3) Patient complaints of fever, vaginal bleeding, pain during sexual intercourse, pain in the suprapubic region, general weakness, blood in the end of the urination, Periodical rash on hands. She worked in Kenya. Condition is moderate. The consciousness is clear. Skin is dry, an itchy, red, blotchy and raised rash on hands. The abdomen is painful in low parts, blood in urine. Hepatomegaly. CBC - leykocytes 8,5x109/L, eosinophil 25%, hemoglobin 110 g/l, erythrocytes - 3,0 x 1012/L. Urine test - erythrocytes, leukocytes, large oval eggs with a spike at one pole. Put diagnosis:
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Finding Sources
Finding Sources
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This is a classic presentation. The diagnosis is clear from the clinical picture and supported fully by the textbook sources.
Diagnosis: Urogenital Schistosomiasis (Schistosoma haematobium infection)
Key Diagnostic Features in This Case
| Finding | Significance |
|---|---|
| Travel history — Kenya | Sub-Saharan Africa is the primary endemic zone for S. haematobium |
| Terminal-spine eggs in urine | Pathognomonic — S. haematobium eggs are ovoid (~140 µm) with a terminal spine at one pole |
| Hematuria (blood at end of urination) | Eggs penetrate bladder endothelium → terminal hematuria is classic |
| Eosinophilia (25%) | Hallmark of helminthic infection; reflects immune response to parasite eggs |
| Itchy, red, raised rash on hands | "Swimmer's itch" — cercarial dermatitis from skin penetration |
| Fever, general weakness, anemia | Systemic inflammatory response (Katayama fever in acute/subacute phase) |
| Vaginal bleeding, dyspareunia, suprapubic pain | Female genital schistosomiasis (FGS) — occurs in 33–75% of infected women; eggs deposit in Fallopian tubes, cervix, vagina, and uterus |
| Hepatomegaly | Granulomatous reaction to eggs in the liver |
| Leukocytes + erythrocytes in urine | Bladder wall inflammation from egg deposition |
Pathophysiology
The adult female worms reside in the venous plexus of the bladder and pelvic organs, laying hundreds to thousands of eggs daily. Eggs penetrate the bladder endothelium to exit in urine, causing hematuria and a granulomatous inflammatory reaction. Retained eggs lodge in the liver (hepatomegaly) and pelvic organs (FGS). The initial cercarial skin penetration causes pruritic dermatitis, and the systemic phase (2–12 weeks post-exposure) produces fever, eosinophilia, and weakness — known as Katayama fever.
Confirmatory Diagnosis
- Urine microscopy: oval eggs with a terminal spike at one pole — diagnostic of S. haematobium
- Eosinophilia ≥ 10% strongly supports helminthic infection
- Hemoglobin 110 g/L → mild anemia from chronic blood loss and inflammation
Treatment
Praziquantel 40 mg/kg (single dose or split over 1 day) — the drug of choice for all schistosome species.
Sources: Campbell-Walsh-Wein Urology; Jawetz Melnick & Adelberg's Medical Microbiology 28e
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