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Cystoscopic view of the bladder mucosa with abundant nodular lesions (A). Biopsy of nodular lesions on bladder mucosa (H–E stain) showed abundant submucosal eosinophil infiltrates (B), Charcot-Leyden crystals are also present. No signs of necrosis of the mucosa were seen. Schistosoma haematobium ova were released to the urine after the biopsy, allowing the morphologic diagnosis (C).
Source publication
We describe a Schistosoma haematobium infection with asymptomatic eosinophilia, persistently negative urine microscopy, and late seroconversion (7.5 months) in a traveler returning from Mali. After initial negative parasitological tests, travel history led to diagnostic cystoscopy, allowing final diagnosis with urine microscopy after the bladder bi...
Contexts in source publication
Context 1
... a third visit (8 months after exposure), a concen- trated 24-hour urine parasitological test was performed, the result of which was also negative. At this moment, the patient continued to deny fresh water contact, therefore, a cystoscopy was performed revealing mul- tiple nodular lesions compromising the bladder mucosa ( Figure 1A). Biopsy of a nodule showed eosinophilic cystitis with giant multinucleated cells ( Figure 1B) without parasites. ...
Context 2
... this moment, the patient continued to deny fresh water contact, therefore, a cystoscopy was performed revealing mul- tiple nodular lesions compromising the bladder mucosa ( Figure 1A). Biopsy of a nodule showed eosinophilic cystitis with giant multinucleated cells ( Figure 1B) without parasites. Microscopic examination of the urine carried out after the biopsy revealed Schistosoma haematobium ova ( Figure 1C). ...
Context 3
... of a nodule showed eosinophilic cystitis with giant multinucleated cells ( Figure 1B) without parasites. Microscopic examination of the urine carried out after the biopsy revealed Schistosoma haematobium ova ( Figure 1C). The results of the ELISA serology were available 1 month after diagnosis, with a positive result (index 3.1; normal below 1.1). ...
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Paciente varon de 23 años y raza negra, procedente de Africa que acude al servicio de urgencias remitido por su medico de Atencion Primaria por hematuria de evolucion subaguda/cronica y dolor lumbar. En la analitica destaca Eosinofilia (11.70%) y se confirma la presencia en el sedimento de orina de huevos de Schistosoma Haematobium.
Male patient,...
Citations
... Seroconversion may be absent until 6 weeks post-exposure, depending on the antigen used. Also, serum reactivity may occur late in an acute infection (15,20,21). Eosinophil counting is another unreliable marker since eosinophilia may not occur, and its absence does not rule out acute infection (20). ...
Acute schistosomiasis (AS) manifests with a broad spectrum of clinical features in pediatric populations. Diagnosis may be difficult in the absence of detectable numbers of eggs. As a result, new approaches may be required to achieve an accurate diagnosis. Optimal praziquantel (PZQ) treatment regimen for young children is debatable. Also, the post-treatment response is still poorly evaluated due to the lack of reliable markers. A group of 6 children (a toddler and 5 pre-school children) and one pre-adolescent were investigated for AS clinical manifestations and followed-up for two years after treatment. Ova detection was performed by Kato-Katz (KK) and presence of Schistosoma mansoni DNA was assessed by real-time PCR (rt-PCR) in stool samples. IgG and IgE anti-Schistosoma levels and urinary antigen were detected by ELISA and point-of-care circulating cathodic antigen (POC-CCA) testing in serum and urine, respectively. AS clinical symptoms were present in 5/7 (71.4%) of the infected children, and hypereosinophilia was detected in all of them. Ova detection and serology were positive in only 3/7 (44.9%) and 4/7 (57.1%), respectively. However, real-time PCR (rt-PCR) showed the presence of Schistosoma DNA in 6/7 (85.7%) of the cases, and urinary antigen was detected in all infected children. The long-term follow-up after treatment with three doses of PZQ (80mg/kg/dose), showed high cure rates (CR) as demonstrated by the DNA-based assay as well as reduced levels of side effects. CR based on urinary antigen detection ranged from 28.6 to 100%, being the highest CR due to double testing the 2-year post-treatment samples. The results suggest that high dose and repeated treatment with PZQ might be effective for AS in young children. Also, new laboratory markers should be considered to diagnosis and monitor the drug response.
... Follow-up testing of initial negative tests using antibodybased assays has proven to be useful in diagnosing cases that were late sero-converters where initial testing was negative but follow-up testing as late as 12 months post infection was positive. A report by Martinez-Calle et al. 29 described a case that did not appear serology positive until 7.5 months post-travel, whilst Soentjens et al. 30 describes late seroconversion in three cases where serology only became positive 3-5 months post infection. 29,30 In instances of late seroconversion, without follow-up samples, the (asymptomatic) patients would not have been offered the appropriate treatment, highlighting the importance of further discussions around follow-up testing beyond the suggested 8-12 weeks. ...
... A report by Martinez-Calle et al. 29 described a case that did not appear serology positive until 7.5 months post-travel, whilst Soentjens et al. 30 describes late seroconversion in three cases where serology only became positive 3-5 months post infection. 29,30 In instances of late seroconversion, without follow-up samples, the (asymptomatic) patients would not have been offered the appropriate treatment, highlighting the importance of further discussions around follow-up testing beyond the suggested 8-12 weeks. An audit of Scottish data is in progress to assess the usefulness of follow-up testing in Scottish travellers. ...
Background:
Imported schistosomiasis is of significant public health importance and is likely to be underestimated since infection is often asymptomatic. We describe data from travellers residing in Scotland which includes a subset of group travellers from one of the largest Health Boards in Scotland.
Methods:
Clotted bloods were obtained during the period 2001-15 from a total of 8163 Scottish travellers. This included seven groups comprising of 182 travellers. Sera were examined for the presence of Schistosome species antibody at the Scottish Parasite Diagnostic and Reference Laboratory (SPDRL).
Results:
Of all, 25% (n = 1623) tested positive with 40% (n = 651) of those patients aged between 20 and 24 years. Although 62% (n = 1006) of those who tested positive reported travel to Africa, important information on the specific region visited was lacking in almost one-third of samples received. Overall, 62 (34%) of group travellers tested positive and 95% (n = 59) reporting travel to Africa.
Conclusions:
Globalization, affordable air travel and improved awareness, are likely to contribute towards the increasing number of imported schistosomiasis cases. Therefore, enhanced surveillance capturing detailed travel history and fresh water exposures will improve risk stratification, pre-travel advice and optimize testing and treatment regimes for this increasingly important parasitic disease.
... Con respecto a la población viajera, se han comunicado casos aislados y series en varias regiones españolas [93][94][95][96][97][98][99][100][101][102][103][104][105][106] . Prácticamente todos los pacientes habían viajado a África, siendo los países más visitados Mali (especialmente el país Dogón), Burkina Fasso, Uganda (isla de Sesé), Malawi, Senegal y Madagascar. ...
The finding of blood eosinophilia in a patient is a relatively frequent reason to refer him/her to a Clinical Department of Infectious Diseases. The doctor usually intends to rule out a parasitic disease in the autochthonous population, travelers or immigrants. It is uncommon for an eosinophilia to be produced by protozoa infection, whereas helminth parasites are more frequently associated with an increase of eosinophil counts in the infected patient. Eosinophilia can be the only abnormal finding, or it could be part of more complex clinical manifestations suffered by the patient. Furthermore, many, but not all, helminth infections are associated with eosinophilia, and the eosinophil level (low, high) differs according to parasite stages, helminth species, and worm co-infections. The purpose of the present article is to carry out a systematic review of cases and case series on helminth infections and eosinophilia reported in Spain from 1990 to 2015, making a distinction between autochthonous and imported (immigrants and travelers) cases, and studying their relationship with immunodepression situations.
Copyright © 2015 Elsevier España, S.L.U. y Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.
... Several schistosome serological tests have been developed, many of which are in-house assays based on egg or worm extracts. Seroconversion generally takes 4-8 weeks, but may sporadically be later [36][37][38]. Although the sensitivity of serological tests ranges from 41% to 78% [39], it is still the most suitable diagnostic test currently available, particularly for travellers. ...
Following the success of nucleic acid-based detection in virology and bacteriology, multiplex real-time PCRs are increasingly used as first line diagnostics in clinical parasitology, replacing microscopy. The detection and quantification of parasite specific DNA in faeces is highly sensitive and specific and allows for cost-effective high throughput screening. In this paper we discuss the clinical consequences of this radical change in diagnostic approach, as well as its potential drawbacks. In the Netherlands, routine diagnostic laboratories have been pioneering the implementation of multiplex real-time PCR for the detection of pathogenic intestinal protozoa and this has resulted in increased detection rates of Giardia lamblia and Cryptosporidium spp. As a consequence of this new diagnostic approach, expertise in the field of parasite morphology by conventional light microscopy seems to be disappearing in most of the high-throughput microbiological laboratories. So in order to maintain a high standard of care, a formalized exchange of critical information between clinicians and laboratory staff is necessary in order to determine the most appropriate testing either in local laboratories or in reference centres, based on clinical signs and symptoms, exposure and immune status. If such a diagnostic algorithm is lacking, important infections in travellers, immigrants and immunocompromised patients may be missed.
Copyright © 2015. Published by Elsevier Ltd.
... We read with great interest the article by Martínez-Calle and colleagues 1 and, being involved in ongoing research strictly related to this topic, we would like to bring some additional comments to the readers' attention. ...
We read with great interest the article by Martinez‐Calle and colleagues1 and, being involved in ongoing research strictly related to this topic, we would like to bring some additional comments to the readers' attention.
We agree that diagnosis of acute schistosomiasis is not straightforward at first presentation, especially in paucisymptomatic cases, and the authors should be congratulated for their obstinacy in seeking diagnosis in this challenging case.2–3 In a case series of patients presenting with fever, diagnosis of schistosomiasis could not be established at first contact in about one third of the cases,4 even when using a combination of parasite examination and two different serological tests [enzyme linked immunosorbent assay (ELISA) and indirect hemagglutination (IHA)]. It must be …
Bu bölümde dünya üzerindeki her yeri görme öğrenme amacındaki gezginlerin
dikkat etmesi gereken ürolojik hastalıklar ve bunların önlenebilmesi açısından yardımcı
olmaya çalışacağız.
Hipokrat döneminde “su dolu karaciğer” olarak tanımlanan hidatik hastalık
Türkiye, Orta Doğu ülkeleri, Güney Afrika ve Avusturalya gibi özellikle Akdeniz
bölgesinin ve tropikal ülkelerin önemli bir endemik sağlık problemidir (1-3). Endemik
olduğu bu ülkelerde sosyal ve ekonomik açıdan zarara neden olmaktadır (2,3).
Artan gezi tercihleri ve zorunlu göçler nedeniyle gelişmiş ülkeler de dahil olmak
üzere dünya üzerinde her yerde bulunabilir hale gelmiştir (4,5). Yıllık insidansı
ve prevelansı sırasıyla 100000’de 1 – 200 ve %1-7’dir (6-9). Tüm dünyada kadınlarda
daha sık izlenmektedir ve insidansı yaşla birlikte artış göstermektedir, genç
erişkinler ve orta yaş hastalar hastaneye başvurudaki en sık hasta grubudur (8).
Kadınlarda daha sık görülmesinin altında genetik farklılıklar, çiğ sebze yeme, evcil
hayvanlarla yakın temas ve onların yaşam bölgelerinin temizlenmesinden dolayı
olduğu düşünülmektedir (6,10).
Türkiye, endemik bir ülke olarak hidatik kistin yaygın olarak görüldüğü bir ülkedir.
En yaygın olarak görüldüğü bölgeler; Doğu Anadolu, Güneydoğu Anadolu
ve İç Anadolu’dur (11-13). Yıllık prevelansının ülkemizde 100.000’de 0.87-6.6 olarak
bildirmiştir (11). Türkiye’de en sık 45 – 64 yaş arası hastalarda izlenmektedir
(8). Akdeniz bölgesi’ndeki diğer ülkeler gibi gezi ziyareti olacak ülkelerde bu yaygınlığın
sebeplerini sıralarsak ise (8,14);
1. Köpek/hayvan/insan zincirinin devamı için insan tarafından oluşturulan koşullar
2. Rahatça sürüyü terk eden ve başka bir sürüye katılan köpekler
3. Büyükbaş hayvan, koyun, keçinin evlerdeki mezbahalarda kesiminden sonra iç
organlarınn köpekler tarafından tüketimi (ör. Sardunya Adas’)
4. Sürülerin veya hayvan yünlerinin nüfusu yoğun bölgelere taşıması
5. Göçebe toplumlar ve gecekondu bölgeleri
6. Sürüleri ile yakın yaşayan toplumlar (ör. Türkiye’nin doğusunda. Sürü sahibinin
bazen evinin altında, sürüyü barındırması).
Gezgin Sağlığı
- 184 -
7. Hayvanların kontrolsüz bölge değiştirmeleri
8. Üretim ve kesim için endemik bölgelerden hayvan alımı
9. Uygun ekolojik ve iklim koşulları
10. Düşük eğitim düzeyi, geleneksel yöntemlerin kullanılması, ön yargı ve yanlış
beslenme koşulları(14)
Hidatik hastalık etiyolojisinde daha sıklıkla Echinococcus granulosus (Kistik
Ekinokkoz, KE) ile karşılaşılır. İkinci sıklıkta ise Echinococcus multilocularis (Alveolar
Kist Hidatik, AK) izlenir. Daha az sıklıkta ise Echinococcus oligartus izlenir
(14,). E. Granulosus çeşitli hayvanların konak olarak kullanması nedeniyle daha
yaygın olarak görülür (14). Esas olarak köğekler ve kurtlar tarafından taşınan E.
Granulosus için koyun, sığırlar ve geyikler ara konakçı olur. İnsanlar ise alternatif
veya kazara konakçı olurlar (15-17) (Şekil 1). En çok tutulan organ olan karaciğeri
(%52 – 77) ikinci sırada akciğerler (%10 – 40) takip eder (18).
The extent of global travel is ever increasing, and this is reflected in the number of travellers attending GP surgeries on their return to the UK. Presenting issues more commonly dealt with by GPs, particularly among returning travellers who have visited developing countries and tropical regions, include gastrointestinal upset, feverish illnesses, potential exposure to schistosomiasis and the finding of eosinophilia. The full spectrum of travel-related illness is too extensive to be covered in detail, but an overview of the assessment and management of these clinical presentations is given.
