Snapshot A 28-year-old female presents to the hospital with a three-week history of pain in the left lumbar region and an episode of hematuria the day prior. She is a recent immgrant from a refugee camp in Somalia. Gynecological history was unremarkable. No tenderness or organomegaly could be detected on physical exam. Complete blood count was remarkable for eosinophilia of 750 cells/mm^3. Sonogram of abdomen reveals a thickened bladder wall. CT scan of the abdomen and pelvis revealed widespread calcifications of bladder and ureters. Sediment examination of a random urine specimen showed 15 RBCs/hpf and Schistosoma haematobium ova. Introduction Parasitic infection caused by trematodes (blood flukes) genus Schistosoma causitive organisms S. mansoni (intestinal schistosomiasis) S. haematobium (urinary schistosomiasis) S. japonicum (Asian intestinal schistosomiasis) most common cause of pulmonary HTN worldwide snails are the intermediary agent between mammalian hosts Epidemiology incidence 85% of those living in Africa approximately 200,000 deaths annually globally a major cause of morbidity and mortality location Asia Africa South America waters containing freshwater snails risk factors washing clothes in contaminated water with infected snails tourism to endemic areas transmission penetration of human skin usually in contaminated fresh waters migration to lungs migration to portal vein migration to venules of mesentery, bladder, or ureters Pathophysiology immunologic reaction to the Schistosoma eggs trapped in tissue granulomatous reaction ensues collagen deposition and fibrosis (latter stages of disease) Associated conditions bladder cancer Presentation Presentation fever diarrhea abdominal pain cough liver fibrosis urinary tract granulomas dysuria Physical exam palpation hepatosplenomegaly vascular portal HTN Evaluation Labs eosinophilia Diagnosis demonstration of eggs in urine or feces parasitic antigens via ELISA Differential Broad and symptom based acute febrile illness eosinophilia hematuria abdominal symptoms Treatment Supportive care stabilize patients that have acute complications Pharmacologic praziquantel indications any diagnosed schistosomiasis infection outcomes 65-90% cure rates side effects dizziness headache nausea/vomiting/diarrhea abdominal discomfort bloody stool fever Operative tumor removals ligation of esophageal varices porta-caval shunt surgeries Prognosis, Prevention, and Complications Prognosis good if treated early Prevention effective water sanitation programs mass treatment of affected populace no vaccines available Complications due to chronic disease pulmonary hypertension bladder cancer portal HTN