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Schistosoma haematobium in Urine Cytology: Diagnosis Is Possible
Accepted Manuscript Title: Schistosoma Haematobium in Urine Cytology: Diagnosis is Possible Author: Salvatore Bellafiore, Matteo Zanichelli, Simonetta Piana PII: DOI: Reference:
S0002-9343(17)31027-6 https://doi.org/doi:10.1016/j.amjmed.2017.09.041 AJM 14322
To appear in:
The American Journal of Medicine
Please cite this article as: Salvatore Bellafiore, Matteo Zanichelli, Simonetta Piana, Schistosoma Haematobium in Urine Cytology: Diagnosis is Possible, The American Journal of Medicine (2017), https://doi.org/doi:10.1016/j.amjmed.2017.09.041. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
CLINICAL COMMUNICATION TO THE EDITOR Schistosoma haematobium in urine cytology: diagnosis is possible Running head: cytological diagnosis of Schsitosoma in urines.
Authors: Salvatore Bellafiore*MD, Matteo Zanichelli° MD, Simonetta Piana* MD *Pathology Unit, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy °Radiolology Unit, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy Correspondence to: Simonetta Piana, MD Pathology Unit Arcispedale Santa Maria Nuova Viale Risorgimento 80 42124 Reggio Emilia Italy Tel 0039 0522 295919 Fax 0039 0522 296954 [email protected] Funding: There has been no significant financial support for this work. Conflict of Interest: There are no conflicts of interest associated with this publication. Authorship: All the authors had access to the data, contributed to write the manuscript and have approved this submission.
Page 1 of 4
TO THE EDITOR Schistosomiasis is an important neglected infectious disease that affects more than 200 million people especially in tropical and subtropical regions 1,2 with immigration contributing consistently to imported cases. In order to reduce long term complications, as development of urinary-tract squamouscell carcinoma, clinicians must rule also out Schistosomias in case of chronic hematuria.
CASE DESCRIPTION An 18-year-old male presented with an 8-month history of gross hematuria. He came from Ghana one year prior to consultation and stated no other symptoms. Physical examination was unremarkable. He underwent an US exam of the abdomen that showed an irregular wall thickening of the bladder with multiple floating papillae, measuring 1 to 2 cm in diameter (Fig.1 a, arrow). A subsequent CT scan revealed an expanded bladder with two small irregularities of the profile of the anterior-basal wall (FIG.1 b, arrow). Urine sediment cytology was therefore performed to rule out any neoplastic disease. A Papanicolaou-stained ThinPrep® liquid-based cytologic preparation revealed many ellipsoid structures with a thick semitranslucent shell and a characteristic terminal spine (FIG.1 b,c) on a dirty background, made up granulocytes, mixed with normal urothelial and squamous cells. Some mature miracidia could be seen, easily recognizable by their finely ciliated outline (FIG.1 d,e). A definitive diagnosis of Schistosoma haematobium was made and the the patient was placed on therapy with Praziquantel.
DISCUSSION Schistosomiasis, also known as Bilharziasis, is considered the second most important tropical disease after malaria. Among the 5 species of Schistosomes, Schistosoma haematobium is one of the principal causes of haematuria. Its larvae are usually found in environmental waters and infections often derive from contact with contaminated fresh water. After burrowing into the human host skin, S. haematobium can complete the sexual stages of its life cycle. Male and female S. haematobium flukes live in the venous plexus of bladder, where the female deposits numerous eggs that move into the lumen of the bladder, ureters, rectum and uterine cervix. At variance with S. japonicum and S. mansoni, S. haematobium’s eggs are easily found in the urine. Also, the free-swimming larval stage of the parasite, released from the eggs and called miracidia, can be seen in urine sediment. Cytological examination of the urine sediment, both with ThinPrep and conventional methods, is an easily available and inexpensive tool that can lead to the rapid detection of Schistosoma3-7, although ThinPrep® liquid-based cytologic specimens usually provide great cellularity, cell preservation, and a cleaner background compared to conventional techniques.
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REFERENCES 1. Davis A. Schistosomiasis. In J. Farrar, P. Hotez, T. Junghanss, et al. (Eds.), Manson's tropical diseases (23rd ed.), Saunders, London (2009), pp. 1425-146 2. Gryseels B, Polman K, Clerinx J, Kestens L. Human schistosomiasis. Lancet 2006; 368: 1106– 1118. 3. Waugh MS, Perfect JR, Dash RC. Schistosoma haematobium in urine: morphology with ThinPrep method. Diagn Cytopathol. 2007;35(10):649-650. 4. Martinez_giron R, Esteban-Sanchis JG, Doganci L. Parasite eggs in urine cytology: fact or artifact? Diagn Cytopathol. 2008;37(5);353-354 5. Laser A, Kacher J, Amodio J, Strubel N, Elgert P, Levine P. Diagnosis of Schistosoma haematobium on voided urine cytology: a case report with radiologic correlation. Acta Cytol. 2009;53(1):98-100 6. Acosta AM, Tarjan G. Identification of miracidia of Schistosoma haematobium in a bladder wash sample. Diagn Cytopathol. 2016;44(5):413-415. 7. Procop GW, Mendez JC, Schneider SK, Rosenblatt JE. Diagnostic value of a miracidium in urinary sediment. Diagn Cytopathol. 1999;20(1):34-37.
Figure 1. Schistosoma haematobium diagnosis
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S0002-9343(17)31027-6 https://doi.org/doi:10.1016/j.amjmed.2017.09.041 AJM 14322
To appear in:
The American Journal of Medicine
Please cite this article as: Salvatore Bellafiore, Matteo Zanichelli, Simonetta Piana, Schistosoma Haematobium in Urine Cytology: Diagnosis is Possible, The American Journal of Medicine (2017), https://doi.org/doi:10.1016/j.amjmed.2017.09.041. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
CLINICAL COMMUNICATION TO THE EDITOR Schistosoma haematobium in urine cytology: diagnosis is possible Running head: cytological diagnosis of Schsitosoma in urines.
Authors: Salvatore Bellafiore*MD, Matteo Zanichelli° MD, Simonetta Piana* MD *Pathology Unit, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy °Radiolology Unit, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy Correspondence to: Simonetta Piana, MD Pathology Unit Arcispedale Santa Maria Nuova Viale Risorgimento 80 42124 Reggio Emilia Italy Tel 0039 0522 295919 Fax 0039 0522 296954 [email protected] Funding: There has been no significant financial support for this work. Conflict of Interest: There are no conflicts of interest associated with this publication. Authorship: All the authors had access to the data, contributed to write the manuscript and have approved this submission.
Page 1 of 4
TO THE EDITOR Schistosomiasis is an important neglected infectious disease that affects more than 200 million people especially in tropical and subtropical regions 1,2 with immigration contributing consistently to imported cases. In order to reduce long term complications, as development of urinary-tract squamouscell carcinoma, clinicians must rule also out Schistosomias in case of chronic hematuria.
CASE DESCRIPTION An 18-year-old male presented with an 8-month history of gross hematuria. He came from Ghana one year prior to consultation and stated no other symptoms. Physical examination was unremarkable. He underwent an US exam of the abdomen that showed an irregular wall thickening of the bladder with multiple floating papillae, measuring 1 to 2 cm in diameter (Fig.1 a, arrow). A subsequent CT scan revealed an expanded bladder with two small irregularities of the profile of the anterior-basal wall (FIG.1 b, arrow). Urine sediment cytology was therefore performed to rule out any neoplastic disease. A Papanicolaou-stained ThinPrep® liquid-based cytologic preparation revealed many ellipsoid structures with a thick semitranslucent shell and a characteristic terminal spine (FIG.1 b,c) on a dirty background, made up granulocytes, mixed with normal urothelial and squamous cells. Some mature miracidia could be seen, easily recognizable by their finely ciliated outline (FIG.1 d,e). A definitive diagnosis of Schistosoma haematobium was made and the the patient was placed on therapy with Praziquantel.
DISCUSSION Schistosomiasis, also known as Bilharziasis, is considered the second most important tropical disease after malaria. Among the 5 species of Schistosomes, Schistosoma haematobium is one of the principal causes of haematuria. Its larvae are usually found in environmental waters and infections often derive from contact with contaminated fresh water. After burrowing into the human host skin, S. haematobium can complete the sexual stages of its life cycle. Male and female S. haematobium flukes live in the venous plexus of bladder, where the female deposits numerous eggs that move into the lumen of the bladder, ureters, rectum and uterine cervix. At variance with S. japonicum and S. mansoni, S. haematobium’s eggs are easily found in the urine. Also, the free-swimming larval stage of the parasite, released from the eggs and called miracidia, can be seen in urine sediment. Cytological examination of the urine sediment, both with ThinPrep and conventional methods, is an easily available and inexpensive tool that can lead to the rapid detection of Schistosoma3-7, although ThinPrep® liquid-based cytologic specimens usually provide great cellularity, cell preservation, and a cleaner background compared to conventional techniques.
Page 2 of 4
REFERENCES 1. Davis A. Schistosomiasis. In J. Farrar, P. Hotez, T. Junghanss, et al. (Eds.), Manson's tropical diseases (23rd ed.), Saunders, London (2009), pp. 1425-146 2. Gryseels B, Polman K, Clerinx J, Kestens L. Human schistosomiasis. Lancet 2006; 368: 1106– 1118. 3. Waugh MS, Perfect JR, Dash RC. Schistosoma haematobium in urine: morphology with ThinPrep method. Diagn Cytopathol. 2007;35(10):649-650. 4. Martinez_giron R, Esteban-Sanchis JG, Doganci L. Parasite eggs in urine cytology: fact or artifact? Diagn Cytopathol. 2008;37(5);353-354 5. Laser A, Kacher J, Amodio J, Strubel N, Elgert P, Levine P. Diagnosis of Schistosoma haematobium on voided urine cytology: a case report with radiologic correlation. Acta Cytol. 2009;53(1):98-100 6. Acosta AM, Tarjan G. Identification of miracidia of Schistosoma haematobium in a bladder wash sample. Diagn Cytopathol. 2016;44(5):413-415. 7. Procop GW, Mendez JC, Schneider SK, Rosenblatt JE. Diagnostic value of a miracidium in urinary sediment. Diagn Cytopathol. 1999;20(1):34-37.
Figure 1. Schistosoma haematobium diagnosis
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