Urinary bilharziasis and urinary tract infection

A case discussion for bilhaeizial case

1. Case scenario

2. محمدين محمد أحمد , male patient, 34 years old, farmer, from Deshna, married for 5 years and has a son 3 years old with no special habits of medical importance, he complains of red discoloration of urine of 10 day s duration, the hematuria is terminal with no presence of clots, renal colic or bleeding from other orifice, there i s no frequency, urgency, pain or difficulty of micturition, the ptn has history of shortness of breath 1 year ago of 2 months duration and improved without medical intervention On examination: the patient had free clinical examination Normal CBC except for eosinophilia, in urine analysis, the urine looked smoky and contains living bilharzial ova

3. Diagnosis 34-year-old male patient complaining of terminal hematuria of 10 months duration most probably bilharzial cystitis

4. Bilharziasis

5. Bilharziasis of the bladder C/P: Cystitis symptoms: painful micturition, frequency, haematuria and pyuria Pain is usually intense, with bladder ulceration, and may be referred to the tip of the penis and to the perineum. In the active phase, there is invariably heavy excretion of viable eggs in the urine and there may also be bacteriuria. Anaemia and eosinophilia are common.

6. Diagnosis schistosomal eggs in the urine. Serology: circulating antigens in chronic inactive cases plain X-ray (KUB) and IVU Cystoscopy: morphology of the gross bladder lesion and biopsy for histopathological study.

7. Linear Calcification

8. Other sites of bilharziasis Ureter  obstructive uropathy Seminal vesicles Prostate Bulbar urethra Spermatic cord

9. TTT MEDICAL: PRAZIQUNTEL ENDOSCOPIC. SURGICAL.

10. Complications 1- chronic cicatricial ulcers, 2- bladder contraction, 3- Bladder neck obstruction (BOO 4- leukoplakia 5- ureteric strictures, 6- bladder carcinoma.

11. Bahea Mohamed Abdallah, 45 years old, from Qena, housewife, not married, she experienced dysuria, fever, nausea, flank pain of 2 days duration, she is known to be diabetic since 2019 and controlled by oral hypoglycemic. On examination there is costovertebral angle tenderness. CBC show leukocytosis, urine analysis shows WBCs casts

12. Diagnosis: a female ptn 45 years old associated with acute onset of dysuria and flank pain of 2 days durations most likely Acute pyelonephritis

13. Genitourinary infections

14. Etiology

15. Routes

16. Anatomical barriers

17. Risk factors

18. Symptoms:

High fever, loin pain, turbid urine, bladder irritation.

Nausea/Vomiting, malaise Febrile UTIs: Parenchymatous organs like Kidney Testis Prostate

19. Diagnosis

-Asymptomatic

-Acute exacerbations

-Persistent pyuria, bacteruria & albuminuria

-Complications: H, anemia, stones

20. TTT: TMP-SMX, or Quinolones for 3-5