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A 21-year-old woman presents to a rural clinic after noticing bright-red blood in her urine earlier during the day. The patient has experienced pain with urination as well as intermittent fevers for the past two-week. Past medical history is unremarkable. The patient has lived in Egypt her entire life and is an agricultural worker. She has been sexually active with two male partners over the past year. Her temperature is 38.6°C (101°F), pulse is 88/min, and blood pressure is 108/77 mmHg. There is suprapubic tenderness. Microscopic urine analysis shows multiple ovoid-shaped organisms with a terminal spine. Which of the following is the most likely cause of this patient’s symptoms? 

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Portal hypertension p. 398

Schistosoma spp. p. 158

Pulmonary hypertension p. 703

Schistosoma p. , 157

Schistosoma spp. p. 157, 158


Schistosomes, commonly known as blood flukes, are a genus of trematodes known to cause schistosomiasis. These worms are transmitted to humans through contact with contaminated freshwater and can live in the blood vessels. Seven schistosome species can cause human infection, but three are much more common. They include two species responsible for intestinal tract diseases (S. mansoni and S. japonicum) and one responsible for genitourinary tract disease (S. haematobium). Symptoms depend on the species and involved organs, and may include abdominal pain, diarrhea, bloody urine, and fever. Treatment involves medications to kill the parasites, such as praziquantel and oxamniquine, as well as those to reduce inflammation, like steroids.


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