Indian Journal of Medical Microbiology IAMM  | About us |  Subscription |  e-Alerts  | Feedback |  Login   
  Print this page Email this page   Small font sizeDefault font sizeIncrease font size
 Home | Ahead of Print | Current Issue | Archives | Search | Instructions  
Users Online: 1443 Official Publication of Indian Association of Medical Microbiologists 
  Search
 
 ~ Next article
 ~ Previous article 
 ~ Table of Contents
  
 ~  Similar in PUBMED
 ~  Search Pubmed for
 ~  Search in Google Scholar for
 ~Related articles
 ~  Article in PDF (804 KB)
 ~  Citation Manager
 ~  Access Statistics
 ~  Reader Comments
 ~  Email Alert *
 ~  Add to My List *
* Registration required (free)  

 
 ~  Abstract
 ~  Case Report
 ~  Discussion
 ~  Acknowledgment
 ~  References
 ~  Article Figures

 Article Access Statistics
    Viewed4519    
    Printed127    
    Emailed2    
    PDF Downloaded152    
    Comments [Add]    
    Cited by others 2    

Recommend this journal

 


 
CASE REPORT
Year : 2010  |  Volume : 28  |  Issue : 2  |  Page : 176-178
 

Accidental intestinal myiasis caused by genus Sarcophaga


1 Department of Microbiology, Subharti Medical College, Meerut, India
2 Department of Medicine, Subharti Medical College, Meerut, India

Date of Submission25-Jul-2009
Date of Acceptance31-Dec-2009
Date of Web Publication16-Apr-2010

Correspondence Address:
A Pandey
Department of Microbiology, Subharti Medical College, Meerut
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0255-0857.62503

Rights and Permissions

 ~ 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


How to cite this article:
Das A, Pandey A, Madan M, Asthana A K, Gautam A. Accidental intestinal myiasis caused by genus Sarcophaga. Indian J Med Microbiol 2010;28:176-8

How to cite this URL:
Das A, Pandey A, Madan M, Asthana A K, Gautam A. Accidental intestinal myiasis caused by genus Sarcophaga. Indian J Med Microbiol [serial online] 2010 [cited 2018 Dec 10];28:176-8. Available from: http://www.ijmm.org/text.asp?2010/28/2/176/62503


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 Top


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 Top


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 Top


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 Top

1.Aguilera A, Cid A, Regueiro BJ, Prieto JM, Noya M. Intestinal myiasis caused by Eristalis tenax. J Clin Microbiol 1999;37:3082.  Back to cited text no. 1  [PUBMED]  [FULLTEXT]  
2.Sehgal R, Bhatti HP, Bhasin DK, Sood AK, Nada R, Malla N, et al. Intestinal myiasis due to Musca domestica: a report of two cases. Jpn J Infect Dis 2002;55:191-3.  Back to cited text no. 2  [PUBMED]  [FULLTEXT]  
3.Singh S, Samantaray JC. Human intestinal myiasis. J Assoc Physicians India 1988;36:741-2.  Back to cited text no. 3  [PUBMED]    
4.Sood A, Mahajan R, Varshney P, Chawla LS, Singh A. Intestinal myiasis-report of two cases. Indian J Gastroenterol 1994;13:28.  Back to cited text no. 4  [PUBMED]    
5.Shenoy S, Prabhu G, Rao PN, Venkatramana DK, Rajan R, Narayanan L. A case of intestinal myiasis. Trop Doct 1996;26:142.  Back to cited text no. 5  [PUBMED]    
6.Bhatia RS. Accidental intestinal myiasis. J Assoc Physicians India 1989;37:403-5.  Back to cited text no. 6      
7.Arya TV, Sehgal R, Bhandari S, Virk K. Human intestinal myiasis. J Assoc Physicians India 1988;36;168-9.  Back to cited text no. 7      
8.Oldrayl H, Kenneth GVS, Eggs and larvae of flies.In: insects and other arthropods of medical importance. Kenneth GVS. The trustees of the British museum. Natural History and John Wiley and Sons Ltd.;1973. p. 289-323.   Back to cited text no. 8      
9.Beaver PC, Jung RC, Cupp EW. Clinical Parasitology. 9th ed. Philadelphia, USA: Lea and Febiger; 1984. p. 680-95.  Back to cited text no. 9      
10.Garcia LS, Bruckner DA. Medically important Arthropods. Diagnostic Medical Parasitology. 3rd ed. Washington DC: ASM Press; 1997. p. 523-63.  Back to cited text no. 10      


    Figures

  [Figure 1], [Figure 2], [Figure 3]

This article has been cited by
1 Gastrointestinal Myiasis by Larvae of Sarcophaga sp. and Oestrus sp. in Egypt: Report of Cases, Andendoscopical and Morphological Studies
Ahmad, A.K., Abdel-Hafeez, E.H., Makhloof, M., Abdel-Raheem, E.M.
Korean Journal of Parasitology. 2011; 49(1): 51-57
[Pubmed]
2 Cutaneous superficial myiasis: Report of a rare nosocomial parasitic disease caused by Sarcophaga spp. (Diptera, Sarcophagidae)
Dutto, M., Bertero, M.
Central European Journal of Public Health. 2011; 19(4): 232-234
[Pubmed]



 

Top
Print this article  Email this article
Previous article Next article

    

2004 - Indian Journal of Medical Microbiology
Published by Wolters Kluwer - Medknow

Online since April 2001, new site since 1st August '04