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A Quantitative Post Mortem Analysis of Urinary Schistosomiasis in Egypt

I. Pathology and Pathogenesis^*

Jerome H. Smith, Ismail A. Kamel, Anwar Elwi AND Franz von Lichtenberg^||

Urinary schistosomiasis was analyzed quantitatively by gross and microscopic pathologic, bacteriologic, tissue digestion, and epidemiologic techniques in 190 consecutive autopsies from the Cairo University Faculty of Medicine Hospitals between December 1970 and April 1971. Urinary schistosomiasis was associated with obstructive uropathy (hydroureter and hydronephrosis), lower urinary tract infection, urothelial changes (hyperplasia, metaplasia and dysplasia), urolithiasis, and a high frequency of renal parenchymal disease. Schistosomal obstructive uropathy was directly related to infection intensity as measured by tissue egg burden. It was also associated with a higher frequency of pyelonephritis than found in all other cases. A close association between lower urinary tract infection and pyelonephritis was observed in patients with schistosomal obstructive uropathy, but not in other patients. Urinary schistosomiasis accounted directly or indirectly for 6.4% of all of the deaths in the series, and for 10% of deaths among all patients infected with Schistosoma haematobium. In those with high intensity infections with S. haematobium, urinary schistosomiasis resulted in or contributed to death in 42.7%. These findings, correlated with clinical and pathological reports from other endemic foci, conclusively show that urinary schistosomiasis is a life threatening disease in areas where high intensity infections are prevalent.

Accepted for publication February 16, 1974.

^* This work was partially supported by the U. S. Navy, Bureau of Medicine and Surgery Work Unit No. MR 041.20.01-0328 and by Contract No. D.A.-49-193-MD-2253 of the U.S. Army Research and Development Command, Armed Forces Epidemiological Board.

Reprint requests should be directed to: Commanding Officer, NAMRU 3, F. P. O. New York 09527.

Chief, Anatomopathologie, Institut de Medecine Tropicale, FOMECO, Hôpital Mama Yemo, B.P. 169, Kinshasa, République du Zaire.

Assistant Professor of Pathology, Faculty of Medicine, Cairo University.

Professor Emeritus, Department of Pathology, Faculty of Medicine, Cairo University.

^|| Pathologist, Peter Bent Brigham Hospital, and Professor of Pathology, Harvard Medical School, Boston.

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