• Andrea

It was a Fluke, Really...

We have another rare case this week, folks!

Check out this amazing photo. This is a pathology slide (H&E) showing Schistosoma haemotobium in a section from a bladder mass.

This patient presented with blood in the urine and a mass in the bladder. An oncologic process was suspected when these results came back and shocked everyone!

Let's review this creepy parasite:

Where do you get it?

S. haemotobium can be found primarily in Africa and the Middle East. Patients have usually lived in the area or had a recent travel history.

How do you get it?

This parasite has a strange life-cycle where a snail is used as a vector.

This particular Schistosome prefers to infect the bladder, so once a human comes in contact with water contaminated with S. haemotobium, it makes its way into the veins of the urogenital system. A chronic infection is seen when eggs have made a happy home in the bladder and have become surrounded by human cells and granulomatous material. Eventually, the eggs will die and calcify. The patient in this case had a pretty significant case of chronic infection, which resulted in a pretty large bladder mass containing the *classic* eggs you see in the photo above.

How do we know this is S. haemotobium?

The defining characteristic of this egg (in addition to its large size) is the significant terminal spine. Look closely. Can you see the pointy spine on the back-end of the egg?

How is this treated?

Currently, the recommended treatment for Schistosomiasis is praziquantel. This drug does not kill developing worms, so treatment given within 4-8 weeks of exposure should be repeated a month or two later to improve the rate of cure.


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