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Indian Journal of Medical Microbiology, Vol. 28, No. 2, April-June, 2010, pp. 176-178 Case Report Accidental intestinal myiasis caused by genus Sarcophaga A Das, *A Pandey, M Madan, AK Asthana, A Gautam Departments of Microbiology (AD, AP, MM, AKS), and Medicine (AG), Subharti Medical College, Meerut, India Correspondence Address: Department of Microbiology, Subharti Medical College, Meerut, India, sideyedoc@yahoo.com Date of Submission: 25-Jul-2009 Code Number: mb10053 PMID: 20404472 DOI: 10.4103/0255-0857.62503 Abstract Myiasis of different organs has been reported off and on from various regions in the world. We report a human case of intestinal myiasis caused by larvae of Sarcophaga. A 25 - year - old male presented with symptom of passage of live worms in stool. Following diagnosis and treatment the patient improved completely with cessation of maggots in stool.Keywords: Intestinal myiasis, sarcophaga, myiasis Myiasis, is the infestation of live human beings or other vertebrate animals with larvae (maggots) of various dipterous flies. Clinically, myiasis may be classified as cutaneous, atrial, wound, intestinal or urinary depending on the location of fly larvae. [1] Intestinal myiasis is an accidental phenomenon which occurs when eggs are ingested in food and passed into the faeces as larvae. It is usually transient and asymptomatic. [2] Intestinal myiasis caused by various species of larvae has been reported in the past from India. [3],[4],[5],[6],[7] However, to the best of our knowledge, till date, no case of intestinal myiasis caused by genus Sarcophaga has been reported from India. The present case report highlights the need for awareness among the physicians and microbiologists that worms passed in faecal samples are not always helminthes but may be the larvae of flies; and these should be closely examined in case of such complaints. Case Report A 25- year-old male from rural area came to our outpatient department with history of periodically passing moving worms in stool for the past 20-25 days. There was no history of abdominal pain, nausea, vomiting. There was no history of haematemesis, malena, rectal bleeding, weight-loss or fever. Clinical examination revealed a thin built reasonably nourished individual. However, the patient was very anxious and disturbed because of passage of worms per stool. His blood pressure was 130/70 mmHg and pulse rate was 70/minute. There was no pallor, clubbing, icterus, lymphadenopathy or pedal oedema. There was no sign of malnutrition such as glossitis, chelitis, angular stomatitis or Bitot's spots. Examination of abdomen, cardiovascular system, chest and central nervous system showed normal findings. His routine haematological examination was within normal limits with no increase in eosinophil count. The patient gave history of living alone and had been taking non vegetarian food from outside vendors for a long time. He was advised to bring fresh stool samples and the samples received, on three different days were sent to the department of Microbiology for routine check-up and microscopic examination. All the stool samples revealed four to five live worms. These were washed with sterile saline in a petridish and observed. Macroscopic examination revealed small, white, segmented worm-like structures about 4-5mm long and 0.5-1mm wide [Figure - 1]. The worms were then mounted on a slide and examined carefully and photographed under a microscope. The larvae had 12 segments, each with short spines at its posterior margin. It had a broader posterior end and a tapering anterior end with two oral hooks and mouth brushes [Figure - 2]. The posterior end of the larvae was cut and washed with normal saline and soaked in 10% NaOH (clearing agent) for approximately six hours and examined microscopically. Posterior spiracles had two parallel slits indicating it to be second instar larvae [Figure - 3]. The posterior spiracles were difficult to find and located inside a fossa (hidden spiracles), which is the characteristic feature of genus Sarcophaga. [8] On the basis of the morphological examination, the larvae were identified as second instar larvae of genus Sarcophaga. For final confirmation by an entomologist, the worm was sent to the department of Zoology (Entomology Division) of Punjab University, Chandigarh, where it was confirmed to be belonging to genus Sarcophaga. Thereafter, the patient was treated with osmotic purgative poly ethylene glycol (PEG). A sachet containing 137.15 gm. of PEG was dissolved in 2 litres of water and patient was asked to drink it in a duration of one to two hours. This produced 3-4/5 loose motions in the next four to five hours. He responded positively with cessation of passage of worms on subsequent follow-up. All the three repeat routine stool examinations were normal with no worms in any of the samples. The patient was also very relaxed and happy on follow-up. Discussion The large greyish flesh fly belonging to family Sarcophagadiae and genus Sarcophaga has a nearly world wide distribution. About 30 species of dipterous larvae including Sarcophaga species have been found capable of producing intestinal myiasis till now. Myiasis-producing flies have been classified as specific, semi specific and accidental. [8],[9],[10] Intestinal myiasis in human is probably an accidental myiasis, which occurs when the fly egg or larvae deposited in food are ingested, survive in gastrointestinal tract and are excreted in faeces. Accidental ingestion of dead or living larvae of the flies without associated pathological lesions or symptoms gives rise to a condition commonly known as "pseudomyiasis". [8],[9],[10] Our patient had accidental intestinal myiasis because he was otherwise asymptomatic except for the passage of worms in stool and despite taking deworming tablets from the private practitioner, he did not improve. In the present case the source of infection would have probably been the food taken by the patient from outside vendors (improperly cooked meat which he often used to take). Our patient responded well to the purgative treatment with spontaneous passage of larvae, which is quite common. Laboratory findings in cases of intestinal myiasis consist of the presence of numerous species of dipteran larvae in one or more consecutive stool specimens. The microscopic examination is diagnostic. Intestinal myiasis, though largely benign, still has reports of symptomatic as well as severe clinical symptoms, depending on the number and species of fly larvae and their location within the digestive tract. [1].Therefore, all possible cases of intestinal myiasis should not be ignored and carefully followed, so that proper and timely treatment may be given when necessary, to avoid disastrous complications. Acknowledgment We thank Prof (Dr) Neelima R. Kumar, (Entomologist), Department of Zoology, Punjab University, Chandigarh, for her valuable opinion and confirmation of the identification of the maggot. References
Copyright 2010 - Indian Journal of Medical Microbiology The following images related to this document are available:Photo images[mb10053f2.jpg] [mb10053f3.jpg] [mb10053f1.jpg] |
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