An unusual case of vaginal myiasis

Review on forensic importance of myiasis: Focus on medicolegal issues on post-mortem interval estimation and neglect evaluation

Myiasis is the infestation of live vertebrates by dipterous larvae that feed on living or necrotic tissues, liquid body substances or ingested food and develop in or on the vertebrate body. In both animals and humans, myiasis plays a fundamental role in forensic practice because of its implications in the evaluation of cases of neglect and in the mPMI (minimum post-mortem interval) estimation. The present study aims to provide a review of forensic issues related to myiasis. A retrospective analysis was conducted by exploring major electronic literature databases. Methodological evaluation of each study was performed according to the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses) standards. Sixty-one papers were included in this review. Entomology shows great potentiality in forensic investigations, mostly because of its contributory role in mPMI estimation. Such evaluation, however, requires a careful consideration of the possibility of an ante-mortem myiasis infestation, which could complicate the correct assessment of the mPMI. Hence, forensic pathologists should pay attention to the entomological fauna on a corpse, in both fresh and decomposed bodies. Moreover, in cases with poor nutritional or hygienic conditions, myiasis should be carefully evaluated as an indicator of neglect.

Urogenital myiasis - An atypical presentation

The infestation of the human body by maggots has been reported worldwide and occurs most commonly in people of lower socioeconomic status and poor personal hygiene. Urogenital is the rarest site of myiasis presentations. Here we report the case of a 20-year-old, sexually inactive female student who presented with a necrotic growth in the paraurethral region infested with numerous maggots. The lesion involved the urethra and the bladder base. She was treated with debridement and bladder irrigation. The cystoscopy and local examination performed 2 weeks after admission, confirmed the complete healing of the urogenital lesion. Managing this patient’s unique challenge was to assess the extent of the involvement and removal of all maggots from the deepest wound portion. The female internal and external urogenital myiasis is a very occasional and under-reported health hazard. Reporting such cases increases the public and physician awareness about the mode of presentation, right diagnosis, and available treatment options.

Grub in the mouth: an unusual case with review of literature

Oral myiasis is a rare disease, identified primarily in non-industrialised nations. It is caused fundamentally by the attack of larvae from Dipteran flies on the human tissues. Predisposing factors for oral myiasis are extraction wounds, destitute oral cleanliness, meagreness, mouth breathing amid rest, suppurative injuries, necrotic tissues, diabetes and perivascular infections primarily within the elderly, extreme halitosis, alcohol addiction, cerebral paralysis and components that favour prolonged mouth opening. Myiasis may have predilection to patients with mental challenges, cerebral palsy and hemiplegia due to unfortunate physical agility. The present case reports an oral myiasis in a 25-year-old woman who was mentally challenged. This condition was treated by topical application of turpentine oil with manual expulsion of hatchlings, taken after by surgical debridement and wide range antimicrobials.