Otorhinolaryngological myiasis: the problem and its presentations in the weak and forgotten

The epidemiology and clinical features of the neglected myiasis: A pilot surveillance study from Oman

BACKGROUND

Myiasis is a neglected disease, characterized by ill-defined diagnostics and management protocols. Published epidemiological and clinical studies of myiasis are still scarce, although several countries, such as Oman, have reported a few cases over the past 30 years. This study explores the epidemiological profile and clinical characteristics of myiasis in South Batinah Governorate (SBG), Oman.

METHODOLOGY

A prospective surveillance study was conducted in SBG from 1st November 2018 to 31st October 2019. Clinical and epidemiological data were collected using a pre-designed reporting form for suspected and confirmed cases.

RESULTS

A total of 188 cases were reported, of which 81.4% were male. One-third of cases were 11-20 years old, and a quarter reported exposure inside house. The rate of exposure was 16 per 10000 in Nakhal and Wadi Mawel. About 57% patients reported multiple re-exposure. Almost 60% of patients developed nasal or oral myiasis, 25% developed myiasis in the eye, and 4% in the ear. The most common respiratory symptoms were cough (83%), runny nose (48%), and foreign body sensation (35%). Over 50% of patients with eye exposures had redness, pain, and itchiness. Most patients (89.3%) kept animals at homes. Many cases occurred between December 2018 and April 2019, with almost one-third of exposures occurring at 5 p.m. Re-exposure likelihood for patients residing in Nakhal and Wadi Mawel was high; OR = 2.49 (95% CI 1.14-5.45), with OR = 3.59 (95% CI 1.37-9.39) for 11-20-year-olds and, OR = 3.01 (95% CI 1.07-8.42) for patients ≥ 31 years.

CONCLUSION

The myiasis exposure rate is high in certain areas and age groups, which is most likely associated with animal-related activities. The disease has a significant impact upon people's health in SBG. Therefore, urgent active-surveillance and clinical studies are warranted to explore possible preventive measures and treatment options. Adopting one health approach could offer an effective strategy for preventing myiasis in human and animal populations.

Oral Myiasis in an Immunocompromised Adult Undergoing Chemotherapy: A Rare Case and Comprehensive Treatment Protocol

Oral myiasis, a rare condition caused by the infestation of live maggots in the oral cavity, can present unique challenges in immunocompromised individuals. This case report presents a unique case of oral myiasis in an immunocompromised adult undergoing chemotherapy. A 67-year-old female suffering from metastatic carcinoma of the ovary was undergoing chemotherapy treatment at the time of presentation. Prompt diagnosis and management, including larval removal, wound care, and systemic antibiotics, were initiated. This case highlights the susceptibility of immunocompromised individuals to uncommon complications, such as oral myiasis, due to their compromised immune system. It also emphasizes the need for heightened vigilance in the oral care and monitoring of immunocompromised patients undergoing chemotherapy, as well as the importance of early intervention to prevent potential complications associated with oral myiasis. In this article, we have also included a comprehensive treatment protocol for treating this condition based on our clinical experience.

The Price of Hospital Reshaping: Nasal Myiasis Caused by Flesh Fly (Diptera: Sarcophagidae) in Reallocated COVID-19 Intensive Care Unit

Myiasis is a condition characterized by fly larvae infestation, most common in tropical regions, but with a risk of occurring anywhere in the world. Here, we report a case of nasal myiasis caused by a sarcophagid fly in a critically ill COVID-19 patient hospitalized in a reallocated ICU department in Serbia and discuss procedures that could prevent the occurrence of similar incidents in reallocated ICU departments worldwide.

A Rare Case of Oral Myiasis Caused by Phormia regina (Meigen) (Diptera: Calliphoridae) in an Intubated Patient

Myiasis is the infestation of tissues with living larvae. Oral myiasis is an extremely rare form of the disease, with open mouth, unconsciousness, and poor oral hygiene being the predisposing factors. It is generally observed in the tropics or subtropics, as well as rural places with low socio-economic income. Mechanical removal and ivermectin are frequently used as treatments. Herein, we present a case of oral myiasis in a 69-year-old male intubated patient with myocardial infarction. Multiple larvae were observed in the mouth and mechanically removed. With the microscopic investigation, the larvae were identified as Phormia regina (Meigen) (Diptera: Calliphoridae), which is extremely rare globally. For preventing oral myiasis, good patient care, good sanitary practice for oral health, efficient treatment of dental diseases, and fly population control, usage of masks for the risk groups are recommended.

Ophthalmomyiasis in a preterm neonate resulting in blindness: A case report from Botswana

Myiasis is an infestation of human tissue by insect larvae. While rare, healthcare-associated myiasis has been reported from immobilized patients in resource-limited healthcare facilities in warm climates without adequate vector control measures. We describe a case of Ophthalmomyiasis in a hospitalized neonate in Botswana that resulted in vision loss. The neonate, who was initially hospitalized due to the complications of prematurity, received phototherapy for jaundice, and to avoid phototherapy-related retinopathy, the neonate's eyes were covered using cotton gauze and adhesive tapes that potentially damaged the skin as commercially available eye covering was not in stock. Therefore, eye covering was not changed and when the eye covering was removed almost 3 days after placement, insect larvae were noted in the patient's eyes and nose. Ophthalmologic evaluation revealed perforated corneal ulcer and uveal prolapse in the right eye resulting in complete blindness and corneal scarring of the left eye. The patient's clinical course was further complicated by an Enterobacter species bloodstream infection. This case highlights the importance of vector control as a major patient safety measure for neonatal units in warm climates. Flies had been observed in the room and mitigation measures included reducing fly populations through traps, screens, and removal of standing water and leftover food. Every mother and staff were sanitizing hands when entering the room and gowns were used. This case also reinforces the importance to conduct vigilant monitoring of patients, especially neonates with eyes covered during phototherapy.

Oral myiasis in humans

Myiasis is a parasitic infestation resulting from flies laying eggs in the host tissues. It is common in animals, but can also occur in humans, including in the oral cavity. The diagnosis is usually quite clear in endemic regions such as Brazil, but it can be challenging to clinicians in nonendemic counties when faced with a patient who has acquired the infection elsewhere. We report two clinical cases of human intraoral myiasis and discuss the diagnosis and treatment of this condition. Two men, both of whom were in situations of vulnerability presented with myiasis: the first patient had larvae infesting the alveolar ridge region after tooth extraction, while the second was diagnosed with inflammatory fibrous hyperplasia associated with larvae along the edges of the lesion. Both were treated with ivermectin and antibiotics, and given guidance on preventative care. Such infestations are often a clear sign of neglect, and clinicians need to pay attention to the general health of patients affected by oral myiasis.

Management of nasal myiasis and type 2 diabetes mellitus: A rare case and review article

Background

Nasal myiasis is a nasal infestation caused by house fly larvae (maggot). It's a rare condition with only a few reported cases and no treatment consensus.

Case presentation

A 54-year-old woman was admitted to the emergency unit with a complaint of larvae found in the left nasal cavity and bloody nasal discharge for 2 days. Anterior rhinoscopy found some living larvae in a narrowed left nasal cavity. Patient's management included larvae removal manually with forceps, nasal saline irrigation, a systemic broad-spectrum antibiotic, and insulin to controlled blood sugar.

Discussion

Removal of larvae in the nasal cavity using irrigation saline and systemic broad-spectrum antibiotics is effective in the absence of bone destruction.

Conclusion

manual extraction combined with nasal saline irrigation and systemic broad-spectrum antibiotic was effective to manage nasal myiasis.

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Nasal myiasis in type 2 diabetes mellitus patients can recover when the patient's blood sugar level is controlled.

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Treatment of nasal myiasis wounds can use saline irrigation.

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Effective management of nasal myiasis with a combination of saline irrigation and systemic broad-spectrum antibiotics.