A 35-year-old male presented with gross haematuria with similar episodes occurring in the past 6 months. No H/O of fever, pain, or burning on urination weight loss or increased sense of urgency to void. There was no history of exposure to toxins either at work or during recreational activities. The patient underwent fibreoptic cystoscopy. A mass was noted in the fundus of the bladder, biopsy of which is shown in Figure. What is the drug of choice of the likely cause?
Correct Answer: Praziquantel
Description: A person who has gross haematuria should be suspected of having infection with S. haematobium regardless of what other diagnoses may need to be enteained by the rest of the history. Infected humans inevitably excrete S. haematobium eggs in their urine, which finds its way into the water. Once thus excreted, these eggs develop into a very motile form called a miracidium that "homes in" on the intermediate host, which is a snail. In the snail, the fluke metamorphoses into a form called a cercaria, which swims freely in the water, waiting to penetrate the intact skin of a person who may be swimming or wading in this water. Once in the human, S. haematobium develops into adults, which migrate to the veins of the vesical plexus around the bladder. The female lays eggs, which create an inflammatory response that leads to bleeding, which is perceived by the infected individual as gross haematuria. The passage of these eggs, in urine, into water inhabited by the correct species of snail, completes the life cycle. The arrow points towards a terminal spine and when obtained from urinary bladder, is characteristic of S. hematobium species. TREATMENT INFECTION DRUG OF CHOICE S. haematobium, S. mansoni, S. intercalatum Praziquantel S. mekongi, S. japonicum Praziquantel C. sinensis, O. viverreni Praziquantel F. hepatica, F. gigantica Triclabendazole Echinostoma spp. Praziquantel F. buski Praziquantel P. westermani, P. kellicotti Praziquantel, Triclabendazole
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