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, hematuria usually resolves.[88] If hematuria persists, a urology specialist 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 postcoital 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.
Gynecology specialists should manage the follow-up of these lesions.
Caused by chronic blood loss from hematuria or bloody diarrhea. Common in heavy S japonicum infections.[22]
These result from a chronic inflammatory reaction to migrating eggs through the bowel wall. This must be differentiated from cancer by a gastroenterology specialist and a biopsy for pathologic tissue exam.
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 gynecology specialists.
Hematochezia and hematemesis indicate esophageal variceal development with portal hypertension.[54]
Management should be directed by a gastroenterology specialist.
A manifestation of portal hypertension secondary to periportal fibrosis. Management by a gastroenterologist is warranted.
Chronic inflammation and polyp formation can occasionally cause obstruction.[99] Severe obstruction may require surgical intervention.
Ectopic eggs can reach the CNS and lead to local granuloma formation, resulting in seizures.[100] 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.[101] 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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