Журнал «Актуальная инфектология» Том 8, №1, 2020

Introduction. Infestation (from the Latin Infestare — attack) — infection of the human or animal body with parasites (insects, mites and other arthropods). Infestations belong together with hirudinosis and helminth infections to the group of invasive parasitic diseases.

Clinical presentation. The clinical observation presented by us in a 9-year-old child is a mixed infection of gastrointestinal form of salmonellosis (S. enteritidis D) in combination with gastrointestinal infestation by the larvae of the present mosquito (Culex), which is widespread in Ukraine. A person can become infected with eggs or larvae of mosquitoes by using poor quality water, liquid food, swimming in reservoirs with stagnant water. Child V. was admitted on the first day of the disease in a moderately severe condition with complaints of weakness, anorexia, shortness of breath of mixed character, rare dry cough, presence of puffiness in the face and elements of the urticaria exanthema on the face, trunk and extremities, small inspiratory dyspnea, sneezing, obstruction of nasal breathing, moderate serous discharge from the nose.

Epidemiological history: possible infection with eggs or larvae of mosquitoes occurred as a result of unboiled water or liquid products, on the surface of which female mosquitoes lay their eggs. According to the mother, the family uses water, which is stored in a jar without a lid. Water is replaced as used, but not every day. The child did not swim in the waters. The child fell ill in early May, at that time of year when there was an active mosquito breeding.

Anamnesis of the disease. The child became seriously ill when the above mentioned complaints appeared, the temperature did not rise. On the 2^nd day of disease, the child’s body temperature rose to 38.7 °C, multiple vomiting appeared (up to 20 times a day), anorexia, cramping abdominal pain, nausea, watery diarrhea started up to 20 times a day on the 3^rd day of the disease, thirst, dry skin, decreased diuresis. At the background of exicosis of 2^nd degrees, metabolic ketoacidosis joined (intense smell of acetone in exhaled air, urine, feces, a sharply positive test with sodium nitroprusside in the urine.).

Objective status. The condition of the child is of moderate severity. The skin is pale, dry, turgor is reduced. On the skin of the trunk and extremities there are separate urticarial rash elements ranging in size from 1.5 to 5 cm in diameter, itchy. Puffy face, there are isolated urticaria. The mucosa of the lips is bright red, dry, the mucous membrane of the mouth is dry, the oropharynx is not hyperemic, there are no covers. Peripheral lymph nodes are not enlarged. Breathing through the nose is difficult due to edema of the mucous membrane, scanty serous discharge, the use of topical decondensants has a positive effect. Vesicular breathing, no wheezing. Slight inspiratory dyspnea: RR-28 per minute. Muffled heart sounds, rhythmic, functional systolic murmur with maximum auscultatory conduction at the apex of the heart. The abdomen is soft, moderately swollen, moderately painful in the epigastrium and mesogaster. There are no symptoms of peritoneal irritation, sigma is not spasmed, mesenteric lymph nodes are not detected. The liver is palpable 2 cm below the costal arch, elastic, the edge is sharp and smooth. The spleen is not enlarged. The feces are abundant, watery, without pathological impurities, with a strong smell of acetone. Emetic masses in the form of a clear liquid with a small admixture of bile. In each portion of vomit there are multiple (10–15 in sight) moving larvae of mosquitoes in black and black and red — pupae (bloodworm). There is a decrease in diuresis to 5 ml/kg/hour. In the hemogram on admission: hemoglobin — 121 G/l, erythrocytes — 4.39 T/l, leukocytes — 27.5 G/l, stab neutrophils — 2 %, segmented neutrophils — 44 %, eosinophilic granulocytes — 4 %, lymphocytes — 40 %, monocytes — 10 %, ESR-3 mm/h. Blood glucose — 3.0 mmol/l, ALAT — 35 U, alpha-amylase — 64 mmo/l//h. Urinalysis: specific gravity — 1030, protein — 0,33 g/l, Leukocytes — single in the field of view, red blood cells — absent; test with sodium nitroprusside ++++. Bacteriological examination of feces: culture of S. enteritidis D is isolated. Anterior rhinoscopy of the nose: bilateral, non-symmetrical edema of the mucous membrane, on which there are watery discharges, the mucous membrane is pale. ECG: sinus rhythm, arrhythmia from 76 to 106 beats, the electrical axis is rejected to the right. (in the history there is septal defect). Coprocytogram: mucus-no, white blood cells 10–30 in the field of view, red blood cells are absent. Identification of insect larvae in the stool and vomit was carried out by light microscopy. The larvae were harvested from vomit samples and stools, washed in saline and fixed in 10 % buffered formalin. Based on the morphological study with light microscopy, the larvae were identified as the third or fourth molt Culex genus.

Final diagnosis: Salmonellosis (S. enteritidis D), gastrointestinal form, moderate severity, exicosis of 1–2 degrees, metabolic ketoacidosis. Concomitant diagnosis: Gastrointestinal infestation by larvae of the genus Culex. Angioedema of the face. Acute urticaria. Allergic rhinitis.

Treatment: the treatment plan included a regulated list of drugs for the treatment of invasive intestinal infection: Pevzner’s diet No. 4, infusion of glucose-saline solutions, rehydron, ceftriaxone for 7 days. Due to the presence of angioedema in the face and urticaria, dexamethasone intravenously was included in the treatment within the first 3 days from the moment of admission and loratadine with a course of up to 7 days until the complete disappearance of the urticaria. For the treatment of infestation with mosquitoes, we prescribed albendazole (Wormil) for 5 days, in the dosage of 15 mg/kg/day. When prescribing this drug, we proceeded from its mechanism of action: the ability to paralyze the muscles and disrupt glucose utilization in parasite larvae.