The maggot therapy supply chain: a review of the literature and practice

Patient Perceptions and Experiences With Maggot Debridement Therapy for Managing Chronic Wounds

PURPOSE

The purpose of this study was to describe patient experiences and satisfaction with use of maggot debridement therapy (MDT) for hard-to-heal wounds.

DESIGN

Descriptive, cross-sectional study.

SUBJECTS AND SETTING

The sample comprised 60 participants, 60% were male (n = 36). Their mean age was 62.9 (SD = 20) years. Almost half of participants had lower extremity wounds (n = 26; 43.3%), diabetic foot ulcers (n = 18; 30%), and pressure injuries (n = 9; 15%). Most received maggot therapy via biobags (n = 36; 60%).

METHODS

Participants completed a questionnaire designed for purposes of the study that queried demographic and pertinent clinical characteristics, current health status including current topical therapies, and duration of their chronic wound. Nine items queried emotional responses prior to MDT, the amount and method of the maggot therapy, discomfort experienced during therapy, and sources of information regarding this treatment.

RESULTS

Emotional responses before starting MDT included disgust (n = 30, 50%), anxiety (n = 26, 43.3%), doubts about its effectiveness (n =20, 33.3%), and disbelief (n = 11, 18.3%). Approximately one-third of participants reported feelings of biting, itching, and fear of the maggots. Despite these feelings, a majority (n = 38, 63.3%) indicated that they were pleased with treatment outcome and willing to undergo additional MDT if needed.

CONCLUSIONS

While a majority of participants with nonhealing chronic wounds reported negative emotions association with MDT, more than half indicated that they were pleased with the outcome of treatment and willing to undergo repeat treatment if indicated.

Actinomycetes Associated with Arthropods as a Source of New Bioactive Compounds

Antimicrobial resistance is one of the main global threats to human health in the 21st century due to the rapid appearance of bacterial resistance and the lack of novel bioactive compounds. Natural products, especially from Actinomycetes, remain the best source to refill the drug industry pipeline. Different strategies have been pursued to increase the chances of discovering new molecules, such as studying underexplored environments like arthropod symbionts, which represent a relevant reservoir for active metabolites. This review summarizes recent research on the identification of bioactive molecules produced by Actinomycetes associated with arthropods' microbiome. The metabolites have been categorized based on their structural properties and host, highlighting that multidisciplinary approaches will be the key to fully understanding this complex relationship.

Pushing the frontiers in the fight against antimicrobial resistance: the potential of fecal and maggot therapies

The escalating crisis of antimicrobial resistance (AMR) warrants innovative therapeutic strategies. Fecal microbiota transplantation (FMT) and maggot debridement therapy (MDT) represent paradigm-shifting approaches, leveraging biological systems to mitigate AMR. FMT restores a healthy gut microbiome, providing a biotherapeutic counter to pathogenic bacteria, thereby reducing reliance on traditional antibiotics. Conversely, MDT, a form of bio-debridement, utilizes the antimicrobial secretions of maggots to cleanse wounds and eliminate resistant bacteria. Despite the promise these therapies hold, their broader clinical adoption faces multifaceted challenges including the need for rigorous scientific substantiation, standardized protocols, deepened understanding of mechanisms of action, and surmounting regulatory and public acceptance barriers. However, their potential integration with precision medicine could revolutionize disease management, particularly with antibiotic-resistant infections.

An Overview of Recent Developments in the Management of Burn Injuries

According to the World Health Organization (WHO), around 11 million people suffer from burns every year, and 180,000 die from them. A burn is a condition in which heat, chemical substances, an electrical current or other factors cause tissue damage. Burns mainly affect the skin, but can also affect deeper tissues such as bones or muscles. When burned, the skin loses its main functions, such as protection from the external environment, pathogens, evaporation and heat loss. Depending on the stage of the burn, the patient's condition and the cause of the burn, we need to choose the most appropriate treatment. Personalization and multidisciplinary collaboration are key to the successful management of burn patients. In this comprehensive review, we have collected and discussed the available treatment options, focusing on recent advances in topical treatments, wound cleansing, dressings, skin grafting, nutrition, pain and scar tissue management.

How Rearing Systems for Various Species of Flies Benefit Humanity

Flies (Diptera) have played a prominent role in human history, and several fly species are reared at different scales and for different beneficial purposes worldwide. Here, we review the historical importance of fly rearing as a foundation for insect rearing science and technology and synthesize information on the uses and rearing diets of more than 50 fly species in the families Asilidae, Calliphoridae, Coelopidae, Drosophilidae, Ephydridae, Muscidae, Sarcophagidae, Stratiomyidae, Syrphidae, Tachinidae, Tephritidae, and Tipulidae. We report more than 10 uses and applications of reared flies to the well-being and progress of humanity. We focus on the fields of animal feed and human food products, pest control and pollination services, medical wound therapy treatments, criminal investigations, and on the development of several branches of biology using flies as model organisms. We highlight the relevance of laboratory-reared Drosophila melanogaster Meigen as a vehicle of great scientific discoveries that have shaped our understanding of many biological systems, including the genetic basis of heredity and of terrible diseases such as cancer. We point out key areas of fly-rearing research such as nutrition, physiology, anatomy/morphology, genetics, genetic pest management, cryopreservation, and ecology. We conclude that fly rearing is an activity with great benefits for human well-being and should be promoted for future advancement in diverse and innovative methods of improving existing and emerging problems to humanity.

Biological behavior of Chrysomya putoria (Wiedemann, 1819) (Diptera: Calliphoridae) after refrigeration: Logistics for use in Biotherapy

The influence of refrigeration on the post-embryonic development of Chrysomya putoria larvae was evaluated, regarding its resistance in the logistics of storage and distribution in biotherapy. Previously sterilized larvae were submitted to four periods of storage under refrigeration (T1=12 h, T2=24 h, T3=48 h and T4=72 h) and control (without sterilization and refrigeration). Newly hatched larvae (0.200 g) were stored between 3 and 9ºC. After refrigeration, 40 neo-larvae (in triplicate) were transferred to 50 g of protein diet and incubated in an acclimatized chamber. There was a significant difference in the larval body mass (T1 and T2) and in the duration of larval, pupal and total development (T3 and T4). The sex ratios found in the four treatments did not differ from what was expected. Normality rates were 100% for all treatments. There was no significant difference between the Control, T1 and T2 treatments for larval, pupal and total viability. There was a significant difference between control (C) and T4 (larval viability), between C, T3 and T4 (pupa) and between C and T4 (total). C. putoria has resistance under refrigeration and storage of up to 56 h, presenting viability above 70% for use in biotherapy.

Reappraisal and updated review of maggot debridement therapy in chronic lower extremity ulcers

BACKGROUND

Dating back to the mid-1500s, maggot debridement therapy (MDT) has been a viable treatment modality for chronic wounds. In early 2004, the sterile larvae of Lucilia sericata received FDA approval for medical marketing for neuropathic, venous, and pressure ulcers, traumatic or surgical wounds, and nonhealing wounds that have not responded to standard care. However, it currently remains an under-utilized therapy. The proven efficacy of MDT begs the question if this treatment modality should be considered as a first-line option for all or a subset of chronic lower extremity ulcers.

OBJECTIVE

This article aims to address the history, production, and evidence of MDT and discuss future considerations for maggot therapy in the healthcare field.

METHODS

A literature search using the PubMed database was conducted using keywords, such as wound debridement, maggot therapy, diabetic ulcers, venous ulcers, among others.

RESULTS

MDT reduced short-term morbidity in non-ambulatory patients with neuroischemic diabetic ulcers and comorbidity with peripheral vascular disease. Larval therapy was associated with statistically significant bioburden reductions against both Staphylococcus aureus and Pseudomonas aeruginosa. Faster time to debridement was achieved when chronic venous or mixed venous and arterial ulcers were treated with maggot therapy versus hydrogels.

CONCLUSIONS

The literature supports the use of MDT in decreasing the significant costs of treating chronic lower extremity ulcers, with emphasis on those of diabetic origin. Additional studies with global standards for reporting outcomes are necessary to substantiate our results.

Large wound surgery of diabetic foot ulcer with Split-thickness skin graft (STSG), and maggot debridement therapy (MDT): A case report

INTRODUCTION AND IMPORTANCE

Diabetic foot ulcers (DFUs) as one of the complications of diabetes mellitus (DM) can lead to death.

CASE PRESENTATION

The present case reports a 56-year-old woman with an 11-year history of type 2 diabetes who has had left DFUs for two years. The patient had antibiotic-resistant DFUs her left foot, which were completely gangrenous and a superficial ulcer up and under her left foot. Despite the routine DFU care, the patient did not recover from DFU using standard methods. The patient was referred to our wound management team. DFU was treated and managed using split-thickness skin graft (STSG) and surgical debridement, maggot debridement therapy (MDT). After two months, the patient's DFUs healed, and he was discharged from our service in good condition.

CLINICAL DISCUSSION

DFU can lead to infection, amputation, and even patient death. Therefore, effective treatment methods are very important for managing DFUs.

CONCLUSION

This case report study was shown that the combined use of STSG, surgical debridement, and MDT is a safe and effective approach to improve the healing of DFUs and prevent foot amputation.

Surgical debridement and maggot debridement therapy (MDT) bring the light of hope to patients with diabetic foot ulcers (DFUs): A case report

Introduction and importance

Management of diabetic foot ulcers (DFUs), one of the complications of diabetes mellitus, can lead to death and amputation, and it is one of the most critical challenges for the patients and their families.

Case presentation

The present case report concerns a 72-year-old man with a 5-year history of uncontrolled type 2 diabetes mellitus. The patient had antibiotic-resistant DFUs on two phalanges of his left foot, which were completely gangrenous, and a superficial ulcer of 1 × 1 cm under his left foot. Despite the routine DFU care, the phalanges of his DFU were amputated. The patient was moved to our wound management team. DFU was treated and managed using surgical debridement and maggot debridement therapy. Ten sessions of Maggot Debridement Therapy (MDT) were conducted (one therapy session every 48 h). After three months, the patient's DFUs healed, and he was discharged from our service in good condition.

Clinical discussion

DFU can lead to infection, amputation, and even patient death. Therefore, effective treatment methods are very important for managing DFUs.

Conclusion

Using surgical debridement and MDT is a safe and effective approach to facilitate the healing of DFUs.

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Management of diabetic foot ulcers (DFUs) is one of the most critical challenges for the patients.

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Diabetic foot ulcers do not respond to standard drug therapies.

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Surgical debridement and Maggot Debridement Therapy (MDT) can manage diabetic foot ulcers.

Combined application of moist exposed burn ointment and maggot therapy in wound healing

Objective:

Hard-to-heal wounds are a global health challenge, and effective treatments are still lacking. Moist exposed burn ointment (MEBO) and maggots are traditional treatments for promoting wound healing. This study was a preliminary exploration of combined maggot therapy and MEBO in the treatment of hard-to-heal wounds.

Method:

A coexistence experiment was conducted to determine the survival rates of maggots in MEBO. The maggots were placed in two different existence conditions: one set in MEBO (MEBO group), and another set as the control group (no MEBO) to compare survival rates. Case reports describe the use of the combined application of MEBO and maggots in the treatment of patients with hard-to-heal wounds.

Results:

The coexistence experiment indicated that maggots in the MEBO group had a higher survival rate. From the therapeutic effect of the clinical cases (n=7), the combined application was safe and effective, with all the reported wounds eventually healing.

Conclusion:

Based on the findings of this study, we believe the combined application of MEBO and maggots is a promising way of promoting wound healing. Further studies and clinical trials are needed to elucidate the mechanism of the combined application in promoting wound healing and to more persuasively clarify the therapeutic effect.

LARVOTERAPIA NO TRATAMENTO DE LESÕES DE DIFÍCIL CICATRIZAÇÃO: REVISÃO INTEGRATIVA

Objetivo:Analisar as evidências disponíveis na literatura acerca da utilização da larvoterapia no tratamento de feridas de difícil cicatrização. Método: Trata-se de revisão integrativa, tendo como questão norteadora: quais são as evidências disponíveis na literatura acerca da utilização da larvoterapia no tratamento de feridas de difícil cicatrização? Elegeram-se como critérios de inclusão: artigos originais, de revisão de literatura e de relatos de experiência, recorte temporal de 2016 a 2021, disponíveis online na íntegra, em português, inglês e espanhol e que respondessem à pergunta de pesquisa. Os critérios de exclusão foram: artigos duplicados, cartas ao editor, dissertações, teses, monografias e pesquisas com animais. Buscas ocorreram na Biblioteca Virtual em Saúde e Biblioteca Nacional de Medicina dos Estados Unidos entre agosto e setembro de 2021. Resultados: Selecionaram-se 10 artigos. As principais vantagens foram: desbridamento seletivo, ação bactericida ou bacteriostática e promoção de tecido de granulação e de fatores cicatrizantes. Já as principais desvantagens abrangeram: dor, desconforto, preconceito e fragilidades com o mercado de produção larval. Conclusão: As vantagens encontradas sobrepõem as desvantagens evidenciadas. Portanto, a larvoterapia é favorável para tratar feridas de difícil cicatrização.

LARVOTHERAPY IN THE TREATMENT OF DIFFICULT-TO-HEAL LESIONS: INTEGRATIVE REVIEW

Objective: To analyze the evidence available in the literature about the use of larvotherapy in the treatment of difficult-to-heal wounds. Method: This is an integrative review, having as a guiding question: what evidence is available in the literature about the use of larvotherapy in the treatment of wounds that are difficult to heal? The inclusion criteria were: original articles, literature review and experience reports, from 2016 to 2021, available online in full, in Portuguese, English and Spanish and that answered the research question. Exclusion criteria were: duplicate articles, letters to the editor, dissertations, theses, monographies and research with animals. Searches took place at Virtual Health Library and United Station National Library of Medicine between August and September 2021. Results: Ten articles were selected. The main advantages were: selective debridement, bactericidal or bacteriostatic action, and promotion of granulation tissue and healing factors. The main disadvantages were: pain, discomfort, prejudice, and weaknesses with the larval production market. Conclusion: The advantages found outweigh the disadvantages evidenced. Therefore, larvotherapy is favorable to treat wounds that are difficult to heal.

Reviving hope by using of maggot debridement therapy in patients with diabetic foot ulcer: A case report study

Introduction and importance

Refractory diabetic foot ulcers (DFUs) do not easily respond to standard therapeutic approaches and the prevention of DFU-related amputation is one of the most important aspects of treatment in patients with DFU.

Case presentation

The present case report is 51-year old male patient with a history of 5-years type 2 diabetes who has had DFU on the first distal phalanx foot of his right foot with size of 2 × 2 cm. The patient was repeatedly hospitalized for receiving DFU treatment, he did not recover using routine wound treatment. The patient was transferred to our wound care team. After ten sessions (one session every 48 h) of maggot debridement therapy (MDT) using sterile Lucilia sericata, the patients' DFU had completely healed.

Clinical discussion

DFUs can change patient's quality of life and lead to infection, amputation, sepsis, and finally death. Thus, efficient therapeutic methods are necessary for management of DFUs.

Conclusion

This case report was revealed that the maggot therapy is an affordable and highly efficacious treatment method to enhance the recuperation of DFUs. Therefore, it is recommended that wound care teams use this approach to speed up the healing process.

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DFU is one of the most significant complications of diabetes mellitus.

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Affordable and efficacious treatment is necessary for the management of DFUs.

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Maggot debridement therapy is effective approach for healing DFUs.

The metabolism and role of free fatty acids in key physiological processes in insects of medical, veterinary and forensic importance

Insects are the most widespread group of organisms and more than one million species have been described. These animals have significant ecological functions, for example they are pollinators of many types of plants. However, they also have direct influence on human life in different manners. They have high medical and veterinary significance, stemming from their role as vectors of disease and infection of wounds and necrotic tissue; they are also plant pests, parasitoids and predators whose activities can influence agriculture. In addition, their use in medical treatments, such as maggot therapy of gangrene and wounds, has grown considerably. They also have many uses in forensic science to determine the minimum post-mortem interval and provide valuable information about the movement of the body, cause of the death, drug use, or poisoning. It has also been proposed that they may be used as model organisms to replace mammal systems in research. The present review describes the role of free fatty acids (FFAs) in key physiological processes in insects. By focusing on insects of medical, veterinary significance, we have limited our description of the physiological processes to those most important from the point of view of insect control; the study examines their effects on insect reproduction and resistance to the adverse effects of abiotic (low temperature) and biotic (pathogens) factors.

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.

Salvage of a mangled limb with Matriderm® augmented split-skin grafting and maggot biodebridement

Salvage of a mangled limb can be a long and strenuous way, but it is feasible even with rather simple techniques such as augmented split-skin grafting and maggot biodebridement.

The effect of Lucilia sericata larval excretion/secretion (ES) products on cellular responses in wound healing

Chronic wounds are still regarded as a serious public health concern, which are on the increase mainly due to the changes in life styles and aging of the human population. There are different types of chronic wounds, each of which requires slightly different treatment strategies. Nevertheless, wound bed preparation is included in treatment of all types of chronic wounds and involves tissue debridement, inflammation, and infection control, as well as moisture balance and epithelial edge advancement. Maggot therapy (MT) is a form of biological debridement which involves the application of live medical grade Lucilia sericata (Meigen, 1826) (Diptera: Calliphoridae) larvae. Whereas it was initially thought to act mainly through debridement, today MT is known to influence all four overlapping physiological phases of wound repair: homeostasis, inflammation, proliferation, and remodelling/maturing. During MT, medical-grade larvae are applied either freely or enclosed in tea-bag like devices (biobag) inside the wounds, which suggests that larva excretion/secretion (ES) products can facilitate the healing processes directly without the need of direct contact with the larvae. This review summarizes the relevant literature on ES-mediated effects on the cellular responses involved in wound healing.

Saving diabetic foot ulcers from amputation by surgical debridement and maggot therapy: A case report

INTRODUCTION AND IMPORTANCE

A diabetic foot ulcer (DFU) is one of the major diabetes complications that may lead to limb amputation. Amputation can have profound physical and psychological effects on an individual's life. Nowadays, the prevention of limb amputation and treatment of DFUs are known as the major health challenges.

CASE PRESENTATION

The present case report is of a 72-year-old woman with a 20-year history of type 2 diabetes who has had asymmetrical and superficial DFUs with sizes of 6 × 5 cm and 3 × 3 cm on the heel and the sole of the right foot, respectively. The ulcers were infected by S. aureus and E. coli. The patient had been hospitalized several times for receiving treatment, and not only the ulcers had not been healed, but also they had considerably extended so that the risk of foot amputation had been greatly increased. The patient was transferred to our wound care service. After conducting one session of surgical debridement, the patient underwent ten sessions of maggot therapy (one session every two days) using sterile Lucilia sericata. After about six months, the patient's DFUs were completely healed.

CLINICAL DISCUSSION

DFU can affect a patient's quality of life and lead to infection, sepsis, amputation, and even patient death. Therefore, using effective treatment approaches is very important for the management of DFUs.

CONCLUSION

The combined use of surgical debridement and maggot therapy is a safe and effective method for improving diabetic foot ulcers and preventing amputation.

Negative Impact of Pseudomonas aeruginosa Y12 on Its Host Musca domestica

High concentrations of Pseudomonas aeruginosa Y12 significantly inhibit the development of housefly larvae and accelerate larvae death. In this study, the dynamic distribution of the gut microbiota of housefly larvae fed different concentrations of P. aeruginosa Y12 was investigated. Compared with low-concentration P. aeruginosa diets, orally administered high-concentration P. aeruginosa diets caused higher mortality and had a greater impact on the community structure and interaction network of intestinal flora in housefly larvae. The bacterial community of the gut microbiota in housefly larvae was reconstructed in 4 days. Bacterial abundance and diversity were significantly reduced in housefly larvae fed high concentrations of P. aeruginosa. With the growth of larvae, the relative abundances of Providencia, Proteus, Myroides, Klebsiella, and Alcaligenes increased significantly in housefly larvae fed with high concentrations of P. aeruginosa, while the relative abundances of Bordetella, Enterobacter, Morganella, Ochrobactrum, Alcaligenaceae, and Empedobacter were significantly reduced. To analyze the role of the gut microorganisms played on housefly development, a total of 10 cultivable bacterial species belonging to 9 genera were isolated from the intestine of housefly larvae among which Enterobacter hormaechei, Klebsiella pneumoniae, Enterobacter cloacae, Lysinibacillus fusiformis, and Bacillus safensis promoted the growth of larvae through feeding experiments. This study is the first to analyze the influence of high concentrations of P. aeruginosa on the gut microbiota of houseflies. Our study provides a basis for exploring the pathogenic mechanism of high concentrations of P. aeruginosa Y12 in houseflies.

Surgical debridement, maggot therapy, negative pressure wound therapy, and silver foam dressing revive hope for patients with diabetic foot ulcer: A case report

Introduction and importance

Diabetic foot ulcers (DFUs), as one of the most debilitating complications of diabetes, can lead to amputation. Treatment and management of d DFUs are among the most critical challenges for the patients and their families.

Case presentation

The present case report is of a 63-year-old man with a 5-year history of uncontrolled type 2 diabetes who has had DFU for the past three years on three sites of the left external ankle in the form of two deep circular ulcers with sizes of 6 × 4 cm and 6 × 8 cm, the sole as a superficial ulcer with a size of 6 × 3 cm, and the left heel as a deep skin groove. Moreover, the left hallux was completely gangrenous. The patient's ulcers were infected with Staphylococcus aureus and multidrug-resistant Pseudomonas aeruginosa. The patient was transferred to our wound management team. DFU was treated and managed using a combination of surgical debridement, maggot therapy, the Negative Pressure Wound Therapy (NPWT), and silver foam dressing. After three months and ten days, the patient's ulcers completely healed, and he was discharged from our service with the excellent and stable condition.

Clinical discussion

DFUs are caused by various pathological mechanisms, the monotherapy strategy would lead to a very low level of recovery. Therefore, DFU management requires multimodal care and interdisciplinary treatment.

Conclusion

Based on the present case report study's clinical results, wound-care teams can use the combination therapy applied in this case report to treat refractory DFU.

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DFUs can lead to amputation.

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DFUs do not respond to standard drug therapies.

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DFUs can be managed by combination therapy.

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The medical teams can benefit from combination therapy.

Ecosystem Services Provided by Insects in Brazil: What Do We Really Know?

Insects are the most abundant and diverse organisms on Earth and provide essential ecosystem services. However, Brazilian society rarely consider the importance of insects in their diverse country. Therefore, in this review, we provide an overview of ecosystem services provided by insects in Brazil. A database search returned 136 articles, published in English or Portuguese, on ecosystem services provided by insects in Brazil. The first article was published in 1982, and majority of the studies were conducted in the Atlantic Forest or the Cerrado biomes. The most frequently studied insect-provided ecosystem services were pollination, decomposition, and biological control of pests. The studies focused primarily on natural and anthropic ecosystems, and most followed an experimental approach. We noted that the term "ecosystem services" was not used frequently in studies on insects in Brazil. The information available was mostly taxon-biased. We discuss the implications of these findings in relation to reconciling economic interests and the need for insect conservation for continued provision of ecosystem services in a broader perspective. In conclusion, we argue that the scientific community should focus on understanding the ecosystem services provided by insects other than those strictly related to economic activities, and on improving communication with policymakers and citizens. As a tropical and megadiverse country, Brazil has the potential to become a protagonist in conserving and using the ecosystem services provided by insects, both locally and internationally, by providing scientific information to policymakers and citizens.