This is a fascinating case report that demonstrates findings and treatment of urinary schistosomiasis while also revealing variations in patient care across varying settings. In the United States, this child received what the authors describe as “gold standard” care—involving a diagnostic surgical procedure and multiple visits with multiple subspecialists. If this child had stayed in Mali, he most certainly would have had received a clinical diagnosis of schistosomiasis and effective treatment with oral praziquantel—without any diagnostic testing. Outside of the endemic area, some reasonable clinicians would still have treated presumptively, and others would have opted for treatment based on symptoms and serologic confirmation of schistomal infection, realizing, as the authors point out, that positive serology alone does not prove an active infection. Still, other clinicians might have opted to test multiple concentrated urine samples (especially the urine produced at the end of voiding) without a surgical search for the definitive...

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