Schistosoma haematobium — DTM&H MCQ

Correct answer: C — Schistosoma haematobium infection

The correct answer is C, Schistosoma haematobium infection. Terminal (end-of-stream) haematuria following freshwater exposure in an African lake such as Lake Malawi 6 to 8 weeks earlier is the classic presentation of urogenital schistosomiasis, as cercariae penetrate skin during swimming and adult worms mature and lay eggs in the vesical venous plexus over this incubation period. Eosinophilia strongly supports a helminth aetiology and is a recognised, though non-specific, marker of schistosome infection. Lake Malawi is a well documented, high-risk transmission site for S. haematobium, making this combination of exposure history, timing, and eosinophilia the diagnostic clincher over other causes of haematuria. Why the other options are wrong: E. Renal tuberculosis: presents with a much longer, indolent history (months), sterile pyuria, and constitutional symptoms rather than an acute eosinophilic picture 8 weeks after a single water exposure. A. Hookworm infection: causes eosinophilia and gastrointestinal blood loss or anaemia from percutaneous larval entry via soil, not haematuria, and is not linked to freshwater swimming. D. Leptospirosis: follows freshwater exposure but presents within days (typically under 2 weeks) with fever, myalgia, conjunctival suffusion and possible renal impairment, not isolated painless terminal haematuria at 8 weeks, and does not cause eosinophilia. B. Acute bacterial cystitis: causes dysuria and frequency with pyuria, not typically terminal haematuria, and does not explain eosinophilia or the freshwater travel history. Key point: Terminal haematuria with eosinophilia weeks after freshwater swimming in an African lake is pathognomonic for Schistosoma haematobium until proven otherwise.

Reference: NaTHNaC (Travel Health Pro), Schistosomiasis factsheet, National Travel Health Network and Centre, UK, https://travelhealthpro.org.uk/factsheet/28/schistosomiasis