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Saudi Journal of Kidney Diseases and Transplantation
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Year : 2013  |  Volume : 24  |  Issue : 1  |  Page : 162-167
Ultrasound findings in urinary shistosomaisis infection in school children in the Gezira state central Sudan

Department of Medical Imaging and Molecular Biology, National Cancer Institute, University of Gezira, Sudan

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Date of Web Publication22-Jan-2013


To evaluate the ultrasound findings of urinary schistosomiasis in Quran school (Khalwas) children in Gezira State Sudan, we studied all the students from two schools. A total of 103 boys were tested for urinary schistosomiasis using the urine filtration method. Schistosoma haematobium (S. haematobium) eggs were counted. Ultrasound was performed for all the positive subjects. Seventy-three (71%) subjects were positive for S. haematobium. The mean age was 11.3 ± 2.9 years. Sixty-six (90.4%) subjects showed urinary tract abnormalities. The findings revealed the following degrees of wall thickening: 53.0% mild, 18.2% moderate and 21.2% severe. Urinary bladder polyp(s) were noted in 43.3% (single) and 40.9% (multiple) of the subjects, and calcification of the bladder wall was observed in 7.6% subjects. Ureteric dilatation was noted in 38/73 (52.0%), while hydronephrosis was detected in 19/73 (26.3%). The vast majority of urinary tract schistomiasis lesions were in the urinary bladder. Ultrasound is a useful tool for identifying the morbidity of S. haematobium in endemic areas.

How to cite this article:
Elmadani AE, Hamdoun AO, Monis A, Karamino NE, Gasmelseed N. Ultrasound findings in urinary shistosomaisis infection in school children in the Gezira state central Sudan. Saudi J Kidney Dis Transpl 2013;24:162-7

How to cite this URL:
Elmadani AE, Hamdoun AO, Monis A, Karamino NE, Gasmelseed N. Ultrasound findings in urinary shistosomaisis infection in school children in the Gezira state central Sudan. Saudi J Kidney Dis Transpl [serial online] 2013 [cited 2018 Apr 23];24:162-7. Available from: http://www.sjkdt.org/text.asp?2013/24/1/162/106362

   Introduction Top

The incidence of urinary schistosomiasis infection is increasing in endemic areas of Africa as a consequence of irrigation programs and hydroelectric power development. [1] Urinary schistosomiasis is a disease of children and young adults. The adult worms live mainly in the venous plexus of the urinary bladder and the morbidity is caused by egg deposition in and around the urinary tract, causing inflammation and lesions. Schistosoma haematobium-related pathology is found mainly in the urinary bladder, the ureters and kidneys. [2] At present, schistosomiasis control programs are targeted at morbidity reduction in the populations. Diagnosis is still based on parasitology and serology, and ultrasound has proven to be an important means to evaluate the extent of the lesions of the urinary tract, such as dilatation of the renal pelvis and bladder wall lesions. [3],[4] Ultrasound can also provide direct information about lesions in the other internal organs. [5] Despite lacking specificity, proteinuria and parasite eggs count are the best methods to predict bladder pathology. [6],[7] Several studies have demonstrated that ultrasound is useful in the detection of morbidity induced by schistosomiasis on an individual basis and at the community level. [8],[9],[10] Ultrasound detects serious consequences of S. haematobium, and it was concluded that schistosomiasis remained an important public health problem in sub-Saharan Africa. [11] Post-treatment monitoring has provided evidence for reversibility of the pathological lesions induced by S. haematobium.[12] Ultrasound has already been used in a number of epidemiological studies in areas where S. haematobium is endemic and has proven to be feasible and useful. [13] The aim of this study was to evaluate the ultrasound findings among school children who were positive for S. haematobium in Gezira State, Sudan.

   Materials and Methods Top

One hundred and three students in two Quran schools for males (Khalwas) were recruited for this cross-sectional study during 2009-2010. Hilat Rodwan is located in the south west of Wadmedani city, Gezira state Sudan, surrounded by irrigation canals. There is no available clean tap water and open canals are the main source of water supply. All the children had an age range between seven and 20 years. Girls were not included in the study because the schools were only for boys; girls in our culture do not frequently go to the canals like boys and most studies showed that boys were more exposed to the infection with mainly S. haematobium than girls (Alamin et al 2009 unpublished). Written informed consent and assent was obtained from each participant. Ethical approval was obtained from the National Cancer Institute Research Ethical Committee (NCIREC). A total of 103 urine specimens were collected between 10:00 am and 2:00 pm, the time of optimum egg passage, and kept cool in an insulated ice box and transferred to the laboratory within 4 h after collection. Microscopy was performed on the product of filtration of 10 mL of urine. The presence of S. haematobium egg was considered as positive for S. haematobium infection. Ultrasound was used by a qualified radiologist to examine the positive cases, using an ultrasound apparatus (Aloka SSD-500 portable ultrasound with a 3.5-MHz curvilinear probe; Aloka, Tokyo, Japan). The subjects were asked to drink water prior to the scan to fill their urinary bladder. Both the lower urinary tract (bladder) and the upper urinary tract (kidneys and ureters) were evaluated. The following changes were considered as pathological lesions in the lower urinary tract: bladder wall thicker than 5 mm and presence of bladder polyp(s) or wall nodularity. In the upper tract, the left and right ureteric wall thickness and dilatation were recorded. Kidney dilation was recorded as mild, moderate and severe.

   Statistical Analysis Top

Data were expressed as the mean and standard deviation (SD), as appropriate. Comparison and characteristics between the variables were performed using the Chi-square test and Fisher's exact test as appropriate. The Statistical Package for Social Science (SPSS 16.0 for windows) was used in performing all the statistical analysis, and P-value less than 0.05 was considered as significant.

   Results Top

All the study subjects were exposed to the S. haematobium infection from 6 months to 12 years. A total of 73/103 (71%) children were positive for S. haematobium, with low (less than 100 eggs/10 mL) and high (more than 200 egss/10 mL) egg counts. All positive subjects were examined by ultrasound. The mean age of all the positive subjects was 11.3 ± 2.9 years, with a range from 7 to 20 years, as shown in [Table 1]. Ultrasound of the urinary bladder revealed that 66/73 (90.4%) patients had some degree of wall thickening [Figure 1]A, ranging from mild to severe, as follows: 35/66 (53%) mild, 12/66 (18.2%) moderate and 14/66 (21.2%) severe. There was no significant difference between the different age groups (P >0.05) as shown in [Table 2]. Twenty-seven out of 66 (40.9%) patients had multiple polyps [Figure 1]C and 22/66 (33.3%) had a single polyp [Figure 1]B, [Table 3]. The ultrasound findings of ureters showed that 38/73 (52%) patients had different degrees of ureteric dilatation, [Figure 1]D and E. However, no patient had a severe degree of ureteric dilatation, and there were no significant differrences between the different age groups [Table 4]. The kidneys ultrasound showed that 19/73 (31.2%) patients had different degrees of hydronephrosis; 18 patients had a mild hydronephrosis [Figure 1]F and only one patient showed a moderate degree of hydronephrosis. However, there were no significant differences between the different age groups [Table 5]. The result showed that 32/66 (48.5%) patients had bladder and ureter abnormalities, while 16/66 (24.4%) showed bladder, ureter and kidney abnormalities and 3/66 (4.5%) had both bladder and kidney abnormalities. There was an increase in the severity of disease with the increased egg count, but it was not significant [Table 6].
Table 1. Distribution of age range of the study subjects (N = 73).

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Table 2. Distribution of subjects according to the severity of the disease using urinary bladder wall thickening in correlation with age.

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Table 3. Distribution of study subjects according to the presence or absence of urinary bladder lesion(s) with age.

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Table 4. Distribution of study subjects according to the degree of severity of the disease using ureteric dilatation with age.

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Table 5. Distribution of study subjects according to the degree of severity of the disease using hydronephrosis of kidneys in correlation with age.

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Table 6. Association between egg count and severity of the disease by US.

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Figure 1. Different ultrasound findings of urinary schistosomaisis, (A) urinary bladder wall thing measuring 98 mm, (B) solitary urinary bladder poly, (C) multiple urinary bladder polyps, (D) axial view of urinary bladder showing bilateral ureteric dilatation (arrows), (E) longitudinal view showing ring distal ureteric dilatation and (F) longitudinal view showing mild hydronephrosis.

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   Discussion Top

In endemic areas in the tropics, ultrasound is highly sensitive for assessment of morbidity related to S. haematobium infection, which is associated with typical bladder lesions. [14] Ultrasound with a simple portable machine offers a unique opportunity to investigate morbidity at the community level. Non-invasively, in large field surveys, it has thus become an important tool for clinical and epidemiological research. [15] This study revealed that 71% of the study subjects were positive for S. haematobium and 83.6% had ultrasound abnormalities, which is comparable to the results of the study done by Serieye et al who found that echographic abnormalities of the urinary tract were present in 50.5% of the study population. [16] The same results were found in Niger in two villages (64.3% and 58.8% ultrasound abnormalities). [17] This demonstrates that lesions involving the upper urinary tract are also well visualized, but do not constitute a specific finding. Community-based screening for S. haematobium in endemic areas has shown a high prevalence of bladder wall thickening, irregularities and polyps, which were usually more frequent and severe in children. [18] In our study, urinary bladder polyps were detected in 80.3%. Similar findings were found in Yemen, Tanzania and Niger. [19],[20],[21] Regarding the upper urinary tract, 52% of our study subjects were found to have ureteric dilatation, which was comparable to other studies. [19] However, Lamothe et al showed that in Niger, the prevalence of hydronephrosis was 36.1% in children. [21] In Tanzania, kidney pathologies (congestive changes) were found in 36% of the school children. [17] Ultrasound can make a valuable contribution to the monitoring of control programs, and the data collected should enable proper decisions to for morbidity reduction. [2] The best applications for ultrasound in schistosomiasis is to include community-based diagnostic studies and post-therapeutic follow-up. In contrast, ultrasound is not suitable for an individual patient attending a health service seeking medical advice. In endemic areas, ultrasound may be useful for an individual diagnosis if more effective methods are unavailable, such as urinalysis for hematuria and egg counts. However, the poor specificity of some images is a major limitation for its use in zones of low prevalence of schistosomiasis. [22] We conclude that ultrasound is a useful tool for identify the morbidity of S. haematobium in endemic areas, especially for children. Ultrasound can be used for detection of complications and follow-up of therapy.

   Acknowledgment Top

The authors would like to thank all participants who collaborated faithfully in this study. They are also grateful to the directors of the Quran schools. Prof. Awad Elsid Mustafa is also acknowledged for his help with reviewing and editing this manuscript.

   References Top

1.Stothard JR, Webster BL, Weber T, et al. Molecular epidemiology of Schistosoma mansoni in Uganda: DNA barcoding reveals substantial genetic diversity within Lake Albert and Lake Victoria populations. Parasitology 2009; 136:1813-24.  Back to cited text no. 1
2.Ekwunife CA, Okafor FC, Nwaorgu OC. Ultrasonographic screening of urinary schistosomiasis infected patients in Agulu community, Anambra state, southeast Nigeria. Int Arch Med 2009;2:34.  Back to cited text no. 2
3.Gigase PL. Urinary bilharziasis. Acta Urol Belg 1992;60:1-13.  Back to cited text no. 3
4.Garba A, Toure S, Dembele R, et al. Present and future schistosomiasis control activities with support from the Schistosomiasis Control Initiative in West Africa. Parasitology 2009; 136:1731-7.  Back to cited text no. 4
5.Hatz C, Savioli L, Mayombana C, Dhunputh J, Kisumku UM, Tanner M. Measurement of schistosomiasis-related morbidity at community level in areas of different endemicity. Bull World Health Organ 1990;68:777-87.  Back to cited text no. 5
6.Kahama AI, Nibbeling HA, van Zeyl RJ, Vennervald BJ, Ouma JH, Deelder AM. Detection and quantification of soluble egg antigen in urine of Schistosoma haematobium-infected children from Kenya. Am J Trop Med Hyg 1998;59:769-74.  Back to cited text no. 6
7.Brouwer KC, Munatsi A, Ndhlovu PD, Wagatsuma Y, Shiff CJ. Urinary schistosomiasis in Zimbabwean school children: Predictors of morbidity. Afr Health Sci 2004;4:115-8.  Back to cited text no. 7
8.Cline BL, Rymzo WT, Hiatt RA, Knight WB, Berrios-Duran LA. Morbidity from Schistosoma mansoni in a Puerto Rican community: A population-based study. Am J Trop Med Hyg 1977;26:109-17.  Back to cited text no. 8
9.Cook JA, Baker ST, Warren KS, Jordan P. A controlled study of morbidity of schistosomiasis mansoni in St. Lucian children, based on quantitative egg excretion. Am J Trop Med Hyg 1974;23:625-33.  Back to cited text no. 9
10.Hsiang MS, Carlton EJ, Zhang Y, et al. Use of ultrasonography to evaluate Schistosoma japonicum-related morbidity in children, Sichuan Province, China, 2000-2007. Am J Trop Med Hyg 2010;82:103-11.  Back to cited text no. 10
11.van der Werf MJ, de Vlas SJ, Brooker S, et al. Quantification of clinical morbidity associated with schistosome infection in sub-Saharan Africa. Acta Trop 2003;86:125-39.  Back to cited text no. 11
12.Doehring-Schwerdtfeger E, Kardorff R. Ultrasonography in schistosomiasis in Africa. Mem Inst Oswaldo Cruz 1995;90:141-5.  Back to cited text no. 12
13.Hatz C, Jenkins JM, Meudt R, Abdel-Wahab MF, Tanner M. A review of the literature on the use of ultrasonography in schistosomiasis with special reference to its use in field studies. 1. Schistosoma haematobium. Acta Trop 1992; 51:1-14.  Back to cited text no. 13
14.Ugbomoiko US, Obiezue RN, Ogunniyi TA, Ofoezie IE. Diagnostic accuracy of different urine dipsticks to detect urinary schistosomiasis: A comparative study in five endemic communities in Osun and Ogun States, Nigeria. J Helminthol 2009;83:203-9.  Back to cited text no. 14
15.Kardorff R, Dohring E. Ultrasound diagnosis of bilharziasis. Ultraschall Med 2001;22:107-15.  Back to cited text no. 15
16.Serieye J, Boisier P, Ravaoalimalala VE, et al. Schistosoma haematobium infection in western Madagascar: morbidity determined by ultrasonography. Trans R Soc Trop Med Hyg 1996;90:398-401.  Back to cited text no. 16
17.Laurent C, Lamothe F, Develoux M, Sellin B, Mouchet F. Ultrasonographic assessment of urinary tract lesions due to Schistosoma haematobium in Niger after four consecutive years of treatment with praziquantel. Trop Med Parasitol 1990;41:139-42.  Back to cited text no. 17
18.Strickland GT, Abdel-Wahab MF. Abdominal ultrasonography for assessing morbidity from schistosomiasis. 1. Community studies. Trans R Soc Trop Med Hyg 1993;87:132-4.  Back to cited text no. 18
19.Salah MA. Ultrasonography of urinary tract lesions caused by bilharziasis in Yemeni patients. BJU Int 2000;86:790-3.  Back to cited text no. 19
20.Hatz C, Mayombana C, de Savigny D, et al. Ultrasound scanning for detecting morbidity due to Schistosoma haematobium and its resolution following treatment with different doses of praziquantel. Trans R Soc Trop Med Hyg 1990;84:84-8.  Back to cited text no. 20
21.Lamothe F, Develoux M, Devidas A, Mouchet F, Sellin B. Echographic study of the morbidity due to urinary bilharziasis in a hyper-endemic village in Niger. Bull Soc Pathol Exot Filiales 1989;82:678-84.  Back to cited text no. 21
22.Boisier P. Ultrasonoic diagnosis of morbidity related to schistosomiasis due to Schistosoma mansoni and Schistosoma haematobium: Epidemiological and individual value. Med Trop 2000;60:395-401.  Back to cited text no. 22

Correspondence Address:
Nagla Gasmelseed
National Cancer Institute, University of Gezira, Waadmedani
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DOI: 10.4103/1319-2442.106362

PMID: 23354218

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  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]

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