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Patient case: Schistosomiasis

Patient case: Schistosomiasis

Discussion

A 42-year-old man presents to the clinic with complaints of fatigue, abdominal pain, and intermittent blood in his urine over the past few weeks. He recently returned from a month-long trip where he engaged in freshwater swimming and fishing. He denies any history of sexually transmitted infections or kidney disease.

On examination, he appears slightly pale but otherwise stable. His temperature is normal, but he has mild hepatosplenomegaly and tenderness in the lower abdomen. Routine urinalysis reveals microscopic hematuria, and stool examination shows ova consistent with Schistosoma haematobium. A blood test confirms eosinophilia.

The patient is diagnosed with schistosomiasis and started on praziquantel. He is advised to avoid freshwater exposure in endemic regions and follow up for monitoring of possible complications such as bladder fibrosis or liver disease. After treatment, his symptoms improve, and repeat testing confirms resolution of the infection.

Questions
1. What is the most likely cause of this patient’s symptoms?

a) Urinary tract infection

b) Schistosomiasis

c) Kidney stones

d) Hepatitis

2. Which diagnostic finding is most suggestive of schistosomiasis?

a) Bacteria in the urine

b) Ova of Schistosoma haematobium in urine or stool

c) Elevated liver enzymes

d) Proteinuria with white blood cell casts

3. What is the most appropriate treatment for this patient?

a) Ciprofloxacin

b) Albendazole

c) Praziquantel

d) Metronidazole

4. How did the patient most likely acquire schistosomiasis?

a) Eating undercooked seafood

b) Swimming in contaminated freshwater

c) Drinking untreated water

d) Mosquito bites

Reveal answers

Answers

1. Answer: b) Schistosomiasis

The patient’s history of freshwater exposure, hematuria, hepatosplenomegaly, and eosinophilia strongly suggest schistosomiasis, a parasitic infection caused by Schistosoma species.

2. Answer: b) Ova of Schistosoma haematobium in urine or stool

The definitive diagnosis is made by identifying Schistosoma eggs in urine (for S. haematobium) or stool (for S. mansoni and others), along with supportive findings such as eosinophilia.

3. Answer: c) Praziquantel

Praziquantel is the drug of choice for schistosomiasis, effectively killing adult worms and reducing long-term complications.

4. Answer: b) Swimming in contaminated freshwater

Schistosomiasis is acquired when larval parasites (cercariae) penetrate the skin during freshwater activities in endemic regions, typically transmitted by infected snails.