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Year : 2021  |  Volume : 5  |  Issue : 2  |  Page : 93-95

Urogenital schistosomiasis in libya, a case report and evaluation of the current situation

1 Leishmania Clinic, National Centre for Disease Control, University of Tripoli, Tripoli, Libya
2 Department of Medical Laboratories Sciences, Faculty of Medical Technology, University of Tripoli, Tripoli, Libya
3 Department of Molecular Microbiology, Faculty of Pharmacy, Al-Quds University, Jerusalem, Palestine
4 National Centre for Disease Control, Tripoli, Libya

Date of Submission13-Mar-2021
Date of Acceptance20-May-2021
Date of Web Publication23-Jul-2021

Correspondence Address:
Prof. Aisha S Gashout
Department of Medical Laboratories Sciences, Faculty of Medical Technology, Tripoli University, Suk El-Guma, P.O. Box 9421, Tripoli
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ljms.ljms_17_21

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Urogenital Schistosomiasis is a parasitic worm disease caused by Schistosoma haematobium and transmitted through the penetration of the human skin by swimming infective larva (Cercaria). Here, we report a new sporadic case of Urinary schistosomiasis in Ubari city in South-West Libya. A 25-year-old male was presented with a history of hematuria, backpain, abdominal, and kidney pain since 2017. The diagnosis of urogenital Schistosomiasis was confirmed by microscopic identification of terminal-spined schistosome eggs and red blood cells in urine samples. The patient was treated with a single dose of 40 mg/kg Praziquantel. By follow-up, a complete recovery of urinary symptoms was observed with no evidence of schistosome eggs in urine. In conclusion, the local health authorities should take proper measures to establish new elimination programs of schistosomiasis, and to increased awareness of this especially in old endemic areas where reemerging of schistosomiasis is most likely.

Keywords: Enzyme-linked immunosorbent assay, Schistosoma IgG, Ubari-Libya, urogenital schistosomiasis

How to cite this article:
Saadawi WK, Gashout AS, Aldobea NM, Amro AY, Annajar BB. Urogenital schistosomiasis in libya, a case report and evaluation of the current situation. Libyan J Med Sci 2021;5:93-5

How to cite this URL:
Saadawi WK, Gashout AS, Aldobea NM, Amro AY, Annajar BB. Urogenital schistosomiasis in libya, a case report and evaluation of the current situation. Libyan J Med Sci [serial online] 2021 [cited 2023 Mar 30];5:93-5. Available from: https://www.ljmsonline.com/text.asp?2021/5/2/93/322201

  Introduction Top

Schistosomiasis (Bilharzia) is a parasitic disease characterized as either intestinal or urogenital, depending on where the adult flukes are located. Schistosomes require the presence of suitable aquatic intermediate snail hosts to complete their life cycle.[1] The species Schistosoma mansoni and Schistosoma japonicum live in venules surrounding the gut, progressively enlarge the liver and spleen, and cause intestinal damage, and portal hypertension. While Schistosoma haematobium lives in the vessels around the urogenital system and progressively causes damage to the bladder, ureters, and kidneys. The adult worm pairs produce eggs that migrate through the surrounding tissue to be excreted primarily in the feces or urine.[2] S. haematobium infection is responsible for the majority of deaths in the world. The disease is found in Africa and the Middle East.[3]

Libya has an old history of Schistosomiasis infections. The first reported case was in 1925 in Ghat district followed by another report in1932 from Wadi Shati in Fezzan region in Southern part of Libya.[4] Both S. haematobium and S. mansoni are endemic in Libya. The prevalence has been estimated at 5% since 2003.[5] The country is dominated by vast tracts of hot, dry, and sandy areas with high-salinity water. These conditions are not favourable to widespread colonization of the snail intermediate hosts, so their distribution is sporadic.[6]

The snail intermediate hosts for S. haematobium in Libya are Bulinus truncatus and Bulinus globosus. Theses hosts were first identified in the Ghat district in 1957 with no human infection being recorded for many years. However, B. truncatus is known to be endemic in one area in the Alfogaha district and S. mansoni, transmitted via Biomphalaria alexandrina snails, is currently locally endemic at the Taourga district.[7],[8]

Despite the low endemicity of the disease in Libya and the WHO elimination programs, there are still some new sporadic cases that appear from time to time. In this report, we discuss a case of 25-year-old Libyan male resident in Ubari city at the Southwest of Libya, who was diagnosed with urogenital schistosomiasis caused by S. haematobium.

  Case Report Top

A 25-year-old man living in Ubari city in Sebha district at the South-Western of Libya, was referred to Khadra Hospital, in Tripoli in 2017. The patient presented with a history of hematuria, kidney pain, and abdominal and back pain. The patient had a history of swimming in Gaberoun Lake near Ubari city. Complete blood count showed normal white blood cell count (7.9 × 103/ul), hemoglobin level of 11.7 g/dl, and platelet counts of 236 × 103/ul. Renal function tests were normal. Chemical examination of urine with urine strip showed 3+ blood and 3+ proteins. Diagnosis of urinary schistosomiasis was done using microscopic examination of urine which showed few eggs of S. haematobium with the characteristic terminal spine, with the presence of numerous red blood cells, 50–70 pus cells, and few epithelial cells were seen [Figure 1]. The diagnosis was confirmed with Schistosoma IgG enzyme-linked immunosorbent assay test. The patient was treated with a single dose of 40 mg/kg Praziquantel. Two month later a complete recovery of urinary symptoms was observed with no evidence of schistosome eggs in urine.
Figure 1: Three eggs of Sichistosoma hematobium with a terminal spine in urine sample

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  Discussion Top

Schistosomiasis remains a public health problem in several parts of the world, particularly in Africa, where 92% of all the populations requiring preventive chemotherapy for schistosomiasis.[9] Treatment of schistosomiasis by administration of the anti-helminth drug Praziquantel is the main control strategy employed in endemic areas.[10] The disease has been eliminated from many countries in the region including Iran, Lebanon, Morocco, and Tunisia. However, low endemicity has been recently described in Egypt, Iraq, Jordan, Libya, Oman, Saudi Arabia, and Syria.[5] The prevalence of S. haematobium and S. mansoni in focally endemic areas in Libya has been estimated at 5% in 2003.[7] In 1990, Libya started control program which included screening and treatment of the whole population with praziquantel chemotherapy, snail control, and health education and as of 2007, the disease prevalence in the community declined to 3%. Whole population treatment and biological control of snails were planned to continue on an annual bases until disease elimination is achieved.[7],[8] However, information and reports are scant and inconsistent on overall schistosomiasis trends in Libya. Moreover, as of 2013, Libya did not require the use of preventative praziquantel chemotherapy to treat schistosomiasis as peer WHO PCT databank.[11] Clinically, Haematuria and proteinuria can resemble many kidney diseases like kidney infection, bladder or kidney stones, cancer or glomerulonephritis. Urogenital Schistosomiasis was not suspected in our patient; hence, urologists should remember this rare clinical condition for proper diagnosis and management of this infection.

Schistosomiasis has been restricted to a few focal areas and oases in the South-Western regions of Libya for a long time. The incidence of this infection has been declining since 2013 and preventative chemotherapy was stopped.[7] However, new sporadic cases have been reported recently. Praziquantel remains the first choice for the treatment of all forms of schistosomiasis and a single dose of 40 mg/kg was sufficient to quire urogenital schistosomiasis.[12]

  Conclusion Top

Urogenital schistosomiasis caused by S. hematobium remains hypoendemic in some areas of Libya. This case is one of the new sporadic cases emerging in the country. However, control program and surveillance system to detect and control these cases are crucially needed. This can be achieved by removing the adult worms by Praziquantel chemotherapy, control of the snail intermediate host, health education to change human behaviors, and providing safe and clean water supplies. Schistosomiasis should be remembered in the differential diagnosis of kidney and bladder diseases.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Steinmann P, Keiser J, Bos R, Tanner M, Utzinger J. Schistosomiasis and water resources development: Systematic review, meta-analysis, and estimates of people at risk. Lancet Infect Dis 2006;6:411-25.  Back to cited text no. 1
WHO. The control of schistosomiasis. Second Report of the WHO Expert Committee. World Health Organ Tech Rep Ser 1993;830:1-86.  Back to cited text no. 2
Hotez PJ, Savioli L, Fenwick A. Neglected tropical diseases of the Middle East and North Africa: Review of their prevalence, distribution, and opportunities for control. PLoS Negl Trop Dis 2012;6:e1475.  Back to cited text no. 3
El-Gíndy MS, El-Edríssy AW. Present situation of schistosomiasis in the Libyan Arab Republic. I. Bilharziasis in Ubari District in Fezzan (Sebha Governorate). Egypt J Bilharz 1975;2:117-30.  Back to cited text no. 4
Rollinson D, Knopp S, Levitz S, Stothard JR, Tchuem Tchuenté LA, Garba A, et al. Time to set the agenda for schistosomiasis elimination. Acta Trop 2013;128:423-40.  Back to cited text no. 5
Doumenge JP, Mott KE. Global distribution of schistosomiasis: CEGET/WHO atlas. World Health Stat Q 1984;37:186-99.  Back to cited text no. 6
Jones I. The history of schistosomiasis in Libya. Stanford Univ 2015;3:1-2.  Back to cited text no. 7
WHO, EMR. Inter-country meeting on strategies to eliminate schistosomiasis from the eastern mediterranean region. World Health Organ Tech Rep Ser 2007;830:6-8.  Back to cited text no. 8
Chitsulo L, Engels D, Montresor A, Savioli L. The global status of schistosomiasis and its control. Acta Trop 2000;77:41-51.  Back to cited text no. 9
Secor WE, Montgomery SP. Something old, something new: Is praziquantel enough for schistosomiasis control? Future Med Chem 2015;7:681-4.  Back to cited text no. 10
WHO. PCT Databank; 2020. p. 1-86. Available from: https://appswhoint/neglected_diseases/ntddata/sch/schhtml. [Last accessed on 2021 Feb 09].  Back to cited text no. 11
Colley DG, Bustinduy AL, Secor WE, King CH. Human schistosomiasis. Lancet 2014;383:2253-64.  Back to cited text no. 12


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