Selective antimicrobial activity of maggots against pathogenic bacteria

A Parallel Randomized Clinical Trial for Comparison of Two Methods of Maggot Therapy, Free-Range Larvae and Larval-bag, in Diabetic Ulcer (Wagner 2)

In the present study, the efficiency of two formulations of maggot therapy: free-range larvae on the wounds and larvae in a special bag (larval-bag), was compared for healing diabetic ulcers with Wagner 2 diabetic ulcer. This study was conducted as a parallel randomized clinical trial. Out of 281 patients with Wagner grade 2 diabetic ulcers referred to the wound clinic, 54 patients who met the inclusion criteria were randomly assigned to intervention groups. The disinfected larvae of Lucilia sericata were put on the wounds with 2 methods, free-range larvae and larval-bag. Follow up was done at every 48 h interval until the full appearance of granulated tissues. The main measures were wound bed preparation, removing of necrotic tissues, appearing of granulated tissues, and removing of bacterial infections in the wounds. Statistical analysis based on the Kaplan-Meier curve and the Wilcoxon (Breslow) test showed a significant reduction in wound healing time by using free-range larvae in comparison with larval-bag (P = .03). The median time to debridement was 4 days in the free-range larval group (95% confidence interval: 3-9 days) while it was 9 days in the larval-bag group (95% confidence interval: 5-16 days). Debridement rate (proportion of removed necrotic tissue surfaces) at any time in the free-ranged larvae group was 1.78 times that of the bagged larvae group (95% confidence interval 1.01-3.15, P = .036). There was no significant difference between free-range larval use and larval-bag in the acceptability of maggot therapy by patients (P = .48). It can be concluded that both of two formulations of the larval therapy (free-range larvae and larval-bag) could be recommended for cleaning out and bed preparation of diabetic ulcers. However, using free-range larvae is hardly recommended on the wounds which are eligible to use.

Effects of antibiotics ceftriaxone and levofloxacin on the growth of Lucilia sericata (Diptera: Calliphoridae)

Lucilia sericata is one of the most studied species in forensic entomology due to its widespread distribution, forensic importance as well as medical use. The growth and development stage of maggots is often used to determine the post-mortem interval in forensic cases. L. sericata can cause myiasis in humans who are not able to maintain personal hygiene due to age or medical condition and can therefore be used to determine the time period of neglect. The influence of the temperature on the maggot development has been examined in various studies. Different examinations on the effects of toxic substances on the maggot development and survival have been conducted in order to test the influence and resulting deviations. In this study, the effects of different therapeutical doses of the antibiotics ceftriaxone and levofloxacin were examined on L. sericata in order to determine and compare deviations in maggot development and survival. The used antibiotics did not significantly influence the maggot weight and length. A significant delay in the time of pupation has been determined in the treatments with high concentrations of levofloxacin. The mortality was significantly increased in all treatments with antibiotics compared to the control, whereby the survivability of all treatments remained over 80%. Because of the high doses needed to produce an effect, we concluded that an overestimation of the post-mortem interval is unlikely but higher antibiotic concentrations or possible interactions with other medications could increase the maggot development time.

In vitro antibacterial activity and synergetic effect of crude extract of the Wohlfahrtia nuba (Diptera: Sarcophagidae) flesh fly larvae

Multidrug-resistant pathogens have become ubiquitous, and effective treatment alternatives are urgently required. Maggot therapy is a promising agent that is being studied to overcome antibiotic-resistant pathogens. This study evaluated the antibacterial activity of the larvae extract of the Wohlfahrtia nuba (wiedmann) (Diptera: Sarcophagidae) flesh fly on the growth of five pathogenic bacterial species (methicillin-sensitive Staphylococcus aureus [ATCC 29213], methicillin-resistant Staphylococcus aureus [ATCC BAA-1680], Pseudomonas aeruginosa [ATCC 27853], Escherichia coli [ATCC 25922], and Salmonella typhi [ATCC 19430]) in vitro by using different techniques. Resazurin-based turbidimetric assay demonstrated that the W. nuba maggot exosecretion (ES) was potent against all the bacterial species tested, and according to the determined minimum inhibitory concentration (MIC) for each bacterium, gram-negative bacteria were more sensitive than gram-positive bacteria. Additionally, colony-forming unit assay showed that maggot ES was able to inhibit bacterial growth rate for all bacterial species tested, where the highest bacterial reduction was observed with methicillin-sensitive S. aureus (MSSA) followed by S. typhi. Moreover, maggot ES was shown to be concentration-dependent, where 100 μL of ES at 200 mg/mL was bactericidal towards methicillin-resistant S. aureus (MRSA) and P. aeruginosa compared with 100 μL at the MIC of the ES. Moreover, based on the result of agar disc diffusion assay, maggot extract was more efficient against P. aeruginosa and E. coli than the remaining reference strains tested. Furthermore, the combination between regular antibiotics with maggot ES at different concentrations indicated that ES acts synergistically with the tested antibiotics against the five bacterial models.

Sterilization of Lucilia sericata (Diptera: Calliphoridae) Eggs for Maggot Debridement Therapy

Maggot debridement therapy (MDT) is a therapy with the medical use of sterile fly larvae of certain species, particularly those within the Calliphoridae family including green bottle fly, Lucilia sericata (Meigan, Diptera: Calliphoridae), for treating chronically infected wounds and ulcers. Lucilia sericata flies were maintained under insectary conditions, and the eggs were sterilized using three treatments: hydrogen peroxide solutions, used as a hand disinfectant (Treatment 1-T1), hydrogen peroxide, surface disinfectant (Treatment 2-T2), and SaniHigene (Treatment 3-T3) and the control (without treatment). All three treatment caused the complete sterilization of eggs, and no bacterial colonies were found on the blood agar culture. The egg hatching rate after 72 h was much higher than after 24 h. Egg mortality in hydrogen peroxide solutions, T1 and T2, was 3-4% and less than in solution T3 (13%). Owing to less mortality and more sterility of the eggs, the aforementioned solutions are suggested to be appropriate for sterility in maggot therapy.

The current and advanced therapeutic modalities for wound healing management

Ever-increasing demands on improving efficiencies of wound healing procedures are a strong driving force for the development of replacement approaches. This review focuses on wound healing management from the point of formation to the point of healing procedures. The most important usual healing modality with key characteristic is explained and their limitations are discussed. Novel interesting approaches are presented with a concentration of the unique features and action mechanisms. Special attention is paid to gas plasma and nanotechnology impact on wound healing management from fundamental processes to beneficial outcomes. Challenges and opportunities for the future trend that combined common protocols and emerging technologies are discussed.

Effectiveness of broad-spectrum antiseptics in production of disinfected maggots of Lucilia sericata for use in wound debridement therapy

The establishment of low-cost, effective, safe and practical methods is necessary to increase the use of larval therapy in wound care. Although studies on external disinfection of calliphorid eggs have been reported, many studies lack data on the effect of disinfection on egg viability and the microorganisms found before disinfection. Therefore, the main objective of this study was to compare three antiseptic solutions, that is, chlorhexidine (5%), Dakin's solution (0.5% NaOCl) and povidone-iodine (10%), in terms of their ability to disinfect Lucilia sericata eggs. Egg viability after disinfection and microorganisms present on the eggs and larvae before and after treatment were also examined. None of the antiseptics had a significant effect on egg viability. Disinfection of L. sericata eggs with 0.5% NaOCl was the best method, as sterility tests showed no contamination. Escherichia coli, Bacillus subtilis and Proteus mirabilis were present in all cultures isolated from the non-disinfected eggs and larvae, while Enterococcus faecium, Enterococcus faecalis, Morganella morganii, Corynebacterium spp. and Providencia stuartii were isolated from more than half of the same cultures. Sterility testing of medicinal maggots after disinfection is crucial to prevent secondary infections and achieve a positive therapeutic outcome.

Effects of antibiotics ceftriaxone and levofloxacin on the growth of Calliphora vomitoria L. (Diptera: Calliphoridae) and effects on the determination of the post-mortem interval

The determination of the post-mortem interval (PMI) is one of the main tasks of forensic entomology, where growth and stages of development of arthropods are used for PMI determination. It is well acknowledged that maggot development is significantly influenced by temperature. Attention has also been paid to the microbial populations of the cadaver, because toxic substances contained in the substrate can influence the microorganisms and affect arthropods growth and development. However, little is known about the influence of antibiotics taken during lifetime of a person on insect development after that persons death. The aim of this study was to test the hypothesis that the antibiotics ceftriaxone and levofloxacin cause inhibition of growth and delay of pupation of the blow fly Calliphora vomitoria, which would then lead to an incorrect determination of the post-mortem interval in forensic cases. It was found that maggot development was delayed by levofloxacin mixed in minced pork, where a mixture of both antibiotics increased this effect. The maggot growth in the samples with ceftriaxone was not delayed. Pupation was delayed in treatments with a mixture of both antibiotics. The mortality was reduced by separate or combined application of ceftriaxone and levofloxacin, which we attribute to a bactericidal effect of the antibiotics on maggot pathogens. Depending on the concentration of the antibiotics, an underestimation of the post-mortem interval between 24 and 48 h could be suspected. We conclude that antibiotics need to be considered if instar stages are to be used to determine the PMI and that some antibiotics may improve the breeding conditions of maggots.

Ignatzschineria larvae Bacteremia Following Lucilia sp. Myiasis in an Irregular Migrant: A Case Report

Bacteremia induced by wound myiasis is uncommon and therefore rarely suspected by clinicians when treating patients with neglected wounds. We present a case of Ignatzschineria larvae bacteremia as a complication of Lucilia sp. maggot wound myiasis in a young male migrant. This is the first reported human case of Ignatzschineria bacteremia in Slovenia and one of the 2 described in the literature where the fly larvae infesting the wounds of the patient with Ignatzschineria bacteremia were not only suspected to be Lucilia sp. but also entomologically identified.

Vertebrate Scavengers Control Abundance of Diarrhea-causing Bacteria in Tropical Plantations

Scavenging is a common phenomenon, particularly amongst carnivorous vertebrates. By consuming carrion, vertebrate scavengers reduce resource availability for both pathogenic bacteria and their insect vectors. We investigated the ability of wild vertebrate scavengers to control agents of human diarrheal diseases (specifically Salmonella spp. and Shiga toxin-producing Escherichia coli [STEC]) in oil palm plantations in Sabah (East Malaysia), and the existence of spillover effect whereby additional vertebrate scavengers from adjacent forest patches result in greater disease control in plantation sections near these forest edges. Experimental carcasses were removed by common scavengers (Varanus salvator, Canis lupus familiaris, and Viverra tangalunga) at different time points, and this determined the length of time that the carcasses persisted in the environment. The amount of pathogenic bacteria on the surfaces of filth flies collected above the experimental carcasses was positively correlated to the duration of carcass persistence, and reduction in pathogenic bacterial abundances was largely due to carcass consumption by these vertebrate scavengers. Instead of a predicted positive spillover effect (greater scavenger activity near forest edges, hence reduced pathogen abundance), we detected a weak inverse spillover effect in which STEC counts were marginally higher in plantation sections near forest patches, and human hunting along the forest-plantation boundaries could explain this. We propose that making oil palm plantations scavenger-friendly could yield great human health benefits for the millions of workers employed in this rapidly-expanding industry, without drastically changing current management practices.

Safety and efficacy of larval therapy on treating leg ulcers: a protocol for systematic review and meta-analysis

INTRODUCTION

Leg ulcers (LUs) not only seriously affect life and work of patients, but also bring huge economic burden to the society. As a potential underused biological debridement, larval therapy provides help for the treatment of LUs. The purpose of our research is to assess whether patients with LUs can benefit from larval therapy.

METHODS AND ANALYSIS

The following electronic databases will be searched: PubMed, EMBASE, Web of Science, the Cochrane Library, China National Knowledge Infrastructure Database, Wanfang Database and Chinese Biological Medicine. Randomised controlled trials are eligible for inclusion. There will be no restrictions with respect to language and search date is up to June 2020. Primary outcomes investigated are complete healing rate after treatment, time to ulcer healing, reduction of wound surface area and adverse events. Risk ratios will be used for categorical data; weighted mean difference will be used for measurement data. Subgroup analysis and sensitivity analysis will be considered if heterogeneity exists. The results of data synthesis will be performed by narrative summary and quantitative analysis.

ETHICS AND DISSEMINATION

This systematic review does not require the approval of the ethics committee because individual data on patients are not collected. The results of the study will be disseminated in peer-reviewed journals.

PROSPERO REGISTRATION NUMBER

CRD42020176953.

Antimicrobial Properties of Nonantibiotic Agents for Effective Treatment of Localized Wound Infections: A Minireview

Wounds present serious health problems in humans and animals. Importantly, if left untreated, wounds invariably lead to long-term morbidity. The inappropriate use and costs of antibiotics place significant challenges globally and affect the health budgets of many countries. Though some antibiotics are administered systemically, treatment of localized infections, in particular, chronic wound infections, does not need such therapy-this would minimize development of antibiotic resistance. Of these measures, nanoparticles of silver, ZnO, and gold seem to give promising results against common wound pathogens while having few limitations. Chemical components of essential oils, which are extracted from different plants, have been shown to act against common wound pathogens. Plant extracts have shown different mechanisms in biofilm elimination. Chlorhexidine and chlorine derivatives act as wound antiseptics. Attempts with biological agents such as maggots have also been shown to provide anti-infective as well as mechanical removal of wound debris. Honey, including those obtained from bees, has a wide coverage against wound pathogens. Glycerin and hypertonic saline are anti-infective through the concentration-dependent killing of pathogens. Hyperbaric oxygen acts against many wound pathogens, in particular anaerobes. This review is focused on nonantibiotic attempts for the cure of localized infections, in particular, chronic wounds with common wound pathogens.

A Survey on Inhibitory Effect of Whole-Body Extraction and Secretions of Lucilia sericata's Larvae on Leishmania major In vitro

Background:

Leishmaniasis is a skin disease caused by Leishmania parasite. Despite being self-limiting, must be treated. Available drugs have side effects and drug resistance has also been seen.

Materials and Methods:

Maggot debridement therapy (MDT) is using sterile fly larvae (maggots) of blow flies (Lucilia sericata) for the treatment of different types of tissue wounds. Larvae have excreted and secreted substances that have been proved to have antimicrobial effects, in addition to the some other specifications.

Results:

In this study, the anti-leishmanial effects of extracts and secretions of sterile second- and third-instar larvae of L. sericata on the growth of Leishmania major promastigotes and amastigotes in the J774 macrophages have been evaluated in vitro.

Conclusion:

The results showed that extracts and secretions had almost the same leishmaniocidal effect on promastigotes and intracellular amastigotes without cytotoxic effect on macrophages.

New Insights Into Culturable and Unculturable Bacteria Across the Life History of Medicinal Maggots Lucilia sericata (Meigen) (Diptera: Calliphoridae)

Because of the nutritional ecology of dung- and carrion-feeding, bacteria are the integral part of Lucilia sericata life cycle. Nevertheless, the disinfected larvae of the blowfly are applied to treat human chronic wounds in a biosurgery named maggot debridement therapy (MDT). To realize the effects of location/diet on the gut bacteria, to infer the role of bacteria in the blowfly ecology plus in the MDT process, and to disclose bacteria circulating horizontally in and vertically between generations, bacterial communities associated with L. sericata specimens from various sources were investigated using culture-based and culture-independent methods. In total, 265 bacteria, including 20 families, 28 genera, and 40 species, were identified in many sources of the L. sericata. Culture-dependent method identified a number of 144 bacterial isolates, including 21 species, in flies reared in an insectary; specimens were collected from the field, and third-instar larvae retrieved from chronic wounds of patients. Metagenetic approach exposed the occurrences of 121 operational taxonomic units comprising of 32 bacterial species from immature and adult stages of L. sericata. Gammaproteobacteria was distinguished as the dominant class of bacteria by both methods. Bacteria came into the life cycle of L. sericata over the foods and transovarially infected eggs. Enterococcus faecalis, Myroides phaeus, Proteus species, Providencia vermicola, and Serratia marcescens were exchanged among individuals via transstadial transmission. Factors, including diets, feeding status, identification tool, gut compartment, and life stage, governed the bacteria species. Herein, we reemphasized that L. sericata is thoroughly connected to the bacteria both in numerous gut compartments and in different life stages. Among all, transstadially transmitted bacteria are underlined, indicating the lack of antagonistic effect of the larval excretions/secretions on these resident bacteria. While the culture-dependent method generated useful data on the viable aerobic gut bacteria, metagenomic method enabled us to identify bacteria directly from the tissues without any need for cultivation and to facilitate the identification of anaerobic and unculturable bacteria. These findings are planned to pave the way for further research to determine the role of each bacterial species/strain in the insect ecology, as well as in antimicrobial, antibiofilm, anti-inflammatory, and wound healing activities.

Terapia Larval con Musca Domestica en el Tratamiento de la úlcera Leishmánicaen un Modelo Murino

La leishmaniosis es una enfermedad con gran impacto en salud pública dado a las características de las lesiones tegumentarias. El tratamiento experimental con terapia larval (TL) ha mostrado su uso potencial para la cura de la leishmaniosis, sin embargo, se han utilizado especies de moscas para TL en heridas causadas por Leishmania que no son de fácil colecta y cultivo bajo condiciones de laboratorio como Lucilia sericata o Calliphora vicina. El objetivo del presente trabajo fue usar una especie de mosca de fácil colecta, y de alta fecundidad como la Musca domestica para aplicarlas en TL de úlceras leishmánicas. Se realizó un estudio cuali-cuantitativo, de tipo descriptivo, mediante un diseño experimental empleado un modelo animal (Mesocricetus auratus), infectado con Leishmania amazonensis para evaluar el efecto terapéutico de la TL y comparar los resultados con el tratamiento químico antimonial de la droga experimental “Ulamina”. Se evidencia cicatrización y cura de la úlcera leishmánica en el 66,66 % de los animales tratados con TL en aplicación simple y del 100 % en TL combinada con Ulamina. El uso combinado de TL+Ulamina, muestra un efecto potenciador de la cura clínica de las úlceras, pero con persistente inflamación. Se observó una efectividad óptima de la TL con M. domestica, sobre las úlceras, aunque no se evidenció un efecto sobre L. amazonensis dado a la presencia de amastigotes en los frotis y a los amplicones obtenidos de 480 bp desde las improntas de los animales.

Bactericidal Activity of Chrysomya rufifacies and Cochliomyia macellaria (Diptera: Calliphoridae) Larval Excretions-Secretions Against Staphylococcus aureus (Bacillales: Staphylococcaceae)

The inhibitory effect of Chrysomya rufifacies (Macquart) and Cochliomyia macellaria (Fabricius) larval excretions-secretions (ES) on Staphylococcus aureus was determined using a portable colorimetric method without the need for any dedicated spectral instrument. Polystyrene 96 well microplates were used and 100 μl of the bacterial inoculum (5 × 105 CFU/ml) plus 100 μl of the dipteran exosecretions at different concentrations were added to each well. Subsequently, 50 μl of a 1% solution of the triphenyl tetrazolium chloride stain was added to each well to determine the bacterial viability. The color development in each well was measured with the ImageJ software S. aureus was exposed to different concentrations of the ES of both species individually. At a concentration of 800 ppm ES of C. rufifacies or Co. macellaria, bacterial growth was inhibited 97.45 ± 1.70% and 82.21 ± 1.88%, respectively. As expected, exposure to a lower concentration (i.e., 50 ppm) was less inhibitory (C. rufifacies ES, 77.65 ± 4.25% and Co. macellaria ES, 43.54 ± 4.63%). This study demonstrates for the first time the bactericidal activity of C. rufifacies and Co. macellaria ES against S. aureus. This finding is promising as it could result in the identification and synthesis of proteins capable of suppressing pathogen development in wounds. Additionally, the proposed method can simplify the use of expensive laboratory instruments for antimicrobial activity determination.

Non-antibiotic antimicrobial interventions and antimicrobial stewardship in wound care

Control of wound infection today relies largely on antibiotics, but the continual emergence of antibiotic-resistant microorganisms threatens a return to the pre-antibiotic era when physicians used antiseptics to prevent and manage infection. Some of those antiseptics are still used today, and others have become available. A diverse variety of non-antibiotic antimicrobial interventions are found on modern formularies. Unlike the mode of action of antibiotics, which affect specific cellular target sites of pathogens, many non-antibiotic antimicrobials affect multiple cellular target sites in a non-specific way. Although this reduces the likelihood of selecting for resistant strains of microorganisms, some have emerged and cross-resistance between antibiotics and antiseptics has been detected. With the prospect of a post-antibiotic era looming, ways to maintain and extend our antimicrobial armamentarium must be found. In this narrative review, current and emerging non-antibiotic antimicrobial strategies will be considered and the need for antimicrobial stewardship in wound care will be explained.

Maggot Therapy in Angiopathic Leg Ulcers: A Systematic Review and Meta-Analysis

Maggot therapy (MT) is a biological debridement tool using blowfly larvae to digest necrotic tissue as its food. In addition, maggot secretion contains several peptides that has antibacterial effect and healing stimulants that might enhance wound healing. Clinical outcomes from previous meta-analyses demonstrated benefit of MT, but results were highly heterogeneous. We have conducted an updated systematic review and meta-analysis with clearly defined clinical outcomes according to mechanism of MT including successful debridement, healing rate, and time to heal. Furthermore, our study was the first meta-analysis that reported wound-related pain between MT and conventional therapy. MEDLINE and Scopus were searched for comparative studies of MT and conventional therapy. Ten studies were eligible, of which 5 studies were angiopathic (venous or mixed arteriovenous ulcers) and the other 5 were diabetic foot ulcer. The MT had significant higher rate of successful debridement with risk ratio of 2.3 (95% confidence interval = 1.7-3.0) with low heterogeneity. Time to heal was about 3.1 weeks (95% confidence interval = 1.2-5.0), significantly shorter in MT but with high heterogeneity. Healing rate and pain were not significantly different between groups with high heterogeneity. In conclusion, MT was an effective debridement tool compared with conventional therapy. More studies should be done to confirm other findings because of high heterogeneity.

Evaluation of Sterilized Artificial Diets for Mass Rearing the Lucilia sericata (Diptera: Calliphoridae)

The impact of six sterilized diets (blood-yeast agar diet, decomposed beef liver diet, powdered beef liver diet, powdered fish diet, milk-based diet, and a chemically defined diet) on Lucilia sericata (Meigen) larvae reared at three densities (10 larvae, 20 larvae, and 40 larvae on 20 g diet) was determined in comparison to fresh beef liver as a control. Specifically, the effects of these diets on the following traits of L. sericata were measured: 1) pupal weight, 2) pupation percentage, 3) eclosion percentage, as well as 4) adult longevity. The experiment included two trials with five technical replicates in each. Lucilia sericata did not successfully develop on the powdered fish, milk-based, or chemically defined diets. Overall, the liver-based diets (decomposed and powdered) resulted in the most similar fly development to the fresh beef liver. Larvae reared on blood-yeast agar diet resulted in a significantly (increased 20.56% ± 8.09%) greater pupation rate than those reared on the decomposed and powdered beef liver diets. Pupae from larvae fed the fresh beef liver were significantly larger (6.27 ± 1.01 mg, 4.05 ± 0.94 mg larger, respectively) than those reared on the blood-yeast agar diet, decomposed beef liver, and powdered beef liver diets. Overall, results revealed larvae reared on sterilized liver-based diets resulted in traits similar to those raised on fresh beef liver. Owing to low costs the sterile liver-based diets could be produced and used with limited infrastructure and economic incomes.

First Record of Larval Secretions of Cochliomyia macellaria (Fabricius, 1775) (Diptera: Calliphoridae) Inhibiting the Growth of Staphylococcus aureus and Pseudomonas aeruginosa

Maggot debridement therapy (MDT) consists on the intentional and controlled application of sterilized larvae of the order Diptera on necrotic skin lesions with the purpose of cleaning necrotic tissue and removing pathogenic bacteria. During MDT, a marked antimicrobial activity has been reported in literature specially associated with antibacterial substances from Lucilia sericata (Meigen); however, regarding Cochliomyia macellaria (Fabricius), little is known. This study aimed to evaluate in vitro inhibition of bacterial growth of Pseudomonas aeruginosa and Staphylococcus aureus in contact with excretions and secretions (ES) from C. macellaria larvae. Larval ES were extracted in sterile distilled water and divided in three groups: ES, containing 400 μL of autoclaved ES; ES+BAC, containing 400 μL of autoclaved ES+0.5-μL bacterial inoculum; and CONT-BAC, containing 400 μL of sterile distilled water +0.5 μL of bacterial inoculum. Aliquots of each experimental group were plated by spreading onto Petri dishes. Seedings were made at 0, 1, 2, 4, and 12 h after the extraction of ES. In ES+BAC groups, inhibition of S. aureus was verified between times 1 and 2 h and P. aeruginosa was inhibited between 0 and 4 h. There was no growth observed in any ES group. In the CONT-BAC groups, the number of colonies from time 4 h became countless for S. aureus and decreased for P. aeruginosa. As reported in the literature, we note here that ES have excellent bactericidal activity for both gram-positive and gram-negative bacteria, and this study shows for the first time the action of the bactericidal activity of exosecretions of C. macellaria against S. aureus and P. aeruginosa.

The effect of Lucilia sericata- and Sarconesiopsis magellanica-derived larval therapy on Leishmania panamensis

This study's main objective was to evaluate the action of larval therapy derived from Lucilia sericata and Sarconesiopsis magellanica (blowflies) regarding Leishmania panamensis using an in vivo model. Eighteen golden hamsters (Mesocricetus auratus) were used; they were divided into 6 groups. The first three groups consisted of 4 animals each; these, in turn, were internally distributed into subgroups consisting of 2 hamsters to be used separately in treatments derived from each blowfly species. Group 1 was used in treating leishmanial lesions with larval therapy (LT), whilst the other two groups were used for evaluating the used of larval excretions and secretions (ES) after the ulcers had formed (group 2) and before they appeared (group 3). The three remaining groups (4, 5 and 6), consisting of two animals, were used as controls in the experiments. Biopsies were taken for histopathological and molecular analysis before, during and after the treatments; biopsies and smears were taken for assessing parasite presence and bacterial co-infection. LT and larval ES proved effective in treating the ulcers caused by the parasite. There were no statistically significant differences between the blowfly species regarding the ulcer cicatrisation parameters. There were granulomas in samples taken from lesions at the end of the treatments. The antibacterial action of larval treatment regarding co-infection in lesions caused by the parasite was also verified. These results potentially validate effective LT treatment against cutaneous leishmaniasis aimed at using it with humans in the future.

Genome sequence of Phormia regina Meigen (Diptera: Calliphoridae): implications for medical, veterinary and forensic research

BACKGROUND

Blow flies (Diptera: Calliphoridae) are important medical, veterinary and forensic insects encompassing 8 % of the species diversity observed in the calyptrate insects. Few genomic resources exist to understand the diversity and evolution of this group.

RESULTS

We present the hybrid (short and long reads) draft assemblies of the male and female genomes of the common North American blow fly, Phormia regina (Diptera: Calliphoridae). The 550 and 534 Mb draft assemblies contained 8312 and 9490 predicted genes in the female and male genomes, respectively; including > 93 % conserved eukaryotic genes. Putative X and Y chromosomes (21 and 14 Mb, respectively) were assembled and annotated. The P. regina genomes appear to contain few mobile genetic elements, an almost complete absence of SINEs, and most of the repetitive landscape consists of simple repetitive sequences. Candidate gene approaches were undertaken to annotate insecticide resistance, sex-determining, chemoreceptors, and antimicrobial peptides.

CONCLUSIONS

This work yielded a robust, reliable reference calliphorid genome from a species located in the middle of a calliphorid phylogeny. By adding an additional blow fly genome, the ability to tease apart what might be true of general calliphorids vs. what is specific of two distinct lineages now exists. This resource will provide a strong foundation for future studies into the evolution, population structure, behavior, and physiology of all blow flies.

Genome Sequence of a Proteus mirabilis Strain Isolated from the Salivary Glands of Larval Lucilia sericata

We announce a draft genome sequence of a Proteus mirabilis strain derived from Lucilia sericata salivary glands. This strain is demonstrated to attract and induce oviposition by L. sericata, a common blow fly important to medicine, agriculture, and forensics. The genome sequence will help dissect interkingdom communication between the species.

Selection and Evaluation of Tissue Specific Reference Genes in Lucilia sericata during an Immune Challenge

The larvae of the common green bottle fly Lucilia sericata (Diptera: Calliphoridae) have been used for centuries to promote wound healing, but the molecular basis of their antimicrobial, debridement and healing functions remains largely unknown. The analysis of differential gene expression in specific larval tissues before and after immune challenge could be used to identify key molecular factors, but the most sensitive and reproducible method qRT-PCR requires validated reference genes. We therefore selected 10 candidate reference genes encoding products from different functional classes (18S rRNA, 28S rRNA, actin, β-tubulin, RPS3, RPLP0, EF1α, PKA, GAPDH and GST1). Two widely applied algorithms (GeNorm and Normfinder) were used to analyze reference gene candidates in different larval tissues associated with secretion, digestion, and antimicrobial activity (midgut, hindgut, salivary glands, crop and fat body). The Gram-negative bacterium Pseudomonas aeruginosa was then used to boost the larval immune system and the stability of reference gene expression was tested in comparison to three immune genes (lucimycin, defensin-1 and attacin-2), which target different pathogen classes. We observed no differential expression of the antifungal peptide lucimycin, whereas the representative targeting Gram-positive bacteria (defensin-1) was upregulated in salivary glands, crop, nerve ganglion and reached its maximum in fat body (up to 300-fold). The strongest upregulation in all immune challenged tissues (over 50,000-fold induction in the fat body) was monitored for attacin-2, the representative targeting Gram-negative bacteria. Here we identified and validated a set of reference genes that allows the accurate normalization of gene expression in specific tissues of L. sericata after immune challenge.

Evaluating the effect of Sarconesiopsis magellanica (Diptera: Calliphoridae) larvae-derived haemolymph and fat body extracts on chronic wounds in diabetic rabbits

We evaluated extracts taken from S. magellanica third instar larvae fat body and haemolymph using a diabetic rabbit model and compared this to the effect obtained with the same substances taken from Lucilia sericata larvae. Alloxan (a toxic glucose analogue) was used to induce experimental diabetes in twelve rabbits. Dorsal wounds were made in each animal and they were infected with Staphylococcus aureus and Pseudomonas aeruginosa. They were then treated with haemolymph and lyophilized extracts taken from the selected blowflies' larvae fat bodies. Each wound was then evaluated by using rating scales and histological analysis. More favourable scores were recorded on the PUSH and WBS scales for the wounds treated with fat body derived from the larvae of both species compared to that obtained with haemolymph; however, wounds treated with the substances taken from S. magellanica had better evolution. Histological analysis revealed that treatment led to tissue proliferation and more effective neovascularisation in less time with both species' fat body extracts compared to treatment with just haemolymph. The results suggest the effectiveness of the substances evaluated and validate them in the animal model being used here as topical agents in treating chronic wounds.

Antimicrobial peptides expressed in medicinal maggots of the blow fly Lucilia sericata show combinatorial activity against bacteria

The larvae of the common green bottle fly (Lucilia sericata) produce antibacterial secretions that have a therapeutic effect on chronic and nonhealing wounds. Recent developments in insect biotechnology have made it possible to use these larvae as a source of novel anti-infectives. Here, we report the application of next-generation RNA sequencing (RNA-Seq) to characterize the transcriptomes of the larval glands, crop, and gut, which contribute to the synthesis of antimicrobial peptides (AMPs) and proteins secreted into wounds. Our data confirm that L. sericata larvae have adapted in order to colonize microbially contaminated habitats, such as carrion and necrotic wounds, and are protected against infection by a diverse spectrum of AMPs. L. sericata AMPs include not only lucifensin and lucimycin but also novel attacins, cecropins, diptericins, proline-rich peptides, and sarcotoxins. We identified 47 genes encoding putative AMPs and produced 23 as synthetic analogs, among which some displayed activities against a broad spectrum of microbial pathogens, including Pseudomonas aeruginosa, Proteus vulgaris, and Enterococcus faecalis. Against Escherichia coli (Gram negative) and Micrococcus luteus (Gram positive), we found mostly additive effects but also synergistic activity when selected AMPs were tested in combination. The AMPs that are easy to synthesize are currently being produced in bulk to allow their evaluation as novel anti-infectives that can be formulated in hydrogels to produce therapeutic wound dressings and adhesive bandages.

Midgut lysozymes of Lucilia sericata - new antimicrobials involved in maggot debridement therapy

Larvae of Lucilia sericata are used for maggot debridement therapy (MDT) because of their ability to remove necrotic tissue and eradicate bacterial pathogens of infected wounds. So far, very few antibacterial factors have been fully characterized (eg lucifensin). Using a molecular approach, some other putative antimicrobial compounds, including three novel lysozymes, have been previously identified and predicted to be involved in MDT. Nevertheless, data on lysozymes tissue origin and their functions have never been elucidated. Therefore, the aim of this study was to investigate the expression of three lysozymes in L. sericata and confirm their antibacterial effects within MDT. Moreover, we characterized the eradication process of bacteria within the digestive system of maggots and determined the role of lysozymes in this process. We found that three lysozymes are expressed in specific sections of the L. sericata midgut. Recombinant lysozymes displayed comparable antibacterial activity against Micrococcus luteus. Furthermore, the majority of Gram-positive bacteria were destroyed in vivo within the particular section of the L. sericata midgut where lysozymes are produced. Larval ingestion and subsequent eradication of wound pathogens during their passage through the intestine of maggots are due to, at least in part, antibacterial action of three midgut lysozymes.

A metagenomic assessment of the bacteria associated with Lucilia sericata and Lucilia cuprina (Diptera: Calliphoridae)

Lucilia Robineau-Desvoidy (Diptera: Calliphoridae) is a blow fly genus of forensic, medical, veterinary, and agricultural importance. This genus is also famous because of its beneficial uses in maggot debridement therapy (MDT). Although the genus is of considerable economic importance, our knowledge about microbes associated with these flies and how these bacteria are horizontally and trans-generationally transmitted is limited. In this study, we characterized bacteria associated with different life stages of Lucilia sericata (Meigen) and Lucilia cuprina (Wiedemann) and in the salivary gland of L. sericata by using 16S rDNA 454 pyrosequencing. Bacteria associated with the salivary gland of L. sericata were also characterized using light and transmission electron microscopy (TEM). Results from this study suggest that the majority of bacteria associated with these flies belong to phyla Proteobacteria, Firmicutes, and Bacteroidetes, and most bacteria are maintained intragenerationally, with a considerable degree of turnover from generation to generation. In both species, second-generation eggs exhibited the highest bacterial phylum diversity (20 % genetic distance) than other life stages. The Lucilia sister species shared the majority of their classified genera. Of the shared bacterial genera, Providencia, Ignatzschineria, Lactobacillus, Lactococcus, Vagococcus, Morganella, and Myroides were present at relatively high abundances. Lactobacillus, Proteus, Diaphorobacter, and Morganella were the dominant bacterial genera associated with a survey of the salivary gland of L. sericata. TEM analysis showed a sparse distribution of both Gram-positive and Gram-negative bacteria in the salivary gland of L. sericata. There was more evidence for horizontal transmission of bacteria than there was for trans-generational inheritance. Several pathogenic genera were either amplified or reduced by the larval feeding on decomposing liver as a resource. Overall, this study provides information on bacterial communities associated with different life stages of Lucilia and their horizontal and trans-generational transmission, which may help in the development of better vector-borne disease management and MDT methods.

Sarconesiopsis magellanica (Diptera: Calliphoridae) excretions and secretions have potent antibacterial activity

The most important mechanism for combating infection using larval therapy depends on larval excretions and secretions (ES). The present work was aimed at evaluating Sarconesiopsis magellanica (Diptera: Calliphoridae) ES antibacterial activity in six bacterial strains (three Gram-positive and three Gram-negative) and comparing this to the effect of Lucilia sericata-derived ES. Antibacterial activity at 50μg/mL minimum inhibitory concentration (MIC) was observed for Staphylococcus epidermidis ATCC-12228 and Staphylococcus aureus ATCC-29213 strains, when the turbidimetry test involving S. magellanica ES was used; the rest of the bacterial strains (Staphylococcus aureus ATCC-6538, Pseudomonas aeruginosa ATCC-10145, Pseudomonas aeruginosa ATCC-9027 and Pseudomonas aeruginosa ATCC-27853) were inhibited at a 100μg/mL MIC. Twice the amount was required to inhibit the aforementioned bacteria with L. sericata-derived ES using this same technique; a similar trend was observed when the agar diffusion method was used instead. Furthermore, when the previously established MIC for each bacterial strain was used, their colonies became reduced following 1-6h incubation with S. magellanica derived ES, whilst the reduction occurred from 2 to 6hours with those from L. sericata. Although the MIC for each strain obtained with ciprofloxacin was lower than those established when using either blowfly derived-ES, the gradual reduction of the colonies occurred at a longer incubation time (6h or more). The results showed that S. magellanica ES antibacterial activity was more potent and effective, compared to that of L. sericata-derived ES.

Selective Antibiofilm Effects of Lucilia sericata Larvae Secretions/Excretions against Wound Pathogens

Background. Maggot debridement therapy (MDT), using Lucilia sericata larvae, represents efficient, simple, and low-cost therapy for the treatment of chronic wounds. Aim. The aim was to investigate the antibiofilm activity of maggot excretions/secretions (ES) against biofilm of wound isolates Staphylococcus aureus (S. aureus), Enterobacter cloacae (E. cloacae), and Proteus mirabilis (P. mirabilis). Methods. Quantification of biofilm formation, was carried out using a microtiter plate assay. Proteolytic activity of maggot ES was performed using skim milk agar plates. A solid phase extraction and reverse phase HPLC C18 chromatography were employed to the isolate of maggot ES antibiofilm compounds. Results. Maggot ES at 100 mg/mL concentration significantly reduced biofilm formation thus disrupting established biofilm of E. cloacae. Heat-treated ES did not show any antibiofilm activity towards E. cloacae. Similar results were obtained in the case of S. aureus; however, the heat-treatment of maggot ES did not affect its antibiofilm activity. Moreover, a compound with molecular weight of 25 kDa exhibiting antibiofilm activity was identified in maggot ES. On the other hand, maggot ES protected and even stimulated P. mirabilis biofilm formation. Conclusions. Our results suggest that maggot ES may act selectively against different bacterial strain.

Lucifensins, the Insect Defensins of Biomedical Importance: The Story behind Maggot Therapy

Defensins are the most widespread antimicrobial peptides characterised in insects. These cyclic peptides, 4–6 kDa in size, are folded into α-helical/β-sheet mixed structures and have a common conserved motif of three intramolecular disulfide bridges with a Cys1-Cys4, Cys2-Cys5 and Cys3-Cys6 connectivity. They have the ability to kill especially Gram-positive bacteria and some fungi, but Gram-negative bacteria are more resistant against them. Among them are the medicinally important compounds lucifensin and lucifensin II, which have recently been identified in the medicinal larvae of the blowflies Lucilia sericata and Lucilia cuprina, respectively. These defensins contribute to wound healing during a procedure known as maggot debridement therapy (MDT) which is routinely used at hospitals worldwide. Here we discuss the decades-long story of the effort to isolate and characterise these two defensins from the bodies of medicinal larvae or from their secretions/excretions. Furthermore, our previous studies showed that the free-range larvae of L. sericata acutely eliminated most of the Gram-positive strains of bacteria and some Gram-negative strains in patients with infected diabetic foot ulcers, but MDT was ineffective during the healing of wounds infected with Pseudomonas sp. and Acinetobacter sp. The bactericidal role of lucifensins secreted into the infected wound by larvae during MDT and its ability to enhance host immunity by functioning as immunomodulator is also discussed.

In vitro antibacterial activity and physicochemical properties of a crude methanol extract of the larvae of the blow fly Lucilia cuprina

The emergence of multidrug-resistant bacterial strains has prompted the reintroduction of maggot therapy in the treatment of chronic, infected wounds. Many previous studies have demonstrated the potent antibacterial activity of larval excretions/secretions of the blowfly Lucilia sericata (Meigen) (Diptera:Calliphoridae) against bacteria. However, the antibacterial activity of its sibling species, Lucilia cuprina (Wiedemann) (Diptera:Calliphoridae) against a wide range of pathogenic bacteria has never been determined. The aim of this study was to develop a new procedure to produce whole body extract of larvae of L. cuprina via methanol extraction as well as to demonstrate the in vitro antibacterial activity of this extract against seven selected wound pathogens (Staphylococcus aureus, methicillin-resistant S. aureus, S. epidermidis, Streptococcus pyogenes, Klebsiella pneumoniae, Pseudomonas aeruginosa and Escherichia coli). The turbidimetric assay demonstrated that L. cuprina larval extract was significantly potent against all bacteria tested (P < 0.001). Additionally, colony-forming unit (CFU), agar well diffusion and minimum inhibitory concentration assays have confirmed the apparent potency of larval extract against P. aeruginosa. The reconstituted larval extract was highly robust and thermally stable. These observations substantiated the feasibility of the methanol extraction method in the production of larval extract.

Diagnosis and management of infection in the diabetic foot

Foot infections are common in persons with diabetes mellitus. Most diabetic foot infections occur in a foot ulcer, which serves as a point of entry for pathogens. Unchecked, infection can spread contiguously to involve underlying tissues, including bone. A diabetic foot infection is often the pivotal event leading to lower extremity amputation, which account for about 60% of all amputations in developed countries. Given the crucial role infections play in the cascade toward amputation, all clinicians who see diabetic patients should have at least a basic understanding of how to diagnose and treat this problem.