In searching for the flukes at autopsy we should make a longitudinal slit in the portal vein and with a spoon scoop out the blood and search for the parasites in a glass dish.
In the intestinal form of schistosomiasis the rectum may be studded with polypoid tumors which when projecting from the anus may ulcerate and lead to a diagnosis of cancer of the rectum. In sections from these masses great numbers of lateral spined eggs may be found.
The connective tissue increase is in the submucosa. The gut section may also present small abscess-like areas.
Eggs have been found in the appendix as well as in the large intestines and the small intestine has been found involved in one case. In rare instances ova have been found in the lungs, spleen and even in the brain and spinal cord.
By digesting selected tissues in 4% NaOH at 75°C. and centrifuging one may find eggs which otherwise would be overlooked. Statistics from Cairo usually note 30 to 40% of infection in natives but Ferguson employing all methods found 61% infected at autopsies on 600 males. In all forms of schistosomiasis but particularly in the Japanese infection, eosinophilia is pronounced.
In Japanese schistosomiasis the intestines may show thickenings at the site of aggregations of eggs. In the liver a marked interlobular cirrhosis occurs with numerous eggs in the connective tissue increase. Rarely, eggs may lodge in the brain, giving granuloma-like areas. The irritating eggs may also give rise to similar areas in the lungs.
Symptomatology
Vesical Schistosomiasis or Endemic Haematuria
This form of the disease is chiefly found in Egypt, Syria, Uganda and South Africa. It is caused by S. haematobium and the period of incubation is approximately six months.
