Cutaneous myiasis

Efficacy of Afoxolaner (NexGard®) in the treatment of furuncular myiasis caused by Dermatobia hominis fly (Diptera: Cuterebridae) in naturally infested dogs

Furuncular myiasis due to Dermatobia hominis is the second most common skin diseases in dogs that live in tropical climates in Central and South America, causing discomfort and injuring in the connective tissue of the affected dog. Therefore, the objective of the study was to evaluate the effectiveness of Afoxolaner (Nexgard®) in the treatment of canine furuncular myiasis. Twenty-five dogs naturally infested with D. hominis were selected and received a single oral dose of 2.5 mg/kg body weight of Afoxolaner (NexGard®). Larval infestations were classified as light (< 2 larvae), moderate (2 to 5 larvae) and severe (> 5 larvae), according to the number of larvae found in the wound. Twenty-four hours post-treatment, infested lesions were inspected, and all larvae were mechanically removed from the lesion site. All removed larvae were identified as D. hominis larvae and were found dead within 24 h after treatment, demonstrating 100% larvicidal efficacy of Afoxolaner against D. hominis larvae.

Human myiasis in Sub-Saharan Africa: A systematic review

BACKGROUND

Human myiasis is a parasitic dipteran fly infestation that infects humans and vertebrates worldwide. However, the disease is endemic in Sub-Saharan Africa and Latin America. In Sub-Saharan Africa, it is under-reported and therefore its prevalence is unknown. This systematic review aims to elucidate the prevalence of human myiasis, factors that influence the infection, and myiasis-causing fly species in SSA. The review also dwelled on the common myiasis types and treatment methods of human myiasis.

METHODS

Here, we collect cases of human myiasis in Sub-Saharan Africa based on literature retrieved from PubMed, Google Scholar and Science Direct from 1959 to 2022. A total of 75 articles and 157 cases were included in the study. The recommendations of PRISMA 2020 were used for the realization of this systematic review.

RESULTS

In total, 157 cases of human myiasis in SSA were reviewed. Eleven fly species (Cordylobia anthropophaga, Cordylobia rodhaini, Dermatobia hominis, Lucilia cuprina, Lucilia sericata, Oestrus ovis, Sarcophaga spp., Sarcophaga nodosa, Chrysomya megacephala, Chrysomya chloropyga and Clogmia albipuntum) were found to cause human myiasis in SSA. Cordylobia anthropophaga was the most prevalent myiasis-causing species of the reported cases (n = 104, 66.2%). More than half of the reported cases were from travelers returning from SSA (n = 122, 77.7%). Cutaneous myiasis was the most common clinical presentation of the disease (n = 86, 54.7%). Females were more infected (n = 78, 49.6%) than males, and there was a higher infestation in adults than young children.

CONCLUSION

The findings of this study reveals that international travelers to Sub-Saharan Africa were mostly infested therefore, we recommend that both international travelers and natives of SSA be enlightened by public health officers about the disease and its risk factors at entry points in SSA and the community level respectively. Clinicians in Sub-Saharan Africa often misdiagnose the disease and most of them lack the expertise to properly identify larvae, so we recommend the extensive use of molecular identification methods instead.

The Human Botfly "Bubbling Sign": Ultrasound Features of Cutaneous Furuncular Myiasis

Dermatobia hominis , the human botfly, is native to South and Central America with cases of infestation seen in travelers to these areas. Myiasis is the cutaneous manifestation of larvae between two periods of molting (instar) and presents as a firm furuncular mass with a central pore that can be easily clinically overlooked. Ultrasound is useful in the diagnostic workup and has specific features and techniques to demonstrate live larva. We present a patient who acquired cutaneous furuncular myiasis caused by D. hominis , the human botfly, during her jungle trek in the Amazon forests in South America. Over 5 weeks, she developed a firm furuncular lesion with a central pore. Ultrasound revealed a hypoechoic mass with a hyperechoic oblong-shaped core that showed a fluid circulation, confirming the presence of a viable larva. Surgery was performed and a second-instar D. hominis larva was confirmed. We discuss the key ultrasound findings and management of cutaneous furuncular myiasis with the aim of raising awareness of this condition, adding to the growing body of literature likely associated with the re-opening of global travel routes.

Present and future: infectious tropical travel rashes and the impact of climate change

In this article, we discuss pertinent cutaneous findings with which patients may present after travel to tropical destinations. We address arthropod-borne infectious diseases such as cutaneous leishmaniasis, Chagas disease, cutaneous larva migrans, and myiasis. We discuss other relevant diseases with cutaneous signs such as monkey pox and severe acute respiratory syndrome coronavirus 2. We provide clinicians with information regarding the background, diagnosis, treatment, and prevention of these tropical rashes. In addition, we address the impact that climate change will have on the temporal and geographic incidence of these rashes. Viral, fungal, and vector-borne diseases have seen a geographic expansion into more northern latitudes. Among these are tick-borne Lyme disease, aquatic snail-related seabather's eruption, and atopic dermatitis. As these diseases spread, we believe that the updated information within this article is significant to the practicing physician in today's warming world.

Case of multiple furuncular myiasis in Northeast Ethiopia

Human myiasis is a neglected disease caused by parasitic infestation of the skin, cavities, and other body parts by larvae (maggots) of a wide variety of dipteran flies. Here, we present a case of multiple furuncular myiasis caused by Cordylobia anthropophaga in a 61‐year‐old woman from Northeast Ethiopia.

Obligate myiasis by Cordylobia species is common throughout tropical areas from Africa. It can occur at any age of the life and clusters of furuncular lesions in which the white end of a maggot can be seen indicating this infestation. It is self‐limiting but can result in secondary infection.

Prevalence, Etiology, and Risk Factors Associated with Occurrence of Canine Cutaneous Myiasis in Kitui County, Kenya

Myiasis is the infestation of living tissues of animals with dipterous larvae. In Africa, Cordylobia species (C. anthropophaga, C. rodhaini, and C. ruandae) and Dermatobia hominis are reported as the principal cause of nonmigratory cutaneous myiasis of domestic animals. None of these have been reported in dogs in Kenya. A cross-sectional study was conducted in eight subcounties of Kitui County, Kenya, from March to August 2021 to estimate the prevalence, risk factors, and etiological agents associated with canine cutaneous myiasis (CCM). A questionnaire was administered to dog owners to collect information on CCM risk factors. A total of 400 dogs were physically examined and larvae collected from myiasis skin lesions and preserved in 70% ethanol, taken to the laboratory, processed and identified using parasitological morphological features. Live larvae were incubated and emerging adults were captured and identified. The overall prevalence of CCM was 45% (180/400) (95% confidence interval: 40.0–50.0%). A total of 434 larvae were collected from 180 dogs infested with cutaneous myiasis. All larvae (100%) were identified as C. anthropophaga and hatched adults were “tumbu” flies. There were no significant differences in the prevalence of CCM at 95% confidence interval among different age and sex groups ( $p>0.05$ ), although puppies (<6 months) appeared more affected. The highest prevalence of myiasis was in Kitui Central at 65% (95% confidence interval: 51.6–76.9%), Mwingi North at 52.5% (95% confidence interval: 36.1–68.4%), Kitui South at 48.5% (95% confidence interval: 31.5–63.9%), Kitui Rural at 40% (95% confidence interval: 27.6–53.5%), Mwingi Central at 40% (95% confidence interval: 24.9–56.7%), Mwingi West at 40% (95% confidence interval: 24.9–56.7%), Kitui West at 38.3% (95% confidence interval: 26.1–51.8%), and Kitui East subcounty at 36.7% (95% confidence interval: 24.6–50.1%). Lack of housing, housing structures, and dog living area environmental hygiene were the main risk factors associated with the occurrence of CCM ( $p<0.05$ ). The CCM occurrence was significantly different among breeds ( $p<0.05$ ). Cordylobia anthropophaga larvae were the etiological agent of CCM in Kitui County. There is a need for improved dog housing and hygiene measures to prevent the occurrence of CCM, and affected dogs should be treated to prevent the spread of CCM among the dogs.

Point-of-Care Ultrasound Findings in a Case of Botfly Myiasis Contracted in the United States

Botfly infiltration is a rare cause of pediatric skin manifestations in the United States, but should be considered in nonhealing wounds even in nontravelers. We describe the case of a healthy 6-y-old female who had never traveled outside of the southeast United States, presenting with a nonhealing skin lesion. The point-of-care ultrasound (POCUS) findings suggested subcutaneous parasitic infiltration. This case demonstrates the role of POCUS in identification of subcutaneous parasitic infiltration, and differentiation from other, more common skin lesions.

Current and future strategies against cutaneous parasites

Cutaneous parasites are identified by their specific cutaneous symptoms which are elicited based on the parasite's interactions with the host. Standard anti-parasitic treatments primarily focus on the use of specific drugs to disrupt the regular function of the target parasite. In cases where secondary infections are induced by the parasite itself, antibiotics may also be used in tandem with the primary treatment to deal with the infection. Whilst drug-based treatments are highly effective, the development of resistance by bacteria and parasites, is increasingly prevalent in the modern day, thus requiring the development of non-drug based anti-parasitic strategies. Cutaneous parasites vary significantly in terms of the non-systemic methods that are required to deal with them. The main factors that need to be considered are the specifically elicited cutaneous symptoms and the relative cutaneous depth in which the parasites typically reside in. Due to the various differences in their migratory nature, certain cutaneous strategies are only viable for specific parasites, which then leads to the idea of developing an all-encompassing anti-parasitic strategy that works specifically against cutaneous parasites. The main benefit of this would be the overall time saved in regards to the period that is needed for accurate diagnosis of parasite, coupled with the prescription and application of the appropriate treatment based on the diagnosis. This review will assess the currently identified cutaneous parasites, detailing their life cycles which will allow for the identification of certain areas that could be exploited for the facilitation of cutaneous anti-parasitic treatment.

Childhood Furuncular Cutaneous Myiasis Associated with Seborrheic Dermatitis: A Case Report

Myiasis is a parasitic infection caused by dipterous fly larvae that can affect various organs in both human and animals. Cutaneous myiasis is the most common type of myiasis and can be classified into three categories, localized furuncular myiasis, migratory myiasis, and wound myiasis. One of the risk factors for myiasis is seborrheic dermatitis. The definitive treatment for the condition requires complete extraction of larvae, in combination with oral therapy, and localized occlusion to promote hypoxia. This paper reports a case of a 12-year-old girl with furuncular cutaneous myiasis associated with seborrheic dermatitis on the occipital region that showed significant improvements after manual extraction of larvae after local anesthesia injection of 2% lidocaine on the base of the lesion, in combination with oral and topical therapies

First record of traumatic myiasis obtained from forest musk deer (Moschus berezovskii)

Myiasis is an infestation of maggots on living tissue in humans and animals all over the world. It is known to occur in wild animals, while no information is reported in forest musk deer (Moschus berezovskii). During our research on the conservation of forest musk deer, we found a new record of traumatic myiasis of an injured forest musk deer. The flies are likely Lucilia caesar (Linnaeus, 1758) according to the results of DNA barcoding technology. We report traumatic myiasis of forest musk deer for the first time, which expands the information on parasite and myiasis of forest musk deer and confirms the potential risk of traumatic myiasis of forest musk deer.

Effectiveness of sarolaner in the clinical management of furuncular myiasis in dogs naturally infested with Dermatobia hominis (Diptera: Cuterebridae)

Background

The human botfly, Dermatobia hominis, is a common cause of furuncular myiasis in dogs in Latin America. Lesions can be single or multiple, each harboring an individual larva, presented as an erythematous nodule that causes pruritus and pain. Typical treatment consists of sedation for removal of larvae by surgical incision or manual pressure. Medications to kill the larva before its extraction can reduce inflammation and discomfort and provide a less traumatic larval removal. Isoxazolines are broad-spectrum ectoparasiticides with larvicidal activity previously reported in the treatment of screwworm myiasis in companion animals. The aim of this study was to evaluate the effectiveness of sarolaner as part of the clinical management of furuncular myiasis in dogs caused by D. hominis larvae.

Methods

Ten short-haired mixed breed dogs naturally infested with D. hominis were enrolled. Clinical diagnosis was achieved by observation of skin nodules and visualization of larval motility through the lesion orifice. Sarolaner was administered at manufacturer recommended dose for fleas and ticks. Lesions were reexamined 24 h post-treatment and assessed for viability of larvae. Larvae were removed by digital compression and identified as D. hominis.

Results

Seventy-five D. hominis larvae were retrieved from ten dogs. No live larvae were observed, demonstrating 100% larvicidal efficacy of sarolaner. Skin lesions were healed 30 days post-treatment and new lesions were not observed.

Conclusions

Sarolaner seems to be effective as larvicidal treatment for dogs with furuncular myiasis, reducing discomfort caused by the presence of the larva in the skin and facilitating its safe removal.

Graphical abstract

Cutaneous myiasis in skin cancer and malignant wounds: a systematic review

BACKGROUND

Cutaneous myiasis in patients with malignant wounds or skin cancer is a rare and undesirable event with limited epidemiological data. A subregister of reports, lack of education in the population, inadequate empirical treatments, and medical underestimation are components of a public health problem that threatens patients' lives.

METHODS

We conducted a systematic review of the literature of cutaneous myiasis associated with malignant wounds and skin cancer, characterizing sociodemographic variables, risk factors, clinical and histological features, and treatment. Additionally, we present a demonstrative case with the adequate taxonomic evaluation.

DISCUSSION

Cutaneous myiasis is an underestimated and poorly managed infestation, which can generate severe complications in oncological patients. This is the first systematic review in the literature about this clinical scenario, which provides information to the physician and clinical researcher about the epidemiological gaps and what has been published so far.

CONCLUSIONS

Findings from the current review have helped to display the sociodemographic, epidemiological, and clinical behavior of myiasis in skin cancer and malignant wounds. Its contribution to the greater tumor tissue destruction is clear; however, more studies are required. The therapeutic management in these patients is equally clarified.

Feeding gastrostomy stoma site cutaneous myiasis: a rare entity

Infestation of any dead or necrotic tissues by the larvae of flies (maggots) is myiasis. This form of habitation is not restricted to any particular tissues in the body and can occur anywhere. However, myiasis at the surgical stoma site is very rare. We present a 55-year-old woman diagnosed with metastatic carcinoma of the oesophagus who underwent feeding gastrostomy (FG). The patient later presented with worms at the FG site. We removed the FG tube, cleared all the maggots, thoroughly cleaned the wound and placed a new FG tube. Although its occurrences have been reported enough in medical history, there are only two documented cases of percutaneous endoscopic gastrostomy stoma site myiasis. Hence, we present the first case in the literature of cutaneous myiasis around an FG stoma site.

Oral myiasis affecting paediatric patients: a systematic review

INTRODUCTION

Oral myiasis is a rare condition caused by Dipteran larvae that feed on living or dead tissues, ingested food or body fluids. It affects immunocompromised individuals with low socioeconomic status or those unable to maintain proper hygiene. Cases of oral myiasis are scarce but debilitating in children. We conducted a systematic review to understand the nature of disease, its causative factors, treatment and ways to prevent the occurrence of this condition among children.

METHODOLOGY

The review was carried out in accordance with Preferred Reporting Items for Systematic Review and Meta-analysis guidelines. A systematic electronic literature search was conducted on major databases using keywords in combination with Boolean Operators. Manuscripts discussing cases of oral myiasis in paediatric patients were included in the review.

RESULTS

The exhaustive literature search and evaluation of full texts revealed 32 studies that fulfilled the inclusion criteria. A total of 68 cases of oral myiasis were reported from 2 to 16 years of children, majorly involving gingiva of maxillary anterior region and palate.

CONCLUSION

The dreadful condition of myiasis can be prevented by decreasing the number of flies, maintenance of good hygiene and by educating the susceptible population. Affected children must be managed by following proper treatment regimens.

Wound myiasis in Western Europe: prevalence and risk factors in a changing climate scenario

Background

Myiasis is an infestation of neglected open wounds by fly larvae. Global warming, related climate changes, and increased traveling in tropical countries may contribute to the worldwide diffusion of new fly species. Common risk factors for myiasis are advanced age, poor hygiene, malnourishment, social isolation, diabetes, cancer, and peripheral artery disease. The aim of this study was to review the characteristics of cases of myiasis reported in Europe.

Methods

A narrative review of cutaneous myiasis was performed using PubMed, EMBASE, Web of Science database, and the search terms “human,” “myiasis,” “cutaneous myiasis,” “maggot,” “Europe,” “wound,” with the combination of “AND” and “OR.” In addition, hospital charts were reviewed to add personal experience to the literature review.

Results

Overall, 52 articles, both single case reports and case series reporting cutaneous myiasis, were found in the medical literature of the past two decades. A total of 64 patients living in Europe were identified, of whom 36% had wound myiasis. In addition to the literature review, we report the case of a male patient who presented with myiasis within a deep scalp ulcer occurring after radiotherapy for basal cell carcinoma.

Conclusion

Myasis is rare and possibly under-reported in Europe. The epidemiology of this infestation may be changing in the future due to climate variability, a rise in travel to tropical areas, and the migration of fly species.

Vector-borne diseases and tourism in Iran: Current issues and recommendations

Iran is one of the largest countries in the Middle East with lots of historical and natural attractions. This country has always been considered to be one of the most important tourist destinations in the world. Several important vector-borne diseases have been reported from different parts of the country. Thus, having comprehensive and adequate knowledge about the main vector-borne diseases in Iran and their high-risk areas are really important. In this review, different provinces of Iran have been studied in terms of arthropod-borne diseases reported in the last decades. Reports indicated that some vector-borne diseases such as Leishmaniasis and CCHF had the highest incidence rate and they need serious attention. However, some diseases reported from Iran are not endemic, and all cases were imported such as Dengue fever. A group of arthropod-borne diseases was reported only from animals, and the health of travelers is not threatened such as Eyeworm infection.

Climate change, human migration, and skin disease: is there a link?

Climate change, exemplified by higher average global temperatures resulting in more frequent extreme weather events, has the potential to significantly impact human migration patterns and health. The consequences of environmental catastrophes further destabilize regions with pre-existing states of conflict due to social, political, and/or economic unrest. Migrants may carry diseases from their place of origin to their destinations and once there may be susceptible to diseases in which they had not been previously exposed to. Skin diseases are among the most commonly observed health conditions observed in migrant populations. To improve awareness among dermatologists of the burden of skin diseases among migrants, the group searched the English language scientific literature to identify articles linking climate change, migration, and skin disease. Skin diseases associated with human migration fall into three major categories: (i) communicable diseases, (ii) noncommunicable diseases, and (iii) environmentally mediated diseases. Adopting comprehensive global strategies to improve the health of migrants requires urgent attention.

Dermatoscopy of Infections and Infestations

Dermoscopy is a non-invasive tool for the diagnosis of skin diseases. Entomodermoscopy is a branch of dermoscopy that deals with infections and infestations. The use of dermoscopy for diagnosis of infections and infestations is rapidly increasing as it can provide useful clues related to diagnosis and effectiveness of treatment. It serves as a useful adjunct to microbiological and histopathological examination. In some cases, like scabies dermoscopy can even clinch the diagnosis.

CRANIAL OSTEOMYELITIS AS A COMPLICATION OF FURUNCULAR MYIASIS

Objective:

To report the case of an infant with infrequent cranial osteomyelitis as a complication of furuncular myiasis.

Case description:

The patient was a 4-month-old male who presented to the emergency department with a nodular skull lesion with edema, tenderness, pain, and purulent drainage, as well as progress of the ulcerated lesion and evidence of larvae inside. Antibiotic treatment was initiated, and the patient was taken to the operating room to remove the larvae, but he had no symptomatic improvement. A skull radiograph was taken to visualize the osteolytic lesion, and a 3D computed tomography scan showed osteomyelitis of the external parietal surface. Antibiotic management readjustment continued for a total of six weeks, and a skin flap was used with clinical improvement.

Comments:

Myiasis is defined as the infestation of vertebrates with fly larvae. In mammals, larvae can feed on host tissue and cause a wide range of infestations depending on their location in the body. The cranial osteomyelitis as a complication of myiasis described in this report seems to be an exceptional case.

The Botfly, A Tropical Menace: A Distinctive Myiasis Caused by Dermatobia hominis

Dermatobia hominis, also known as the human botfly, is native to tropical and subtropical Central and South America and seen in travelers from endemic to temperate regions including the United States and Europe. Cutaneous infestation botfly myiasis involves the development of D. hominis larvae in the skin and is common in tropical locations. The distinct appearance of a cutaneous D. hominis infestation facilitates early diagnosis and intervention where cases are common. However, the identification of D. hominis in temperate regions may prove challenging due to its rarity. D. hominis may be misdiagnosed as folliculitis, an epidermal cyst, or an embedded foreign object with secondary impetigo. One should have a heightened suspicion in someone returning from a vacation in an endemic area, such as Belize. Here we describe the presentation, differential diagnosis, and treatment and encourage enhanced preventative measures among tourists when visiting tropical and subtropical regions. Additionally, we propose a novel classification system for assessing the various stages of infestation and suggest that patients reporting travel to Latin America and experiencing pain disproportionate to an insect bite should lead physicians to consider myiasis caused by D. hominis.

Painful lesion in the forearm of a child traveller

In this article, we intend to discuss a case of cutaneous myiasis in a British child traveller who recently travelled to Somaliland. A Cordylobia anthropophaga larva was identified as the species that caused the disease. The case report, which contains a video illustration of the causative agent, proved a diagnostic challenge at presentation.

Oral myiasis: Analysis of cases reported in the English literature from 1990 to 2020

Myiasis is an infection caused by the deposition of fly larvae in tissues, and its involvement in the human oral cavity is uncommon. Herein, we have performed a data analysis of published cases of oral myiasis. A search was performed in PubMed, Ovid, Web of Science, Scopus, and LILACS. Geographic distribution, demographic data, associated factors, clinical features, fly types, treatment, and presence of sequelae were analyzed. A total of 122 articles reported the cases of 157 infected individuals. The most affected countries were India (41%) and Brazil (29.5%). Male predominance (67.5%) and a mean of 41.9 years of age were observed. The gingiva (29%) was the most affected site, followed by palate (25%) and lip (21%). There were different forms and combinations of treatments: manual removal of larvae and surgical debridement, application of asphyxiating substances, antibiotic therapy, and use of ivermectin. The condition predominantly affects individuals with neurological and/or locomotor disabilities, of low socioeconomic status, with poor oral hygiene and chemical dependence and individuals with previous injuries or with the absence of lip sealing. The establishment of a standard treatment protocol, enabling comparison in future studies and providing uniformity in treatment strategies offered by health services is strongly recommended.

Case Report: Furuncular Myiasis in Malawi

Furuncular myiasis results when the larva penetrates healthy skin to cause a furuncle like nodule which may mimic common dermatoses like insect bites and pyoderma leading to misdiagnoses. Tumbu fly (Cordylobia anthropophaga) is the most common cause in Africa and is endemic in Malawi. We describe a case of C. anthropophaga furuncular myiasis from a 6-month-old baby who presented with an acute history of a rash and was initially misdiagnosed on two occasions. Treatment consisted of manual removal of the larva and subsequent local wound care with a good outcome. We believe that much as Malawi is in the endemic region of the Tumbu fly, the disease’s clinical mimicking of common dermatoses and the patients’ preference to treat themselves at home may result in clinicians gaining less experience in managing furuncular myiasis cases in their daily practice leading to misdiagnoses. This report therefore demonstrates the practical challenges which unwary clinicians and patients in Malawi might encounter when faced with this otherwise common condition. It further highlights the importance of dermatologists and other non-dermatologist clinicians to consider furuncular myiasis among differential diagnoses in like lesions which in turn will reduce the unnecessary use of antibiotics and delay correct patient treatment.

Cutaneous Myiasis Around Gastrostomy (PEG) Tube Insertion Site: The Second Case Report

Background:

Myiasis refers to the infestation of live human with 2-winged larvae (maggots). Cutaneous myiasis is the most commonly encountered clinical form. It is divided into 3 main forms: furuncular, creeping (migratory), and wound (traumatic) myiasis.

Case report:

In this article, we report an extremely rare case of myiasis around percutaneous endoscopic gastrostomy (PEG) tube in a 71-year-old female patient. She had the tube placed for feeding purposes, 8 months prior to her presentation. Family noticed alive worms emerging from skin at the gastrostomy tube insertion site. Patient was treated conservatively with daily dressing with no debridement or use of systemic agents.

Conclusions:

PEG tube cutaneous myiasis is an extremely rare disease. Conservative management with petroleum-based and sterilizing agents is shown to be efficient to clear the disease in a short period of time.

A formulation of neem and hypericum oily extract for the treatment of the wound myiasis by Wohlfahrtia magnifica in domestic animals

Untreated, traumatic, or wound myiases can cause severe consequences to animal health and welfare as well as economic losses to livestock productions. For healing myiasis-caused wounds, disinfectant such as creolin is wrongly but currently used in association with insecticides. Though effective, creolin is highly toxic to the patients, is inadequate with respect to the repellent effect, and may delay the healing of treated wounds. In this uncontrolled study, the efficacy of the patented plant-derived formulation 1 Primary Wound Dressing© (1-PWD), composed of neem oil (Azadirachta indica A. Juss.) and the oily extract of Hypericum perforatum (L.) flowers, has been investigated. Forty-four domestic animals of different species suffering from wound myiasis lasting for up to 25 days, at different parts of the body, were enrolled in the study. No systemic or local antibiotic or disinfectants' treatment was administered. Larvae recovered on open wounds and adults reared from mature larvae were identified as Wohlfahrtia magnifica. All the treated wounds healed in a range of 10 to 32 days without further infestation. None of the recruited animals presented bacterial complications. Data herein presented indicate that the tested natural plant-derived formulation is able to manage the infestation caused by W. magnifica larvae and the healing process of traumatic infested wounds in several domestic animal species, without any side effect on the living tissue and without the need to use local or systemic chemical or other products.

Cutaneous myiasis in an elderly woman in Somaliland

Background

Cutaneous myiasis is a self-limited skin infestation by developing fly larvae, with three clinical subtypes: furuncular, migratory, and wound myiasis. Furuncular myiasis is endemic throughout much of Africa; however, few reports are from the Horn of Africa.

Clinical presentation

An 85-year-old woman in Somaliland presented with a 12-day history of multiple painful and pruritic nodules on the temple, arm, chest, breast, flank, and legs. The posterior of a larva was visible within several lesions. One larva was extracted from an arm nodule and identified as Cordylobia anthropophaga (tumbu fly) by morphologic examination. The patient was instructed to occlude the other nodules with petroleum jelly and return in 3 days. Instead, she visited a traditional healer who extracted the remaining larvae.

Conclusions

We present a case of furuncular cutaneous myiasis due to Cordylobia anthropophaga. Treatment options for this infestation include occlusion with petroleum jelly to cause larvae to exit, surgical extraction, and oral ivermectin. Occlusion may not be acceptable for some patients. Extraction may cause significant inflammatory response if the larva is damaged during the process. To our knowledge, this is the first published report of myiasis in Somaliland, although it is probably underreported. Myiasis is a common dermatosis associated with travel to endemic areas. Furuncular myiasis can easily be misdiagnosed as furunculosis or cellulitis. Dermatologists must be familiar with the clinical features and management of this dermatosis.

Tungiasis, a rare case of plantar inflammatory disease, a review of travelers skin lesions for emergency providers

Parasitic infections while common in underdeveloped nations are rarely seen in developed urban centers. We report a case of a thirty-three-year-old male with no past medical history who presented to the emergency department with a chief complaint of "eggs coming out of my foot" after returning home from Brazil. Based on clinical presentation, travel history, and appearance of the lesion, diagnosis was most consistent with tungiasis infection which was confirmed by the pathology examination. It is important to make the appropriate diagnosis when skin lesions are found in returning travelers and emergency providers should take broad differential diagnosis into consideration.

Otomyiasis: Systematic Review

Introduction  Myiasis is a disease caused by fly larvae that grow in the tissues of animals and humans. It can cause a variety of local symptoms, like erythema or pain, depending on its location, and generalized symptomatology, such as fever and malaise. Myiasis can generate severe complications, for instance sepsis, or directly impact vital tissues. Its management varies depending on the location, and on the preferences of the doctor that faces this challenge. Myiasis usually occurs in tropical countries, and, in many places, it is not a rare condition. The cases are rarely reported, and there are no published management protocols. Objective  To review the literature regarding the most common agents, the predisposing factors and the treatment alternatives for otic myiasis, a rare form of human myiasis caused by the infestation of fly larvae in the ear cavities. Data synthesis  We present a systematic review of the literature. The search in five databases (Medline, Embase, Cochrane Database of Systematic Reviews, LILACS and RedALyC) led to 63 published cases from 24 countries, in the 5 continents. The ages of the patients ranged from newborn to 65 years old. The most common agents belong to the Sarcophagidae or Calliphoridae families. Chronic otitis media, previous otic surgical procedures, mental deficit, alcohol or drug abuse, sleeping outdoors, prostration, and malnutrition were predisposing factors. The treatment alternatives are herein discussed. Conclusion  The results highlight the need for monitoring, follow-up and standardization of medical approaches.

Efficiency of an air curtain as an anti-insect barrier: the honey bee as a model insect

BACKGROUND

Vector-borne diseases are of high concern for human, animal and plant health. In humans, such diseases are often transmitted by flying insects. Flying insects stop their flight when their kinetic energy cannot compensate for the wind speed. Here, the efficiency of an air curtain in preventing insects from entering a building was studied using the honey bee as a model.

RESULTS

Bees were trained to visit a food source placed in a building. The air curtain was tested with strongly motivated bees, when the visiting activity was very high. Airflow velocity was modulated by setting an air curtain device at different voltages. At the nominal voltage, the anti-insect efficiency was 99.9 ± 0.2% compared with both the number of bees at a given time in the absence of the air curtain and the number of bees before the activation of the air curtain. The efficiency decreased as the airflow velocity decreased.

CONCLUSION

The results show that an air curtain operating at an airflow velocity of 7.5 m s^-1 may prevent a strong flyer with high kinetic energy, such as the honey bee, from entering a building. Thus, air curtains offer an alternative approach for combating vector-borne diseases. © 2018 Society of Chemical Industry.

Travelers' tropical skin diseases: Challenges and interventions

Tropical regions receive a significant part of the traveling population. It is very important that health professionals are familiar with the main tropical skin diseases and able to advice patients appropriately. This article reviews the main tropical diseases of travelers, with an emphasis on diagnosis, management, and prevention. Among others, cutaneous larva migrans, myiasis, tungiasis, Chagas disease, Dengue fever, African trypanosomiasis, filariasis, and leishmaniasis are discussed. Increasing awareness among travelers and health care professionals can help reduce morbidity and mortality. Continued research on new drugs and vaccines is needed to reduce the risks of tropical diseases.

Wound myiasis: the role of entodermoscopy

Although wound or traumatic myiasis is common in tropical countries, only recently cases associated with underlying dermatoses, such as seborrheic dermatitis and psoriasis, have been reported. We describe a patient with seborrheic dermatitis and an ulcerated lesion on the scalp, in which the dermatological examination with the aid of dermoscopy allowed the identification of larvae (maggots) compatible with infestation by Cochliomyia hominivorax. Treatment was performed with oral and topical ivermectin, followed by manual extraction of the larvae.

Cutaneous myiasis: Think beyond furunculosis

Background

Cutaneous myiasis is the infestation of the skin by larvae (maggots) of the order Diptera (two winged). Being an imported and sporadic illness, furuncular myiasis often poses a diagnostic challenge to the treating physician. This traditionally endemic entity is being more frequently reported worldwide as 'vacation' disease in travellers returning from these regions. However, there is a paucity of large scale study, especially on individuals occupationally stationed for longer periods of time in these endemic geographic locations.

Methods

Sixteen Indian male patients with cutaneous furuncular myiasis presenting to dermatology outpatient department at a tertiary care field hospital deployed in a United Nations peacekeeping mission in Central Africa were studied for clinical presentation, sites involved, larvae/maggot extracted, period of resolution and complications if any.

Results

Average age of patients was 29 years. The average duration of infestation was 4 days. All lesions were found to be confined to sites over body normally covered with clothing, commonest being anterior abdomen in 9 (56.25%) patients followed by chest in 6 (37.5%) patients. The lesion count was also highest on anterior abdomen with 39 lesions. The average time to resolution following extraction of larvae (Cordylobia anthropophaga) was 6 days.

Conclusion

The purpose of this study was to familiarize oneself with an endemic infestation which often masquerades itself as pyoderma to the naïve physician, more so in an imported case or more importantly, an 'exported' health care professional.

Idiopathic, Infectious and Reactive Lesions of the Ear and Temporal Bone

A number of infectious, inflammatory and idiopathic lesions develop within otologic tissues that may share similar clinical and/or microscopic features. This review first provides a working classification for otitis externa, and then otitis media and includes two recently described entities, eosinophilic otitis media and otitis media with ANCA-associated vasculitis. Next, the microscopic findings of a spectrum of otopathologic conditions are described, including post-inflammatory conditions such as tympanosclerosis and aural polyps, an overview of animate aural foreign body as well as iatrogenic aural foreign body reactions. Finally, a review of fungal disease affecting the ear with a brief synopsis of Candida auris, a recently described and virulent organism, is presented.

A Case of Cutaneous Myiasis Caused by Cordylobia anthropophaga Larvae in a Korean Traveler Returning from Central Africa

The cutaneous myiasis has been rarely reported in the Republic of Korea. We intended to describe here a case of furuncular cutaneous myiasis caused by Cordylobia anthropophaga larvae in a Korean traveler returned from Central Africa. A patient, 55-year-old man, had traveled to Equatorial Guinea, in Central Africa for a month and just returned to Korea. Physical examinations showed 2 tender erythematous nodules with small central ulceration on the left buttock and thigh. During skin biopsy, 2 larvae came out from the lesion. C. anthropophaga was identified by paired mouth hooks (toothed, spade-like, oral hooklets) and 2 posterior spiracles, which lack a distinct chitinous rim. Although rarely described in Korea until now, cutaneous myiasis may be encountered more frequently with increasing international travel and exchange workers to tropical areas.

Parasitic Infections of the Skin and Subcutaneous Tissues

A variety of arthropods, protozoa, and helminths infect the skin and subcutaneous tissues and may be identified by anatomic pathologists in standard cytology and histology preparations. The specific organisms seen vary greatly with the patient's exposure history, including travel to or residence in endemic countries. Arthropods are the most commonly encountered parasites in the skin and subcutaneous tissues and include Sarcoptes scabei, Demodex species, Tunga penetrans, and myiasis-causing fly larvae. Protozoal parasites such as Leishmania may also be common in some settings. Helminths are less often seen, and include round worms (eg, Dirofilaria spp.), tapeworms (eg, Taenia solium, Spirometra spp.), and flukes (eg, Schistosoma spp.). This review covers the epidemiologic and histopathologic features of common parasitic infections of the skin and subcutaneous tissues.

Dermatoscopy in Diagnosis of Cutaneous Myiasis Arising in Pemphigus Vulgaris Lesions

Myiasis, infestation of live human and vertebrate animals by larvae, can complicate ulcers and open wounds. Although myiasis occurs in neglected erosions of pemphigus, such a complication is not documented in the literature. Herein, we report a case of myiasis complicating pemphigus vulgaris and describe its dermatoscopic features.

A Case of Furuncular Myiasis Due to Cordylobia anthropophaga in a Korean Traveler Returning from Uganda

A fly larva was recovered from a boil-like lesion on the left leg of a 33-year-old male on 21 November 2016. He has worked in an endemic area of myiasis, Uganda, for 8 months and returned to Korea on 11 November 2016. The larva was identified as Cordylobia anthropophaga by morphological features, including the body shape, size, anterior end, posterior spiracles, and pattern of spines on the body. Subsequent 28S rRNA gene sequencing showed 99.9% similarity (916/917 bp) with the partial 28S rRNA gene of C. anthropophaga. This is the first imported case of furuncular myiasis caused by C. anthropophaga in a Korean overseas traveler.

Emerging infectious diseases with cutaneous manifestations: Fungal, helminthic, protozoan and ectoparasitic infections

Given increased international travel, immigration, changing climate conditions, and the increased incidence of iatrogenic immunosuppression, fungal, protozoan, helminthic, and ectoparasitic infections that were once uncommon are being seeing more frequently in the Western hemisphere. However, the diagnosis and management of these infections is fraught with a lack of consistency because there is a dearth of dermatology literature on the cutaneous manifestations of these infections. In addition, delays in the diagnosis and treatment of these diseases can lead to significant patient morbidity and mortality. We review the epidemiology, cutaneous manifestations, diagnostic modalities, and treatment options for emerging fungal, protozoan, helminthic, and ectoparasitic infections. It should be noted, however, that throughout this review we cite statistics documenting their increased incidence to back-up these infections as emerging, and although some of the diagnoses are clinical, others rely on newer laboratory tests, and the possibility exists that the increased incidence could be caused by better detection methods.

A rare case of digital myiasis

Cutaneous myiasis is the infestation of the skin or mucous membranes by larvae of the order Diptera. Wound myiasis affect the skin with a previous lesion, and it may consume both dead and living tissue. Finger infestation is rarely a cause of death, but it may provoke considerable morbidity. Prompt wound exploration and careful total larvae removal is essential to achieve healing. In the reported case, the patient was presented in an advanced stage of the infestation, with a large area of finger necrosis and amputation, associated with cellulitis extending from the finger's base to the hand. This diagnosis helped uncover a familiar history of severe abuse and neglect. The accurate understanding and management of such injuries are important not only for the orthopaedic treatment but also for the acknowledgment of their social and forensic implications.

Canine Wound Myiasis Caused by Lucilia sericata (Diptera: Calliphoridae) in Korea

Myiasis is a relatively common infection of animals kept as pets, although only 1 case of canine myiasis has been described so far in the Republic of Korea. In the present study, we report an additional case of canine wound myiasis with identification of its causative agent, Lucilia sericata. An 8-year-old male Siberian husky dog was referred with anorexia, vomiting, and diarrhea to the Chungbuk National University Veterinary Medical Center, Cheongju-si (city), Chungcheongbuk-do (province), Korea in July 2013. Physical examination indicated the patient had a deep wound filled with a maggot swarm as a left gluteal lesion. A total of 216 maggots were removed by forceps, and the wounded area was sponged with gauzes and disinfected with 70% alcohol and a povidone-iodine solution. After daily care and suturing the wound, the patient was discharged at day 19 after admission. Recovered worms possessed morphological characteristics similar to those of L. sericata, namely, a sub-cylindrical body with 6–8 lobed anterior spiracles, round shaped with a button surrounded by a peritremal ring with no gaps, and similar distances between dorsal, median, and outer papillae of the 12th segment. Additionally, cox1 partial sequences (528 bp) obtained in the present study showed 100% identity with those of L. sericata (GenBank no. KT272854.1). L. sericata is indicated as a pathogen of myiasis infection not only in humans, but also in animals kept as pets in Korea.