Abstract

Schistosomaisis is a chronic debilitating infection of humans and animals and hence the disease is of a public health importance. In the present study, a male farmer from Barakat of the Gezera State, a schistosomiasis endemic area in Central Sudan was admitted to the Reproductive Health Care Center (RHCC) in Khartoum, Sudan. The patient complains of history of primary infertility for 18 years with complain of painful ejaculation, he had several semen analysis, all showed a picture of azoospermia and no sperm was detected neither in the sample nor in the pellet after centrifugation. On genital examination both testes are of average size, enlargement of epidedimis on both sides vasa differences were present in both sides. Semen analysis showed that the semen was turbid, infilterated with inflammatory cells. Hence, the patient was diagnosed with infertility due to azoospermia. In addition, numerous Schistosoma mansoni eggs were detected in the semen pellet. This study suggested that physician should consider schistosoma mansoni as a cause of male infertility in schistosomiasis endemic areas.

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INTRODUCTION

Human schistosomosis caused by Schistosoma mansonis is one of the major public health problems in many parts of the world including the Sudan (Aradaib et al., 1995; Aradaib and Osburn, 1995; Aradaib et al., 1993). In endemic areas of the Gezera State and the White Nile Province of the Sudan, the prevalence rate of the infection is very high as judged by fecal egg counts. Monthly incidence rates estimated from fecal examinations of initially uninfected individuals showed a marked seasonal pattern with the infection level being much higher in the rainy months. This coincided with a high snail infection rate (Majid et al., 1980).

In the vicinity of Khartoum, internal parasitic infections including S. mansoni were diagnosed in Khartoum Hospital. This constitutes a newly reported focus of the disease. In general, the prevalence of schistosomosis increases in areas where development in agriculture and industry depends on construction of new dams and irrigation canals which provide a suitable habitat for the snail intermediate host, the Bulinus and biomphalaria sp. Therefore, it is not surprising for the disease to be encountered in the vicinity of Khartoum as there is growing irrigated projects. Special attention has been paid to the control of the disease in the Sudan (Hussien, 1968). The control of contaminated water and/ or destruction of the snail intermediate host were impractical and not economical (Bushara et al., 1978). In spite of the development of effective and relatively safe drugs, prevention of rapid reinfection has remained a problem which requires repeated drug applications over a long period of time. Partial protection develops following prior exposure to S. mansoni (Hussien, 1968). This indicates that vaccination could be a feasible and effective method for limiting the extent of pathology and level of transmission (Aradaib et al., 1995; Bushara et al., 1978).

A lot of research effort has been directed to study the infertility in males caused by S. Hematobium. However, the literature on infertility due to S. mansoni is scanty and a few reports are available on the role of this parasite as a cause of infertility in Sudanese patients living in schistosomiasis endemic areas (Saad et al., 1999). It was suggested that schistosomiasis of the reproductive organs is unlikely to induce male infertility in some African countries (Patil and Elem, 1988; Pereira et al., 1997; Oqubanio et al., 1989). However, in the presented case, a large number of schistosoma mansoni eggs were demonstrated in the semen sample of the patient and were associated with azoospermia.

MATERIALS AND METHODS

Case presentation: A 48 years old male farmer was visited the Reproductive Health Care Center (RHCC) in Khartoum, Sudan. The farmer was complaining of primary infertility for 18 years associated with severe painful ejaculation. He was referred to the RHCC clinic for semen evaluation. A total volume of 2 mL semen was collected for semen evaluation and other diagnostic laboratory investigations. Semen analysis indicated that no sperms were seen in the semen sample and hence the patient was diagnosed with azoospermia. Micrscopic examination revealed the presence of a trematode parasite eggs with lateral spine, characteristic of Schistosoma mansoni egg. Urine analysis showed that the urine sample was clear. Fecal examination revealed increased pus cells, red blood cells and mucous. However, schistosome eggs were not detected neither in the urine nor in the faeces. Reproductive hormones including serum prolactin, Follicle Stimulating Hormone (FSH) and Luteinizing Hormone (LH) indicated that the values were within the normal limits.

RESULTS AND DISCUSSION

Schistosoma mansoni is one of the most abundant parasitic infections in the areas of construction of new dams and irrigation projects (Fig. 1). Schistosomiasis is a disease of public health importance in many African countries including the Sudan (Aradaib et al., 1995; Hussien, 1968; Bushara et al., 1978). Depending on the species, schistosome adults migrate to various organ-specific venous plexuses. S. hematobium migrates to urinary bladder venous plexus where as S. mansoni migrates to the mesentric vessels (Connor et al., 1997). Owing to the extensive anastomoses among the venous plexuses of the pelvic organs, S. haematobium and to a lesser extent, S. mansoni is the organism most often identified in genital organs in females (Feldmeier et al., 1995; Helling-Giese et al., 1996; Poggensee et al., 1999). The 2-3 cm adult worms may cause venous obstruction where they reside. The pathology is more commonly caused by the daily deposition of numerous eggs by the female which induces a localized host response and can lead to extensive tissue damage (Koneman et al., 1997; Connor et al., 1997). Live schistosome eggs excretion in feces or urine begins the life cycle again (Morgan et al., 2001).

Fig. 1:	Demonstration of Schistosoma mansoni eggs in semen sample from the patient with infertility

Schistosomiasis has been suggested to decrease the reproductive potential or castrate both invertebrate and vertebrate hosts. Furthermore, schistosomiasis may cause anatomic anomalies of the reproductive organs responsible for permanent or reversible infertility (Saad et al., 1999). Urinary schistosomiasis is caused by Schistosoma haematobium which affects in a diffuse manner all the genitourinary tract (Pereira et al., 1997). In earlier studies, it has been reported that schistosome eggs were demonstrated in the tissue of prostate and seminal vesicles in histological samples (Patil and Elem, 1988; Connor et al., 1997).

The presence of the parasite eggs in tissues will probably lead to destruction of the reproductive organs or even degeneration of the germinal epithelium; thus resulting in permanent infertility in males. The seminal vesicles and the prostate are frequently affected by egg-induced inflammation in Schistosoma haematobium infected men. The present study demonstrated that egg excretion caused by S. mansoni infection is associated with sperm apoptosis and reduced production of seminal fluid. Egg induced inflammation in the seminal vesicles and the prostate could be the reason for reduced semen volume and apoptosis could be the reason for azoospermia.

CONCLUSION

In the present study, an unusual case of schistosomiasis was reported in a male farmer from Barakat of the Gezera State, Central Sudan. The patient was admitted to the Reproductive Health Care Center (RHCC) in Khartoum, Sudan for infertility problems. The patient was diagnosed with infertility due to azoospermia. Surprisingly, numerous schistosoma mansoni eggs were demonstrated in the semen of the infected patient and were associated with painful ejaculation. This study suggests that schistosoma mansoni should be considered as a cause of male infertility in schistosomiasis endemic areas.

How to cite this article:

E. Tayrab, A.K. Ashmaig, H. Shareef, S.B. Bedawi and I.E. Aradaib. Association of Schistosoma mansoni with Infertility in a Sudanese Patient from Schistosomiasis Area of Endemicity: A Case Report.
DOI: https://doi.org/10.36478/rjmsci.2010.125.127
URL: https://www.makhillpublications.co/view-article/1815-9346/rjmsci.2010.125.127