In the diagnosis of Schistosoma haematobium infection, which specimen and finding is most diagnostic?

• A Stool microscopy showing eggs with a lateral spine
• B Rectal snip biopsy showing cercariae
• C Blood film showing microfilariae
• D Terminal urine microscopy showing eggs with a terminal spine ✓

Explanation

Schistosoma haematobium infects the vesical venous plexus and deposits eggs in the bladder wall; eggs are shed in urine and are characterised by a terminal (end) spine. Terminal urine (last 10 mL, ideally collected around noon when shedding peaks) microscopy is the diagnostic method of choice. S. mansoni eggs have a lateral spine and are found in stool. Cercariae are free-swimming larval forms in water, not seen in tissue. Microfilariae are diagnostic of filarial infections.

Reference: Ananthanarayan & Paniker's Textbook of Microbiology, 11th ed.

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