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Journal of Postgraduate Medicine, Vol. 55, No. 2, April-June, 2009, pp. 155-156 Letter Recurrent vomiting and anemia: An unusual clinical condition caused by midge larva Wilson G, Bhat G Laboratory Medicine and Pathology, Al Khor Hospital, Hamad Medical Corporation, Doha Code Number: jp09047 PMID: 19550072 Sir, Midges are true flies belonging to the family Chironomidae. They are most widely distributed and are the most abundant insects in freshwater. [1] The herbivorous larvae that are found in the sediment are an important source of food for larger aquatic insects and fish. They may cause allergic reactions in approximately 20% of exposed people, predominantly aquarists using larva as fish food. [2] They are not known to cause any other kind of human illness. Here we report an unusual condition due to ingestion of midge larvae along with water. A 27-year-old female with subnormal intelligence was presented with swelling of neck, dysphagia, cough, and vomiting. There was history of excretion of red-colored ′worms′ in vomitus. She was afebrile. The patient was previously treated by a clinician with mebendazole, which did not relieve the symptoms. Chest X-ray was normal. Hematological examination revealed total count 9400/mm 3 , differential count - neutrophils 55%, lymphocytes 20%, monocytes 15%, and eosinophils 10%. The Erythrocyte sedimentation rate was 4 mm/h. Stool did not have any parasitic forms. She had microcytic hypochromic anemia. One-centimeter long red-colored ′worms′ were present in the gastric aspirate. She used to drink water directly from a tank situated near her house before vomiting. This prompted us to examine the tank water. The water contained red-colored larvae, one centimeter in length in large number which were morphologically identified as midge larvae. [3] They were morphologically identical to the larvae found in the vomitus [Figure - 1]. The water was kept at room temperature in a bottle and larvae were allowed to develop. Twenty-four hours later the larvae developed into small, delicate mosquito-like flies, which did not have scales on the body and wings [Figure - 2]. After examination they were identified as midges belonging to the Family Chironomidae . The tank was cleaned and the patient was prevented from drinking its water. She stopped vomiting larvae in 24 h. Midges (Family Chironomidae ) are harmless flies, which inhabit fresh water. Excepting allergic reactions, they are not known to cause any other human disease. The case presented here was due to consumption of non-potable water, which contained numerous midge larvae. The larvae are called bloodworms because of their red color, which is due to hemoglobin. [1] The symptoms of the patient could have been due either to mechanical irritation caused by the larvae or allergic reaction. The hemoglobins of midge larvae are known to cause immediate hypersensitivity reaction in humans. [4] This communication may be of importance for clinicians treating patients with similar conditions. References
Copyright 2009 - Journal of Postgraduate Medicine The following images related to this document are available:Photo images[jp09047f2.jpg] [jp09047f1.jpg] |
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