Maggot therapy for treatment of osteomyelitis and deep wounds: an old remedy for an actual problem

Squamous cell carcinoma associated with an active cutaneous leishmaniasis in immunocompetent patient: case presentation of an unlikely association and literature—review

Background

Association between leishmaniasis and malignancy can be classified into four categories: leishmaniasis mimicking malignancy, leishmaniasis co-existing with malignancy, malignancy developing in patients with leishmaniasis scar, and leishmaniasis developing in patients with malignancy. In immunocompetent patients, the main form of association is cutaneous squamous cell carcinoma (cSCC) developing within cutaneous leishmaniasis scar years after cutaneous leishmaniasis is cured. Association of active cutaneous leishmaniasis and cSCC is exceptional, we are aware of two more cases.

Case presentation

A 30-year-old man presented with 2 years history of an unhealed wound on the dorsum nasi. As there still exist few sites of leishmaniasis in Morocco, systematic screening for leishmania was performed. Leishmania bodies were identified on slit skin smear by Giemsa staining. The patient received local antibiotic and on-site injections of 4 cc of meglumine antimonate for 2 months without any improvement. The lesion volume has increased significantly, a biopsy revealed an invasive squamous cell carcinoma. After staging assessment, the patient underwent a complete removal of the nasal tumor with a 1-cm margin, associated with right modified radical neck dissection. Histopathological examination confirmed the diagnosis of SCC with no lymph nodes metastasis. Nasal reconstruction was performed 2 weeks later using a frontal flap. Oncology meeting board advised adjuvant radiation on the tumor. The patient is followed up regularly and remains free of disease for a year now.

Conclusion

Although many cancers are related to infection (viral or parasitic), there is no proven link between leishmaniasis and malignancy. However, there are many etiopathogenic theories based on pathology finding that involve chronic inflammation inducing dysplasia, mitotic abnormalities, and expression of p53.

Detection of Leishmania spp. in Chronic Dermatitis: Retrospective Study in Exposed Horse Populations

Leishmania infantum is a protozoan causing human zoonotic visceral leishmaniasis (ZVL) and visceral–cutaneous canine leishmaniosis (CanL) in the Mediterranean Basin. L. infantum is able to infect a large number of wild and domestic species, including cats, dogs, and horses. Since the 1990s, clinical cases of equine leishmaniasis (EL), typically characterized by cutaneous forms, have been increasingly diagnosed worldwide. The aim of the present study was to evaluate the presence of clinical forms of EL in CanL-endemic areas in Italy, where exposure of equine populations was ascertained from recent serological surveys. For this purpose, formalin-fixed and paraffin-embedded skin biopsies of 47 horses presenting chronic dermatitis compatible with EL were retrospectively selected for the study and subjected to conventional and q-PCR. A singular positivity for L. infantum was found; BLAST analysis of sequence amplicons revealed a 99–100% homology with L. infantum sequences. The histological examination revealed a nodular lymphoplasmacytic and histiocytic infiltrate; immunohistochemistry showed rare macrophages containing numerous positive amastigotes. The present retrospective study reports, for the first time, a case of a cutaneous lesion by L. infantum occurring in an Italian horse. Pathological and healthy skin samples should be investigated on a larger scale to provide information on the potential clinical impact of EL in the practice, and to define the role of horses in epidemiological ZVL and CanL scenarios.

Maggot debridement therapy for postsurgical wound infection in scoliosis: a case series in five patients

STUDY DESIGN

Case series of 5 patients who developed resistant wound infection after scoliosis surgery.

OBJECTIVE

To present maggot debridement therapy (MDT) as an effective alternative to the conventional treatment in postsurgical infection in scoliosis.

SUMMARY OF BACKGROUND DATA

Numerous clinical reports have been published that describe outstanding effects of MDT, most notable on debridement, cleansing, disinfection, and healing of indolent wounds, many of which have previously failed to respond to conventional treatment. However, till date no reports have been found in the literature describing its use for the treatment of wound infection after scoliosis surgery, which has relatively longer and deeper wound.

METHODS

A total of 5 patients (2 females and 3 males) who developed wound infection after scoliosis correction surgery were included in this study. All were operated for neuromuscular scoliosis using posterior approach with pedicle screw fixation. All developed deep wound infection within 2 to 6 weeks of surgery, which was resistant to all kinds of conventional therapy. MDT applied in all using prepared commercially available maggot bags, and dressing was changed twice a week till wound shows signs of healing. After confirming negative culture, MDT was stopped and routine dressings or secondary closure was done. During the treatment, wound appearance, size, and development of healing were observed.

RESULTS

There were 1 patient with paralytic scoliosis and 4 with cerebral palsy. All wound healed completely within 5.2 ± 1.8 weeks of MDT or 8.8 ± 3.8 cycles of MDT. There was no recurrence on final follow-up of 21.6 ± 5.9 months. Wound size was also decreased from 24.2 ± 3.3 cm of pre-MDT to 11.8 ± 4.5 cm post-MDT showing 51.2% reduction in wound size. There was partial implant removal in 2 cases before MDT; however, no further implant extraction was needed in any case after MDT. Treatment was tolerated well by all patients without any obvious complications due to MDT.

CONCLUSION

We would propose to use MDT for the treatment of wound infection after scoliosis surgery as an effective alternative to conventional treatment. In this way, implant extraction could be avoided without losing any correction.

Clinical research on the bio-debridement effect of maggot therapy for treatment of chronically infected lesions

OBJECTIVE

To evaluate the bio-debridement effect of maggot therapy for treating chronically infected lesions.

METHODS

A retrospective study was conducted of 25 patients with diabetic foot ulcers and 18 patients with pressure ulcers after spinal cord injury treated by maggot therapy or traditional dressing. Changes in the lesions were observed and bacterial cultures tested.

RESULTS

All ulcers healed completely. The times taken to achieve bacterial negativity, granulation and healing of lesions were all significantly shorter in the maggot therapy group than in the control group, both for diabetic foot ulcers (P < 0.05) and pressure ulcers (P < 0.05).

CONCLUSION

Maggot therapy is a safe and effective method for treating chronically infected lesions.

Maggot Debridement Therapy in the Treatment of Chronic Wounds in a Military Hospital Setup in Turkey

BACKGROUND

The medicinal use of maggots for the biological debridement of chronic wounds is increasing around the world, due to its efficacy, safety and simplicity. Thousands of patients have been treated in private and governmental hospitals during the last 10 years.

OBJECTIVE

To examine the efficacy of maggot debridement therapy (MDT) in the debridement of chronic wounds in a military hospital.

METHODS

MDT was applied for 1-9 days to 7 male and 4 female soldiers or their family members (21-72 years old) with chronic wounds.

RESULTS

Complete debridement was achieved in 10 out of 11 patients, while in 1 patient the wound could be cleaned only partially. A remarkable reduction in the odor emanating from the wound and notable granulation were observed in all debrided wounds. Increased pain was observed in 1 patient with a venous stasis ulcer.

CONCLUSION

We believe that MDT is a rapid and effective method for the debridement of chronic wounds in a military environment especially in times of war in developing countries.

Amputation-sparing treatment by nature: "surgical" maggots revisited

Maggots were used as adjunct treatment for infected wounds that showed no response to the classical approach of wound debridement and antibiotic therapy. We summarize findings for 11 patients with necrotic wounds who received treatment with "surgical" maggots (100-2900 applied in 3-10 changes of dressing) for 11-34 days, which apparently aided in tissue remodeling and cure, and describe 2 typical patients in detail.