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1/75. Acute pulmonary schistosomiasis in travelers returning from Lake malawi, sub-Saharan Africa.

    We describe four cases of acute schistosomiasis presenting to the Infectious Diseases Unit of John Radcliffe Hospital (Oxford, england) during a 2-month period in autumn 1997. All four patients had swum in Lake malawi, a freshwater lake in sub-Saharan Africa that is associated with schistosoma haematobium and, less commonly, schistosoma mansoni infections. All four patients had a severe acute illness and had prominent pulmonary involvement, both clinically and radiologically. This represents a change in the recognized pattern of presentation and could possibly reflect a new parasite variant in the lake. ( info)

2/75. female genital schistosomiasis.

    Schistosoma haemtobium infection in travelers from endemic areas is usually asymptomatic, or presents with hematuria. Uncommon manifestations include neurological syndromes, genital dysaesthesias and watery or blood stained semen. This organism also causes disease within all structures of the female genital tract because of communications between pelvic venous complexes, and can occur long after return home. schistosomiasis may not be suspected, resulting in delays in diagnosis and treatment. We present two cases which illustrate the diverse nature of this condition. ( info)

3/75. Cutaneous schistosomiasis: report of a case and review of the literature.

    Cutaneous disease is a previously reported but unusual presentation for schistosomiasis. We report a case of schistosoma haematobium infection that appeared 3 years after exposure, with skin lesions as the sole manifestation. The diagnosis was made on the basis of a routine skin biopsy and the patient did well after therapy with praziquantel. Dermatologists should be aware of this presentation of schistosomiasis when evaluating patients with unusual skin lesions who have traveled in areas where schistosomiasis is endemic. ( info)

4/75. Localized papular cutaneous schistosomiasis: two cases in travellers.

    schistosomiasis is endemic in many parts of the tropics and subtropics with an estimated 200 million people, at least, infected worldwide. The symptoms and signs of vesical and gastrointestinal forms are readily recognized but ectopic forms are rare even in endemic areas and present a greater diagnostic challenge, particularly when they are encountered in nontropical climes. We now report two cases of cutaneous schistosomiasis presenting in Edinburgh with subtle, but remarkably similar, skin lesions. ( info)

5/75. Schistomiasis of the spinal cord: report two cases.

    schistosomiasis affects over 200 million people worldwide. schistosomiasis of the spinal cord is a rare occurrence. In Africa, there have been recent reports from egypt and south africa. In uganda, the last histological records were over two decades ago. schistosomiasis of the spinal cord is commonly caused by schistosoma mansoni although schistosoma haematobium has been isolated. Two case reports are presented. In both patients, the diagnosis was made retrospectively. The first patient was a female patient with a lesion in the thoracic region. The second patient was a 21 year old male with a lesion in the conus. Apart from a block on the myelograms, all other laboratory investigations were negative. The diagnosis was made histologically in both cases with the identification of eggs of schistosoma in the spinal cord. The eggs could however, not be retrieved from the stool or urine samples. Both patients were treated with antischistosomal drugs and steroids. On follow up they had marked improvement in their neurological signs. We hope to renew attention in this rare but devastating neurological manifestation of a disease which affects many in our region and which if left untreated can lead to permanent neurological damage. ( info)

6/75. Subacute pulmonary granulomatous schistosomiasis: high resolution CT appearances--another cause of the halo sign.

    A case of probable acute granulomatous pulmonary schistosomiasis is described with multiple focal opacities on chest radiography and widespread, but predominantly peribronchovascular, nodules with ground-glass halos on high resolution CT (HRCT). The HRCT appearances in early schistosomiasis have not been described previously. Although the features are not diagnostic and may be seen in other conditions, in the appropriate clinical context they may suggest pulmonary involvement in schistosomiasis. The features of pulmonary schistosomiasis in the different stages of infection are discussed. Pulmonary involvement should be suspected in patients with even minor respiratory symptoms when there is a history of exposure to fresh water in endemic areas. ( info)

7/75. Schistosoma induced squamous cell carcinoma of the bladder.

    schistosomiasis or Bilharziasis caused by S. hematobium is endemic in Africa, egypt, southern tips of europe and japan. Though not unknown in india, it is a much less common occurrence. schistosomiasis of the bladder is known to be a causative factor for bladder carcinoma; which is usually of the squamous type. These cancers are usually of a higher grade and the average initial stage is higher than those for transitional cell carcinomas. We present a case of schistosoma induced squamous carcinoma of the bladder as this is not a common association in india. ( info)

8/75. Schistosomal appendicitis in pregnancy.

    Acute appendicitis is the most common acute surgical infection during pregnancy. Although usually pyogenic in origin, parasitic infections account for a small percentage of cases. Despite the relatively high prevalence of acute appendicitis in our environment, it is not commonly associated with schistosomiasis. We report here the association of pregnancy and appendicitis caused by schistosoma haematobium. schistosomiasis is very common complication of pregnancy in hyperendemic areas. Schistosome egg masses can lodge throughout the body and cause acute inflammation of the appendix, liver and spleen. Congestion of pelvic vessels during pregnancy facilitates passage of eggs into the villi and intervillous spaces, causing an inflammatory reaction. Tourism and immigration make this disease a potential challenge for practitioners everywhere. ( info)

9/75. schistosoma haematobium presenting as an intrinsic conus tumour.

    In the small and diverse group of atypical, non-neoplastic intramedullary spinal cord lesions, parasitic infections are rarely considered, especially in Caucasian patients without systemic complaints or eosinophilia. A case of atypical myelopathy caused by schistosoma haematobium is presented. The clinical, laboratory and imaging features in the MRI era both before and after treatment are discussed. ( info)

10/75. Delayed salmonella bacteriuria in a patient infected with schistosoma haematobium.

    The authors report a case of schistosoma haematobium infection with delayed occurrence of salmonella bacteriuria following treatment of schistosomiasis. Standard models of interaction between these two pathogens may not be fully satisfactory in such a case of co-infection. The role played by a decreased host immune response following schistosomiasis may thus be highlighted to explain a delayed or prolonged infection with salmonella. ( info)
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