Apparently the worst thing that can happen to a parasite is to end up inside the wrong host…
Although the dangers posed by the Candiru or Toothpick fish are certainly exaggerated, it really can embed itself in the human urethra as this case described by Dr Samad Anoar demonstrates. All things considered, I suggest resisting the urge to urinate in the Amazon should the opportunity arise.
The classic account is by Eugene Willis Gudger in 1930 wherein he describes the candiru as “very small, but uniquely occupied in doing evil”. This early publication, collects and analyses accounts from as early as 1829, but mostly deals with with speculation, hysteria and urban legend…
The candiru is a tiny Amazonian catfish that, according to legend, will swim up the stream of urine and enter the urethra of a victim unlucky enough to micturate in the river. Once the fish enters the orifice, its fins expand making removal, um, painful and potentially dangerous. The candiru was the subject of a 1991 review article in the Journal of Wilderness Medicine, which reported that:
Remedies have ranged from penile amputation and suprapubic cystostosmy to application of a native herb that softens the spines…
- Gudger EW. On the alleged penetration of the human urethra by an Amazonian catfish called candiru with a review of the allied habits of other members of the family pygidiidae. Part I. The American Journal Of Surgery 1930;8(1):170-188 and Part II 1930;8(2):443-457
- Gussow L. Just When You Thought It Was Safe to Go Back to the Amazon. TPR
- Hensley J. Is candiru really the scourge of the Amazon? 2018
- Breault JL. Candirú: Amazonian parasitic catfish. Journal of Wilderness Medicine. 1991;2(4)304-312
- Kaar CRJ, Nakanishi AK. Recreational and Commercial Catfishing Injuries: A Review of the Literature. Wilderness & Environmental Medicine. 2017;28(4): 348-354
- Gabbatiss J. Would the Candiru fish really eat your genitals. BBC 2016
- Nickson C. Look on the Bright side. LITFL 2018
Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also the Innovation Lead for the Australian Centre for Health Innovation at Alfred Health, a Clinical Adjunct Associate Professor at Monash University, and the Chair of the Australian and New Zealand Intensive Care Society (ANZICS) Education Committee. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.
After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.
He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE. He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of LITFL.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.
His one great achievement is being the father of two amazing children.
On Twitter, he is @precordialthump.