Diptera: Psychodidae) with Morphological Description of Larva and Pupa

J Arthropod-Borne Dis, December 2017, 11(4): 533–538 N Ali El-Dib et al.: Case Report of … Case Report Case Report of Human Urinary Myiasis Caused by Clogmia albipunctata (Diptera: Psychodidae) with Morphological Description of Larva and Pupa *Nadia Ali El-Dib 1, Wegdan Mohamed Abd El Wahab 2, Doaa Ahmed Hamdy 2, Mona Ibrahim Ali 2 1Department of Medical Parasitology, Cairo University, El Manial, Cairo, Egypt 2Department of Medical Parasitology, Beni-Suef University, Beni-Suef, Egypt (Received 27 Oct 2016; accepted 16 Dec 2017) Abstract Background: Urinary myiasis is a form of myiasis caused mainly by larvae of Fannia scalaris, Musca, Sarcophaga, Lucilia, Wohlfahrtia, Calliphora, and rarely by Eristalis and Clogmia albipunctata. Methods: This report presents a case of female patient complaining of dysuria and frequency of micturition associated with intermittent passage of small, motile, dark-colored worm-like organisms in urine. She was a married housewife aged 24 years old referred from the Tropical Outpatient Clinic of Beni-Suef University Hospital, Egypt. The patient was subjected to a full questionnaire sheet and investigations such as CBC, stool and urine analysis and urinary ultrasonography. Collected larvae and pupae from urine samples were examined macroscopically and microscopically. Results: The examined larvae and pupae belonged to C. albipunctata. Ivermectin was prescribed to the patient with complaint withdrawal and complete disappearance of the larvae from urine. Conclusion: This study reports the first case of urinary myiasis caused by C. albipunctata in Beni-Suef Governorate, the second in Egypt and third case worldwide. The study throws some light on the medical importance and management of urinary myiasis. Keywords: Urinary myiasis, Clogmia albipunctata, Egypt Introduction Myiasis is the infestation of human or an- vectors of leishmaniasis and Psychodinae (moth imal tissues by dipterous fly larvae of the class flies) not adapted for blood sucking. Clogmia Insecta. Urogenital myiasis is a rare form of albipunctata is Nematocera of the family Psy- myiasis occurring in humans (1). Like all other chodidae, subfamily Psychodinae. Adults live types of myiasis, urinary myiasis is usually as- in dark and moist areas including bathrooms sociated with poor hygienic measures, lack of and toilets and can be frequently found in drains cleanliness and disability. It may be associat- or sewers hence are called "filter flies or drain ed with urinary symptoms as dysuria, hema- flies or bathroom flies". Larvae live in and feed turia, and obstruction of the urinary system (2). on decaying organic matter (4). Urinary myiasis is caused by larvae of Myiasis occurs worldwide with more cases Fannia scalaris, Musca, Sarcophaga, Lucilia, being reported from tropical, subtropical and Wohlfahrtia, and Calliphora. Few cases of uri- warm temperate areas. In Egypt, some cases nary myiasis were caused by Eristalis and Psy- of human urogenital myiasis were previously choda flies (3). The family Psychodidae in- reported (3, 5-8). These detected cases of uri- cludes six subfamilies, only two of them have nary myiasis in Egypt throw some light on the medical importance for humans, Phlebotom- medical importance and management of this inae (sand flies) which are bloodsuckers and disease in our area. *Corresponding author: Prof Nadia Ali El-Dib, E- 533 mail: [email protected] http://jad.tums.ac.ir Published Online: December 30, 2017 J Arthropod-Borne Dis, December 2017, 11(4): 533–538 N Ali El-Dib et al.: Case Report of … Case presentation Macroscopical examination of the larvae and pupae A married housewife patient aged 24yr By naked eye examination, the larva was old was referred from the Tropical Outpa- cylindrical in shape with rounded ventrally tient Clinic of Beni-Suef University Hospital, curved anterior end and tapering posterior end. Egypt complaining of intermittent passage of The body of the larva was segmented and cov- small, motile, dark-colored worm-like organ- ered by short seta. Larvae were dark brown isms in urine. The condition started two years to black in color, rapidly motile when freshly ago associated with dysuria and frequency of passed with different sizes ranging from 8– micturition. At periods of larval passage, which 12mm in length. In addition, identified pupae ranged from two to three days, about 3–4 lar- in freshly passed urine were actively motile, vae were seen in each voided urine sample. pyriform in shape with cephalothorax carry- This was followed by periods of symptoms ing two antennae and segmented abdomen. The remission, concomitant with invisibility of the size of pupa ranged from 4–5mm in length. larvae for weeks. However, there was no fe- Four fresh larvae from the patient’s urine were ver, no hematuria or itching in the periure- placed in a clean container supported with nu- thral and genital regions. trition in the form of few sugar particles and The patient was living in Ashmant, a rural covered with gauze in a trial for breeding area in Beni-Suef Governorate, Egypt in poor them into adults and were followed up daily. hygienic conditions. The patient gave history The larvae remained alive for about two weeks that she urinates in unsanitary toilets "cabinet" but were not able to develop into adult flies. or "pit latrine", with presence of abundant mos- Dead larvae were placed in 5% formalin for quitoes and flies in the bathroom. Therefore, fixation. for lack of water pipes, water used for rinsing and bathing was stored in wide uncovered Microscopical examination of the larvae and buckets in the bathroom. There was no rela- pupae tionship with farming or livestock rising. No Larvae fixed in 5% formalin, were washed history of traveling or previous operations. several times in saline and then incubated in Consent was taken from the patient. transparent glass bottles containing 30% po- Investigations such as CBC, stool analy- tassium hydroxide until they became trans- sis “with direct and concentrated smears” and parent under the microscope. Subsequently, urinary ultrasonography were done and all re- larvae were washed thoroughly in distilled wa- vealed no abnormalities. The patient was asked ter, dehydrated in ascending grades of ethyl to collect urine samples in clean tightly cov- alcohol (30%, 50%, 70%, 90% and 99%) for ered containers at periods of larval passages. 30min each, and then in xylene for 30min, Complete urine analysis revealed amorphous mounted in Canada balsam and dried in the urate crystals while the numbers of red blood oven at 38 °C for two days (9). The mounted cells (1–3/HPF) and pus cells (5–7/HPF) in larvae were examined microscopically and urine were within the normal range. Collect- photographed. ed larvae and pupae were examined macroscopically and microscopically at the Parasit- Description of full-grown larva ology Department of Faculty of Medicine, The microscopically examined larvae were Beni-Suef University, Egypt. identified as larvae of C. albipunctata of different stages depending on the following char- acters. The larvae were hairy, segmented and yellowish brown in color. The anterior end, 534 http://jad.tums.ac.ir Published Online: December 30, 2017 J Arthropod-Borne Dis, December 2017, 11(4): 533–538 N Ali El-Dib et al.: Case Report of … posterior end and dorsal plates were slightly the last segment provided only with 2 caudal darker, while the ventral aspect was slightly processes (Fig. 2c). lighter in color than the rest of the body. On the follow-up visits, the patient was Their length ranged from 8 to 12mm. The body advised to take a single oral dose of iver- of the larva consisted of the head and eleven mectin (200ug/kg), to drink plenty of water segments, 3 thoracic and 8 abdominal seg- to help expel any other larvae in the bladder, ments (Fig. 1a). The head is triangular, not re- to keep the water bucket tightly covered in tracted into the thorax with 2 min hairy an- the bathroom and to use spraying insecti- tennae and 2 ventral mandibles. The mandi- cides to kill any insects and larvae on the bles are opposing each other so can be moved walls and floor of the toilet. She was also against each other on a horizontal plane (Fig. advised to change the pit latrine to a toilet 1b). The dorsal and lateral aspects of the body seat. After one week, all the patient’s com- segments are covered with 26 saddles shaped plaints improved with gradual reduction in chitinous plates, 2 for each thoracic segment number and frequency of passing of larvae in and 3 for each abdominal segment except the urine until complete disappearance of the first abdominal segment with two plates and larvae after treatment. The patient was fol- the eighth one without plates. Accordingly, lowed up two months later without recur- each segment appears divided into several sub- rence of symptoms or voiding larvae in divisions (secondary annuli) by these chitin- urine. ous plates (Fig. 1c). These plates are covered dorsally and laterally with long dark backward- ly directed filiform setae arising from rounded chitinous button–shaped basal plates (Fig. 1d). The prothorax has a pair of anterior respiratory spiracles while posterior respiratory spiracles are located on the apical part of the respiratory tube on the siphon. The siphon is cone-shaped, longer than broad (4:1) and its ventral aspect showed spinose anal papillae (Fig. 1e). Fig. 1. a) Clogmia albipunctata full larva with elon- gated, hairy, segmented body (x40). b) Anterior part Description of pupa of the larva showing the triangular head (x200). c) The pupa is pear-shaped and measures The dorsal aspect of the abdominal segments showing 4–5mm in length, with cephalothorax, and 7 the saddle-shaped chitinous plates and the subdivi- visible abdominal segments. The head car- sions (x40).

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