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Review
. 2013 Sep;4(5):453-9.
doi: 10.1016/j.jare.2012.08.004. Epub 2012 Nov 5.

Urinary schistosomiasis: review

Affiliations
Review

Urinary schistosomiasis: review

Rashad S Barsoum. J Adv Res. 2013 Sep.

Abstract

In this review, the clinical manifestations of urinary schistosomiasis are displayed from a pathogenetic perspective. According to the prevailing host's immune response profile, urinary schistosomiasis may be broadly categorized into cell-mediated and immune-complex-mediated disorders. The former, usually due to Schistosoma haematobium infection, are attributed to the formation of granulomata along the entire urinary tract. As they heal with excessive fibrosis, they may lead to strictures, calcifications and urodynamic abnormalities. The main impact is lower urinary, the site of heaviest ovi-position. Secondary bacterial or viral infection is common, any may be incriminated in secondary stone formation of the development of bladder malignancy. Immune-complex mediated lesions are usually associated with hepatosplenic schistosomiasis due to Schistosoma mansoni infection. Circulating complexes composed of schistosomal gut antigens and different classes of immunoglobulins deposit in the kidneys leading to several patterns of glomerular pathology. The latter have been categorized under six classes based on the histological and immunofluorescence profile. These classes have been linked to respective clinical manifestations and depend on the stage of evolution of the host's immune response, extent of associated hepatic fibrosis and co-infection with salmonella or hepatitis C. Secondary amyloidosis develops in 15% of such patients, representing a critical impairment of macrophage function.

Conclusion: The wide clinicopathological spectrum of urinary schistosomiasis mirrors the evolution of the host's immune response according to chronicity of infection, bacterial or viral co-infection and, in the case of glomerulonephritis, to the extent of hepatic co-morbidity.

Keywords: Amyloidosis; Bladder cancer; Glomerulonephritis; Hepatitis C; Hepatosplenic schistosomiasis; Salmonellosis.

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Figures

Fig. 1
Fig. 1
Cystoscopic appearances of common bilharzial lesions in the urinary bladder. (A) Bilharzial pseudotubercles and adjacent ulcer; (B) Bilharzial sessile mass covered by psudotubercles; (C) Sandy patches; (D) cystitis cystica; (E) malignant ulcer (squamous cell carcinoma) with adjacent phosphate encrustations and sandy patches; and (F) fungating malignant mass (squamous cell carcinoma). Hand painted images, courtesy of Professor Naguib Makar, Cairo University. Reproduced from Barsoum , with permission.
Fig. 2
Fig. 2
Radiographic appearances in advanced urinary schistosomiasis: (a) Linear calcifications of the urinary bladder. (b) Intravenous urography showing massive right hydronephrosis and hydroureter with a non-functioning left kidney. (c) Ascending cystography showing an irregular filling defect due to a fungating malignant tumor, and bilateral grade I vesicoureteric reflux. Reproduced from Barsoum .
Fig. 3
Fig. 3
Histological patterns of schistosomal glomerular lesions. Classes I–VI in sequence from A to F (Explanation n Table 1). Adapted from Barsoum with permission.
Fig. 4
Fig. 4
Bladder cancer. Surgical specimen showing an extensive ulcerating growth occupying the bladder vault. Reproduced from Barsoum with permission.
None

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