TREMATODA HATI : Clonorchis sinensis Opisthorchis viverrini

TREMATODA DARAH: Schistosoma haematobium

Zambia. Sudan.Schistosoma haematobium Geographic Distribution : • Africa (54 countries) . and Zimbabwe. • Eastern Mediterranean . Malawi. ex: Egypt.


• Hospes definitif: –Manusia. or urinary bilharziasis) . (schistosomal hematuria.vesical schistosomiasis. Baboon dan sejenisnya • causes urinary schistosomiasis.


Schistosoma haematobium telur .


Pathogenesis & Clinical symptom : • skin rash at site of cercarial penetration (swimmer’s itch) • it is the eggs not the adult flukes which are responsible for the clinical features • egg deposits in the bladder mucosa and submucosa were seen during the acute phase • Continuous aggravation in the bladder wall leads to carcinoma of the bladder • .

urinary infection (cystitis ) • eventually kidney damage. • hematuria is the most characteristic symptom.Pathogenesis ( cont’d) • damage to the bladder or ureters : obstructed and the bladder wall thickened • abnormal bladder function with painful • frequent urination. .

The Relationship Between Schsitosomiasis and Bladder cancer • Prevalence : – Carcinoma of the urinary bladder is the most common malignancy in the Middle East and parts of Africa where schistosomiasis haematobium is a widespread problem – The major histological cell type of bladder cancer is Squamous Cell Carcinoma .

Cancer of the bladder • In Egypt : 60 % of the Egyptian population is at risk of infection. which contrasts to Western countries. where the frequency of SCC in bladder cancer cases is much lower (3 to 10%) . Prevalence of 37 to 48% with high incidence • In Iraq : The proportion of SCC varied from 54 to 81% of all bladder cancer cases in different areas of endemic infection.

.g. e.Cancer of the Bladder • eggs can act as a mechanical irritant to the urothelium • it was also found that endogenous levels of host cell DNA damage were related to the intensity of infection. • chronic inflammatory lesions continuous exposure to the carcinogens. N-nitroso compounds. which were detected in larger quantities in the urine of patients with schistosomiasis .

in endemic countries : the mean age is between 40 and 49 years • The ratio of bladder cancer incidence (males to females) in countries with endemic infection was reported to be 5:1 .Epidemiologi • Age and Gender Ratios : • In schistosome-free countries : the peak incidence of bladder cancer is in the 6 th or 7 th decade ( max between the ages of 65 and 75 years) • By contrast.

eggs can be found in faeces • detecting eggs in rectal biopsy or bladder mucosal biopsy .LABORATORY DIAGNOSIS: • Specific : • Finding the eggs or occasionally the hatched miracidia in the urine • occasionally.

Biopsy of the mucosal bladder .