|Year : 1966 | Volume
| Issue : 4 | Page : 178-181
A few observations on cases of ophthalmo-dermatozoosis
S Mukherjee, E Ahmed
Department of Ophthalmology, B. .S. Medical College, Bankura (West Bengal), India
|Date of Web Publication||17-Jan-2008|
Department of Ophthalmology, B. .S. Medical College, Bankura (West Bengal)
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Mukherjee S, Ahmed E. A few observations on cases of ophthalmo-dermatozoosis. Indian J Ophthalmol 1966;14:178-81
The aetiological aspect, symptoms and signs, differential diagnosis, experimental observations on beetles of genus PAEDERUS, and review of literature on the subject of Ophthalmodermatozoosis have been exhaustively dealt with by Somerset (1961, 1962). We are freely quoting some of the features from his publications before adding our own case records and comments.
This condition attributable to genus PAEDERUS was originally described by Vonderman (1901). Since then some 17 different species of this beetle have been recorded in different parts of the world. The beetle breeds in damp porous soil near water. Eggs are laid down which hatch into larva. Larva; develop into pupae and then into adult insects. The insects can fly easily into the air. In India the commonest offending insect is P. fusipes.
Noxious fluid of unknown nature is liberated from the glands of the insect's hinder part or by the haemolymph from all parts of its body as a defensive mechanism when it is reflexly brushed away by the patient.
History of contact with the insect in most cases may be absent. Any part of the exposed skin e.g. skin of the eyelid and the neighbouring face area may be affected. In the eye-lids, there may be oedema and tenderness. Later on "the linear coagulation of the skin" is characteristic. Occasionally there may be conjunctival hyperemia, chemosis and corneal abrasion.
The condition disappears in 7 to 10 days. It should be differentiated mainly from the bites and stings of bees, wasps, spider, and scorpion and fish etc.; juices of certain toxic leaves and plants: caterpillar dermatitis; and erysipelas.
We have selected 6 consecutive cases who for the first time visited the ophthalmic outpatients' department of Bankura Sammilani Medical College Hospital during six weeks (vide [Table 1]). A careful history has been taken. Examination of lid, neighbouring face area, conjunctiva and cornea has been done. The cases have been followed up regularly and the findings have been recorded.
Case 1: J. K., a medical student, suddenly felt a burning sensation, and noticed swelling of the right lower eyelid and alaenasi with no precedent history of any bite, dermatitis, allergy or contact with an insect. Before attending the Ophthalmic outpatients' department he had an injection of Crystalline Penicillin 500,000 units daily and Antistine (0.1 gm) tablet T.D.S. for 3 days. Two rows of interrupted erythematous areas along the inferior orbital palpebral sulcus, tender to touch, medially confluent with one another and sodden skin area in between these two rows were seen. Oedema of the affected area and a few minute vesicles on the left side of the nose were also noticed. He was given Inj. crystalline penicillin 500,000 units intramuscularly twice daily and Antistine I tablet thrice a day. After two days' therapy there was much improvement of the condition, only a slight pigmentation of the affected area was left behind, which gradually disappeared. There was no scarring subsequently.
Case 2: A. P., while cycling beside a pond at night, suddenly felt an insect getting into his left eye which came out immediately, following which there was some irritation of the eye. Next morning he awoke with pain and swelling of the eyelids. Examination revealed cedamatous and tender lids, narrow interpalpebral aperture, welling out of conjunctival discharge and chemosis. He was advised frequent washes with normal saline and application of Achromycin ophthalmic suspension. The condition did not improve much within 48 hours with this treatment. Inj. Crystamycin intramuscular daily for 6 days and Avil (25 mg) tablet thrice daily for 3 days were further given. After 4 days of this treatment the condition became quiet with no trance of scarring.
Case 3: S. D.. about 9 hours after cycle riding at night, felt pain and noticed swelling of the medial side of right lower lid with no history of contact with an insect. On examination there were slight erythema and oedema over the medial canthus of the right eye and the adjoining part with a central brownish black area. He was advised injection of Omnamycin I vial. intramuscularly daily for 6 days and frequent painting of the affected area with "caladryl" lotion. After 48 hours there was desquamation of the pigmented area only. In the course of about 2 weeks, the whole of the affected area looked normal.
Case 4: T.D., following a sense of tenseness of the lids and irritation of left eye with no precedent history of trauma or insect bite the night before, noticed swelling and redness of the lids in the morning. Eyelids were red and odematous. Chemosis was limited to lower half of the bulbar conjunctiva. Slight conjunctival discharge was present. Peculiar gelatinous-looking conjunctiva and brownish discoloration of skin of the lower lid were also noted. He was advised injections of Crystalline Penicillin 500,000 units intramuscularly twice daily and Andantol tablet twice a day for 3 days. After 48 hours, the conjunctiva became normal. Disappearance of oedema and that of discoloration of the lower 'lid took a few more days.
Case 5: B.D., while returning home at night an insect suddenly got into the left eye and the insect was reflexly rubbed against the lids. Next morning he developed swelling and pain of both eyelids. Oedema, erythema of both lids and tenderness of the lower lid were detected. Conjunctival congestion and discharge with minute subconjunctival hemorrhages were also present.
He was given lotio normal saline as an eye wash, lotio calamine for painting the skin and sulphathiazole 2 tablets three times a day. The patient was seen next day and the condition improved to a certain extent. Unfortunately the patient did not report to us later.
Case 6: S.S., a medical student gave the following history. He was cycling late one evening beside a pond where an insect was reflexly rubbed and taken out immediately by the patient himself. He instantaneously experienced slight irritation and excessive watering for about half an hour. He felt no pain and sleep was unaffected. When he woke up next morning he felt heaviness of the lids and noticed swelling of the upper lid. He was given lotio normal saline as an eye-wash and Efcorline eye ointment thrice daily. After 48 hours the swelling increased and involved the lower lid along with tender rashes near the medial canthus and over the bridge of the nose. Efcorline was stopped. Next day the swelling increased still more and the patient could not open the eye. Now the examination revealed burst vesicles with some bleeding points. The whole area was extremely tender. Intramuscular injections of Crystalline Penicillin twice daily for one week were advised. After two days of penicillin therapy the patient got dramatic relief with reduction of the extent of the swelling of the upper lid, ease in opening the eye and healing of the ulcerated area with formation of scales. The condition became quiet after 4 more days' administration of Penicillin.
| Observations|| |
1. All the cases of the present series attended during the period from 4th week of March to 2nd week of June, 64.
2. All affections were unilateral and in males and occured at night with fairly immediate onset of symptoms following insect hits, but the characteristic clinical picture did not get established till about 12 hours later
3. History of insect hit was available in 3 cases.
4. The signs were following:
Oedema + tenderness... 6 cases
"Linear coagulation of the skin"... 3 cases
Conjunctival discharge... 3 cases
Chemosis... 2 cases
Vesiculation and pustule formation... 2 cases
Brownish discoloration of the skin... 2 cases
Subconjunctival Hemorrhage... 1 cases
Skin rashes... 1 cases
Corneal abrasion... Nil. cases
Signs of general Toxemia Nil. cases
5. Antihistaminic drugs orally and Calamine for skin applications were effective to a certain extent, but treatment with Penicillin or Penicillin streptomycin intramuscularly were very effective. Local corticosteroid therapy at least in one case aggravated the condition.
| Discussion|| |
Somerset (1961) stated that the incidence of these cases in and around Calcutta was mainly in February to June. We saw 4 consecutive cases in the course of I week (March-April). The question is yet to be answered whether the larvae develop into adult insects which fly freely at this time and whether the offending insect in our series is morphologically identical with that described by Somerset, because there is a difference in the timing of peak incidence between our series of patients and those of Somerset. Unfortunately we could not have any access to a specimen of an insect living or dead.
Development of typical 'Linear coagulation of skin' is rather late.
Chemosis, conjunctival discharge, vesiculation, pustule formation and brownish discoloration of skin are some of the characteristic signs in our series, though conjunctival hyperaemia and chemosis were occasionally noted by Somerset. Skin rashes, subconjunctival hemorrhage and bleeding in the vesicles are not mentioned in literature. The probable explanation of effectiveness of intramuscular injections of Penicillin and/or strepto-Penicillin in Ophthalmodermatozoosis may be that it controls the accompanying secondary infection. Conjunctival discharge and vesiculation seen in our series support the above hypothesis, otherwise we are not in a position to explain why in a case local corticosteroids aggravated the condition, instead of controlling the inflammation.
Reports of this condition are rare in literature. This may be explained by occasional erroneous identification of the cases e.g. blepharitis, allergic conjunctivitis, orbital cellulitis. etc. We are not sure that the 'blister beetles' mentioned by Manson-Bahr producing intestinal, urinary, cutaneous & ocular varieties is any way are related to the insect in question.
| Conclusion|| |
1. The peak incidence is observed in March & April.
2. Typical Skin-coagulation develops rather late.
3. Signs vary in different cases.
4. Some features viz., skin rashes. vesiculation subconjunctival hxmorrhage and bleeding were observed in the present series.
5. Intramuscular injections of Penicillin with or without streptomycin are effective.
| Acknowledgement|| |
Our sincere thanks are due to Dr. J.Bose, Head of the Department of Ophthalmology for his help in preparing this paper.
| References|| |
Manson's Tropical diseases (1960), Ed.Manson Bahr. 15th Edition. Casell. London, pp. 677-78.
Somerset E. J. (1961), Brit. J. Ophthal. 45, 395.
Somerset E. J. (1962), "Ophthalmology in the Tropics", Baillard-Tinda! and Cox. London pp. 23.