first case report of gastrointestinal infection in an ... · first case report of gastrointestinal...

First case report of gastrointestinal infection in an infant

caused by the larvae of Lasioderma serricorne (Coleoptera: Anobiidae)

Journal: Journal of Medical Entomology

Manuscript ID JME-2016-0082.R1

Manuscript Type: Short Communication

Date Submitted by the Author: n/a

Complete List of Authors: Mokhtar, Aida Syafinaz; University of Malaya, Parasitology

Sridhar, Ganiga; University of Malaya Medical Centre, Medicine Mahmud, Rohela; University of Malaya, Parasitology Jeffery, John; University of Malaya, Parasitology Lau, Yee Ling; University of Malaya, Parasitology Wilson, John; University of Malaya, Museum of Zoology, Institute of Biological Sciences Abdul-Aziz, Noraishah Mydin; University of Malaya, Parasitology

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Short Communication

Field Keywords: Medical Entomology

Organism Keywords: Anobiidae, Coleoptera

https://mc.manuscriptcentral.com/medent

Manuscripts submitted to Journal of Medical Entomology

Abdul-Aziz et al.: Gastrointestinal infection N. M. Abdul-Aziz 1

caused by the larvae of L. serricorne Department of Parasitology, Faculty of 2

Medicine, University of Malaya, 3

Journal of Medical Entomology 50603 Kuala Lumpur, MALAYSIA 4

Phone: +60172604310 5

Fax: +60379674754 6

E-mail: [email protected] 7

8

First case report of gastrointestinal infection in an infant caused by the larvae of Lasioderma 9

serricorne (Coleoptera: Anobiidae) 10

11

Aida Syafinaz Mokhtar,1 Ganiga Srinivasaiah Sridhar,

2 Rohela Mahmud,

1 John Jeffery,

1 Lau 12

Yee Ling,1 John-James Wilson,

3,4 and Noraishah Mydin Abdul-Aziz

1 13

14

1Department of Parasitology, Faculty of Medicine, University of Malaya, 50603 Kuala 15

Lumpur, Malaysia 16

2Department of Medicine, University Malaya Medical Centre, 50603 Kuala Lumpur, 17

Malaysia 18

3Museum of Zoology, Institute of Biological Sciences, Faculty of Science, University of 19

Malaya, 50603 Kuala Lumpur, Malaysia 20

4Ecology and Biodiversity Program, Institute of Biological Sciences, Faculty of Science, 21

University of Malaya, 50603 Kuala Lumpur, Malaysia 22

23

24

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ABSTRACT We report an unusual cause of gastrointestinal infection occurring in a one-25

year-old infant patient who was brought to a public hospital in Kuala Lumpur, Malaysia. 26

Larvae passed out in the patient’s faeces were confirmed as belonging to Lasioderma 27

serricorne by DNA barcoding. We postulate the larvae of L. serricorne were acquired from 28

contaminated food and were responsible for gastrointestinal symptoms in the patient. To our 29

knowledge, this report is the first on human gastrointestinal infection caused by L. serricorne 30

larvae. 31

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KEY WORDS Lasioderma serricorne, DNA barcoding, gastrointestinal infections, 33

paediatric, Malaysia 34

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Infection of the gastrointestinal tract is common in infancy (Purssell 2009), in which viruses 49

(rotavirus, norovirus and enteric adenoviruses) account for the majority of cases (Iturriza-50

Gómara et al. 2008). Bacterial infections (including Salmonella and Campylobacter spp. 51

infections) are significantly less common (Davies et al. 2001). Occasionally, insects of the 52

order Diptera have been reported to cause gastrointestinal infections (referred to as intestinal 53

myiasis; due to infestation of dipteran larvae) in children (Kandi et al. 2013, Francesconi and 54

Lupi 2012). Occurrence of gastrointestinal disorders associated with Lasioderma serricorne 55

has never been reported. L. serricorne, known as the cigarette beetle, is a cosmopolitan pest 56

of stored tobacco (Ashworth 1993). L. serricorne also infests a wide range of other stored 57

commodities such as grains, rice, pasta and beans and is of considerable economic 58

importance (Blanc et al. 2006). 59

Case Report 60

A one-year-old baby girl was brought to the Paediatric Emergency Department in 61

November 2015, with a 3 day history of fever and one episode of passing multiple larvae in 62

her stool (Fig. 1). In the last 2 days she also had frequent bowel movements of 4 to 5 times a 63

day. The stool consistency was normal and it was not associated with blood or mucous. Her 64

oral intake was good and she had no vomiting. However, she was slightly irritable and the 65

parents were unsure why the child was crying on and off, especially at night. There was no 66

history of respiratory or urinary tract infections. 67

Upon examination, the child weighed 9.0 kg and was febrile with a body temperature 68

of 39.6 °C. Blood pressure and heart rate were 86/60 mmHg and 130/min, respectively. 69

General physical and systemic examinations were unremarkable. Since larvae were found in 70

the patient’s stool, the child thus was given a single dose of syrup albendazole 200 mg as a 71

treatment for parasitic infection, to be repeated in two weeks; and syrup paracetamol 125 mg 72

four times a day to treat fever. At the one-week follow up appointment, it was reported the 73

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child continued to pass larvae until Day 4 of illness. Her fever subsided by Day 5 and she 74

recovered without further complications. 75

Materials and Methods 76

The collected larvae were sent to the Department of Parasitology, Faculty of 77

Medicine, University of Malaya, Kuala Lumpur, Malaysia, for identification. Four larval 78

specimens were examined under a stereomicroscope (Leica Microsystems), revealing 79

approximately 3.5 mm yellowish-white, hairy, full grown larvae, with visible legs and light 80

brown coloured head (Fig. 2). 81

DNA barcoding (Ratnasingham and Hebert 2013) was employed to obtain species 82

identification for the specimen. DNA was extracted from the whole larva specimen using the 83

NucleoSpin® Tissue (Macherey-Nagel, Germany) and a fragment of cytochrome c oxidase 84

subunit 1 (COI) mitochondrial DNA (mtDNA) gene was amplified using the “Lep” primer 85

combinations via polymerase chain reaction (PCR) (Wilson 2012). Cycle sequencing was 86

performed bi-directionally using the PCR primers. The DNA barcode from the specimen 87

demonstrated 99.85% similarity to the closest matching DNA barcode in BOLD (BOLD: 88

ACG7582) and nested within other DNA barcodes named L. serricorne on a BOLD 89

identification tree (Fig. 3). Therefore, using a strict tree-based assignment model (Wilson et 90

al. 2011), we concluded that this specimen is the larval stage of L. serricorne. 91

The University of Malaya Medical Centre Ethics Committee (MEC Ref. No. 201312-92

0608) approved our research protocols involving human subjects. The parents provided 93

written consent for this study. 94

Results and Discussion 95

Gastrointestinal infection in infants is usually self-limiting and treatable. However, severe 96

complications can occasionally arise, particularly when the infection manifests as acute 97

infectious enteritis, which can be fatal in children (Thapar and Sanderson 2004). In 98

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developing countries, cases of gastrointestinal infection remains high with an estimated 1.8 99

billion episodes of childhood diarrhoea and is an important clinical problem in children 100

despite improvements in public health and economic status (Casburn-Jones and Farthing 101

2004). 102

The life cycle of L. serricorne is completed in 45-70 days (Retief and Nicholas 1988). 103

Females oviposit as many as 100 eggs singly onto dried food materials and the eggs hatch in 104

6-8 days. The larvae undergo 4 to 6 instar stages before they transform into inactive pupae 105

and emerge into fully developed adult beetles in about 7 to 18 days, depending on the 106

environmental temperature and humidity (Retief and Nicholas 1988, Reed and Vinzant 107

1942). The adult is small, stout, oval and brownish red in colour and lives for 2 to 4 weeks. 108

When fully grown, both adults and larvae are 2-3 mm long. 109

The present case is noteworthy as this is the first report of gastrointestinal infection 110

associated with the larvae of L. serricorne, which is not known to be medically important. 111

This patient was a full-term baby weighing 3.0 kg at birth. Her developmental milestones 112

were appropriate and she received up-to-date immunizations. The family lives in a healthy 113

and hygienic environment with a domestic helper taking care of the baby. The working 114

parents are well-educated and they have another healthy and asymptomatic 3-year-old 115

daughter. 116

At the time of infection, the baby was no longer breast-feeding and had started eating 117

solid food. The larvae passed out in the patient’s faeces may have developed in the intestine 118

after the baby ingested eggs from contaminated food; prepared from ingredients that do not 119

involve cooking such as cereals and biscuits infested with cigarette beetles. The baby might 120

also have become infected by drinking contaminated infant formula. A similar case of 121

intestinal disorder in a newborn due to consumption of milk powder contaminated with eggs 122

and larvae of Musca domestica has been reported in India (Shekhawat et al. 1993). Babies by 123

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nature have the habit of putting things into their mouth; as reported by the parents in the 124

present case. It is also plausible that the baby picked up contaminated materials (food or non-125

food substances infested with eggs or larvae) off the floor that leads to the infection. Two 126

dogs also reside in the house, and the source of infection could be pet food; pet food is one of 127

the commonly infested items by L. serricorne at home (Choe 2013). However, sources of the 128

infection were not further investigated. 129

The risk of gastrointestinal infections in infancy can be reduced through good hygiene 130

practices by the parents and carers. Cigarette beetle infestations in food products can be 131

prevented and controlled by locating and eliminating the source of infestation. Infested items 132

can be cold-treated (16 days at 2 °C, 7 days at -4 °C or 0 °C for 4 to 7 days) or heat-treated 133

(88 °C for an hour, 49 °C for 16 to 24 hours) to eliminate the infestation of all stages of L. 134

serricorne (Cabrera 2014). Healthcare professionals can raise awareness and provide advice 135

on proper treatment for the underlying cause of gastrointestinal infections particularly when 136

the symptoms signify serious complications. To our knowledge, this report is the first on 137

human gastrointestinal infection caused by L. serricorne larvae. 138

139

Acknowledgements 140

This study was supported by research grants PG042-2013A, RP003D-13SUS, and 141

RG509-13HTM from University of Malaya, Kuala Lumpur, Malaysia; and 142

UM.C/625/1/HIR/MOHE/CHAN/14/3 from the Ministry of Higher Education, Malaysia. 143

144

References Cited 145

Ashworth, J.R. 1993. The biology of Lasioderma serricorne. J. Stored Prod. Res. 29: 291-146

303. 147

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Blanc, M.P., N., Lugon-Moulin, C., Panighini, H., Pijnenburg, and L., Rossi. 2006. 148

Structure of worldwide populations of Lasioderma serricorne (Coleoptera: Anobiidae) 149

as revealed by amplified fragment length polymorphism profiles. Bull. Entomol. Res. 150

96: 111-116. 151

Cabrera, B.J. 2014. Cigarette Beetle, Lasioderma serricorne (F.) (Insecta: Coleoptera: 152

Anobiidae). UF/IFAS Extension, Ft. Lauderdale, FL. 153

Casburn-Jones, A.C., and M.J.G. Farthing. 2004. Management of infectious diarrhoea. 154

Gut. 53: 296-305. 155

Choe, D.H. 2013. Pantry pests. In M.L. Fayard (eds.), Pest Notes. UC ANR, Oakland, CA. 156

Davies, E.G., D.A.C. Elliman, C.A. Hart, A. Nicoll, and P.T.Rudd. 2001. Manual of 157

Childhood Infections. W.B .Saunders, London, UK. 158

Francesconi, F. and O. Lupi. 2012. Myiasis. Clin. Microbiol. Rev. 25: 79-105. 159

Iturriza-Gómara, M., R. Simpson, A.M. Perault, C. Redpath, P. Lorgelly, D. Joshi, M. 160

Mugford, C.A. Hughes, J. Dalrymple, U. Desselberger, and J. Gray. 2008. 161

Structured surveillance of infantile gastroenteritis in East Anglia, UK: incidence of 162

infection with common viral gastroenteric pathogens. Epidemiol. Infect. 136: 23-33. 163

Kandi, V., S.K. Lal, Akhila, Shruthi, K. Sandhya, H. Simar, M. Pranuthi, M.V. Kumar, 164

K. Anand, and S.D. Rao. 2013. Persistent pediatric gastro-intestinal myiasis: a case 165

report of fly larval infestation with Musca domestica with review of literature. J. Glob. 166

Infect. Dis. 5: 114-117. 167

Purssell, E. 2009. Prevention and management of gastrointestinal infections in infants from a 168

nutritional perspective. J. Fam. Health Care. 19: 200-203. 169

Ratnasingham, S., and P.D.N. Hebert. 2013. A DNA-based registry for all animal species: 170

The barcode index number (BIN) system. PLOS ONE. 8: e66213. 171

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Reed, W.D., and J.P. Vinzant. 1942. Control of insects attacking stored tobacco and 172

tobacco product. United States Department of Agriculture, Washington. 173

Retief, E. and A. Nicholas. 1988. The cigarette beetle Lasioderma serricorne (F.) 174

(Coleoptera: Anobiidae): a serious herbarium pest. Bothalia. 18: 97-99. 175

Shekhawat, P.S., K.R. Joshi, and R. Shekhawat. 1993. Contaminated milk powder and 176

intestinal myiasis. Indian. Pediatr. 30: 1138-1139. 177

Thapar, N., and I.R. Sanderson. 2004. Diarrhoea in children: an interface between 178

developing and developed countries. Lancet. 363: 641-653. 179

Wilson, J.J. 2012. DNA barcoding for insects. Method Mol. Biol. 858: 17-46. 180

Wilson, J. J., R. Rougerie, J. Shonfeld, D.H. Janzen, W. Hallwachs, M. Hajibabaei, I. J. 181

Kitching, J. Haxaire, and P. D. N. Hebert. 2011. When species matches are unavailable 182

are DNA barcodes correctly assigned to higher taxa? An assessment using sphingid 183

moths. BMC Ecol. 11. 184

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Figure Legends 197

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Fig. 1. Macroscopic examination of the stool sample showing multiple white coloured, 199

scarab-like shaped larvae. 200

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Fig. 2. Stereomicroscope examination of cigarette beetle larva, L. serricorne (A, lateral view 202

and B, ventral view) which revealed a C-shaped, yellowish-white larva, thinly covered with 203

fine brown hairs with visible legs. The light brown coloured head is evenly rounded dorsally. 204

205

Fig. 3. BOLD identification tree. This tree is produced by a full database sequence 206

identification request in BOLD for the larval specimen. The sequence (designated as 207

unknown specimen) groups closely with those from Egypt, France, Cambodia, China, and 208

Brazil; and the species is nested within a cluster of Lasioderma serricorne. 209

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Macroscopic examination of the stool sample showing multiple white coloured, scarab-like shaped larvae. 1151x863mm (72 x 72 DPI)

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Stereomicroscope examination of cigarette beetle larva, L. serricorne (A, lateral view and B, ventral view) which revealed a C-shaped, yellowish-white larva, thinly covered with fine brown hairs with visible legs. The

light brown coloured head is evenly rounded dorsally.

236x88mm (150 x 150 DPI)

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