Genitourinary schistosomiasis: treatment, diagnosis, symptoms

Schistosomiasis is a chronic disease caused by active vital activity in the human body of parasitic worms. Annually treatment of this pathology is required for more than 200 million people.

general information

Schistosomiasis is a serious enough 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, intestinal damage or directly the genitourinary system. The clinical picture in this case is due to the development of an immunoallergic reaction to the fluky eggs.

Parasites penetrate the human body, usually during the most common agricultural or production activities as a result of contact with water contaminated with them. Children of adolescence and younger age are most susceptible to illness because of non-observance of elementary rules of personal hygiene or bathing in dirty water. The World Health Organization actively struggles with this problem, conducting preventive treatment several times a year.

In total, two forms of schistosomiasis are distinguished: intestinal and urogenital. It is the latter that we will discuss in more detail in this article.

What is urogenital schistosomiasis?

It is a disease of helminthic nature with a primary lesion of the genitourinary system. This pathology is common in the north of Africa, in Egypt, Saudi Arabia, Lebanon and Syria. On the territory of our country there are no proper natural conditions for vital activity 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 along the body, general malaise, fever, and headache are noted. Such signs are characterized by urogenital schistosomiasis.

Causes

Symptoms of the disease appear immediately after the entry into the body of the parasite Schistosoma haematobium. The length of the male body does not exceed 15 mm. The front part of it has a cylindrical shape, on it there are a lot of suckers. The length of the female body can reach 20 mm.

The parasite penetrates the skin of people bathering / working in water. There are also cases of infection after drinking low-quality drinking water. On blood vessels and even lymphatic channels, Schistosoma haematobium rushes to the organs of the small pelvis, where it lays eggs in the lumen of the veins. Further they pass through the vascular wall into the membrane of the bladder, and in some cases also into the genital organs. From there, it is subsequently taken out with urine. Scientists suggest that the eggs of these parasites can also be transmitted during sexual intercourse.

In residents of epidemic regions of these parasites can be found in the genitals. However, specialists in this field can not yet prove the existence of a connection between spontaneous termination of pregnancy and activity of helminths.

They can live from three to about 10 years in the body. There have been recorded cases where eggs of parasites were transmitted by contact with a person infected about 30 years ago.

Pathogenesis of the disease

Genitourinary schistosomiasis is a very interesting disease, which has always attracted the attention of scientists around the world. Infection occurs during direct human contact with parasitized water. At the heart of the pathogenesis of this disease lie the toxic-allergic reactions that arise as a result of the decay of the products of the vital activity of helminths. In the skin around the places of introduction of larvae develop edema, and in the course of their migration formed the so-called infiltrates, 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 very quickly ripen and turn into schistosomes. Then the parasites penetrate into the peripheral veins, where they gradually degenerate into sexually mature individuals. Fertilized females are sent to the organs of the genitourinary system, laying eggs here. Some of them are excreted together with urine and feces directly into the external environment.

Epidemiology

Genitourinary schistosomiasis is prevalent mainly in subtropical and tropical areas, deprived of quality water and proper sanitary conditions for living. According to experts, currently about 90% of people with this diagnosis are on the African continent.

The disease affects, as a rule, poor rural communities. Representatives of the fair sex who use contaminated water in domestic work are also at risk. Genitourinary schistosomiasis in children and adolescents in these regions is no exception. Due to inadequate hygiene and constant contact with contaminated water during bathing, they are especially at risk of getting sick.

The constant migration of the population and the movement of refugees contribute to the infiltration of the disease in all new areas. As the desire of people to get to know unknown countries is increasing, the disease is diagnosed more and more often among tourists.

Clinical picture

What are the signs of urogenital schistosomiasis (symptoms)? Both treatment and diagnosis of the disease are impossible without the presence of a characteristic clinical picture.

The incubation period averages from 10 to 12 weeks. At the moment of penetration of the parasite through the skin, the person observes slight discomfort, as if with a needle prick. During the migration of helminths, the body develops allergic reactions in the form of dermatitis with severe itching, rashes. There are also symptoms of intoxication (headache, anorexia, increased sweating). In some cases, the liver and spleen increase in size. However, not always such signs are accompanied by urogenital schistosomiasis. 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 an acute and early chronic stage of pathology, hematuria often appears, which is accompanied by the release of blood during urination. Patients, as a rule, complain of general malaise, an increase in temperature to 37 degrees, pain in the area of the bladder. In addition, the liver and spleen are even larger in size. Such symptoms are associated with the introduction of parasites in the tissues of organs.

During the passage of eggs through the wall of the bladder, there may be spot hemorrhages and hyperemia of the mucous membrane. Due to such a 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.

Genitourinary schistosomiasis in the absence of timely treatment can go to the chronic stage. The defeat of the ureters is characterized by a decrease in their distal parts, which leads to 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 organ tissues and its calcification. In this kind of situation, eggs of helminths undergo calcification. The shape of the bladder changes, the intravesical pressure rises. In particularly serious 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 - multiple ulcers of the vaginal mucosa.

Establishing diagnosis

Recognition of genitourinary schistosomiasis is carried out on the basis of clinical data (hives, weakness, general malaise, dysuric disorders).

According to experts, the most intensive eggs of parasites are excreted in urine around noon. However, for their detection, a daily portion of urine is usually examined. It is initially protected in high banks, the packed liquid is drained and the pellet is centrifuged. Then microsporia of the precipitate is carried out. The presence of larvae in the urine is determined by a similar scheme.

In some cases, the doctor may prescribe a biopsy of a piece of the bladder mucosa. In addition, cystoscopy and radiography are used to assess the condition of the genito-urinary tract. Such diagnostic measures allow to reveal thinning of vessels, deformation of the ureters' mouths, polyposic growths.

Necessary therapy

Treatment and prevention of schistosomiasis is carried out exclusively in a hospital. Patients are usually recommended "Praziquantel" or "Azinox" in 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 symptomatic therapy to improve the work of the affected internal organs. In case of secondary infection, antibiotics are prescribed. In severe cirrhosis, polyposis, surgical intervention is recommended.

Note that "Prazikvantel" is an effective and at the same time inexpensive drug that can defeat all schistosomiasis (bilharziosis). Treatment with this tool is also shown to children and adolescents. Despite the fact that after the course of therapy there is a chance of re-infection, the risk of developing a serious form of the disease can still be reduced and even prevented.

The prognosis with the use of the above-described drugs is usually favorable.

Possible complications

An important condition for combating this pathology is timely treatment. Schistosomiasis of the genitourinary tract otherwise threatens the development of very unpleasant complications. These include the following diseases: pyelonephritis, chronic renal failure. In addition, this pathology is considered a true precancer, as against the background of a chronic inflammatory process, squamous cell carcinoma of the bladder often develops.

Preventive measures

How to prevent urogenital schistosomiasis? Treatment, causes, symptoms of this disease are described above in this article. Below we list its main preventive measures.

1. Timely detection and subsequent treatment in hospital patients.
2. Prevention of the penetration of eggs with schistosomes into water bodies.
3. Destruction of mollusks by molluscicides.
4. Use of special irrigation systems.
5. Wear protective clothing during direct contact with contaminated water.
6. Water treatment (filtration, boiling) before use.
7. Settlement in reservoirs of predators, destroying mollusks.
8. Centralized water supply of regions.
9. Active sanitary education work with the population living in the respective regions.

Particular attention should be paid to tourists who come from areas where urogenital schistosomiasis is common. Symptoms of the disease should alert everyone. This is an obvious reason to seek help from the appropriate specialist. Only in this way can prevent further spread of the infection and literally save a person's life.

The WHO strategy to combat this disease is primarily aimed at reducing the incidence through periodic treatment precisely "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 infection. In areas with a high level of transmission of the disease, it is often necessary to repeat the course of therapy annually, and for several years.

The proposed treatment allows us 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, to be more precise, to "Praziquantelu". According to available information, in 2012 it was received only by 14% of people who really need treatment.

Conclusion

In this article was presented information on the topic "Genitourinary schistosomiasis: causes, symptoms, diagnosis and treatment." WHO experts are actively working on the prevention of tropical diseases forgotten by modern society, including the pathology described by us. Despite all the variety of such ailments, they have common features that allow them to sustainably manifest themselves in conditions of poverty.

Schistosomiasis is a serious enough disease, which is diagnosed every year with increasing frequency. However, adherence to elementary rules of hygiene and timely treatment can forever forget about this problem.

We hope that all the information presented in this article will be useful for you. Be healthy!