Urogenital Schistosoma haematobium Cases at the Hospital for Tropical Diseases, London (1998-2018), and Suggested Pragmatic Follow-up Pathway for Non-endemic Settings

Background. Characteristics of confirmed urogenital Schistosoma haematobium infections and outcomes in non-endemic regions are scarce in the literature and there is a minimal evidence base for appropriate management in this setting. Specific schistosomal urinary and urological complications include risk of hydronephrosis, renal impairment, and malignant transformation. Therefore, approach to follow-up should be robust and systematic. Methods. This is a retrospective case-note review of all patients with confirmed S haematobium infection (defined as visible ova in terminal urine and/or histopathological diagnosis on biopsy) at the Hospital for Tropical Diseases (HTD), London, between 1998 and 2018. Outcomes of follow-up were reviewed and formulated into a pragmatic guideline for follow-up of these patients in this setting. Results. A majority of the 186 patients with confirmed S haematobium infection presented before 2012. Young, male migrants were at highest risk of complications from chronic infection and were most prone to being lost to follow-up. One patient was referred with squamous cell carcinoma of the bladder found on biopsy with S haematobium infection. Conclusions. We put forward a pragmatic pathway for S haematobium investigation and follow-up for patients presenting to nonendemic settings with the current resource capabilities of the United Kingdom.