ABSTRACT
The Palpada genus, which belongs to the Diptera order (family, Syrphidae), has been rarely reported to cause accidental myiasis in humans. Herein, we report the first case of genitourinary myiasis caused by a larva of the Palpada genus in a 9-year-old girl from Colombia. The girl, who resided in a rural area in the municipality of Floridablanca, Santander, near Bucaramanga city, in eastern Colombia, presented with lower abdominal pain accompanied by oliguria, followed by the subsequent elimination of a larva through the urine. The next day, the patient visited a primary healthcare centre, and no signs or symptoms were observed on clinical examination. Haematological analysis showed high plateletcrit levels and platelet large cell counts. The results of the urine test revealed a decrease in specific gravity and a slight increase in bacterial content and mucus. DNA barcoding analyses showed that the etiological agent corresponded to a third instar larva of the Palpada scutellaris species. This is the first case to report genitourinary myiasis caused by larvae of the genus Palpada in humans. However, we believe that additional cases might be accurately detected if adequate tests are performed to confirm the clinical and molecular features associated with this infection.
Subject(s)
Diptera , Myiasis/parasitology , Urogenital Diseases/parasitology , Abdominal Pain , Animals , Child , Colombia , DNA Barcoding, Taxonomic , Diptera/classification , Diptera/genetics , Female , Humans , Larva , Myiasis/diagnosis , Oliguria/parasitology , Rural Population , Urogenital Diseases/diagnosisABSTRACT
Malaria is an endemic disease caused by one of the several Plasmodium species. Severe malaria is mainly due to Plasmodium falciparum in highly endemic areas. Acute renal failure (ARF) is a criterion of malaria severity as defined by WHO. Often observed in adults, particularly in India and Southeast Asia, this complication remains a rare complication of malaria in children. We report a case of oliguric ARF that occurred in a 7-year-old girl a few days after the onset of fever. The vascular obstruction by parasitized erythrocytes often causing tubular necrosis is the primary mechanism of renal failure. As a possible diagnosis, hemolytic uremic syndrome, renal failure and quartan hemoglobinuric nephropathy are other possible causes of renal failure in malaria. Renal biopsy, which was not performed in our patient, would have been a great help, but was not available. The outcome was favorable with recovery of renal function after 3 weeks of diuretic therapy. This development is not always the rule and the prognosis depends on early diagnosis and treatment options.
Subject(s)
Acute Kidney Injury/parasitology , Malaria, Falciparum/complications , Plasmodium falciparum , Acute Kidney Injury/diagnosis , Acute Kidney Injury/drug therapy , Antimalarials/therapeutic use , Child , Diuretics/therapeutic use , Drug Therapy, Combination , Endemic Diseases , Female , Furosemide/therapeutic use , Humans , Malaria, Falciparum/diagnosis , Malaria, Falciparum/drug therapy , Oliguria/parasitology , Plasmodium falciparum/isolation & purification , Quinine/therapeutic use , Treatment OutcomeABSTRACT
To identify factors associated with acute renal failure among patients with severe falciparum malaria (MARF), we studied 189 severe malaria patients admitted to the Hospital for Tropical Diseases, Faculty of Tropical Medicine, Mahidol University, in Bangkok, Thailand. Among these, 63 had MARF, and 126 did not. Baseline clinical demographics and laboratory variables were evaluated with univariate analysis. Logistic regression was used to ascertain adjusted odds ratios. By univariate analysis, factors associated with MARF included male gender, fever duration > 4 days, patients who lived in a non-endemic area prior to malaria infection, body mass index > 18.5 kg/m(2), oliguria, abdominal pain, impaired consciousness, jaundice, anemia, liver enlargement, total white blood cell count > 10x10(9)/1, total bilirubin > 3 mg/dl, aspartate aminotransferase > 120 U/l, alanine aminotransferase > 120 U/l, albumin < 3 g/dl, fever clearance time >72 hours, and parasite clearance time > 72 hours. A hemoglobin > 10 g/dl, patients living in a malaria endemic area, non-oliguria on the day of admission, and splenomegaly were negatively associated with MARF. After multivariate logistic regression, oliguria during the first 24 hours of admission and a history of living in a nonendemic area prior to malarial infection were factors associated with MARF. We conclude the most significant factors associated with MARF were oliguria on the day of admission and living in a non-endemic area prior to malaria infection.
Subject(s)
Acute Kidney Injury/parasitology , Malaria, Falciparum/complications , Acute Kidney Injury/therapy , Adolescent , Adult , Aged , Chi-Square Distribution , Female , Humans , Logistic Models , Malaria, Falciparum/therapy , Male , Middle Aged , Oliguria/parasitology , Oliguria/therapy , Risk Factors , Sex Factors , Statistics, Nonparametric , Thailand , Time Factors , Treatment OutcomeABSTRACT
BACKGROUND: Blackwater fever is a rare but serious form of malaria in children. Diagnosis relies on clinical symptoms and on the color of the urines. OBJECTIVES: To describe blackwater fever in children, a disease whose prevalence seems to be increasing. METHOD: We report 3 cases of blackwater fever observed in our institution. RESULTS: In 2 cases, acute renal insufficiency with oligoanuria was observed. In all the 3 cases, treatment with quinine was stopped and replaced by injectable artemether. Evolution was dependent on renal function, and included in 1 patient neurological sequels consisting in aphasia. CONCLUSION: Blackwater fever is a severe affection whose diagnosis should be evoked using the color of urine. Evolution is usually favorable in the pediatric population, when adequate care can be provided.
