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A flagellated protozoa in the urine: other than Trichomonas
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http://www.kidney-international.org & 2014 International Society of Nephrology
Kidney International (2014) 85, 1476; doi:10.1038/ki.2013.385
A flagellated protozoa in the urine: other than Trichomonas Jose´ A.T. Poloni1, Chaiane M.O. Moraes2, Daniela C. Seelig3, Liane N. Rotta4 and Alessandro C. Pasqualotto5 1
Urinalysis Sector, Central Laboratory of Clinical Analysis, Irmandade da Santa Casa de Miserico´rdia de Porto Alegre, Universidade Federal de Cieˆncias da Sau´de de Porto Alegre, Porto Alegre, Brazil; 2Hematology Sector, Central Laboratory of Clinical Analysis, Irmandade da Santa Casa de Miserico´rdia de Porto Alegre, Porto Alegre, Brazil; 3Nephrology Unit, Irmandade da Santa Casa de Miserico´rdia de Porto Alegre, Porto Alegre, Brazil; 4Universidade Federal de Cieˆncias da Sau´de de Porto Alegre, Porto Alegre, Brazil and 5Molecular Biology Laboratory, Irmandade da Santa Casa de Miserico´rdia de Porto Alegre, Universidade Federal de Cieˆncias da Sau´de de Porto Alegre, Porto Alegre, Brazil Correspondence: Jose´ A.T. Poloni, Urinalysis Sector, Central Laboratory of Clinical Analysis, Irmandade da Santa Casa de Miserico´rdia de Porto Alegre, Universidade Federal de Cieˆncias da Sau´de de Porto Alegre, Bara˜o do Gravataı´ 360/306, Porto Alegre 90050-330, Brazil. E-mail: [email protected]
Figure 1 | Trypanosoma cruzi in the blood smear. Bright-field microscopy. Original magnification 1000.
Figure 2 | Trypanosoma cruzi in the urine sediment. Phase-constrast microscopy. Original magnification 400.
A 33-year-old woman with a history of renal cortical necrosis that followed pre-eclampsia was prescribed to undergo kidney transplantation. Approximately 1 month after the transplant procedure, she was admitted to the hospital because of a 3-day history of nocturnal fever. During routine analysis of the blood smear, a large number of parasites morphologically resembling Trypanosoma cruzi trypomastigotes were observed (Figure 1). Immunoglobulin (Ig)G and IgM antibodies (by enzyme-linked immunosorbent assay and immunofluorescence, respectively) to Chagas disease all tested negative in the serum. A detailed review of case showed that the donor was known to have positive serology to Chagas (IgG antibodies); however, no amastigotes were found in the tissue of the transplanted kidney. On the basis of the patient history of hematuria and proteinuria, in an attempt to search for the parasite in the urine sediment, a urine sample was requested. Using phase-contrast microscopy, we were able to visualize the parasite in movement in the fresh and unstained urine sediment (Figure 2 and
Supplementary Movie S1 online). The patient was successfully treated with benzonidazol started on the day when the parasite was detected. To the best of our knowledge, this is the first report of the visualization of trypomastigote forms of T. cruzi in the urine sediment. According to the literature, soluble T. cruzi antigens and DNA have already been detected in the urine, and this was associated with kidney injury and detection of the parasite in other body sites. These findings suggest the potential to detect the parasite and/or its antigens/DNA in the urine, especially in the acute phase of Chagas disease, something that may have an important impact in the management of these individuals.
1476
ACKNOWLEDGMENTS
We thank Carlos F. Voegeli, Karla L Pegas, Gisele Meinerz, and the staff at the Hematology Sector of the Central Laboratory of Clinical Analysis. SUPPLEMENTARY MATERIAL Supplementary material is linked to the online version of the paper at http://www.nature.com/ki
Kidney International (2014) 85, 1476
http://www.kidney-international.org & 2014 International Society of Nephrology
Kidney International (2014) 85, 1476; doi:10.1038/ki.2013.385
A flagellated protozoa in the urine: other than Trichomonas Jose´ A.T. Poloni1, Chaiane M.O. Moraes2, Daniela C. Seelig3, Liane N. Rotta4 and Alessandro C. Pasqualotto5 1
Urinalysis Sector, Central Laboratory of Clinical Analysis, Irmandade da Santa Casa de Miserico´rdia de Porto Alegre, Universidade Federal de Cieˆncias da Sau´de de Porto Alegre, Porto Alegre, Brazil; 2Hematology Sector, Central Laboratory of Clinical Analysis, Irmandade da Santa Casa de Miserico´rdia de Porto Alegre, Porto Alegre, Brazil; 3Nephrology Unit, Irmandade da Santa Casa de Miserico´rdia de Porto Alegre, Porto Alegre, Brazil; 4Universidade Federal de Cieˆncias da Sau´de de Porto Alegre, Porto Alegre, Brazil and 5Molecular Biology Laboratory, Irmandade da Santa Casa de Miserico´rdia de Porto Alegre, Universidade Federal de Cieˆncias da Sau´de de Porto Alegre, Porto Alegre, Brazil Correspondence: Jose´ A.T. Poloni, Urinalysis Sector, Central Laboratory of Clinical Analysis, Irmandade da Santa Casa de Miserico´rdia de Porto Alegre, Universidade Federal de Cieˆncias da Sau´de de Porto Alegre, Bara˜o do Gravataı´ 360/306, Porto Alegre 90050-330, Brazil. E-mail: [email protected]
Figure 1 | Trypanosoma cruzi in the blood smear. Bright-field microscopy. Original magnification 1000.
Figure 2 | Trypanosoma cruzi in the urine sediment. Phase-constrast microscopy. Original magnification 400.
A 33-year-old woman with a history of renal cortical necrosis that followed pre-eclampsia was prescribed to undergo kidney transplantation. Approximately 1 month after the transplant procedure, she was admitted to the hospital because of a 3-day history of nocturnal fever. During routine analysis of the blood smear, a large number of parasites morphologically resembling Trypanosoma cruzi trypomastigotes were observed (Figure 1). Immunoglobulin (Ig)G and IgM antibodies (by enzyme-linked immunosorbent assay and immunofluorescence, respectively) to Chagas disease all tested negative in the serum. A detailed review of case showed that the donor was known to have positive serology to Chagas (IgG antibodies); however, no amastigotes were found in the tissue of the transplanted kidney. On the basis of the patient history of hematuria and proteinuria, in an attempt to search for the parasite in the urine sediment, a urine sample was requested. Using phase-contrast microscopy, we were able to visualize the parasite in movement in the fresh and unstained urine sediment (Figure 2 and
Supplementary Movie S1 online). The patient was successfully treated with benzonidazol started on the day when the parasite was detected. To the best of our knowledge, this is the first report of the visualization of trypomastigote forms of T. cruzi in the urine sediment. According to the literature, soluble T. cruzi antigens and DNA have already been detected in the urine, and this was associated with kidney injury and detection of the parasite in other body sites. These findings suggest the potential to detect the parasite and/or its antigens/DNA in the urine, especially in the acute phase of Chagas disease, something that may have an important impact in the management of these individuals.
1476
ACKNOWLEDGMENTS
We thank Carlos F. Voegeli, Karla L Pegas, Gisele Meinerz, and the staff at the Hematology Sector of the Central Laboratory of Clinical Analysis. SUPPLEMENTARY MATERIAL Supplementary material is linked to the online version of the paper at http://www.nature.com/ki
Kidney International (2014) 85, 1476