Oral myiasis caused by the screwworm Cochliomyia hominivorax treated with subcutaneous ivermectin and creolin: report of six cases after trauma.

Human myiasis is a rare condition that is more common in regions with a warm and humid climate. The larvae involved in myiasis are voracious; they destroy healthy tissues and may cause serious haemorrhage. The condition can be life threatening. Six patients with craniofacial trauma and oral myiasis are reported. The diagnoses were made after larvae had been extracted. Treatment consisted of subcutaneous ivermectin therapy and the application of a phenol preparation (10% creolin) as a local measure for the control of larvae. After 12 (±1) days of hospitalization, no larvae remained in the patients' mouths and the patients were discharged. The laboratory identified the larvae as those of the fly Cochliomyia hominivorax. Healing was uneventful in the six cases presented, and no undesirable reactions were observed throughout the period of treatment. Although the usual treatment for myiasis involves surgical removal of the maggots, pharmacological therapies are emerging as effective alternatives.

Necrotizing ulcerative periodontal diseases in children and young adults in Medellín, Colombia, 1965--2000.

Previous findings that necrotizing ulcerative gingivitis (NUG) is a precursor to noma or cancrum oris were confirmed by the follow-up of these clinical conditions in a study of 45 Colombian patients: necrotizing ulcerative gingivitis (NUG, n = 29), necrotizing ulcerative periodontitis (NUP, n = 7) and noma (n = 9). Patients were diagnosed at the outpatient clinic of the School of Dentistry at the University of Antioquia, at the University Hospital Saint Vincent of Paul, at the Luz Castro de Gutierrez University Hospital, at the Red Cross Hospital and at the private office of one of the authors (Jiménez L., M) in Medellín, Colombia, from 1965 until 2000. Almost all the patients came from low socioeconomic groups and presented with predisposing and/or contributing factors, such as acute herpetic gingivostomatitis, measles, and leukemia (including acute lymphoblastic and chronic lymphoid leukemia). Malnutrition and poor oral hygiene were associated with the necrotizing process and favored progression from the gingiva to deeper periodontal tissues and other structures within the oral cavity or the facial tissues. No patients had human immunodeficiency virus (HIV) or AIDS, which makes these findings different from other reports. Noma can be prevented by vaccinating children against infectious diseases, by controlling malnutrition and by improving their oral hygiene. It is arrested by mechanical lesion debridement, improving oral hygiene and antibiotic therapy. Necrotizing ulcerative gingivitis may progress in some cases to ulcerative necrotizing stomatitis, necrotizing ulcerative periodontitis, and, finally, to noma. Microbial studies among new Colombian NUG, NUP and noma patients are necessary, using bacterial culturing and identification methods and molecular techniques such as PCR for viruses and bacteria, in order to establish the exact nature of these lesions.