Study flow.

Background

Historically, urinary tract pathology caused by S. haematobium infection was thought to affect predominantly school-age children (SAC) and adults. Increasing availability of ultrasound data from endemic areas demonstrates that even younger children develop potentially irreversible pathology.

Methodology/principal findings

Point-of-care ultrasound for urinary schistosomiasis and urine microscopy were performed across age groups in 105 patients with symptomatic urogenital schistosomiasis in Lambaréné, Gabon. Of 96 ultrasound scans with sufficient image quality, bladder wall thickening > 5mm was found in 9/20 (45%) preschool-age children (PSAC), 29/51 (57%) SAC and 7/25 (28%) adults. Upper urinary tract pathology was found in 19/90 (21%) patients across age groups, up from three years of age. Urine egg counts were highest in PSAC, with high-intensity infection (≥ 50 eggs/10 ml urine) in 19/24 (79%) and hyper-infection (≥ 500 eggs/10 ml urine) in 10/24 (42%). Bladder wall thickening > 5mm and upper urinary tract pathology correlated significantly with high-intensity infection with crude odds ratios of 8.6 (95% CI 3.1-23.8; p<0.001) and 6.6 (95% CI 1.4-30.7; p=0.02), respectively. Three months after praziquantel treatment, parasitology showed a cure rate of 51% and egg reduction rate of 95%, while bladder wall thickening and upper urinary tract pathology persisted in 12/41 (29%) and 7/12 (58%) patients.

Conclusions/significance

A high proportion of PSAC in areas endemic for urogenital schistosomiasis already have detectable urinary tract pathology. Our findings highlight the urgent need to include this age group in mass drug administration programs, as recommended now by WHO. Further, particular attention should be paid to individual patient care.