|LETTER TO THE EDITOR
|Year : 2013 | Volume
| Issue : 2 | Page : 153-155
Paederus dermatitis among residents of nursing hostel in central India: An outbreak investigation
Neelam Anupama Toppo1, Ajeet Singh Bhadoria2, Pradeep Kumar Kasar1, Anshuli Trivedi3
1 Department of Community Medicine, Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh, India
2 Department of Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India
3 Department of Community Medicine, Government Medical College, Bhopal, Madhya Pradesh, India
|Date of Web Publication||17-Apr-2013|
Ajeet Singh Bhadoria
Room No.118, Department of Human Nutrition, All India Institute of Medical Sciences, New Delhi - 110 029
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Toppo NA, Bhadoria AS, Kasar PK, Trivedi A. Paederus dermatitis among residents of nursing hostel in central India: An outbreak investigation. Indian Dermatol Online J 2013;4:153-5
|How to cite this URL:|
Toppo NA, Bhadoria AS, Kasar PK, Trivedi A. Paederus dermatitis among residents of nursing hostel in central India: An outbreak investigation. Indian Dermatol Online J [serial online] 2013 [cited 2020 Apr 2];4:153-5. Available from: http://www.idoj.in/text.asp?2013/4/2/153/110643
Paederus dermatitis is a peculiar irritant contact dermatitis. It occurs when beetles of the genus Paederus belonging to the family Staphylinidae (rove beetles), order Coleoptera (beetles) are crushed on the skin, releasing the hemolymph pederin.  It is characterized by sudden onset of burning or stinging sensation with appearance of vesicles and pustules on erythematous base.  Vesicular dermatitis due to contacts with beetles is common worldwide, although the condition has been infrequently described in India with limited data on clinico-entomological aspects. On March 28 th 2010, an outbreak of skin rashes at girl's hostel of Anushree Nursing College was reported to the Department of Community Medicine in Netaji Subhash Chandra Bose Medical College of Jabalpur district. An investigation was conducted to determine the epidemiology of skin rash outbreak, to identify the cause, and to recommend therapeutic and preventive measures. Investigation included interview of all cases using a predesigned and prestructured questionnaire to collect personal information and presenting complaints. Physical examination of all cases was done by trained doctors. Cases were defined as all who were present at the hostel on the day of investigation and developed skin rashes. Environmental and entomological survey was carried out. Ninety-seven residents of a girl's hostel were examined for skin rashes. All were females in the age group of 18-24 years. Mean age was 21.2 ± 1.4. Among those, 35 (36%) residents had complains of skin rashes. Most common presentation was linear erythematous lesions with vesicles seen among 32 (91.4%) cases as shown in [Figure 1] as compared with nonlinear irregular bizarre erythematous lesion with vesicles seen among three (8.6%) cases. Lesions were present on exposed areas like face, nape of neck, forearms, and legs among 29 (82.8%) cases as shown in [Figure 2] as compared with six (11.2%) cases had lesions on trunk and other areas. Twenty-three (65.7%) subjects were living in the rooms with windows opening toward the fields. (Relative risk = 2.4; 95% confidence interval: 1.4; 4.3) (P < 0.001, Chi-square test). The attack rate was 53.5% (23/43) among residents living in rooms with windows toward the fields, while it was 22.2% (12/54) among the residents living in rooms with no window facing toward the fields. Multiple lesions at different sites indicating multiple exposures were seen among 15 (42.8%) cases, while single lesion was seen in 20 (57.2%) cases. The earliest complaint was burning sensation among 33 (94.3%) cases. Other initial complaints were itching and redness on the exposed skin. Out of 35 cases, 23 (65.7%) admitted the encounter with rove beetle either in the form of brushing or in the form of crushing over skin. Others were unclear about the exact mode of contact with the beetle or not remembering any such encounter. All cases developed sign and symptoms of contact dermatitis within 48 hours of exposure to insects, while in maximum cases 16 (45.7%) skin rashes developed within 8-12 hours of exposure. Nineteen (54.28%) girls received outpatient treatment and were given analgesic, antihistamines, antibiotics, and corticosteroid cream to apply on the affected area. A total of 90% of these girls reported to be wrongly diagnosed burn marks, herpes zoster infections, and healed scars by the consulting doctors. During environmental survey, it was found that hostel was surrounded with agricultural field on two sides. Reportedly paddy harvesting had just begun during this time. Windows of nearly half of the hostel rooms were opened facing the fields. Hostel campus was not covered properly and windows and doors of the rooms were not screened to prevent the entry of insects. Fluorescent lamps used for lighting in the hostel rooms attract beetles. For entomological investigation, insects were trapped from the hostel rooms, courtyard, and agricultural fields and sent to entomology wing of Rural Malaria Research Center for Tribals (RMRCT), Jabalpur, Madhya Pradesh, India. Insects were identified as rove beetles (order Coleoptera, family Staphylinidae, genus Paederus and species fucipes). They were 4-10 mm long with alternate red and black stripes [Figure 3]. Similar seasonal outbreaks were documented in most of the studies and mentioned that peak incidence of the disease was either April - May , or September - October,  while it was found in spring and summer in another study.  The variation probably attributed to the variation of rainy season across different areas of the world. The beetle lives on moist and rotten leaves and on the organic part of the soil, causing it to multiply on rainy days.  The population of the insect increases rapidly at the end of the rainy season and then rapidly diminishes with the onset of dry weather.  Our study found this type of dermatitis occurs more commonly over the uncovered parts of the body and the majority of the lesions were on the neck and face similar with the findings of other studies from different parts of the world. , These lesions were misdiagnosed as burn marks, cutaneous herpetic zoster infections, and healed scars by the physicians who lacked the knowledge about Paederus dermatitis. Gradual resolution with residual areas of hypo- and hyperpigmentation was also reported in other studies.  The management of the lesions consists of antihistamines along with analgesics and corticosteroids to soothe the itchy and burning sensation which was experienced by victims. Antibiotics were effective to control the superimposed bacterial infection. The prevention of these lesions is based on effective insecticides and repellent, which will ensure avoidance of contact with offending insect. We found that girls living in rooms which opened toward agriculture land side were mostly affected. Similarly, it was reported in a study, that students residing in hostels within a distance of 1 km from rice fields were commonly affected.  Increased awareness for signs and symptoms of Paederus dermatitis may prevent misdiagnosis. Rove beetle dermatitis should be added to the differential diagnosis of vesicular dermatitis. Preventing human-beetle contact is the primary method of preventing Paederus dermatitis.
Interventions and recommendations given
- Treatment was given to the cases.
- Educating them to recognize the beetle and avoid handling them.
- Wash the contact areas with soap and water.
- They were told to use repellants, use bed nets, and spray "Hit- Insects" in rooms.
- It was suggested to improve the sanitary condition around hostel.
- It was also suggested to screen the windows and doors.
- Regular deep cleaning of habitat area and broad-spectrum pesticide like deltamethrin is suggested as a control measure.
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[Figure 1], [Figure 2], [Figure 3]