title: Population Explosions of Tiger Moth Lead to Lepidopterism Mimicking Infectious Fever Outbreaks.
abstract: Lepidopterism is a disease caused by the urticating scales and toxic fluids of adult moths, butterflies or its caterpillars. The resulting cutaneous eruptions and systemic problems progress to clinical complications sometimes leading to death. High incidence of fever epidemics were associated with massive outbreaks of tiger moth Asota caricae adult populations during monsoon in Kerala, India. A significant number of monsoon related fever characteristic to lepidopterism was erroneously treated as infectious fevers due to lookalike symptoms. To diagnose tiger moth lepidopterism, we conducted immunoblots for tiger moth specific IgE in fever patients' sera. We selected a cohort of patients (n = 155) with hallmark symptoms of infectious fevers but were tested negative to infectious fevers. In these cases, the total IgE was elevated and was detected positive (78.6%) for tiger moth specific IgE allergens. Chemical characterization of caterpillar and adult moth fluids was performed by HPLC and GC-MS analysis and structural identification of moth scales was performed by SEM analysis. The body fluids and chitinous scales were found to be highly toxic and inflammatory in nature. To replicate the disease in experimental model, wistar rats were exposed to live tiger moths in a dose dependant manner and observed similar clinico-pathological complications reported during the fever epidemics. Further, to link larval abundance and fever epidemics we conducted cointegration test for the period 2009 to 2012 and physical presence of the tiger moths were found to be cointegrated with fever epidemics. In conclusion, our experiments demonstrate that inhalation of aerosols containing tiger moth fluids, scales and hairs cause systemic reactions that can be fatal to human. All these evidences points to the possible involvement of tiger moth disease as a major cause to the massive and fatal fever epidemics observed in Kerala.
authors.affiliation: MIMS Research Foundation, Malabar Institute of Medical Sciences (Aster MIMS), Kozhikode, Kerala, India.
authors.forename: Pallara Janardhanan
authors.initials: PJ
authors.lastname: Wills
authors.affiliation: MIMS Research Foundation, Malabar Institute of Medical Sciences (Aster MIMS), Kozhikode, Kerala, India.
authors.forename: Mohan
authors.initials: M
authors.lastname: Anjana
authors.affiliation: ICFO-Institut de Ciències Fotòniques, Barcelona, Spain.
authors.forename: Mohan
authors.initials: M
authors.lastname: Nitin
authors.affiliation: MIMS Research Foundation, Malabar Institute of Medical Sciences (Aster MIMS), Kozhikode, Kerala, India.
authors.forename: Raghuveeran
authors.initials: R
authors.lastname: Varun
authors.affiliation: State Forensic Science Laboratory, Thiruvananthapuram, Kerala, India.
authors.forename: Parayil
authors.initials: P
authors.lastname: Sachidanandan
authors.affiliation: Department of Statistics, Nirmala College, Muvattupuzha, Kerala, India.
authors.forename: Tharaniyil Mani
authors.initials: TM
authors.lastname: Jacob
authors.affiliation: MIMS Research Foundation, Malabar Institute of Medical Sciences (Aster MIMS), Kozhikode, Kerala, India.
authors.forename: Madhavan
authors.initials: M
authors.lastname: Lilly
authors.affiliation: MIMS Research Foundation, Malabar Institute of Medical Sciences (Aster MIMS), Kozhikode, Kerala, India.
authors.forename: Raghava Varman
authors.initials: RV
authors.lastname: Thampan
authors.affiliation: MIMS Research Foundation, Malabar Institute of Medical Sciences (Aster MIMS), Kozhikode, Kerala, India.
authors.forename: Koyikkal
authors.initials: K
authors.lastname: Karthikeya Varma
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D003141:Communicable Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D017449:Dermatitis, Allergic Contact / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D004196:Disease Outbreaks; D005076:Exanthema / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D005334:Fever / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009036:Moths / Q000276:immunology / Q000472:pathogenicity*; D051381:Rats; D017207:Rats, Sprague-Dawley; D017208:Rats, Wistar; D055815:Young Adult