[Hepatic fasciolasis diagnosed in state phase]. / Fasciolosis hepática diagnosticada en fase de estado.

INTRODUCTION: Hepatic fasciolosis is a zoonosis that accidentally can invade the human. REPORT OF A CASE: 62 years old male, farmer, lives in a rural community in Tehuacan, Puebla, Mexico. His living space is not provided with running water nor drainage. He has contact with sheep and bovines. Started presenting symptoms two years before. Suffered from myalgia, joint pain, fever of 38 degrees C and epigastric pain that radiated the hypocondrium and the right shoulder. He had diarrhea five times in 24 hours as well as lack of appetite that lead to a weight loss of 20 kilograms in two years. He was hospitalized and the physical examination revealed diminished muscular mass, right hypocondrium pain and hepatomegaly of 3 cm below costal margin. He said he ate watercress (Nasturium officinalis) two or three times a week. Blood test revealed erythrocytes of 3.6 x 105 mm3; hemoglobin of 11.9 g/dL; hematocrit of 30%; leukocytes 8950 mm3; neutrophils 65%; lymphocytes of 30%; eosinophils of 3%; monocytes of 1% and basophiles of 1%. Globular sedimentation was 83 mm and hemoglobin concentration was 33. Liver test results were normal and mycobacterium in fecal samples was negative, but stool detection tests revealed eggs of Fasciola hepatica. The diagnosis was hepatic fasciolosis in its biliar stage. Dehidrohemetine (1.5 mg/kg) was administered during 10 days. Symptoms disappeared within 48 hours. CONCLUSION: The lack of knowledge about fasciolosis makes it hard to diagnose it. The publication of case reports must help to facilitate its diagnosis.

Miasis de nasofaringe, completando ciclo biológico in vitro / Myasis of nasopharynx, biologic cycle completed in vitro

Introducción. Miasis es la destrucción de tejidos de animales, incluido el hombre, por larvas de moscas. Caso clínico. Paciente femenino de 13 años de edad con antecedente de convivencia con aves de corral, que presentó, 5 días previos a su ingreso, temperatura de 38° C, dolor y prurito nasofaríngeo. En el servicio de urgencias se diagnosticó como rinofaringitis bacteriana, prescribiéndole penicilina procaínica y clorfeniramina. A los 3 días refirió salida de gusanos por boca y nariz en número de 10. A la exploración física se apreció faringe con hiperemia, saliendo por nariz y boca gusanos activamente móviles de color blancoamarillento, de 10 mm de longitud y 3 mm de ancho, en número de 20. Enviados a la Facultad de Medicina de Puebla, donde completaron ciclo biológico. La mosca obtenida fue Dermatobia hominis, familia Enterebridae. En el hospital se le practicó extracción de 85 larvas utilizando anestesia general e irrigación continua. Fue dada de alta 10 días después, asintomática. Conclusiones. La miasis es poco frecuente y puede ocasionar grandes destrucciones de tejido.

Introduction. Myasis is the parasitism of organs and tissues of warm-blooded vertebrates by the larvae of flies of different species. Case report. Thirteen year old female. Her house is provided with running water and sewer she had contact with farm house poultry. She began presenting symptoms 5 days prior to admission she presented with nasal discharge and pharyngitis. Her temperature was 38° C. At emergency services the patient was diagnosed with bacterial pharyngytis. Penicillin and clorfeniramine were administered. Three days later, larvae started coming out of her nose and mouth. In total 10 larvae were documented. In emergency services at a hospital, physical examination revealed pharyngeal erythema and rinorrhea. The larvae were described as yellowish, 10 mm long and 3 mm wide. The worms were sent to the Department of Parasitology of the School of Medicine of Puebla, Mexico, where they completed the in vitro cycle and were identified as Dermatobia hominis (fly), belonging to the Enterebridae family. In the hospital, 85 larvae were extracted from the patient. She discharged after 10 days of asymptomatic hospitalization. Conclusion. Myasis is not frequent and it can cause great tissue destruction. Antibiotic administration is generally not warranted unless there is evidence of concomitant superinfection.