Post-Quinine Bilious Hemoglobin Fever in an 8-Year-Old Child Monitored for Severe Malaria at the Yalosase Health Center, Isangi, DR Congo

It has been known since March 2013 that Artesunate is considered the gold standard treatment for severe malaria [1] [2] [3]. However, in our regions, the drug of choice available to treat patients with severe malaria remains quinine until today. However, frequent and sequential use of quinine is associated with the occurrence of hemoglobinuria [2]. We report a probable case of bilious hemoglobin fever (BHF) in an 8-year-old child. This was an 8-year-old child with a history of frequent and recent treatment with quinine, received in consultation for coca-cola urine emission with rapid diagnostic test (RDT) positive. In search of a particular terrain, the retroviral and syphilitic serologies were negative. Considering the context, the diagnosis of post-quinine hemoglobin bilious fever (BHF) was retained and the patient had progressed well after administration of artemisinin and its derivatives. The child was followed, on an outpatient basis, without any sequelae. It would therefore be prudent for the time being to avoid them in prophylaxis and self-medication.

Intestinal ascariasis at pediatric emergency room in a developed country

Ascaris lumbricoides infection is rare among children in developed countries.Although large numbers of adult Ascaris in the small intestine can cause various abdominal symptoms,this infection remains asymptomatic until the number of worms in the intestine considerably increases in most cases.Ascaris causing bilious vomiting suggesting ileus is rare,especially in developed countries.A 6-year-old boy who lived in Japan,presented with abdominal colic,bilious vomiting at the pediatric emergency room.He appeared pale,and had no abdominal distention,tenderness,palpable abdominal mass,or findings of dehydration.He experienced bilious vomiting again during a physical examination.Laboratory tests showed mild elevation of white blood cells and C-reactive protein levels.Antigens of adenovirus,rotavirus,and norovirus were not detected from his stool,and stool culture showed normal flora.Ultrasonography showed multiple,round-shaped structures within the small intestine,and a tubular structure in a longitudinal scan of the small intestine.Capsule endoscopy showed a moving worm of Ascaris in the jejunum.Intestinal ascariasis should be considered as a cause of bilious vomiting in children,even at the emergency room in industrial countries.Ultrasound examination and capsule endoscopy are useful for diagnosis of pediatric intestinal ascariasis.