Indian Journal of Medical Microbiology Medknow Publications on behalf of Indian Association of Medical Microbiology ISSN: 0255-0857 EISSN: 1998-3646 Vol. 26, Num. 1, 2008, pp. 97-98

Indian Journal of Medical Microbiology, Vol. 26, No. 1, January-March, 2008, pp. 97-98

Correspondence

Acute urticaria associated with Dicrocoelium dendriticum infestation

Sing A, Tybus K, Fackler I

Bavarian Health and Food Safety Authority, Veterinärstraße 2, 85764 Oberschleißheim; Max-von-Pettenkofer-Institut für Hygiene und Medizinische Mikrobiologie, Ludwig Maximilians-Universität München, Pettenkoferstraße 9a, 80336 München
Correspondence Address:Bavarian Health and Food Safety Authority, Veterinärstraße 2, 85764 Oberschleißheim; Max-von-Pettenkofer-Institut für Hygiene und Medizinische Mikrobiologie, Ludwig Maximilians-Universität München, Pettenkoferstraße 9a, 80336 München, andreas.sing@lgl.bayern.de

Date of Submission: 09-Jan-2007
Date of Acceptance: 29-Apr-2007

Code Number: mb08031

Dear editor,

A 21-year-old Afghani woman, who had recently come to Germany, presented with acute urticaria affecting the complete integument. Parasitologic examination of four stool specimens obtained over two weeks revealed Dicrocoelium dendriticum eggs [Figure - 1] and non-pathogenic amebae. Topical prednicarbate treatment and praziquantel (3 x 600 mg for 3 days) were recommended. Due to her state as refugee, the patient was lost to follow-up. Adult D. dendriticum live in the gall bladder and bile ducts of their final hosts (ruminants). Worm eggs are passed in faeces, which are swallowed by terrestrial snails. Snails excrete cercaria in mucous balls, which are eaten by ants. Infected ants stick to the tip of a grass-blade due to tetania of their mandibles. Herbivorous animals may ingest infected ants while grazing. In these animals, flukes develop, which migrate into the liver. ^[1] Humans may rarely get infected by ingesting ants. However, in most cases, D. dendriticum eggs in human stools are not due to infection but by the ingestion of undercooked liver of infected animals. ^[2],[3] Such a "spurious" infestation (pseudoparasitism) seems unlikely in our patient, since D. dendriticum eggs were present in spite of a liver-free diet. Parasite-associated chronic urticaria are well known. Our case differs considerably from others in many respects: (i) in contrast to most urticaria-associated parasites, D. dendriticum is not a gastrointestinal parasite; (ii) in contrast to most parasite-associated urticaria, the presentation in our patient was acute, much like schistosome-caused urticaria; (iii) in contrast to schistosomal larvae, D. dendriticum does not require wandering in humans. Symptoms caused by D. dendriticum in rare cases of human infections include chronic constipation or diarrhoea, hepatomegaly and biliary obstruction. ^[4] Unfortunately, since the patient was lost for follow-up, it could not be proven that D. dendriticum was in fact responsible for her acute urticaria. We believe that ants can cause urticaria not only directly by venom but also indirectly by transmitting D. dendriticum . Parasitological stool examination is worthwhile in the diagnostic workup of urticaria.

References

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