LGCmain
Indian Journal of Pathology and Microbiology
Home About us Instructions Submission Subscribe Advertise Contact e-Alerts Ahead Of Print Login 
Users Online: 2375
Print this page  Email this page Bookmark this page Small font sizeDefault font sizeIncrease font size
IJPM is coming out with a Special issue on "Genitourinary & Gynecological pathology including Breast". Please submit your articles for these issues


 
LETTER TO EDITOR Table of Contents   
Year : 2008  |  Volume : 51  |  Issue : 2  |  Page : 309-310
Cervical schistosomiasis


Department of Pathology, Krishna Institute of Medical Sciences, University Karad, India

Click here for correspondence address and email
 

How to cite this article:
Naniwadekar MR. Cervical schistosomiasis. Indian J Pathol Microbiol 2008;51:309-10

How to cite this URL:
Naniwadekar MR. Cervical schistosomiasis. Indian J Pathol Microbiol [serial online] 2008 [cited 2019 Oct 17];51:309-10. Available from: http://www.ijpmonline.org/text.asp?2008/51/2/309/41706


Sir,

Schistosomiasis is a human disease, commonly caused by infection from one of the three species of parasitic trematodes of the genus Schistosoma: S. hematobium , S. mansoni and S. japonicum . About 90 million people are infected by S. hematobium world wide. [1] S. hematobium is most commonly implicated in female genital schistosomiasis (FGS). FGS affects 9-13 million women world wide, mainly in areas where S. hematobium is endemic. [2] The organs involved are cervix, vulva,  Fallopian tube More Detailss and ovary. As S. hematobium infection commonly involves the lower urinary tract, the presence of schistosomal ova in the urine is a diagnostic finding. FGT is usually secondarily affected. We describe a 39-year-old Saudi female patient, whose urine examination was negative for schistosomal ova and diagnosis of schistosomiasis was done on cervical biopsy.

A 39-year-old Saudi female patient presented at OPD with chief complaints of vaginal discharge and postcoital bleeding for 1 year. Patient was suffering from dysuria and pelvic pain for last 15 years on and off. Patient was married for 16 years and was under investigations for secondary infertility. She had delivered an anencephalic baby 10 years back. Her urine examination showed mild proteinuria, hematuria and leukocyturia and was negative for schistosomal ova. Routine hemogram was normal. On ultra sonography, urinary bladder was partially distended and there was minimal dilatation of pelvicalyceal system on both sides. Uterus and ovaries were normal. Intravenous pyelography showed moderately dilated ureters and pelvicalyceal system due to bilateral ureteric strictures. Cystoscopic findings were suggestive of chronic inflammation of urinary bladder and ureters and calcified bladder wall.

Per speculum examination showed two suspicious cervical ulcers on anterior and posterior lips. Biopsy was done from both the lips. Histopathological examination showed cervical tissue, lined by stratified squamous epithelium showing surface ulceration. The subepithelial tissue showed numerous ova of S. hematobium having terminal spine, with mild mononuclear cell infiltration [Figure 1]. Urine examination was repeated twice and was negative for schistosomal ova.

Wright et al , [3] have observed that schistosomiasis is a significant cause of gynecological morbidity, particularly, when involved the lower genital tract. Schistosomiasis affects cervix, ovaries, vulva, vagina and fallopian tubes. The diseased woman suffers from menstrual irregularities, pelvic pain, spontaneous abortion and permanent sterility. In most of the cases, the ova of S. hematobium included in the tissues are responsible for these anatomopathologic manifestations. [3] In the present case, the patient's complaints of chronic vaginal discharge and postcoital bleeding were because of the involvement of cervix by schistosomiasis. Impaired fertility in schistosomiasis can be secondary to schistosomal salpingitis with fibrosis and tubal occlusion or inflammatory reaction near hilus of ovary causing adhesions and anovulation. In the case described, although the patient was having urinary complaints, urine examination did not show presence of schistosomal ova and the cervical biopsy clinched the diagnosis of schistosomiasis. Poggensee et al , [4] in their study, in Tanzania, found that urinary and genital schistosomiasis coexisted in 62% of the women. But S. hematobium ova were found in the cervix without excretion of ova in the urine in 23% of the women. Gundersen et al , [5] have observed that cases of schistosomiasis can be overlooked, if only a single morning urine sample was examined.

The case is presented to stress the importance of other diagnostic modalities like cervical biopsy for diagnosis of schistosomiasis in endemic regions, if urine examination fails to detect any. It also suggests that cervical tissue or smear examination had to be routinely done, in the areas prevalent for S. hematobium , considering the high incidence of FGS.


   Acknowledgment Top


The case was diagnosed by the author while working as histopathologist in Kingdom of Saudi Arabia. Author's acknowledgements are due towards Dr. Mohammad Khogaly, the Chief Consultant, Department of Obstetrics and Gynaecology, for making clinical case sheets available to her.



 
   References Top

1.Chakraborty P. Text book of medical parasitology. 1 st ed. Kolkatta: New Central Book Agency (P) Ltd; 2004. p. 233.  Back to cited text no. 1    
2.Carey FM, Quah SP, Hedderwick S, Finnegan D, Dinsmore WW, Maw RD. Genital schistosomiasis. Int J STD AIDS 2001;12:609-11.  Back to cited text no. 2    
3.Wright ED, Chiphangwi J, Hutt MS. Schistosomiasis of the female genital tract: A histopathological study of 176 cases from Malawi. Trans R Soc Trop Med Hyg 1982;76:822-9.  Back to cited text no. 3    
4.Poggensee G, Kiwelu I, Saria M, Richter J, Krantz I, Feldmeier H. Schistosomiasis of the lower reproductive tract without egg excretion in urine. Am J Trop Med Hyg 1998;59:782-3.  Back to cited text no. 4    
5.Gundersen SG, Kjetland EF, Poggensee G, Helling-Giesa, Richter J, Chitsulo L, et al . Urine reagent strips for diagnosis of Schistosoma hematobium in women of fertile age. Acta Trop 1996;62:281-7  Back to cited text no. 5    

Top
Correspondence Address:
Manjiri Ramchandra Naniwadekar
Naniwadekar Hospital, Market Yard, Shaniwar Peth, Karad - 415 110, Satara, Maharashatra
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.41706

Rights and Permissions


    Figures

  [Figure 1]



 

Top
 
  Search
 
  
  
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Email Alert *
    Add to My List *
* Registration required (free)  


    Acknowledgment
    References
    Article Figures

 Article Access Statistics
    Viewed2707    
    Printed55    
    Emailed0    
    PDF Downloaded135    
    Comments [Add]    

Recommend this journal