Cutaneous myiasis: diagnosis, treatment, and prevention

The periscope sign as a new dermatoscopy finding to facilitate the diagnosis of furuncular myiasis

In this text, we introduce the ‘periscope sign’ as a novel dermatoscopic finding in furuncular myiasis. This clinical sign may aid in diagnosing this rare condition, particularly in patients with a history of travel to endemic areas.

Cordylobia anthropophaga Myiasis Mimicking Hyperproliferative Skin Disorder in Traveler Returning from Sub-Saharan Africa

Myiasis is one of the most common skin diseases found in travelers returning from tropical and subtropical regions, where humans living in or visiting the African continent are most commonly infested by C. anthropophaga during the rainy season in regions with a warm climate. Here, we present a case of furuncular myiasis caused by C. anthropophaga in a Serbian patient returning from temporary work in Kenya, where the initial histology of skin lesion mimicked hyperproliferative skin disorder.

Morphological and Molecular Characterizations of Cochliomyia hominivorax (Diptera: Calliphoridae) Larvae Responsible for Wound Myiasis in French Guiana

Myiasis is an ectoparasitic infection caused by the larvae of true flies (Diptera). We came across a rather rare case of myiasis in an immunocompetent 34-year-old man from French Guiana with advanced wound myiasis masquerading as cavitary myiasis and a history of cholesteatoma surgery in the left ear. The Diptera larvae responsible for the disease were isolated and identified using morphological and molecular approaches as Cochliomyia hominivorax. We underline the importance of this parasitosis as the second case of myiasis caused by C. hominivorax and the first case of wound myiasis in this overseas department of France and its incidence in pre-urban areas of the capital, Cayenne, in South America.

Traumatic sheep myiasis: A review of the current understanding

Myiasis, or the infestation of live humans and vertebrate animals by dipterous larvae, is a health issue worldwide. The economic impact and potential threat to animal health and wellbeing of this disease under the animal husbandry sector is considerable. Sheep are a highly vulnerable livestock category exposed to myiasis (sheep strike), due to several unique predisposing factors that attract flies. The successful mitigation of this disease relies on a thorough understanding of fly population dynamics associated with the change in weather patterns and the evaluation of this disease through different branches of science such as chemistry, molecular biology, and microbiology. The present review provides a summary of the existing knowledge of strike in sheep, discussed in relation to the application of volatile organic compounds, metagenomics, and molecular biology, and their use regarding implementing fly control strategies such as traps, and to increase the resilience of sheep to this disease through improving their health and wellbeing.

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

Ignatzschineria indica bacteremia in a patient with a maggot-infested heel ulcer: a case report and literature review

An elderly patient was admitted with sepsis to a community hospital. The individual was found to have a foot wound infested with maggots, and clinical evidence of cellulitis. A blood culture was positive on day 2 with Ignatzschineria indica . The patient was treated successfully with a combination of antibiotics and manual removal of the maggots. Poor living conditions were central to his presentation.

Ether for Wound Debridement of Wild Maggots

Myiasis is defined as an infestation of the organs or tissues of live vertebrates (humans or animals) by dipterous larvae, commonly referred to as maggots. Wound myiasis is a common presentation in the emergency department. The presence of wild maggots and larvae in wounds is concerning for subsequent myiasis-induced infections and complications. Proper extraction of wild maggots and larvae is required to avoid complications that may occur with wound myiasis. Surgical debridement is often utilized to extract wild maggots and larvae, but can be painful and time-consuming. There is limited literature available on alternative approaches for removal of wild maggots and larvae. We present a case of lower extremity wound myiasis that had wild maggots and larvae successfully removed with no complications using ether. This procedure is a novel, noninvasive, and pain-free way to extract wild maggots and larvae from wound myiasis.

Management of Malignant Wound Myiasis with Ivermectin, Albendazole, and Clindamycin (Triple Therapy) in Advanced Head-and-Neck Cancer Patients: A Prospective Observational Study

INTRODUCTION

Myiasis, tissue infestation by housefly larvae, is commonly found in malignant fungating wounds of cancer patients from climatic condition and lower socio-economic strata.

AIM OF STUDY

It was aimed to study the effectiveness of systemic Ivermectin, Albendazole& Clindamycin (Triple Therapy) in reducing signs & symptoms associated with maggots in malignant head and neck wounds.

METHOD

25 adult, advanced head and neck cancer patients presenting with maggots either from wound, oral cavity or nostril, with ECOG score 3 or less were enrolled in this study. Symptoms were assessed using Edmonton Symptom Assessment Scale (ESAS) and wound by Wound Assessment Tool - Hospice, at baseline and then Days 1, 3, 5, and 7. All patients received 3 days course of oral Ivermectin 12 mg per day, Albendazole 400 mg twice per day and Clindamycin 300 mg three times per day for 5 days along with Terpentine oil dressing. All patients received oral Morphine as per their pain score.

RESULTS

Mean age (yrs) and weight (Kg) were 42.15 ± 8.23 and 52.31 ± 5.18 respectively. 84% patients were male. Mean oral morphine dose was 100.38 mg. There was significant decrease in number of maggots from day 0 (77.28 ± 13.465) to day 1 (20.60 ± 7.263; 73.34% reduction) to day 3 (1.52 ± 2.104; 92.62% reduction). We found statistically significant improvement (P = <0.05) in scores of wound and all other related symptoms on days 1, 3, 5 & 7, except bleeding, edema, nausea, anxiety, appetite loss and feeling of wellbeing, which remained same on Day 1, but improved afterward. Side effects were self-limiting.

CONCLUSION

Systemic treatment with Ivermectin, Albendazole and Clindamycin (Triple Therapy) enhances the removal of maggots, early recovery and relief from distress and associated symptoms.

Eyelid inflammation: An uncommon cause in occidental countries

BACKGROUND

Myiasis designates the infestation of live human and vertebrate animals with dipterous (two-winged) larvae (maggots) and is the fourth most common travel-associated skin disease. Furuncle is the most common aspect of cutaneous myiasis.

CASE PRESENTATION

A 24-year-old Caucasian female had been back from Cap-Vert. She described pruritus, slight pain, and the sensation of a foreign body moving in the eyelid. Physical examination showed a single furuncle-like nodule with surrounding erythema and a central pore of the upper eyelid through which a serosanguinous fluid was exuding. A larval end was visible to the naked eye through the aforementioned pore. Treatment consisted of the application of petroleum jelly (Vaseline®) to produce localized hypoxia. A transparent occlusive dressing was set for a duration of 2 h. The larva, Cordylobia antropophaga, spontaneously externalized to breathe and was extracted.

DISCUSSION

There is an increase in travelers returning from tropical countries. Consequently, travel-associated dermatoses are increasing in non-endemic countries. Context of travel and typical clinical presentation strongly suggested to evoke a cutaneous myiasis. The typical furuncular lesion is a papule or nodule with a central punctum that exudes serosanguinous or purulent fluid. Ultrasound can be used to confirm the diagnosis. Treatment consists of three techniques: methods producing localized hypoxia to force emergence of the larvae, application of toxic substances to the eggs and larvae, and mechanical or surgical debridement. Surgery and antibiotics are usually unnecessary. Prevention of furunculous myiasis is based on vector control and individual actions to improve hygiene.

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.

Incidence of myiasis among humans-a review

Myiasis, the infestation of tissues of live humans and other vertebrate animals with dipteran larvae (maggots), is a phenomenon of widespread occurrence throughout the tropical regions of the world. It is commonly seen in domestic and wild animals but occurs rarely in man also. The tissue invasion in man by maggots is generally a well-recognized complication of neglected wounds. The condition may be asymptomatic but occasionally results in more or less severe problems and even death when larvae invade body cavities or areas that forbid their direct visual examination. Many cases of myiasis, however, usually do not reach the attention of medical practitioners because of the tendency of the mature larvae to migrate out of the lesion for pupation. In the present study, the authors reviewed the past literature describing the cases of human myiasis, causative fly species and predisposing factors for the onset of the same. The aim of the present manuscript is to provide a database for the future reference of medical entomologists, medical practitioners and veterinarians. Review of literature revealed that 37 fly species belonging to ten families were responsible worldwide for the onset of human myiasis. The incidence of myiasis among humans can be correlated to increasing fly populations, poor hygienic conditions and presence of domestic animals in the close vicinity. Other factors responsible for myiasis include neglected open wounds and foul-smelling discharge from natural body openings. Moreover, ignorance plays a key role in its occurrence since people are generally unaware about the actual cause and often correlate the condition to their superstitious beliefs. It is emphasized that the patients should not neglect their wounds and should take proper medical care; otherwise, myiasis may supervene.

Furuncular Myiasis Caused by Cordylobia rodhaini (Diptera: Calliphoridae): A Case Report and a Literature Review

Some African flies may cause myiasis not only in animals but also in humans, representing a serious health problem for the local population and for tourists. We report a rare case of furuncular myiasis due to larvae of Lund's fly Cordylobia rodhaini Gedoelst (Diptera: Calliphoridae), a species which usually parasitizes small mammals. The myiasis was diagnosed in Italy in a tourist guide who travelled in Central African rainforests of Uganda. The clinical case and the morphological criteria used for species identification are described here, together with a review of all literature cases of human furuncular myiasis due to C. rodhaini.

Simple and effective field extraction of human botfly, Dermatobia hominis, using a venom extractor

After a trip to Belize, a 25-year-old man noticed an erythematous papule on his upper right chest that enlarged over a 6-week period and formed a central aperture. The patient reported feeling movement and intermittent lancinating pains under the skin. The history and examination were consistent with cutaneous myiasis, likely secondary to the human botfly, Dermatobia hominis. The objective of reporting this case is to present a simple method of extraction of a botfly larva using a commercial venom extractor. The patient's upper chest was prepared, and an occlusive dressing was placed over the lesion for 30 minutes. The Extractor Pump (Sawyer Products, Safety Harbor, FL) was applied and activated, and the larva was rapidly extracted completely intact with no significant discomfort to the patient. The wound fully healed without complication. D hominis is a common etiology of cutaneous myiasis endemic to Belize. The larva burrows under the skin of mammals where it develops for a period of weeks before erupting and falling to the soil to pupate. The diagnosis and treatment of botfly infestation is pertinent to doctors in the United States as Central and South America are common travel destinations for North Americans. In this case, a commercially available venom extractor was demonstrated to be a safe, noninvasive, and painless method for botfly extraction in the field without use of hospital resources.

Oral myiasis in children

Oral myiasis is a rare condition in humans and is associated with poor oral hygiene, severe halitosis, mouth breathing during sleep, mental handicap, cerebral palsy, epilepsy, anterior open bite, incompetent lips, and other conditions. In this report, a 14 year-old boy who had an orofacial trauma in the maxillary dentoalveolar region,which was neglected, has been described. There was a deep lacerated wound on the upper vestibule which was infected and maggots were found on the same wound. The clinical features, management, treatment are discussed and relevant literature is reviewed.

Myiasis infestation in advanced oral squamous cell carcinoma

Oral myiasis is a rare manifestation in humans and is vulnerable to attack in conditions leading to persistent mouth opening along with poor oral hygiene, suppurating lesions and cancerous wound, mainly in tropical countries. Myiasis is diagnosed clinically based on the presence of maggots and traditional management is the mechanical removal of the larvae. This is a case report of myiasis in a 44-year-old man diagnosed with invasive oral squamous cell carcinoma. The treatment consisted of manual removal of the larvae and cleaning with aqueous chlorhexidin 0.12%. The patient's management was antisepsis, larval removal and general care, performed weekly. The patient died 2 months later. The management of patients by healthcare service and hygiene orientations is recommended to prevent oral myiasis infestation, mainly in patients living in fly breeding habitats and who do not comply with basic oral hygiene measures, which may be make individuals more prone to develop myiasis.

Oral myiasis in an elderly patient

BACKGROUND

Myiasis is the invasion of living tissue of humans and other mammals by eggs or maggots of flies of the order of Diptera. It occurs mainly in the Tropics and is associated with inadequate public and personal hygiene. Oral myiases in an older man appears to be rare.

OBJECTIVE

To relate a case of oral myiases in a debilitated older man treated by mechanical removal of the maggots, identifying the adult insect that caused the infestation.

METHODS

The diagnosis of oral myiasis was established by the clinical examination and it was detected that the infestation involved only soft tissue and the sinus cavity. The patient was submitted to two mechanical removal of the visible maggots.

RESULTS

Total of 110 maggots was removed from the oral cavity of the patient and adult insects was identified as belonging to the Calliphoridae Family, Cochliomyia hominivorax species. The patient died two days after the second procedure by severe systemic complications.

CONCLUSIONS

The mechanic removal and the identification of the maggots must be adopted as soon as possible to prevent further tissue damage and bacterial infection in cases of oral myiasis. Special attention should be given to the debilitated old patients that are particularly susceptible to oral myiasis infestation.