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BLOK NEOPLASIA
TREMATODA DARAH:
Schistosoma haematobium
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Schistosoma haematobium
Geographic Distribution :
• Africa (54 countries) , ex: Egypt, Sudan,
Zambia, Malawi, and Zimbabwe,
•
Eastern Mediterranean• 180 million people live in endemic areas and
90 million are infected with the parasites
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• Hospes definitif:
–Manusia, Baboon dan sejenisnya
• causes urinary schistosomiasis,
(schistosomal hematuria,vesical
schistosomiasis, or urinary bilharziasis)
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source: http://www.dpd.cdc.gov/dpdx/HTML/Schistosomiasis.htm
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Schistosoma haematobium
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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
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Pathogenesis ( cont’d)
•damage to the bladder or ureters :obstructed and the bladder wall thickened
• abnormal bladder function with painful
frequent urination, urinary infection
(cystitis )
•
eventually kidney damage.• hematuria is the most characteristic
symptom.
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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
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Cancer of the bladder
• In Egypt : 60 % of the Egyptian population is at
risk of infection.
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, which
contrasts to Western countries, where the
frequency of SCC in bladder cancer cases is
much lower (3 to 10%)
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Cancer of the Bladder
• eggs can act as a mechanical irritant to theurothelium
• it was also found that endogenous levels of
host
cell DNA damage were related to theintensity of infection.
• chronic inflammatory lesions
continuous exposure to the carcinogens,
e.g.,N-nitroso compounds, which were detected in
larger quantities in the urine of patients with
schistosomiasis
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Control
Treated Mice
Histo-pathological changes
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Epidemiology
• 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, in endemic countries : the mean age is
between 40 and 49 years
•
The ratio of bladder cancer
incidence (males tofemales) in countries with endemic infection was
reported to be 5:1
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LABORATORY DIAGNOSIS:
• Specific :
• Finding the eggs or occasionally the hatched
miracidia in the urine
• occasionally, eggs can be found in faeces
• detecting eggs in rectal biopsy or bladder
mucosal biopsy
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Biopsy of the mucosal bladder