Strange animated bodies in othorinolaringology
Ricardo R. Figueiredo 1, Sandro Dorf 2, Márcia S. Couri 3, Andréia A. Azevedo 4, Fernanda Mossumez 54
Study design: Clinical retrospective. Material and method: Fufty-six cases of animated foreign bodies collected inside human ears (55 insects and 1 arachnid) and one case collected in nasal fossae (insect) were reported. The material was collected in the Emergency sector of Souza Aguiar Hospital, in Rio de Janeiro, between 1998 and 2000, and was identified by zoologists of Museu Nacional, Rio de Janeiro. Most of the cases had occurred in Nova Iguaçu and Campo Grande, suburbs of Rio de Janeiro. Clinical features and complications were analyzed. Results: The recorded insects are: 30,35% Blattaria (cockroaches); 25% Diptera (flies and mosquitos); 12,5% Lepidoptera (butterflies and moths); 10,7% Coleoptera (beetles); 7,15% Hemiptera (bugs, cicads, aphids, etc.), 5,35% Hymenoptera (wasps, bees, ants, and sawflies) and 5,31 % others.
Different types of organisms may invade the human body in many different manners. They may be inhaled, ingested with contaminated food or water, or through sexual contact, thus penetrating the natural cavities of the human body. Consequences may range from a slight discomfort to severe clinical conditions, if they are pathogenic to humans. There are reports in the literature of injuries and ulcerations in cavities, such as infestations of the oral mucosa, among others.
Some species of arthropod animals may invade the human body through its natural openings, especially the mouth, nostrils and external acoustic duct. These invaders include insects, both in their adult and young forms. One example of human invasion by insects is myiasis, that is, the infestation of live or dead tissues by the larvae of flies. Larvae may cause many types of injuries, depending on the species and circumstances of the infestation, such as secondary bacterial infections and the patient’s immune status.
In human beings, the ears, nose and throat are the most commonly infested areas, and deadly cases have been reported in the literature (Guimarães & Papavero, 1999).
The objective of this study was to identify the main invaders in the State of Rio de Janeiro, classify them, describe the clinical changes they cause, and their treatment, so as to prevent future invasions.
MATERIAL AND METHODS
The specimens studied were collected in the Emergency Room of the Otorhinolaryngology Clinic of Municipal Hospital Souza Aguiar, in Central Rio de Janeiro, between 1998 and 2000. It comprises 56 samples of invading organisms preserved in test tubes with formaldehyde. For each case, a form was filled out recording information such as common name of the insect (given by the patient or staff), what the patient was doing when the invasion occurred (lying, walking, etc.), time elapsed since the invasion, and others (Figure 1).
Specimens were collected by means of an otologic lavage or with the help of Hartmann forceps. Some of the specimens were examined with the help of a microscope, after checking whether the insect was alive or dead. When they were alive, they were first killed with the instillation of ether, except the larvae. Given the technical difficulties to remove them in some cases, certain samples were extremely damaged, thus making impossible the identification to the level of species.
The information on the samples has been summarized in Table 1, which also includes the identification of the organisms, separated by Order. Researchers of the Departments of Entomology and Invertebrates of the National Museum of Rio de Janeiro identified the organisms. All the specimens are stored in the collection of the National Museum.
Table 1. Animated foreign bodies in the ear of patients at the ER of Hospital Souza Aguiar - identification and information about the patient and the insect.
Note: MT: tympanic membrane; M/F: male and female; side R/L: right and left.
RESULT AND DISCUSSION
All of the material examined included insects, except for samples 7 and 45, which were arachnids. Most of them were identified to the level of species or genus, some to the level of family, either due to the lack of experts in that certain group of insects, or due to the state of the sample. Table 1 shows the identifications.
The data show that most (about 55.35%) of the invaders were either Blattidae (cockroaches) or Diptera (flies and mosquitoes), which accounted, respectively, for 30.35% and 25% of the cases. Next, were the Lepidoptera (butterflies and moths), 12.50%; Coleoptera (beetles), 10.70%; Hemiptera (bedbugs, cicadas, etc.), 7.15%; Hymenoptera (wasps, bees, ants), 5.35%; Isoptera (termites) and Araneae (spiders), 3.60% and only 1.71% was Thysanura.
The Blattidae (Figures 2-3) were represented chiefly by Periplaneta spp. (47.5%) and Blattella spp. (29.5%), which are household species. These cockroaches look for food remains inside households and may account for the transmission of bacterial and protozoal diseases and food contamination. They may also invade the labial mucosa of people during sleep, looking for food remains, causing a form of herpes known as “Herpes blattae” (Costa Lima, 1938). All of the Blattella specimens were B. germanica (Linnaeus). Other species found were Pycnoscelus surinamensis (17%) and Ischnoptera spp. (6%).
Almost all the dipteran found belong to the genus Cochliomyia Townsend (25%), which is endemic in the New World. Most of them were (54%) C. hominivorax (Coquerel) (Figure 4) and only 7.7% were C. macellaria (Fabricius). Both species were collected in their larvae stage; they belong to the family Calliphoridae, and are two of the most abundant and widespread species of this genus. The larvae are obligatory parasites that cause myiasis in men and in other animals; they usually develop between the dermis and subcutaneous layer. C. hominivorax is found from southern USA to northern Chile, Argentina, and Uruguay. It is an obligatory parasite of wounds in mammals, feed on living tissues, and infest almost all forms of domestic animals, wild animals, and human beings (Guimarães and Papavero, 1999). C. macellaria is common in the tropical and subtropical regions of the Western Hemisphere. They may act as secondary invaders of wounds. One of the cases of C. hominivorax occurred in both nasal cavities of a beggar.
Other dipterans are four mosquitoes of the family Culicidae and one fly of the family Sarcophagidae, Oxysarcodexia amorosa (Townsend). The members of the family Sarcophagidae are, without exception, either viviparous or oviparous. Their larvae develop in carcasses, excrement or decaying matter. Males are frequent visitors of flowers, but the female of some species are parasites of other invertebrates, sometimes destroying the host’s eggs or larvae (Shewell, 1987). There are reports of accidental cases of myiasis by larvae of Sarcophagidae, including a case of auricular myiasis caused by Bercaea haemorrhoidalis (Fallen) in Argentina (Guimarães & Papavero, 1999).
The coleopterans (Figures 5-6) collected belong to the family Scarabaeidae, which comprises phytophagous species, easily attracted by mercury-vapor lamps. Here, they have been represented by the sub-families Rutelinae (60 %) and Dynastinae (40%). 40% of the invader beetles were Leucothereus spp.. Lepidoptera is one of the largest orders of predominantly phytophagous insects, and here were represented by 7 families (Nielsen & Common, 1991).