A case of bowel schistosomiasis not adhering to endoscopic findings.
Schistosomiasis is a chronic worm infection caused by a species of trematodes, the Schistosomes. We may distinguish a urinary form from Schistosomes haematobium and an intestinal-hepatosplenic form mainly from Schistosomes mansoni characterized by nausea, meteorism, abdominal pain, bloody diarrhea, rectal tenesmus, and hepatosplenomegaly. These infections represent a major health issue in Africa, Asia, and South America, but recently S mansoni has increased its prevalence in other continents, such as Europe countries and North America, due to international travelers and immigrants, with several diagnostic and prevention problems. We report a case of a 24-year-old patient without HIV infection, originated from Ghana, admitted for an afebrile dysenteric syndrome. All microbiologic studies were negative and colonoscopy revealed macroscopic lesions suggestive of a bowel inflammatory chronic disease. Since symptoms became worse, a therapy with mesalazine (2 g/d) was started, depending on the results of a bowel biopsy, but without any resolution. The therapy was stopped after 2 wk when the following result was available: a diagnosis of ""intestinal schistosomiasis" was done (two Schistosoma eggs were detected in the colonic mucosa) and this was confirmed by the detection of Schistosoma eggs in the feces. Therapy was therefore changed to praziquantel (40 mg/kg, single dose), a specific anti-parasitic agent, with complete recovery. Schistosomiasis shows some peculiar difficulties in terms of differential diagnosis from the bowel inflammatory chronic disease, as the two disorders may show similar colonoscopic patterns. Since this infection has recently increased its prevalence worldwide, it has to be considered in the differential diagnosis of our patients with gastrointestinal symptoms.
Rizzo
Manfredi
M
Department of Clinical Medicine and Emerging Diseases, University of Palermo, Italy. mrizzo@unipa.it
Mansueto
Pasquale
P
Cabibi
Daniela
D
Barresi
Elisabetta
E
Berneis
Kaspar
K
Affronti
Mario
M
Di Lorenzo
Gabriele
G
Vigneri
Sergio
S
Rini
Giovam Battista
GB
D000328:Adult; D000818:Animals; D000871:Anthelmintics / Q000627:therapeutic use; D005243:Feces / Q000469:parasitology; D006801:Humans; D007413:Intestinal Mucosa / Q000166:cytology / Q000469:parasitology* / Q000473:pathology; D008297:Male; D010270:Parasite Egg Count; D011223:Praziquantel / Q000627:therapeutic use; D012547:Schistosoma; D012555:Schistosomiasis mansoni / Q000175:diagnosis* / Q000188:drug therapy
D000871:Anthelmintics; D011223:Praziquantel