Complications
Occurs with egg migration through the bladder wall. It is often a presenting symptom with acute or chronic disease (Schistosoma haematobium), but can also be a symptom of bladder cancer. After treatment, haematuria usually resolves.[87] If haematuria persists, a urology consultant should direct further management. A repeat course of praziquantel should be considered with persistent egg shedding in urine.
Genital tract lesions are common in women infected with S haematobium and can serve as an entry point for HIV or other sexually transmitted infections.[42]
These complications are associated with post-coital bleeding and lower abdominal pain. Cervical lesions have been misdiagnosed as cancer.
Praziquantel treatment has not always resulted in reversal of these types of lesions.
Gynaecology consultants should manage the follow-up of these lesions.
Caused by chronic blood loss from haematuria or bloody diarrhoea. Common in heavy S japonicum infections.[22]
Result from a chronic inflammatory reaction to migrating eggs through the bowel wall. This must be differentiated from cancer by a gastroenterology consultant and a biopsy for pathological tissue examination.
Ectopic S haematobium eggs have been found in fallopian tubes, resulting in scarring, obstruction, infertility, or ectopic pregnancies.[51] Management should be directed in consultation with gynaecology consultants.
Haematochezia and haematemesis indicate oesophageal variceal development with portal hypertension.[54]
Management should be directed by a gastroenterology consultant.
A manifestation of portal hypertension secondary to periportal fibrosis. Management by a gastroenterologist is warranted.
Chronic inflammation and polyp formation can occasionally cause obstruction.[98] Severe obstruction may require surgical intervention.
Ectopic eggs can reach the CNS and lead to local granuloma formation resulting in seizures.[99] Management should be directed in consultation with a neurologist and/or neurosurgeon.
Ectopic eggs can reach the CNS and lead to local granuloma formation and spinal cord compression.[28][49][52][53]
Management should begin with MRI of the spine and be directed in consultation with a neurologist and/or neurosurgeon.[100] Early aggressive treatment with high-dose corticosteroids followed by schistosomicides (e.g., praziquantel) is usually required.
With increasing portal hypertension, excreted eggs can be shunted to the lungs, where inflammatory reactions can result in fibrosis leading to pulmonary hypertension.[50] Pulmonary or cardiology specialists should be consulted to help manage this condition.
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