Kawasaki Disease with Retropharyngeal Edema following a Blackfly Bite

Abstract

We describe a patient with Kawasaki disease (KD) and retropharyngeal edema following a blackfly bite. An 8-year-old boy was referred to our hospital because of a 3-day-history of fever and left neck swelling and redness after a blackfly bite. Computed tomography of the neck revealed left cervical lymph nodes swelling with edema, increased density of the adjacent subcutaneous tissue layer, and low density of the retropharyngeum. The patient was initially presumed to have cervical cellulitis, lymphadenitis, and retropharyngeal abscess. He was administered antibiotics intravenously, which did not improve his condition. The patient subsequently exhibited other signs of KD and was diagnosed with KD and retropharyngeal edema. Intravenous immunoglobulin therapy and oral flurbiprofen completely resolved the symptoms and signs. A blackfly bite sometimes incites a systemic reaction in humans due to a hypersensitive reaction to salivary secretions, which may have contributed to the development of KD in our patient.

Skin Lesions and Systemic Reactions in Humans Infested by Blackflies (Diptera: Simullidae) in Recreational Areas in Southeastern Poland

“…Systemic reactions to the blackfly bites were observed in the patients eight times less frequently than skin lesions. The most common systemic reactions detected in the present study and described in the literature include headache, abdominal pain, arthralgia, nausea, weakness, increased body temperature, chills, menstrual disorders, nervous agitation, and cardiovascular disorders (e.g., [41,56,58,64,65]).…”

Blackfly fever and dermatitis caused by Simulium kiritshenkoi: a human case report in Iran

“…Blackfly fever is a systemic reaction in humans following a blackfly bite that includes headache, nausea, joints aching, high fever, weakness, and swollen lymph nodes [1]. In Japan, Watanabe described an 8-year-old boy with Kawasaki disease and retropharyngeal edema following blackflies bite [5]. Kawasaki disease, known also as mucocutaneous lymph node syndrome, causes inflammation in the walls of blood vessels throughout the body.…”

“…Moreover, they transmit pathogenic nematodes (such as Onchocerca gutturosa and Onchocerca cervicalis), viruses causing Eastern equine encephalitis and vesicular stomatitis, protozoa (the genus Leucocytozoon) to livestock and birds [3,4]. Also, blackfly bites could cause local pain, redness, dermatitis, wounds, blackfly fever, and retropharyngeal edema in humans due to a reaction to blackfly salivary compounds [4,5]. Blackfly fever is a systemic reaction following a blackfly bite that includes headache, nausea, fever, weakness, and swollen lymph nodes [1].…”

Simulum fly bites

“…Case reports from different parts of the world have been reported. [1][2][3][4][5] Only one singular rare case of ocular Onchocerciasis has been reported from non-endemic north eastern part of India. 3…”