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Case Report
 
Scarabiasis in Children
Keywords :
Sumathi Bavanandam, Nirmala Dheivamani, B. Bhaskar Raju, Gomathy Srividya
Department of Pediatric Gastroenterology, Institute of Child Health & Hospital for Children, Chennai-8,Tamil Nadu, India


Corresponding Author
:
Dr Sumathi Bavanandam
Email: drbsumathi@rediffmail.com


DOI: http://dx.doi.org/10.7869/tg.481

Scarabiasis is a dung beetle, temporarily infesting the gastrointestinal tract without mucosal invasion, clinically characterized by passage of beetles in stool  during defecation. Awareness is important to recognise this rare entity in children.

Case 1

One year old female child from southern part of Tamil Nadu was brought with intermittent episodes of passing live black coloured beetles in the stool for six months. The beetles were brought by the parents in a small polythene bag. There was no fever, abdominal pain or perianal itching. On examination, the beetle was  about 0.5 cms in size and black in colour (Figure 1). Diagnosis of scarabiasis was made. Clinical examination was unremarkable with normal growth. Investigations showed normal hemoglobin without any peripheral eosinophilia. Motion for ova, cyst were negative. Colonoscopy showed normal mucosa. She was treated with saline purgatives, oral metronidazole along with advice to use tight underclothing especially during sleeping, playtime and to avoid contact with cowdung. 




Case 2

Three years old female child from low socioeconomic status was brought with intermittent passage of live beetles during  defecation for three months.  Child used to play in the open land without clothing  at times.  Clinically she was under nourished, with weight and height less than 3rd percentile. Systemic examination  was normal. Motion ova, cyst were negative. Peripheral smear study was normal. Colonoscopy showed normal mucosa. Scarabiasis was considered and treated as mentioned in our   first child.

Discussion

Scarabiasis  or  Canthariasis  or  Beetle  disease is  a condition in which the beetles temporarily  infest  the digestive tract and rarely  the  urinary tract. Dung beetle belongs to Scarabiaediae family. The two species of dung beetles seen in India are Onthophagusbifascicatus  and  Coccobius. These beetles play a useful role in  agriculture by burying and  consuming  dung, thereby    improving   the nutrient  cycling  and  soil  structure.1  Though controversy exist in the mode of entry, the most recent accepted theory is that the larval form of beetles enter through anus, especially in naked children, develop into adult ones and then fly out of the rectum. Rarely  adult  beetlesinvade  the gastrointestinal, urinary tract  and  rarely  nose  and eyes  causing severe irritation. The most common  presentation is presence of beetle in the stools or a swarm of beetle flying away from the anus during defecation.Loss of appetite, diarrhoea and abdominal pain has been reported.2 Peripheral eosinophilia can occur in some.3 Colonoscopy is usually normal as this is an ectoparasite without any mucosal involvement. Treatment consists of saline purgatives, improvement in personal hygiene, wearing protective underclothes during  playtime and sleep to prevent recurrence. Oral metronidazole helps to remove the insects from human digestivetract.4

References
  1. Brown  J,  Scholtz  CH,  Janeau  JL,  Grellier  S, Podwojewski  P.  Dung  beetles  (Coleoptera: Scarabaeidae)  can  improve  soil  hydrological properties. Applied Soil Ecology 2010;46:9-16
  2. Rajapakse S. Beetle marasmus. BMJ 1981; 283:1316-1317
  3. Nilratan Majumder, Shib Sekhar DattaScarabiasis in children: study from rural north-east India. Indian Journal of medical specialities. 2012;3(1):75-76
  4. Karthikeyan  G,  Ganesh  R,  SathiasekeranM.Scarabiasis. Indian Pediatr 2008;45:697-9.