Blood Flukes:

Schistosoma haematobium
Geographic Distribution :
 Endemic in Africa (54 countries) , ex: Egypt, Sudan,
Zambia, Malawi, and Zimbabwe,
 The Middle East.
Definitive Host:
 Human, monkeys, baboons,
chimpanzees
 causes urinary schistosomiasis,
(schistosomal hematuria,vesical
schistosomiasis, or urinary
bilharziasis)
telur
 skin rash at site of cercarial penetration
(swimmer’s itch)
 During migration to portal blood in liver :
may present fever, hepatitis, enlarged
liver, spleen, and lymph nodes, and
eosinophilia.
 Pulmonary symptoms are possible but
rare.
Adult worms in humans reside in the
venous plexus of bladder
it is the eggs not the adult flukes
which are responsible for the clinical
features
egg deposits in the bladder mucosa
and submucosa were seen during the
acute phase
 abnormal bladder function with
painful frequent urination or
difficult urination (dysuria)
hematuria is the most characteristic
symptom.
 Bacterial urinary tract infection
damage to the bladder or ureters :
obstructed and the bladder wall
thickened kidney damage.
occasionally embolic egg granulomas
may result in a transverse myelitis
with flaccid paraplegia.
Continuous aggravation in the
bladder wall leads to carcinoma of
the bladder
Microscopic identification of:
 eggs in urine ( or faeces )
 occasionally the hatched miracidia
in the urine
detecting eggs in rectal biopsy or
bladder mucosal biopsy
Antibody detection :
 All serum specimens are tested by
FAST-ELISA
Prevalence :
 Carcinoma of the urinary bladder is the
most common malignancy in the Middle
East and parts of Africa where
schistosomiasis haematobium is a
widespread problem
 The major histological cell type of
bladder cancer is Squamous Cell
Carcinoma
 InEgypt : 60 % of the Egyptian population
is at risk of infection.
Prevalence of 37 to 48% with high
incidence
 NationalSchistosomiasis Control
Program : mass treatment in schools
and high-prevalence villages
prevalence dropped to 6.6% in 1993
and then to 1.9% in 2002 and 1.2% in
2006 ( Hussein Khaled, 2013)
 InIraq : The proportion of SCC varied
from 54 to 81% of all bladder cancer cases
in different areas of endemic infection,
which contrasts to Western countries,
where the frequency of SCC in bladder
cancer cases is much lower (3 to 10%)
 eggs can act as a mechanical irritant :
bladder irritation, inflammation, and
concurrent chronic bacterial infections
 deposition of worms and eggs in the tissue
chronic inflammatory reaction consists of
macrophages and neutrophils, which produce
endogenous oxygen radicals
lead to the formation of carcinogenic N-
nitrosamines
Oxygen radicals are also responsible for
various mutations, like sister chromatid
exchanges , and DNA breaks
Biopsy of the mucosal bladder
 Age and Gender Ratios :
 In schistosome-free countries : the peak
incidence of bladder cancer is in the 6 th
or 7 th decade ( max between the ages of
65 and 75 years)
 By contrast, in endemic countries : the
mean age is between 40 and 49 years
 The ratio of bladder cancer incidence
(males to females) in countries with
endemic infection was reported to be 5:1