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International Journal of Medical Science and Innovative Research (IJMSIR) P Age 183 Abstract ISSN- O: 2458 - 868X, ISSN–P: 2458 – 8687 Index Copernicus Value: 49. 23 PubMed - National Library of Medicine - ID: 101731606 International Journal of Medical Science and Innovative Research (IJMSIR) IJMSIR : A Medical Publication Hub Available Online at: www.ijmsir.com Volume – 4, Issue – 1, January - 2019, Page No. : 183 - 187 Outbreak of Insect exposed Dermatitis in Yavatmal District Dr. Anand Saraswat, Dr. Amar Surjushe Department of Dermatology, Venereology and Leprology, Shri Vasantrao Naik Government Medical College, Yavatmal, Maharashtra, India- 445001 Corresponding Author: Dr. Amar Surjushe, Address- Dr Amar Surjushe, Rachana Skin and Cosmetic Clinic Veer Wamanrao Square Yavatmal- 445001, Type of Publication: Original Research Article Conflicts of Interest: Nil Abstract the main cause of skin allergy. Patients were treated with Background: Cotton related issues are the prime focus in oral antihistamines, topical steroid, calamine lotion and if the farmers’ suicide district of Yavatmal. Sudden required oral coticosteroids. outbreaks of skin related issues affects morbidity of the Conclusions: Insect exposed dermattitis is not uncommon farmers. We came across such skin related outbreak in our entity, but till date there are no literature found to report Department of Dermatology, Venereology and Leprosy, this entity as an epidemic in the farmer in the rural part of at Shri Vasantrao Naik Government Medical College, Maharashtra. Proper personal care, proper stoarage of Yavatmal. cotton, mass education can to some extent prevent such Aims and Objectives: To study the demography, types of epidemic in future. morphology, cause and treatment of sudden outbreak of Keywords: Outbreak, Insect, Dermatitis, Itching, Cotton, insect exposed dermatitis. Biopsy, Antihistamines, Coticosteroids Methods: Total 437 patients, who complaining of itching Introduction after exposed to cotton, were included in the study. Cotton is one of the most important economic crops Detailed history regarding exposure to cotton, other worldwide. In 2006, it was grown in 75 countries with a family members or neighbours affected were taken. A total production of 27 billion kilograms, and supplied detailed clinical examination, skin scrapping and biopsy almost 40% of the global demand for fiber [1,2]. of patients were done. Field surveys were done to assess However, India ranks third in global cotton production the cause of dermatitis. Patients were managed with after USA and China. India accounts for approximately 25 proper treatment and follow up done at regular interval. percent of world's total cotton area and 16 percent of Results: Out of total patients, 247 were male and 190 global cotton production [3]. were female. Age of the patients ranged from 5-55 years. Cotton area was on the decline in India because of The main presenting symptoms were itching to affected frequent bollworm infestation and outbreaks. The area parts or whole body part, appearance of red spots, bumps declined from an average of 87 lakh hectares upto 2001 to 183 or swelling. Clinical examination found that insect was a meager 78 lakh hectares in 2002 and 2003. With the Page Corresponding Author: Dr. Amar Surjushe, Volume – 4 Issue - 1, Page No. 183 - 187 Dr. Amar Surjushe, et al. International Journal of Medical Sciences and Innovative Research (IJMSIR) advent of Bt-cotton, the area increased to 121.91 lakh reported allergic reactions to Bt cotton, (Image 2), such hectares in 2011. Thus there was an additional increase of reaction are severe itching of the skin, swollen apparatus, at least 30 lakh hectares because of the introduction of Bt- white eruptions on the skin, upper respiratory problems. cotton. Bt cotton is genetically modified cotton crop that Insect exposed dermattitis is not uncommon entity, but it expresses an insecticidal protein whose gene has been has never been reported as an epidemic in the literature. derived from a soil bacterium called Bacillus We are the first to report this entity as an epidemic in the thuringiensis, commonly referred as Bt, (Image 1) [4]. Bt farmer in the rural part of Maharashtra. cotton was introduced in North India in 2005 and the Image 2: Allergic Reactions from BT Crops in yields were already high in these states. However biggest Farmers gains were made in Gujarat, Maharashtra and AP. There is a huge demand characterized by long farmer queues each year for Bt-cotton seeds of specific brands. Image 1: BT Cotton Materials and Methods All the patients visiting Dermatology outpatient Department of SVNGMC, Yavatmal and who were attending Special camp at Ralegaon Rural Hospital, with complaint of itching after exposed to cotton were included Maharashtra is the largest cotton growing state in the in the study. Total 437 patients were included in this country. It covers about 34% of total cotton area and study. A detailed history regarding exposure to cotton, contributes 17% of the production [srmh.pdf]. In other family members or neighbours affected were taken. Maharashtra cotton is cultivated in 27 districts out of Complete and detailed clinical examination, skin which Bt. Cotton seeds were distributed in 19 districts [3]. scrapping and Biopsy of patients were done. Field surveys Vidarbha region is considered as the major cotton- were done to assess the cause of dermatitis. Management growing region in Maharashtra state, because it covers of patients was done and patients were following up at nearly half of the area of cotton in Maharashtra. Among regular intervals. Vidarbha region Yavatmal is the main district of Results and Discussion cultivation of cotton [5]. The cotton production in In the present study, total 437 patients presented with the Yavatmal faces many constrains most important of which complaint of itching after exposed to cotton (Image 3- is the problem of insect pests. Farmworkers and mill some patients with itching) were included, out of which employes have experienced arthopod (insect) borne 247 were male and 190 were female. The age of the urticarial/allergic reaction, bite reaction, borne papular patients were ranged from 5-55 years. urticarial and insect exposed dermatitis. Many farmers 184 184 184 184 184 Page Page Page © 2019 IJMSIR, All Rights Reserved PagePage Dr. Amar Surjushe, et al. International Journal of Medical Sciences and Innovative Research (IJMSIR) Image 3: Patients with complaint of itching after the present study were shown in table 1 with their exposed to cotton symptoms. Table 1: Infected person and symptoms Infected Persons Symptoms • Farmers and their • Itching to affected parts family members or whole body part • Cotton handling • Appearance of red spots, farmworkers bumps or swelling • Farmers who stored • Appearance of above cotton in their symptoms to other homes or their family members or Act of Bt Cotton on Farmers' Health in Barwani and Dhar neighbors neighbors District of Madhya Pradesh, was conducted between • Labours working in October and December 2005. From this press report: Dr. ginning factory or Gurpiar Singh told that poisonous types of genes have mills been used in the Bt cotton that’s why the farmers and the A detailed clinical examination was done for all the laborers are affected most. The team further revealed, the patients to find out the causes of itching, (Image 4). toxins inside the Bt cotton seed which helps the cotton Itching occurs may be exposed to cotton, pink bollworm, plant fight the deadly American Bollworm, was the main insecticide, and insect. The clinical examination reveals reason behind the allergy. Dr Gupta said that all that the insect was the main cause of skin allergy. respondents had itching of skin, while 86 pct of them had Image 4: Clinical Examination eruptions on body and 56 pct had swelling of face where as in some cases, the itching was so severe that they had to discontinue their work, or had to work after taking anti- allergy medicine [6]. The survey resulted in a report which concluded [6]: “All the evidence gathered during the investigation shows that Bt has been causing skin, upper respiratory tract and eye allergy among persons exposed to cotton. The allergy is not restricted to farm labourers involved in Insects are arthropods of the class Insecta. Insects can be picking cotton but has affected labourers involved in distinguished from other arthropods by the presence of 3 loading and unloading Bt from villages to market, those body segments, a pair of antennae, and 6 legs [7]. It involved in its weighing, labourers working in ginning represents more than half of all known living organisms factories, people who carried out other operations in the and potentially represents more than 90% of the differing field of Bt cotton, or farmers who stored cotton in their life forms on Earth. Hence, human contact with insects is homes etc.” Similar to this report, the infected patients in unavoidable. Exposure to biting or stinging insects or to 185 185 185 185 185 Page Page Page © 2019 IJMSIR, All Rights Reserved PagePage Dr. Amar Surjushe, et al. International Journal of Medical Sciences and Innovative Research (IJMSIR) their remains can range in severity from benign or barely generalized reaction to an insect bite as with the bites of noticeable to life threatening [8]. sand fly, chigger bite, ticks, kissing bugs, etc., but none Insect bites and stings can be divided into two groups’ i.e. such case was reported in our study [10]. Yet many venomous and non-venomous. Non-venomous insects species inject saliva while biting. Most lesions are the (Mosquito, Flea, Tick, Bed bug, Louse, Scabies, result of the victim's immune response to these secretions. Caterpillars and moths) pierce the skin to feed on blood, Most cases are not even reported. Most does not require this usually results in intense itching. Some caterpillars hospital care as well. Most insects are minor and cause and moths have irritating hairs and sharp spines, causing only superficial puncture wounds to the skin.
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