What is the treatment for a UTI (Urinary Tract Infection) associated with schistosomiasis, specifically Schistosoma haematobium?

Treatment of UTI Associated with Schistosoma haematobium

Praziquantel at a dose of 40 mg/kg as a single dose is the recommended treatment for urinary tract infection associated with Schistosoma haematobium. 1

Diagnosis and Clinical Presentation

Schistosoma haematobium infection typically presents with:

• Urinary symptoms (dysuria, frequency, urgency)
• Hematuria (microscopic or macroscopic)
• Proteinuria
• Potential complications including bladder stones, obstructive uropathy, and bacterial superinfection

The diagnosis should be confirmed through:

• Microscopy of terminal urine samples (preferably collected at midday when egg shedding peaks)
• Serology testing
• Urine dipstick for hematuria and proteinuria (though this has low sensitivity)

Treatment Algorithm

First-Line Treatment

• Praziquantel 40 mg/kg as a single oral dose 1
• For travelers or those with suspected high-intensity infections, some experts suggest repeating the treatment after 6-8 weeks to ensure complete clearance 1

Special Considerations

• If neurological symptoms are present (suggesting neuroschistosomiasis), corticosteroids should be initiated before antischistosomal therapy to avoid neurological complications 1
• For patients with confirmed bacterial UTI superinfection, appropriate antibiotics should be administered in addition to praziquantel

Treatment Failures

If treatment failure occurs (persistent eggs in urine after 4-6 weeks):

• Consider repeating praziquantel at 60 mg/kg in two divided doses 1
• Some treatment failures have been reported in travelers with S. haematobium, suggesting possible tolerance to standard doses in some strains 2

Monitoring and Follow-up

• Repeat urine examination at 4-6 weeks post-treatment
• Serology is not useful for monitoring treatment success as it may remain positive for years 1
• Monitor for resolution of hematuria and proteinuria
• Consider ultrasound to evaluate for complications in cases of heavy infection

Efficacy and Safety

• Praziquantel has demonstrated cure rates of >90% for S. haematobium at the standard dose 3, 4
• The drug is generally well-tolerated with mostly mild to moderate adverse effects including:
  • Abdominal pain (most common)
  • Nausea
  • Dizziness
  • Headache

Important Caveats

• Eggs and immature schistosomulae are relatively resistant to treatment, which is why repeat treatment after 6-8 weeks may be necessary 1
• Serology may remain positive for many years after successful treatment, so it cannot be used to assess cure 1
• S. haematobium infection has been linked to squamous cell carcinoma of the bladder, so patients with heavy or chronic infections warrant further urological investigation 1
• Swimmers' itch (cercarial dermatitis) is a separate entity caused by non-human schistosome species and resolves spontaneously without specific treatment 1

Prevention

For prevention of reinfection or new infections:

• Avoid contact with freshwater in endemic areas
• If exposure occurs, vigorous towel drying may help prevent cercarial penetration
• Treat all infected individuals in endemic communities to reduce transmission