The Candirú
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…
References:
- 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, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the Clinician Educator Incubator programme, and a CICM First Part Examiner.
He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.
His one great achievement is being the father of three amazing children.
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