Schistosomiasis remains a public health challenge in most of the developing countries including Malawi where it is nationally represented (9). This was a retrospective study conducted at Mzuzu Central Hospital northern part of Malawi. In this study, a total of 790 histopathological samples from six different patterns (Cervix, Ovary, GIT, Ureter, Liver and Urinary bladder) were analysed and 14 schistosomiasis cases out of 790 cases were identified representing prevalence of 1.7% (14/790). Detection of schistosoma in these mentioned organs, directly correlate with the findings of other studies which equally revealed schistosomiasis infection in the mentioned organs (1,10–14).
In this study, schistosomiasis cases were highly noted in cervical tissues (6/501) followed by GIT (2/265), Ureter (2/42) and Liver (2/13). These findings are in support of the data from similar studies which equally detected schistosomiasis infection from cervix and suggestively to be the possible cause of tissue lesions (15,16).
The common clinical presentations and findings in about 90% of the positive schistosomiasis cases were; inflammation, mass, lesions, endometriosis, dyspareunia, nodular and hydronephrosis. Lack of specificity of these clinical features have made Clinicians misdiagnosing the schistosomiasis disease as cancer or other related diseases ignoring schistosoma infection. Our study confirms this as most extra urogenital and extra GIT lesions were clinically diagnosed as cancer and were sent to pathology lab for confirmation. According to (17) found out that chronic schistosomiasis infection has frequently been misdiagnosed as cancer due to nonspecific conditions as some mimic cancer. This directly correlate with the above narrative.
The chronic schistosomiasis disease has always been neglected or misdiagnosed due to limited clinical skills and laboratory diagnostic tools especially in developing countries (4,18). Currently, available diagnostic methods for schistosomiasis include those that are relying on stool and urine for miracidium or egg detection, serum antibodies, antigen detection and the detection of Deoxyribonucleic Acid (DNA). However, most developing countries including Malawi rely on microscopy technique as it is a cheap test and easy to use (3). Unfortunately, microscopic examination of eggs in urine or stool is less sensitive as it takes about two months from the time of infection for eggs to appear in stool or urine. The method is again less sensitive to detect oviposition infection. In addition, the test is known to be less sensitive in non-endemic areas (3).
The detection of schistosomiasis infection in regions rather than urogenital and gastrointestinal organs such as ureter, ovary, liver and cervix, highlights the complexity of the disease and act as a recommendation to Clinicians to consider investigation of Schistosoma infection in such clinical cases. Despite the fact that this is the first ever presented data from Malawi, findings of studies conducted elsewhere have indicated similar findings confirming presence of escalating disease of chronic organ schistosomiasis (11).
Prompt diagnosis and management of schistosomiasis is of paramount importance as the disease has strongly been linked to cancer. According to Zepeda et al., 2015, S. haematobium is being recognised as a group 1 carcinogen due to the strong evidence linking chronic infection to bladder cancer. Similarly, Mostafa & Sheweita, 1999 indicated that of 11,626 cancer cases of all types recorded at Cairo Cancer Institute from 1970 to 1974, 27.6% were bladder cancer cases associated with schistosomiasis and that of 2,500 new cancer patients, 27% had cancer of the bladder associated with schistosomiasis. Furthermore, the following studies have strongly linked schistosomiasis to various malignancies (1,6,10,11,20).
In the current study, it was very limited to ascertain total cases of S. haematobium and S. mansoni as histological reports did not specify species. It was again limited to associate HIV sero status to schistosomiasis infection as only 29% (4/14) of the patients with schistosomiasis had sero status known.
The study has revealed high prevalence of chronic schistosomiasis prompting for more consideration in management of cancer suspected diseases. It is recommended to consider targeted screening of schistosoma infection in chronic cancer suspected patients. The microscopy test should be replaced or support by the most sensitive, accurate and rapid antigen or antibody test for quality, reliable and rapid results. Further studies at a large scale are recommended to determine responsible species.