Fig. 110.—Vesical schistosomiasis showing fistulous tracts opening from penis and scrotum. (From Ruge and zur Verth.)
The first symptoms are pricking sensations about urethra and slight haematuria which comes on at the end of the act of micturition. Excesses or fatigue are apt to increase the haematuria. The diagnosis is made by finding the ova in the sediment of the centrifuged urine.
Symptoms of cystitis and even pyelitis may follow the early bladder and urethral manifestations. Pain in the back or symptoms suggesting renal colic may be present. Anaemia and physical weakness gradually develop. An important sequel is vesical calculus. It is a question whether the eggs or some other product of the infection form the nucleus of such a stone. Not only can stone be recognized by cystoscopy but rather distinctive are small, glazed yellowish nodules with areas of granulation tissue. Papillomatous growths may also be seen upon cystoscopy.
Perineal fistulae in the male and vaginitis in the female may be noted.
When reinfection does not occur the haematuria tends slowly to disappear but recovery does not usually take place for several years. The vesical schistosome (S. haematobium) often causes pathological changes in the rectum so that a case may show both vesical and rectal symptoms. The rectal schistosome (S. mansoni) does not give rise to vesical trouble.
Rectal Schistosomiasis
While terminal spined eggs may be found in rectal lesions, but usually combined with lateral spined eggs, in countries where the vesical form of the disease exists, yet there are many parts of the world where, with the exclusive existence of an intestinal bilharziasis, only lateral spined eggs are found. The infection resulting from S. mansoni is the sole one in the West Indies, Congo Free State and in North-eastern South America.
The symptoms are usually those of a chronic dysentery with more or less tenesmus and straining. Prolapse is a common result and is the cause of the ulcerations which may cause the disease to be diagnosed as cancer. Cirrhosis of the liver is more apt to occur than in pure vesical schistosomiasis.
Most writers fail to mention other than the later manifestations of rectal bilharziasis, the earlier symptoms being overlooked or attributed to other causes. The same was true of Japanese schistosomiasis in which the initial “urticarial fever” was only recognized as connected with the late manifestations of liver cirrhosis and ascites a few years ago.
In 1916 Lawton noted in a number of Australian soldiers, encamped in Egypt, a fever of about 7 to 10 days’ duration in which the evening rise approximated 103°F. A diarrhoea and abdominal pain accompanied the fever and along with this a cough and patchy consolidation. Most of the cases showed urticaria which lasted from one to seven days. All cases showed a well marked eosinophilia. The diagnosis, but frequently only after prolonged and continued search, was made by the finding of the lateral spined eggs of S. mansoni. The period of incubation in these cases seemed to be from one to three months.