1. BILHARZIASIS Common Schistosomiasis Strains Comment Distribution
Name of pathogen
Genitourinary
All Africa, Middle East and India
Schistosomiasis Haematobium
Intestinal
All Africa, Brazil and most of Caribian
Schistosomiasis Mansoni
China, Philippen
Schstosomiasis Japonicum
Central Africa
Schistosomiasis intercalatum
Cambodia
Schistosomiasis Mekongi

2. Egg
Meracedium ←
Snail
Cercaria → → →

3. Female Schistosoma
Male Schistosoma

7. BILHARZIASIS
Definition: Chronic granulomatous inflammation caused by bilharzial infection, It is endemic in Egypt
The granuloma is formed of macrophages, lymphocytes, plasma cells, eosinophils, giant cells, and fibroblasts

8. Life cycle of urinary bilharziasis:
Caused by: Schistosoma hematobium.
The life cycle
Cercaria → skin → small vein → right side of the heart → lung → left side of the heart → Liver → maturation into adult worms →pass in blood to the urinary bladder (vesical venous plexus) → lay eggs → eggs pass with the urine → ovum hatch → miracidium → snail (intermediate host) → cercaria.

9. Pathogenesis
The ovum retained in the bladder wall (submucosa) → granuloma formation chronic irritation & inflammation → epithelial changes →
1-Sandy patchs: healing of the granuloma by fibrosis → atrophy of the overlying epithelium
2- B ulcer
3-B polyp: epithelial hyperplasia

10. Bilharzial polyp

12. 4-Brunn’s nests dipping of the transitional epithelium in the submucosa
5-Cystitis cystica :
hydropic degeneration in Brunn’s nest→↓
6-columner metaplasia of the transitional epithelium ↓
Cystitis glandularis
7- squamous metaplasia
(Precancerous)

14. Squamous metaplasia of the urothelium

15. Bilharziasis, liver

17. Complications of urinary bilharziasis
1-Terminal hematurea → microcytic hypochromic anaemia
2-Bacterial infection
3-stone formation
4-Fibrosis (healing of B reaction) → difficulty in micturation → trabeculation of the bladder wall → stenosis of the bladder neck → hydroureter& hydronephrosis → renal failure
5- Squamous cell carcinoma

19. Intestinal bilharziasis
Caused by schistosoma mansoni
Life cycle:
Cercaria → penetrate the skin → venous blood → Rt side heart → lung →Lt side of the heart → liver ( maturation into adult worms) → pass to rectal venous plexus → lay eggs → pass with stool → ovum hatch in water → miracidium → snail → cercaria

20. Pathogenesis:
1-( granuloma) : B ovum trapped in the intestinal wall (submucosa) → B inflammatory reaction
2-Sandy patch: healing of B reaction by fibrosis + calcification of the ovum with atrophy of the mucosa
3-Ulcers: necrosis of the mucosa
4-B polyp: epithelial hyperplasia overlying B granuloma
5- Fibrosis → narrowing of the intestinal lumen

21. Bilharziasis in the colon

22. Complications of intestinal Bilharziasis
1-Desentry
2-Blood in stool → microcytic hypochromic anaemia
3-Fibrosis → stenosis of the intestinal lumen + polyp → chronic intestinal obstruction

23. Bilharziasis of the liver
Pathogenesis:
1-Impaction of the B ovum in the portal vein → deposited in portal tract → Granuloma → healing by fibrosis
2-Fatty change

24. Bilharzial granuloma

25. Bilharzial granuloma in the liver

26. 3-Fine B fibrosis
4-Coarse B fibrosis

27. Complications of Bilharziasis in the liver
1-Portal hypertension → porto-systemic anastomosis →
Splenomegally
ascitis
eosophageal varieces → hematemesis
piles → bleeding per rectum
2-Hepatomegally
3-liver failure

28. Bilharzial splenomegally
Pathogenesis:
Hyperplasia of the reticuloendothelial system by B antigene
Chronic venous congestion and portal hypertension

29. Microscopically:
Hyperplasia of the lymphoid follicles, congestion of the sinusoids
Thick capsule
Fibrosis
Interstitial hemorrhage
Hyaline degeneration
Atrophy of the follicles