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Case 28. Bilharziasis of colon
(25 y-o M)
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| Sigmoid colon biopsy from a student who traveled on foot through the African continent 3 years earlier |
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Key words : Schistosoma haematobium, bilharziasis, pseudotubercle
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| Endoscopic observation reveals localized pallor and mild thickening of the colonic mucosa. | Localized submucosal fibrosis (pseudotubercle) is seen (HE, low power). | |
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| Foreign body granuloma is formed in the pseudotubercle (HE, high power). Miracidial nuclei are seen in some ova. | The 1:500 diluted patient's own serum specifically reacts with the ova (indirect immunoperoxidase). | |
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| Route of the transcontinental survival tour in Africa The route mostly overlaps with the endemic area of bilharzian schistomiasis. A 10-minute contact with contaminated water may cause percutaneous infection of cercaria. |
Urine sediment Hematuric urine contains number of ova of S. haematobium. A large-sized, spiculated ovum contains a living miracidium inside. |
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| Urine cytology Spiculated ova containing miracidium (Papanicolaou). The elongated ovum shows spiculation at one end and no operculum (Papanicolaou). Note the internal miracidium and eosinophilic host reaction. |
Urine cytology Heavily ciliated miracidium with numerous nuclei (Giemsa). Centrifugation of urine artificially induces hatching of the miracidium. |
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