr of incubation. Spermatogonial cells developed into labeled mature sperm after 6 days of transplantation in all species. Insemination of females was detected on the same day indicating copulation is frequent. Oogonia labeled in the initial incubation matured into primary oocytes after 7 days of transplantation for S. mansoni and S. haematobium and after 6 days in S. japonicum. Cytoplasmic thymidine label was observed after 2-hr incubations in the primary oocytes of all species. Initial label in the vitellaria was scattered and heavy. After 3 days of transplantation, label was considerably diluted and by day 6 was undetectable in vitelline glands. These times for development and movement of reproductive cells are considered to be standards against which the effects of stressful conditions on the reproductive system can be assessed.

Culture of Schistosoma haematobium in vivo and in vitro

The maximum rate of development of Schistosoma haematobium in the hamster was determined by examination of the most advanced worms recovered at short intervals throughout the course of development. In culture S. haematobium developed at the same rate as in the hamster up to day 31 when pairing first occurs and male worms produce some spermatozoa. In vitro males formed some spermatozoa but pairing did not take place and, probably for this reason, females did not complete sexual maturation as occurs in the host between days 57-65. Somatic growth continued in vitro and at 70 days male worms had achieved almost the same length as in the hamster at this time. The culture medium, previously used for S. mansoni, consisted of equal volumes of serum and Earle's balanced saline with a final concentration of 0.25% lactalbumin hydrolysate, 100 units/ml penicillin, 100 mug/ml streptomycin and 1% rbc. The best culture results were obtained with one particular human serum; seven other human sera gave a wide range of growth support. The samples of baboon, rhesus monkey or foetal calf sera tested provided little or no growth support but prolonged survival was possible in all the sera.