Clinical presentations of schistosoma hematobium: three case reports and review

Urinary schistosomiasis is a prevalent parasitic infection in certain areas of Africa and the Middle East. It could present with common as well as unusual urological symptoms, which poses a considerable diagnostic challenge in countries where there is relative low incidence of the disease. We describe three unusual cases of urinary schistosomiasis identified in patients presenting to a London hospital. One patient was found to have schistosomiasis in the seminal vesicles following surgery for prostatic adenocarcinoma. Another was found to have schistosoma-related granulomatous inflammation within a urachal cyst. Thirdly a patient was found to have simultaneous occurrence of transitional cell carcinoma and schistosomiasis of the bladder. We review the literature on the presentations of the parasite and its association with malignancy. In conclusion, awareness of the disease prevalence, clinical and histopathological features will help to avoid missing the diagnosis.

[Schistosomiasis mansoni in the seminal vesicle]

In endemic regions, Mansoni schistosomiasis is responsible for high morbidity-mortality rates due to diseases associated with infestation of the hepatic system. Genital involvement caused by Mansoni schistosomiasis is rare. We report the first case of Mansoni schistosomiasis in the seminal vesicle, which was diagnosed incidentally by means of histopathological study of the prostate and seminal vesicles after surgical removal.

Possibility of Neospora caninum infection by venereal transmission in CB-17 scid mice

CB-17 scid and BALB/c male mice were inoculated intraperitoneally with Neospora caninum to examine the possibility of its venereal transmission. Some of these mice were killed on days 7 and 20 post-inoculation to examine the genital organs for presence of the parasite. The remaining scid male mice were housed with non-infected female mice from day 7 p.i. and kept with them for 14 days. These scid mice died between days 28 and 35 p.i. N. caninum DNA was detected in the testis of mice on days 7 and 20 p.i. by PCR and tachyzoite viability was determined by bioassay conducted by means of mouse inoculation. Microscopically, fewer tachyzoites were detected in the testis obtained on day 20 p.i., than in other organs. The inoculated BALB/c male mice survived until the end of the experiment with no clinical signs and N. caninum DNA was detected in the testis on day 7 p.i. but not on day 14 p.i. Five of eight female scid mice housed with infected males became pregnant. Tachyzoites were detected in three of these mice and their neonates (n=3, 5 and 13, respectively). In three non-pregnant mice, no parasite was detected. Two of the four female BALB/c mice housed with infected male scid mice became pregnant but the parasite was not detected in them or in the neonates (n=3 and 13, respectively). These results indicate that the tachyzoites were present in the genital organs of the immunodeficient mice from day 7 p.i. and suggest that transmission may occur through mating with male mice.

Hydatid cyst of the seminal vesicle

We present a rare case of a hydatid cyst involving the seminal vesicle of a 48-year-old man. Urinary retention was the initial symptom. Both imaging and clinical evaluation revealed a substantial retrovesical cystic mass. The histopathological report was 'hydatid cyst of the seminal vesicle'.

Primary seminal vesicle hydatidosis with exophytic component

We report a rare case of primary seminal vesicle hydatidosis in a 47-year-old male with symptoms of pain on micturition. Computed tomography examination revealed a smooth bordered, multilocular mass-like lesion with fine septations abutting the left seminal vesicle, suggestive of hydatidosis. Pathological study of surgically excised specimen showed hydatidosis of seminal vesicle with large exophytic growth.

Genitourinary changes in hamsters infected and reinfected with Trypanosoma cruzi

Authors describe genitourinary changes in male hamsters infected and reinfected with Trypanosoma cruzi. Changes in genital organs have been described in human and in experimental chagasic infection. Genital dysfunctions in chronic chagasic patients affect ejaculation, libido and sexual potency, and testis biopsies may show arrested maturation of germ cells, oligozoospermia and azoospermia. Sixty-five male hamsters were inoculated and reinoculated with 2x10 trypomastigotes of T. cruzi VIC strain, and 22 non-infected animals constituted the control group. Animals were necropsied and fragments from testis, epididymis, seminal vesicle and bladder were collected and stained with hematoxylin-eosin. Peroxidase anti-peroxidase procedure was utilized to detect tissue parasitism. T. cruzi nests were found in testis, epididymis and seminal vesicle of these hamsters. Such parasitism plays a role in the origin of genital lesions observed in humans and laboratory animals during chronic chagasic infection.

Effects of Trichinella spiralis on survival, total mass, and organ mass of oldfield mice (Peromyscus polionotus)

Trichinella spiralis is a parasitic nematode that infects many mammals, including humans. Hosts may experience significant physiological changes or may die because of acute inflammatory immune responses toward the parasite. In this study, oldfield mice (Peromyscus polionotus) were used as a new experimental host for T. spiralis. Males of P. polionotus were infected with increasing doses of T. spiralis to determine the effect infection had on survival, mass change, total mass, and relative organ masses. Total juvenile worm burden increased in an asymptotic fashion with infective dose. Large doses (> or = 600 juveniles) significantly reduced survival. There were significant negative correlations between infection intensity (log10[juveniles]/g) and both mass gain and final total mass. Infection had no effect on liver or spleen size. But there were significant negative correlations between T. spiralis intensity and both testis and seminal vesicle masses. These effects on male size and reproductive organs may help explain behavioral changes, such as the elimination of male dominance, seen in previous studies on mice infected with T. spiralis.

Demonstration of Tritrichomonas foetus in the external genitalia and of specific antibodies in preputial secretions of naturally infected bulls

Portions of penis and prepuce were collected from 24 bulls with current or recent Tritrichomonas foetus infection. Epididymides were collected from seven of the bulls, and seminal vesicles and prostate were collected from four. Following immunohistochemical staining with two monoclonal antibodies (34.7C4.4 and TF1.15) prepared against T. foetus surface antigens, trichomonads were identified in sections from 15 of the bulls. Organisms were most often located in penile crypts in the midshaft and caudal regions and less often in preputial crypts. Trichomonads were not observed in sections from other genitalia or in subepithelial tissue. T. foetus antigen, however, was present in the cytoplasm of some epithelial cells and the cytoplasm of some mononuclear cells in subepithelial lymphoid aggregates and follicles. Preputial smegma was collected from 16 T. foetus-infected bulls and from 16 control bulls with negative T. foetus cultures. Preputial antibody levels to TF1.17, a surface antigen of T. foetus, were determined by an enzyme-linked immunosorbent assay. Preputial secretions from infected bulls contained specific antibody of each isotype and subisotype tested. IgG1 responses were the greatest, IgM and IgA responses were approximately equal, and IgG2 responses were low. Each isotype and subisotype response in infected bulls was significantly greater than that in the controls. These results confirm previous speculation concerning anatomical sites of infection and suggest that parasite antigen can be taken up and processed locally, resulting in deposition of specific IgG1, IgG2, IgA, and IgM antibodies in the preputial cavity.

Schistosomiasis of the male genital tract: transrectal sonographic findings

PURPOSE

Schistosomal infection of the prostate and seminal vesicles is seldom found in clinical practice and rarely mentioned in the radiological literature. However, the presence of schistosoma eggs has been reported in 50% of postmortem studies of the prostate and seminal vesicles performed in endemic areas.

MATERIALS AND METHODS

We report the results of transrectal studies of the prostate and seminal vesicles performed in 9 white travelers (age less than 35 years) who complained of hemospermia. Diagnosis was confirmed by positive identification of parasites in the urine and semen.

RESULTS

Prostatic calcification was observed in 7 cases, hyperechogenic foci in 2, increase in prostate size in 2, calcifications in the seminal vesicles in 1 and dilatation of the seminal vesicles and ejaculatory ducts in 1. After treatment, prostate size and hyperechogenic foci were reduced. In some cases, calcified lesions diminished during followup.

CONCLUSIONS

Prostatic and seminal calcifications should alert physicians to the possibility of schistosoma infection when they are found in young patients who have been in endemic areas. Parasitological study of semen as well as urine confirms and increases the number of diagnoses.

Hydatid cysts of the kidney, seminal vesicle and gluteus muscle

Hydatid disease has a high incidence in Turkey and causes significant complications. A case is reported here of unusual localization of hydatidosis, with involvement of hydatid cysts of the seminal vesicle, kidney and gluteus muscle. A review of the literature is also included.

Schistosomiasis of the prostate and the seminal vesicles: observations in Zambia

The pattern of schistosomiasis of the prostate and seminal vesicles in Zambia is presented. The results were based on histological examination and digestion of tissue obtained from 50 cadavers. Compared to the bladder (62%) and seminal vesicles (58%), the infestation was least common (50%) in the prostate. The infection was due to Schistosoma haematobium alone in all organs. The most significant finding was the histological inactivity secondary to this parasitic infection. It is suggested that schistosomiasis of these organs is unlikely to be causally related to male infertility in Zambia.

Haemospermia: observations in an area of endemic bilharziasis

Observations are presented on 11 cases of haemospermia in the University Teaching Hospital, Zambia, a country where bilharziasis is endemic. Seven patients were severely hypertensive but only two had urinary bilharziasis. The incidence of Schistosoma haematobium infection of the prostate and seminal vesicles is discussed and it is concluded that there is no significant association between the parasitic infection and haemospermia.

Patterns of Schistosoma haematobium egg distribution in the human lower urinary tract. II. Obstructive uropathy

In a series of 32 unselected consecutive autopsies of Egyptian male adults, we found a significant prevalence of schistosomal obstructive uropathy (SOU) and of precursor lesions of stenosis, fibrosis and induration of the ureters (62.5%). Lower urinary tracts with obstructive uropathy had a significantly higher total egg burden (TEB) than did lower urinary tracts with any other type of gross lesion (i.e., benign prostatic hypertrophy, other urethral outlet obstruction, or SOU precursor lesions). In turn, lower urinary tracts with any type of gross change had higher egg burdens than did tracts which appeared grossly normal. Lower urinary tracts with any type of gross lesion had significantly larger seminal vesicles than did tracts which were grossly normal. Moreover, relative weight of seminal vesicles could be correlated with the S. haematobium egg burdens in the seminal vesicles. In a series of lower urinary tracts taken from unselected consecutive American autopsies, seminal vesicle weight could be correlated with increase in prostatic weight in those tracts with prostatic hypertrophy; the same correlation could not be found in tracts without prostatic hypertrophy. Thus, seminal vesicle hypertrophy appears to correlate with obstructive uropathy in general, not solely obstructive uropathy of schistosomal origin. Digital evaluation of seminal vesicle size may be useful in the clinical evaluation of such patients.

Patterns of Schistosoma haematobium egg distribution in the human lower urinary tract. I. Noncancerous lower urinary tracts

Schistosoma haematobium egg burdens (eggs/g of tissue) of 17 anatomic segments of lower urinary tracts from 32 unselected Egyptian autopsies have been determined by tissue digestion and replicate counts of aliquots of the digestate. There were three anatomic patterns of egg distribution in these lower urinary tracts: apical, basal and diffuse. Regression of egg burdens of each of the anatomic segments as the dependent variable against egg burdens of the entire lower urinary burden yielded a good fit for 15 of 17 of these segments. Statistical analyses revealed that many of these equations for discrete anatomic segments can be combined, generally giving one equation for anatomic regions which are in continuity, indicating that the female worm lives and oviposits in specified venous plexes. These equations also suggest that there are differences in the rates, duration and onset of egg accumulation which may be responsible for schistosomal obstructive uropathy as a cause of death in fairly young individuals.

Patterns of Schistosoma haematobium egg distribution in the human lower urinary tract. III. Cancerous lower urinary tracts

The distribution of S. haematobium eggs in urinary bladders containing tumors and removed at surgery has been studied; the majority of these tumors are well differentiated squamous cell carcinomas. The same three anatomic patterns of egg accumulation described in part I of this series (noncancerous lower urinary tracts) were found in these cancerous bladders, but, in addition, most of the tumors were surrounded by a collar of heavy S. haematobium egg deposition. The egg burdens in these collars were, on the average, twice the average egg burden in the remainder of the urinary bladder. These collars do not seem to be artifacts created by growth of the tumor and subsequent displacement of the adjacent normal tissue, creating a region of heavy egg concentrations; rather, these heavy S. haematobium egg concentrations seem to act as promoters of urothelial carcinogenesis.

The relation of worm burden to passage of Schistosoma haematobium eggs in the urine of infected patients

Patients scheduled for cystectomy for bladder carcinoma or exstrophy of the bladder were studied. The number of eggs per day passed in the urine preoperatively was compared with the number of worms recovered from the cystectomy specimen by dissection. A mean of 203 embryonated Schistosoma haematobium eggs per day per worm pair were recovered from the urine of active, untreated cases. The relation between the number of S. haematobium females recovered and the number of living eggs passed in the urine was questionably significant. The correlation between S. haematobium females and all eggs (living and dead) passed in the urine was somewhat better. Several S. mansoni females were recovered from one specimen. This patient passed 139 embryonated S. mansoni eggs per day in the urine for each female worm recovered. Only one active case, treated 6 weeks before operation, might have been missed on routine parasitological examination of the urine.