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Identification of miracidia of Schistosoma haematobium in a bladder wash sample

Schistosoma haematobium is a trematode—i.e. a flatworm with a differentiated digestive tube—that infects humans, where it can complete the sexual stages of its life cycle (http://www.cdc.gov/dpdx/schistosomiasis/index.html). Infected humans eliminate eggs with feces or urine which, under adequate conditions, hatch and release miracidia. These miracidia can swim and penetrate a specific snail intermediate host, where they give rise to two generations of sporocysts that in turn produce tailed cercariae. Upon release from the snail, the free-swimming cercariae penetrate the skin of the human host, shed their forked tail, and transform into schistosomulae. The schistosomulae migrate through the venous and lymphatic circulation to the lung, where they mature and subsequently gain access to the arterial system to be transported to different tissues. Adult worms reside in the venules and veins of different organs, which seem to be relatively specific for each species. While S. japonicum, S. mansoni, and S. haematobium can all infect humans, the eggs of the latter are the ones which are most frequently found in the urine. The male and female S. haematobium flukes reside in the venous plexus of bladder, where the female deposits numerous eggs that are moved toward the submucosa and into the lumen of the bladder, ureters, and uterine cervix. S. haematobium infection can cause a spectrum of clinical lesions in the urinary tract, which are dependent on the parasite burden and the stage of the infection. In the active phase, the eggs are usually found in the bladder wall, surrounded by an intense granulomatous inflammation with numerous eosinophils. With longstanding infection the inflammatory infiltrate becomes less prominent, the destroyed eggs undergo dystrophic calcification, and fibrosis ensues. As a consequence of scarring, urinary obstruction can occur. The epithelial lesions induced by S. haematobium include keratinizing squamous metaplasia and intestinal metaplasia, with a well-established epidemiological relationship between schistosomiasis and squamous carcinoma of the bladder.