A man's high fever and difficulty urinating were found to be linked to the presence of a large worm in his body. (Image credit: © 2016 Journal of Clinical and Diagnostic Research. Adapted from: Dioctophymiasis: A Rare Case Report, J Clin of Diagn Res. 10(2), DD01-DD02.)
Patient: 35-year-old man from India.
Symptoms: A man was taken to the emergency room of an Indian hospital after being unable to urinate and suffering from a fever for two days. Doctors noted that his vital signs were normal except for tachycardia, which is defined as a heart rate of more than 100 beats per minute. He also had pale skin and enlarged kidneys. Blood tests showed a possible infection.
What happened next: Medical staff inserted a catheter into the patient, and administered intravenous fluids and antibiotics to combat a potential infection. On his second day in the hospital, the man looked at the bag that was collecting his urine and saw blood in it — and a thin, wriggling worm.
Over the next three days, doctors analyzed the patient's urine but found no additional invertebrates or worm eggs. However, they sent urine and worm samples to the hospital's microbiology lab for further testing.
Diagnosis: Microbiological examination confirmed that it was a rare parasite known as Dioctophyma renale, commonly referred to as the giant kidney worm. The patient's symptoms were also consistent with this diagnosis.
The reddish parasite found in the patient's urine was 11.8 inches (30 centimeters) long and about 0.13 inches (3-4 millimeters) in diameter. The worm was male, according to health workers.
Doctors believe the patient contracted the parasite after eating raw fish from a lake near his home, which he did regularly. The patient also mentioned that this was not the first time he had encountered the worm.
Treatment: Doctors used the above methods to treat the patient's symptoms, but the parasite eventually passed out of his kidneys on its own. After the urine was free of worms, he left the hospital, despite medical advice. The case report did not mention the use or prescription of any antiparasitic medications.
What makes the case unique: In the case report, doctors noted that while D. renale worms are found worldwide, they rarely infect humans. It is the largest known parasitic nematode that can infect humans. The female worm can grow to be over one meter long and can typically survive in a person's kidney for up to five years.
There have been about 37 cases of human infection with this species worldwide as of 2019. These cases typically result in kidney damage, which may require surgical removal.
Doctors emphasize that D. renale infections can be prevented by properly cooking fish containing the worm's larvae. Infectious larvae can be found in tadpoles, frogs, or fish and are usually transmitted to humans by eating raw or undercooked food from these foods.
Disclaimer
This article is for informational purposes only and does not constitute medical advice.
TOPICS Diagnostic Dilemma
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