An unusual drug death involving maggots

Effect of Lorazepam on the Development of the Hairy Maggot Blow Fly, Chrysomya rufifacies (Macquart): Implication for Forensic Entomology

Entomotoxicology is based on using insect evidence recovered from a dead body to find out the cause and time of the death. Drugs can accumulate in fly larvae when they ingest the flesh of deceased persons and alter the normal development of the fly causing implications in calculating postmortem intervals. Lorazepam is an antidepressant generally used to treat anxiety. Larvae of Chrysomya rufifacies were fed on the beef liver mixed with lorazepam to study the effect of lorazepam on the developmental rate of larvae and to count delay in postmortem interval. Larvae grown on the beef liver with different doses of lorazepam showed delayed development as compared to normal larvae. The life cycle durations in experimental cultures with different concentrations of lorazepam completed in 1 ppm (272.56 hrs), 2 ppm (289.23 hrs), 3 ppm (324.10 hrs), and 4 ppm (350.72 hrs), while in the control culture life cycle completed in 257.26 hrs. The length, weight, and width of the larvae treated with lorazepam were smaller than the untreated culture. Length, weight, and width decreased with increased concentration of lorazepam. This delay in development ultimately affects the postmortem interval. That is why prior knowledge of the life cycle of flies with respect to various drugs needs to be studied, and these baseline data can be used to calculate postmortem interval and cause of death.

In the case of extensively putrefied bodies, the analysis of entomological samples may support and complement the toxicological results obtained with other alternative matrices

Entomotoxicological analysis is not part of routine toxicological analysis. This work aims to present two cases to illustrate the potential of entomological samples as complementary matrices to identify substances in cases of advanced putrefaction. (Case#1) A woman wasexhumed after 14 months to ascertain the exact cause of death. She died after six weeks of hospitalization because of intestinal ischemia followed by multiorgan failure. (Case#2) The corpse of a woman, known to have a psychiatric disorder, was discovered in her apartment. The state of decomposition of the body was consistent with a post-mortem period of several weeks (approximately 6 weeks). Toxicological investigations were performed in the biological and entomological samples of case#1 (hair, adipocere, brain, and pupae) and of case#2 (hair, bone, flies, and pupae) using liquid chromatography with high-resolution mass spectrometry and tandem mass spectrometry detection methods. In case#1, several drugs and metabolites were detected. In particular, the pupae analyses allowed the objectification of morphine administration, whereas morphine was only found in adipocere, but not in hair nor in brain. In case#2, the pupae analyses allowed the detection of three metabolites of quetiapine, and the flies analyses allowed the detection of valpromide, which was only detected in hair. In conclusion, the pupae and flies analyses in these two cases complemented the results obtained in the other alternative biological samples, which may guide hypotheses about the possible causes of death. Nevertheless, additional data and case reports would be of benefit to assess the value of entomotoxicology in routine forensic investigations.

Unexpected results found in larvae samples from two postmortem forensic cases

Purpose

In forensics, entomological specimens can be used as additional/alternative matrices to detect xenobiotics when human specimens are limited in their application. Despite some advantages over implementing putrefied human remains, most medico-legal laboratories do not include entomotoxicological procedures as routine analytical methods. We thus applied two authentic cases to evaluate necrophagous larvae’s potential as complementary matrices for toxicological analysis after extensive postmortem decomposition.

Methods

Larvae and postmortem human samples, including hair, stomach contents, pericardial fluid, liver, lung, and skeletal muscle, were collected at autopsy. Samples were analyzed by liquid chromatography–tandem mass spectrometry and liquid chromatography–quadrupole time-of-flight mass spectrometry for pharmaceutical substances, illicit drugs, and new psychoactive substances, including synthetic cannabinoids, benzodiazepines, new synthetic opioids, and stimulants.

Results

Nearly all substances detected in human specimens, including several benzodiazepines and synthetic cannabinoids, were also detected in larvae. Surprisingly, some drugs, including the new psychoactive substances EAM-2201 and U-47700, were found exclusively in larvae and hair. The benzodiazepine etizolam was detected only in liver, lungs, and stomach contents, possibly resulting from characteristic tissue distribution in humans and/or larvae.

Conclusions

Antemortem external hair contamination with synthetic cannabinoids from side-stream smoke and postmortem hair contamination with substances in putrefaction fluids can be supposed in these cases. Our findings suggest that supplementary information can indeed be gained from analyzing larvae additional to those human specimens that are typically used for toxicological analysis after extensive postmortem decomposition. Nevertheless, these results represent merely two cases, requiring in-depth studies to determine whether such findings can identify acute intoxications as possible causes of death.

The implication of morphometrics and growth rate of dipteran flies in forensic entomotoxicology research: a review

Forensic entomotoxicology integrates toxicology into forensic entomology to estimate minimum postmortem interval (PMI_min) and circumstances of death where toxicants and poisonous substances are the suspected cause of death. Forensic entomotoxicology not only confirms the presence of toxicants in insects feeding off a cadaver but also studies its effect on the bio-morphometry and growth rate of insects. This review article highlights the effects of various toxicants on forensically important species of dipteran flies. It also discusses the parameters that may affect accuracy in estimation of time since death. The bio-physical effects of toxicants (excluding the analytical approach for qualitative detection) would help understand the trends in forensic entomotoxicological research worldwide.

Detection of heroin metabolites at different developmental stages of Lucilia cuprina (Diptera: Calliphoridae) reared in heroin-treated meat: a preliminary analysis

Background

Blowfly larvae and pupae collected during post-mortem forensic investigation can be analysed to detect drugs or toxins in a dead body. Drug or toxin-contaminated tissues of human remains consumed by blowfly larvae are stored in the crop even after a body has decomposed to the point where no fluid or tissues are retrievable. Therefore, blowfly larva and pupa are favourable specimens under conditions in which host tissues or blood samples are not available.

Methodology

We carried out a study to detect heroin metabolites in Lucilia cuprina (Weidemann, 1830) immatures fed on different concentrations of heroin-treated meat: 500, 1000, 2500, 5000, and 10,000 ng/μl. Heroin metabolites detection was performed by a gas chromatography mass spectrophotometry (GCMS) analysis.

Results

This study indicates that L. cuprina can be utilized in a toxicological analysis to detect heroin in a host. However, the expected complete metabolites of heroin were not detected in the first instar larvae and pupa, while the second and third instar larvae contributed to a complete heroin metabolite which was morphine. This was subject to the heroin concentration given. Morphine was detected in the third instar larvae treated with 5000 and 10,000 ng/μl heroin, while in the second instar, it was detected only at 10,000 ng/μl. Heroin metabolites detected in the second and third instar larvae proves that biochemical conversions occur in the fly larvae.

Conclusion

The absence of heroin metabolites in the first instar larvae and pupa does not necessarily mean that the drug was not present in the host. Therefore, the limitations of heroin detection capability during these stages should be always kept in mind, as this could contribute to a false-negative result in a forensic analysis. If all stages are available during sample collection, it is crucial to prioritize the third instar larvae in a toxicological analysis.

Development and validation of a LC/MS method for the determination of Δ(9)-tetrahydrocannabinol and 11-carboxy-Δ(9)-tetrahydrocannabinol in the larvae of the blowfly Lucilia sericata: Forensic applications

In a number of forensic toxicological cases, Δ(9)-tetrahydrocannabinol (THC) and its metabolite 11-carboxy-delta-9-tetrahydrocannabinol (THCA) are frequently considered as contributor factors to the event. To that, a liquid chromatographic mass spectrometric method is described for the identification and quantitation of THC and its metabolite THCA in the forensically important larvae of L. sericata. Larvae of Lucilia sericata were fortified with varying concentrations of THC and THCA covering the calibration range between 10 and 500pg/mg. For the isolation of the analytes from larvae, several extraction techniques were evaluated and finally liquid-liquid extraction under acidic pH was selected using hexane-ethyl acetate (50:50, v/v) as extraction solvent. For the chromatographic separation, a Waters Symmetry® C18 analytical column was used while the mobile phase was acetonitrile-ammonium acetate (2mM) (30:70, v/v). The detection was performed using electrospray ionization source in negative mode (ESI-) and the selected ions monitored were m/z 313 for THC and m/z 343 for THCA. The proposed method which is simple and sufficiently sensitive for the detection of THC and THCA even in a single larva sampling, assisted the investigation of a forensic case.

Effect of ketamine on the development of Lucilia sericata (Meigen) (Diptera: Calliphoridae) and preliminary pathological observation of larvae

The estimation of postmortem interval (PMI) based on the growth patterns of necrophagous arthropods is the main mission of forensic entomology in practice. The larval development rates can be affected by various drugs or toxins, causing deviation in PMI estimate. Ketamine is a widely used anesthetic and recreational drug in Asia, which is rarely focused on in the previous entomotoxicological studies. The present work investigated the effect of ketamine on the development of Lucilia sericata (Meigen) (Diptera: Calliphoridae) by the measurement of body length and weight and the analysis of relationship between the ketamine effect and drug dosage or time interval, meanwhile the difference between ketamine effect on larval body length and weight was also analyzed. Additionally, the preliminary pathological observation of larvae was also employed for evaluating the drug effect in morphology. Significant differences were observed between control and treatment colonies of L. sericata at each life stage, and the effect of ketamine displayed a dosage-and-time-dependent manner, but no differences were noticed between the effects of ketamine on larval body length and weight, which provided a useful indication for larvae sample collection in practice. The pathological observation revealed that ketamine could promote the growth of trophocytes in fat body of L. sericata.

Entomotoxicology, experimental set-up and interpretation for forensic toxicologists

Forensic entomotoxicology studies the usefulness of insects as alternative toxicological samples. Use of insects as alternative matrix for drug detection is well documented and recommended when conventional matrices such as blood, urine or internal organs are no longer available. However, several limitations of entomotoxicology have been highlighted, especially concerning interpretation of the drug concentrations in insects on human forensic cases. In addition, the lack of knowledge in pharmacokinetic of drugs in insects, large variability of experimental set-up and toxicological analysis compromise the utility of this science. This review focuses on the current knowledge of factors influencing drug detection in insects. Reasons for the current limitations, but also recommendations for future research are discussed and proposed in this paper.

Postmortem toxicology of drugs of abuse

Conducting toxicology on post-mortem specimens provides a number of very significant challenges to the scientist. The range of additional specimens include tissues such as decomposing blood and other tissues, hair, muscle, fat, lung, and even larvae feeding on the host require special techniques to isolate a foreign substance and allow detection without interference from the matrix. A number of drugs of abuse are unstable in the post-mortem environment that requires careful consideration when trying to interpret their significance. Heroin, morphine glucuronides, cocaine and the benzodiazepines are particularly prone to degradation. Moreover, redistributive process can significantly alter the concentration of drugs, particularly those with a higher tissue concentration than the surrounding blood. The designer amphetamines, methadone and other potent opioids will increase their concentration in blood post-mortem. These processes together with the development of tolerance means that no concentration of a drug of abuse can be interpreted in isolation without a thorough examination of the relevant circumstances and after the conduct of a post-mortem to eliminate or corroborate relevant factors that could impact on the drug concentration and the possible effect of a substance on the body. This article reviews particular toxicological issues associated with the more common drugs of abuse such as the amphetamines, cannabinoids, cocaine, opioids and the benzodiazepines.

Drug analysis in blowfly larvae and in human tissues: a comparative study

The present study investigates the correlation between concentrations of drugs in human tissues and Diptera larvae feeding on these tissues. Samples of liver were taken from 18 cases in which preliminary toxicological screening indicated the presence of drugs. Blowfly larvae (Diptera: Calliphoridae) were reared on these samples and subsequently analyzed for drug content. Toxicological analyses were carried out using ONLINE Abuscreen (Roche) and GC/MS for available body fluids (blood, urine and bile) as well as liver samples and maggots. All drugs detected in human tissues were also detected in insect specimens. Opiates, cocaine and barbiturates as well as some antidepressants (clomipramine, amitryptiline, nortryptiline, levomepromezine and tioridazine) were observed. Comparisons of drug concentrations between those in human tissues and blowfly larvae showed different patterns of distribution that may be attributed to differences in physiology. Results confirm the reliability of entomological specimens for qualitative analyses, although quantitative extrapolations are unreliable. All xenobiotics detected were in higher concentrations in human tissues than in maggots. Concentrations in post-feeding maggots were significantly lower than for feeding maggots, suggesting that the feeding state of maggots may affect toxicological analyses as they metabolize and eliminate drugs during development.

Postmortem drug analysis: analytical and toxicological aspects

Publications focusing on the analysis of postmortem specimens for the presence of drugs were reviewed with particular reference to systematic toxicological analysis. Specimens included blood, liver, other solid specimens, and fly larvae. Extraction techniques published during the past 10 years most commonly used traditional solvent extraction techniques. High-performance liquid chromatography coupled to multichannel wavelength detection was most commonly used, which would easily lend itself to liquid chromatography-mass spectrometry. There were few practical differences in the assays validated for a range of postmortem specimens to those in other forms of forensic toxicology, unless substantially decomposed tissue was used. When putrefied specimens were analyzed, a back-extraction or other form of specimen cleanup was recommended to reduce interfering substances. Many immunoassays designed for urine have been adapted for use in blood and tissue homogenates. Immunoassays designed for blood analysis, however, are likely to have more useful cutoff values than immunoassays optimized for urine testing. Postmortem specimens provide less stability for a number of drugs than other types of specimens. This is particularly a problem for cocaine, heroin, and some antidepressants, antipsychotics, and benzodiazepines. A number of artifacts occur postmortem, which affects the concentration of drug in specimens. This includes postmortem redistribution for drugs with a high tissue concentration relative to blood. Consequently, the likely extent of any change in concentration is relevant to the interpretation of doses and drug effects.