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Renal disease is a common complication in malaria infection. In acute falciparum malaria renal involvement is usually mild, but in severe disease acute renal failure is a major problem. Acute renal failure has been attributed to ischaemic tubular necrosis from hypovolaemia resulting from vasodilatation due to endothelial injury. Though myositis is recorded as a common manifestation in falciparum malaria, only 1 case with myositis and myoglobinuria with acute renal failure has been documented; but no renal biopsy was performed in the patient. In the present study we examined the case of a 17-year-old man with severe falciparum malaria with myositis and myoglobinuria who developed acute renal failure requiring dialysis. Muscle biopsy revealed severe myositis with macrophages and T lymphocytes including CD4+ cells. The kidney biopsy showed scanty T cells and macrophages in the glomeruli which were only mildly hypercellular. The renal tubules showed myoglobin casts in the lumen and foci of interstitial inflammatory cells, including macrophages and T lymphocytes but no CD4+ cells. Rhabdomyolysis induced by macrophages and T cells with myoglobinuria and acute renal failure is a problem in severe falciparum malaria infection.

Sixty patients were enrolled In a prospective, randomized study to evaluate the efficacy of two different regl mens for the empirical treatment of continuous ambulatory peritoneal dialysis (CAPD) peritonitis. At presentation, Group I received Intraperitoneal vancomycin (1 g) and oral pefioxacin (400 mg b.l.d.), and Group II Intraperitoneal vancomycin (1 g) and gentamicin (80 mg loading dose, followed by 15 mg/2 L). Treatment duration was 14 days. Despite randomization, Group I had significantly more patients with primary Candida peritonitis. When fungal peritonitis was excluded from analysis, there were no significant differences In the treatment success rate (Group I, 73.3% vs Group II, 80.0%, p=NS), number of relapses (Group 1,0 vs Group II, 1), and Tenckhoff catheter removal rates (Group 1,26.6% vs Group 11,16.6%, p=NS) between the two groups. The patients treated with pefioxacin had an increased incidence of nausea and vomiting. In selected situations oral pefioxacin may be a suitable substitute for intraperitoneal gentamicin as outpatient therapy for CAPD peritonitis.