Schistosomiasis is a chronic disease caused by active activity in the human body of parasitic worms. More than 200 million people need treatment for this pathology every year.
General information
Schistosomiasis is a rather serious disease provoked by blood flukes from the genus Schistosoma. During the introduction of parasites into the body, a person develops dermatitis, which is later complicated by fever, intoxication, damage to the intestines or directly to the genitourinary system. The clinical picture in this case is due to the development of an immunoallergic reaction to fluke eggs.
Parasites enter the human body, usually during the most common agricultural or industrial activities as a result of contact with water contaminated with them. Adolescents and young children are most susceptible to the disease due to non-observance of elementary rules of personal hygiene or bathing in dirty water. The World He alth Organization is actively fighting this problem through preventive treatment.several times a year.
There are two forms of schistosomiasis: intestinal and genitourinary. It is about the latter that we will describe in more detail in this article.
What is urogenital schistosomiasis?
This is a disease of a helminthic nature with a primary lesion of the genitourinary system. This pathology is common in northern Africa, in Egypt, Saudi Arabia, Lebanon and Syria. On the territory of our country there are no proper natural conditions for the life of schistosomes.
Infection occurs by direct contact with water, where these parasites live. After their introduction into the human body, the infected person gradually develops an allergic reaction in the form of itching, rash. During the migration of helminths through the body, general malaise, fever, and headache are noted. Such signs are characterized by urogenital schistosomiasis.
Reasons
Symptoms of the disease appear immediately after ingestion of the parasite Schistosoma haematobium. The length of the male body does not exceed 15 mm. Its front part has a cylindrical shape, it has many suction cups. The length of the female body can reach 20 mm.
The parasite enters the skin of people who swim/work in the water. There are also known cases of infection after drinking poor-quality drinking water. Schistosoma haematobium rushes through the blood vessels and even lymphatic tracts to the pelvic organs, where it lays eggs in the lumen of the veins. Then they penetrate through the vascular wall into the membrane of the bladder, and in some cases into the genitals. From there afterwardsare expelled along with urine. Scientists suggest that the eggs of these parasites can also be transmitted during sexual intercourse.
The inhabitants of epidemically dangerous areas of these parasites can be found in the genitals. However, experts in this field have not yet been able to prove the existence of a link between spontaneous abortion and helminth activity.
They can live from three to about 10 years in the body. Parasitic eggs have been reported to have been transmitted through contact by a person infected approximately 30 years ago.
Pathogenesis of disease
Urinary schistosomiasis is a very interesting disease that has always attracted the attention of scientists around the world. Infection occurs during direct human contact with parasite-infested water. The pathogenesis of this disease is based on toxic-allergic reactions resulting from the breakdown of waste products of helminths. Edema develops in the skin around the places where the larvae penetrate, and in the course of their migration, so-called infiltrates are formed, consisting mainly of leukocytes and lymphocytes.
Eggs of parasites "live" a certain cycle of their development in the body of mollusks to the stage of cercariae, which already enter the human body through the skin. Here they ripen very rapidly and turn into schistosomuls. Then the parasites penetrate into the peripheral veins, where they gradually degenerate into sexually mature individuals. Fertilized females go toorgans of the genitourinary system, lay eggs here. Some of them are excreted together with urine and feces directly into the external environment.
Epidemiology
Urinary schistosomiasis occurs predominantly in subtropical and tropical areas that lack quality water and proper sanitation for living. According to experts, at present, about 90% of people with such a diagnosis are on the African continent.
The disease tends to affect poor rural communities. Women who use contaminated water in their household work are also at risk. Urogenital schistosomiasis in children and adolescents in these regions is no exception. Due to poor hygiene and constant contact with contaminated water while bathing, they are especially at risk of getting sick.
The constant migration of the population and the movement of refugees contribute to the penetration of the disease into new areas. As the desire of people to explore unfamiliar countries increases, tourists are now increasingly diagnosed with the disease.
Clinical picture
What are the signs of urogenital schistosomiasis (symptoms)? Both treatment and diagnosis of the disease are impossible without a characteristic clinical picture.
The average incubation period is 10 to 12 weeks. At the moment of penetration of the parasite through the skin, a person notes slight discomfort, as if pricked with a needle. During the migration of helminthsthe body develops allergic reactions in the form of dermatitis with severe itching, rashes. Also, there are symptoms of intoxication of the body (headache, anorexia, increased sweating). In some cases, the liver and spleen increase in size. However, urogenital schistosomiasis is not always accompanied by such signs. The symptoms of the disease, or rather the degree of their severity, depend on the individual sensitivity of the person and the severity of the invasion.
At the end of the acute and the beginning of the chronic stage of the pathology, hematuria often appears, which is accompanied by the release of blood during urination. Patients usually complain of general malaise, fever up to 37 degrees, pain in the area of the bladder. In addition, the liver and spleen also increase in size. Such symptoms are associated with the introduction of parasites into the tissues of organs.
During the passage of eggs through the wall of the bladder, pinpoint hemorrhages and hyperemia of the mucous membrane are possible. Due to such mechanical damage, an infection often joins the pathological process, which leads to the development of cystitis. Inflammation can spread up the ureters directly to the kidneys.
Urinary schistosomiasis in the absence of timely treatment can go into a chronic stage. The defeat of the ureters is characterized by a decrease in their distal sections, which entails stagnation of urine, the formation of stones and the development of pyelonephritis. The late stage of the disease is characterized by the appearance of fibrosis of the tissues of the organ and its calcification. In this kindsituation, helminth eggs are calcified. The shape of the bladder changes, intravesical pressure increases. In severe cases, schistosomiasis can lead to disability and even premature death.
In men, pathology is often accompanied by fibrosis of the seminiferous tubules, and in the fair sex, by multiple ulcerations of the vaginal mucosa.
Diagnosis
Recognition of urogenital schistosomiasis is based on clinical findings (urticaria, weakness, general malaise, dysuric disorders).
According to experts, parasite eggs are excreted most intensively in the urine around noon. However, to detect them, a daily portion of urine is usually examined. It is defended initially in high jars, the packed liquid is then drained, and the precipitate itself is centrifuged. Then the microsporia of the sediment is carried out. Determination of the presence of larvae in the urine is carried out according to a similar scheme.
In some cases, the doctor may order a biopsy of a piece of bladder mucosa. In addition, cystoscopy and radiography are used to assess the condition of the genitourinary tract. Such diagnostic measures make it possible to detect thinning of blood vessels, deformation of the mouths of the ureters, and polypous growths.
Essential Therapy
Treatment and prevention of schistosomiasis are carried out exclusively in a hospital. Patients are usually advised"Praziquantel" or "Azinox" at a daily dose of 40 mg / kg twice a day. The effectiveness of these funds, according to experts, is 80-95%. Important in the treatment of this pathology belongs to symptomatic therapy to improve the functioning of the affected systems of internal organs. If a secondary infection occurs, antibiotics are prescribed. In severe cirrhosis, polyposis, surgery is recommended.
Note that "Praziquantel" is an effective and at the same time inexpensive drug that can defeat all schistosomatosis (bilharzia). Treatment with this remedy is also indicated for children and adolescents. Despite the fact that after a course of therapy there is a possibility of re-infection, the risk of developing a severe form of the disease can still be reduced and even prevented.
Prognosis with the above drugs is generally good.
Possible Complications
An important condition for the fight against this pathology is timely treatment. Urinary schistosomiasis otherwise threatens with the development of very unpleasant complications. These include the following diseases: pyelonephritis, chronic renal failure. In addition, this pathology is considered a true precancer, since against the background of a chronic inflammatory process, squamous cell carcinoma of the bladder often develops.
Preventive measures
How to prevent urinary schistosomiasis? Treatment, causes, symptoms of this disease are describedabove in this article. Below we list its main preventive measures.
- Timely detection and subsequent treatment in hospitals of patients.
- Preventing schistosome eggs from entering waterways.
- Destruction of molluscs with molluscicides.
- Use of special irrigation systems.
- Wear protective clothing when in direct contact with contaminated water.
- Water treatment (filtration, boiling) before use.
- Settling in water bodies of predators that destroy mollusks.
- Centralized water supply for regions.
- Active he alth education with the population living in the respective regions.
Special attention is recommended for tourists who come from areas where urogenital schistosomiasis is common. Symptoms of the disease should alert everyone. This is a clear reason to seek help from the appropriate specialist. Only in this way can the further spread of the infection be prevented and literally save a person's life.
The WHO strategy to combat this disease is primarily aimed at reducing the incidence through periodic treatment with Praziquantel. This kind of therapy is intended for all people at risk (all those who live in endemic areas).
The frequency of such treatment depends solely on the prevalence of the infection. In areas with high transmission rates, it is not uncommon for an annual repeat course of treatment to be required, withfor several years.
The proposed treatment allows you to overcome schistosomiasis of the genitourinary system in the early stages and prevent its transformation into a chronic form in already infected people. Currently, the main obstacle to the implementation of the program described above is limited access to medicines, and more specifically to Praziquantel. In 2012, only 14% of people who actually needed treatment were reported to receive it.
Conclusion
This article provided information on the topic "Urinary schistosomiasis: causes, symptoms, diagnosis and treatment." WHO experts are actively working on the prevention of tropical diseases forgotten by modern society, which include the pathology we have described. Despite the variety of such ailments, they have common features that allow them to persist in conditions of poverty.
Schistosomiasis is a fairly serious disease that is being diagnosed more and more every year. However, observance of elementary hygiene rules and timely treatment allow you to forget about this problem forever.
We hope that all the information presented in this article will be really useful for you. Stay he althy!
