OBJECTIVE: A case description of a rare occurrence of female genital schistosomiasis affecting the upper genital tract that presented with features mimicking an ovarian neoplasm.
METHODS: Female genital schistosomiasis is a neglected clinical manifestation of the water-born parasitic disease which occurs due to the presence of schistosome eggs in the genitalia of women. A 23-year-old nulliparous woman presented with progressive abdominal distension. An abdominopelvic CT scan revealed a multilobulated right adnexal mass with gross ascites. Diagnosis of schistosomiasis was made by histology of biopsied specimens following laparotomy. Cervical colposcopic findings were consistent with female genital schistosomiasis. She was successfully treated with praziquantel.
CONCLUSIONS: Female genital schistosomiasis of the upper genital tract can mimic an ovarian malignancy. Hence there is a need for its consideration as a differential diagnosis in patients with non-classical presentations of pelvic tumours in schistosomiasis-endemic areas.

UNASSIGNED: schistosomiasis is a neglected parasitic infection caused by nematode worms. It affects approximately 200 million people globally. Prevalence in Ghana is 23.3%, mostly affecting school children. On November 28th 2018, the Disease Surveillance Department received reports of increase in occurrence of bloody urine among students of a basic school in the Volta Region. We investigated to identify the agent and source, to determine the magnitude, risk factors and to implement control measures.
UNASSIGNED: we conducted a case-control study. A suspected case was any student of the school, who has bloody urine with or without: dysuria, itching of the skin, frequent urination or lower abdominal pain from September 2018 to November 2018. A confirmed case was one with laboratory-isolation of Schistosoma ova in appropriate urine sample. We identified cases from the school and hospital records. We collected socio-demographic, clinical and exposure data from cases and controls. Descriptive and inferential analysis were performed to estimate odds ratios at 95% confidence intervals (CI) to determine associations.
UNASSIGNED: of 880 students, 112 suspected cases were identified (attack rate = 12.7%). Mean age of suspected cases was 14-years (standard deviation = ±3.5). Confirmed cases were 76.8%(86/112). Males had twice odds of becoming cases (cOR = 2.3, 95% CI = 1.35-3.96). Fishing (cOR = 7.29, 95% CI = 4.08-13.04) and swimming (aOR = 44.63, 95% CI = 4.73-420.86) were factors significantly associated with infection. Students with previous history of bloody urine had greater odds of being cases (aOR = 47.9, 95% CI = 4.19-546.55).
UNASSIGNED: Schistosoma haematobium was isolated in this outbreak. Fishing and swimming were risky water-related activities. WASH education and mass drug administration with Praziquantel were control measures.

INTRODUCTION: A case description of a rare incidence of female genital schistosomiasis related to vulva squamous cell carcinoma in a 76-year-old woman from the schistosomiasis-endemic region of Gombe State, Nigeria. Physicians should be aware of the high incidence rate of female genital schistosomiasis (FGS) in women and girls in schistosomiasis-endemic areas, which is often related to gynecological morbidity and the risk of HIV infection to avoid unnecessary interventions.
INTRODUCTION: Description d\'une incidence rare de schistosomiase génitale féminine associée à un carcinome épidermique de la vulve chez une femme de 76 ans de la région endémique de la schistosomiase de l\'État de Gombe, au Nigeria. Les médecins doivent être conscients du taux d\'incidence élevé de la schistosomiase génitale féminine (SGF) chez les femmes et les filles dans les régions où la schistosomiase est endémique, ce qui est souvent lié à une morbidité gynécologique et au risque d\'infection par le VIH, afin d\'éviter des interventions inutiles. MOTS CLÉS: Schistosomiase génitale, Carcinome épidermoïde vulvaire, Femme.

Schistosomiasis is a neglected disease that is prevalent in tropical and subtropical areas. A 20-year-old woman presented to the emergency room with a history of right flank pain and lower abdominal discomfort for one day, which coincided with the onset of menses. The patient did not provide any history of premenstrual hematuria. The physical examination revealed right costovertebral angle tenderness and was otherwise unremarkable. The urinalysis demonstrated a mild increase in red and white blood cells and no ova or parasite. The blood test was normal, except for eosinophilia. A right pedunculated intraluminal urinary bladder mass was detected by the computerized axial tomographic scan and ultrasonography, and after the transurethral resection of the mass, the patient was diagnosed with urinary schistosomiasis. The patient received two doses of oral praziquantel of 1200 mg every 12 h for one day. The cure was confirmed with a one-month post-treatment follow-up that revealed a normal urine microscope and eosinophil count. The S. haematobium infection should be evaluated as a possible cause of urinary bladder lesion in those who have travelled or lived in endemic areas.

BACKGROUND: Urinary schistosomiasis (US), also known as bilharziasis is a waterborne parasitic infection most common in rural areas of developing countries. The infection is associated with haematuria but little or nothing is known about its association with other urinary parameters, induction of Nitric Oxide (NO) and IgE production around the Bamendjing Dam an area highly suspected of Schistosoma haematobium infections. The study sought to address this problem for possible future interventions and control.
METHODS: Urine samples were collected from 301 randomly selected participants and analysed for the presence of S. haematobium using the syringe filtration concentration method. Sera from patients infected with S. haematobium and also from some uninfected individuals were analysed for IgE and NO using ELISA and colorimetric methods respectively.
RESULTS: The results showed a prevalence of 16.9% (51/301). Sixty percent of the 49 patients with nitrite in their urine, were infected with urinary schistosomiasis (US) (30/49; p = 0.00). Meanwhile only 40% of the 15 patients with bilirubinuria were infected with US (6/15; p = 0.0241). The risk of patients with US having leucocytes and nitrites was high (OR of 1.3 and 1.7 respectively). Total IgE serum levels were significantly higher in patients with US (648.872 ± 223.142) compared to uninfected individuals (275.682 ± 181.674) (p = 0.00). Infected persons had heightened mean NO levels (2,583,617.647 ± 1,100,678.786) than non-infected participants (1,689,766.667 ± 1,163,084.729). Urinary Schistosomiasis in association with urinary parameters had a significant impact on mean IgE levels (F = 4.248, p = 0.022). Patients infected with Urinary Schistosomiasis alone had significantly higher mean total IgE levels than non-infected participants (p = 0.004).
CONCLUSIONS: Apart from haematuria, this study has demonstrated that Urinary Schistosomiasis is prevalent among inhabitants around the Bamendjing Dam and results in an increase of other urine parameters such as leucocytes and nitrates and high levels of serum NO and total serum IgE in patients. These parameters are important in the screening of patients for treatment and control of urinary schistosomiasis.

A man in his early 20s, originally from north-central Africa, presented with a high incidental serum creatinine level. A non-contrast CT scan was taken which was suggestive of urinary schistosomiasis. The diagnosis was confirmed on obtaining biopsies from the bladder. Due to bilateral hydronephrosis, an attempt at bilateral renal decompression was made. This failed to improve renal function. He eventually underwent a right nephrectomy. He is in end-stage renal failure, undergoing long-term dialysis, and has been placed on the waiting list for renal transplant.

Many countries exclude pregnant and lactating women from mass drug administration (MDA) programmes with praziquantel against schistosomiasis due to historic safety concerns over drug use during gestation and breast feeding. More than 10 years of empirical evidence from the field and a growing body of dedicated research has prompted the World Health Organisation and schistosomiasis control initiatives to advocate the inclusion of this vulnerable group into MDA. This qualitative descriptive case study explored, over a five-week period, the subjective experiences, perceptions, opinions, and attitudes of pregnant women attending government supported clinics on Unguja island, United Republic of Tanzania, towards praziquantel use during pregnancy in MDA programmes. The aim of the study was to identify and determine how to overcome potential barriers to effective use of MDA medications during pregnancy. Additionally, it was to determine trusted communication channels for future messaging and discover behavioural and community opportunities to increase participation of pregnant women in future MDA efforts. A 60 min, semi-structured qualitative interview was undertaken with 25 pregnant women recruited from 4 health centres on Unguja along with testing for Schistosoma haematobium infection. Using a modified-grounded theory approach, narrative data were transcribed, coded and analysed using a thematic analysis of the emergent themes. Women reported that they rely on traditional home remedies to stay healthy during pregnancy. Influenced by their mothers, husbands and neighbours, women predominately made medication choices during pregnancy and breastfeeding based on what they heard at home. Most women had been excluded from government MDA programmes in the past due to pregnancy. Women valued healthcare services for antenatal education and pregnancy advice. Women reported they would trust and follow direction from healthcare providers about taking praziquantel during pregnancy. Antenatal clinics offer an excellent opportunity to educate and expand praziquantel treatment to this cohort. Efforts should be augmented with training for providers and behavioural education for the community as a whole and family members of pregnant women.

Genital schistosomiasis is mainly located in the neck of the uterus and the vagina, less frequently on the vulva, the fallopian tubes and ovaries and rarely in the body of the uterus. We here report the case of a 10-year-old girl admitted with a swelling on the vulva in whom histological examination showed cutaneous schistosomiasis due to Schistosoma haematobium. Outcome was favorable with a single 40 mg/kg mg dose of praziquantel, with tumor regression.

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Globally, schistosomes infect approximately 200 million people, with 90% of infections in sub-Saharan Africa. Schistosomiasis is hypothesized to increase HIV-1 acquisition risk, and multiple cross-sectional studies reported strong associations. We evaluated this hypothesis within four large prospective cohorts.
We conducted nested case-control analyses within three longitudinal cohorts of heterosexual HIV-1 serodiscordant couples and one female sex worker (FSW) cohort from Kenya and Uganda. The serodiscordant couples studies were conducted between 2004 and 2012 while the FSW cohort analysis included participant follow-up from 1993 to 2014. Cases HIV-1 seroconverted during prospective follow-up; three controls were selected per case. The presence of circulating anodic antigen in archived serum, collected prior to HIV-1 seroconversion, identified participants with active schistosomiasis; immunoblots determined the schistosome species. Data from serodiscordant couples cohorts were pooled, while the FSW cohort was analysed separately to permit appropriate confounder adjustment.
We included 245 HIV-1 seroconverters and 713 controls from the serodiscordant couples cohorts and 330 HIV-1 seroconverters and 962 controls from the FSW cohort. The prevalence of active schistosomiasis was 20% among serodiscordant couples and 22% among FSWs. We found no association between schistosomiasis and HIV-1 acquisition risk among males (adjusted odds ratio (aOR) = 0.99, 95% CI 0.59 to 1.67) or females (aOR = 1.21, 95% CI 0.64 to 2.30) in serodiscordant couples. Similarly, in the FSW cohort we detected no association (adjusted incidence rate ratio (aIRR) = 1.11, 95% CI 0.83 to 1.50). Exploring schistosome species-specific effects, there was no statistically significant association between HIV-1 acquisition risk and Schistosoma mansoni (serodiscordant couples: aOR = 0.90, 95% CI 0.56 to 1.44; FSW: aIRR = 0.83, 95% CI 0.53 to 1.20) or Schistosoma haematobium (serodiscordant couples: aOR = 1.06, 95% CI 0.46 to 2.40; FSW: aIRR = 1.64, 95% CI 0.93 to 2.87) infection.
Schistosomiasis was not a strong risk factor for HIV-1 acquisition in these four prospective studies. S. mansoni was responsible for the majority of schistosomiasis in these cohorts, and our results do not support the hypothesis that S. mansoni infection is associated with increased HIV-1 acquisition risk. S. haematobium infection was associated with a point estimate of elevated HIV-1 risk in the FSW cohort that was not statistically significant, and there was no trend towards a positive association in the serodiscordant couples cohorts.