Myiasis in Neglected Cutaneous Squamous Cell Carcinoma of the Head and Neck: Review of Management and Current Protocol Recommendations.

OBJECTIVE: To propose a first-aid management protocol for myiasis in neglected cutaneous squamous cell carcinoma (SCC) in the ED based on a recent literature review. DATA SOURCES: PubMed. STUDY SELECTION: Inclusion criteria were all series and case reports of primary/secondary cutaneous SCC with myiasis of the head and neck, including orbital SCC cases, published after 2005. DATA EXTRACTION: A total of 14 articles including 15 patients were included. DATA SYNTHESIS: Demographics, socioeconomic situation, site of the lesion, larvae species with bacterial suprainfection, and first-aid treatment options were discussed. Two representative cases are described. CONCLUSIONS: Large, ulcerated, necrotic, myiasis-burdened SCC lesions in the head and neck area present a challenge for treatment, and to date, no consensus regarding first-aid management exists. The authors' proposed four-pillar first-aid management scheme may be a valid option to rapidly improve wound condition through disinfection, pain relief, and malodor and discharge eradication as a bridge to surgery.

First molecular characterization of hypodermin genes of Hypoderma bovis and serodiagnosis of bovine hypodermosis with recombinant hypodermin C antigen and a synthetic peptide containing its linear B-cell epitope.

Hypodermins A (HA), B (HB), and C (HC) of warble flies are modulatory antigens involved in host inflammation and immune responses during migration of the warble fly larvae through host connective tissues. In the current study, molecular characteristics of the genes encoding HA, HB, and HC were revealed from cDNA constructs of third-instar larvae of Hypoderma bovis. The open reading frame (ORF) of each hypodermin gene was amplified with modified gene-specific primers, and the resulting PCR products were cloned into pGEM-T Easy Vector to produce recombinant plasmids (rHA, rHB, and rHC). The ORF sequences of rHA, rHB, and rHC genes are 705 bp, 771 bp, and 783 bp long and encode proteins of 234, 256, and 263 amino acids with predicted sizes of 25.74 kDa, 27.79 kDa, and 28.51 kDa, respectively. The rHC gene was subcloned into the pET 100/D-TOPO Expression Vector, and the recombinant HC was purified using affinity chromatography. Western blotting indicated that rHC was recognized by the sera of cattle naturally infested with H. bovis. The rHC and a synthetic peptide (sHC) containing its linear B cell-specific epitope were evaluated as serological markers in indirect ELISA (iELISA) for the diagnosis of bovine hypodermosis. Both sHC and rHC iELISAs had sensitivity values equal to or higher than 90 % and specificity values of 100 %. A total of 200 serum samples from cattle in the Central Anatolia Region of Turkey were also analyzed by rHC and sHC-iELISAs to reveal the seroprevalence of bovine hypodermosis. The results of both iELISAs were consistent with one another and revealed a hypodermosis prevalence of 62 %. Our study provides the first data on molecular characterization of hypodermin genes of H. bovis and indicates the efficacy of recombinant antigen and peptide-based iELISA for serodiagnosis of bovine hypodermosis.

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.

High morbidity cutaneous enzootic myiasis by Dermatobia hominis (Diptera: Oestridae) in sambar deer (Rusa unicolor).

This study describes the first known occurrence and treatment of enzootic cutaneous myiasis by Dermatobia hominis in a herd of sambar deer (Rusa unicolor). Sambar deer are clinically affected by enzootic cutaneous myiasis during the spring and summer in Rio de Janeiro, Brazil. Through direct inspection and clinicopathological evaluation in the herd with 80 R. unicolor, it was observed that infestation by D. hominis caused 100% morbidity. At histological exam, skin had eosinophilic and granulomatous chronic active severe necrohemorrhagic dermatitis associated with botfly and moderate surrounding fibroplasia. The systemic treatment with oral ivermectin at 0.08% was effective in 93.7% of deer with enzootic cutaneous myiasis after fourteen days. After treatment, the skin deer had eosinophilic and granulomatous chronic severe dermatitis associated with degenerated botfly and severe fibroplasia. Notable differences in leukocyte profile were observed between groups pre- and post-treatment. Decrease of relative values of neutrophils and eosinophils were significant in the treated deer group. An increase of relative values of monocytes was also confirmed in the treated group. Sambar deer was the only species affected by D. hominis, even though several other wild herbivores were kept in the same area. More studies are needed to elucidate the susceptibility of R. unicolor to D. hominis cutaneous infestations.

Dermatobia hominis in a dog imported from Brazil to Romania.

BACKGROUND: Dermatobia hominis (Diptera: Oestridae: Cuterebrinae) is a parasite with an important zoonotic and economical impact in the cattle industry, distributed in Central and South America, inhabiting wooded areas along rivers and lowlands. It infests mammals including humans. Lately, there has been a growing trend for people to travel on holidays with their pet dog and also international trade of dogs has increased significantly in the last two decades. Hence, the risk of importation of exotic parasites, including agents of myiasis has increased. Dermatobia hominis has been commonly reported as an imported parasite to various countries, mostly as human cases and currently there are only two published cases of D. hominis imported with dogs to Europe. Herein, we report a case of D. hominis infestation in Romania in a dog recently imported from Brazil. METHODS: Larvae were manually extracted from nodules of a 4-month old non-neutered male, Fila Brasileiro in Arad, Romania. The larvae were morphologically identified, and one specimen was characterized molecularly by amplification and sequencing of a fragment of the mitochondrial cytochrome c oxidase subunit 1 gene (cox1). RESULTS: All larvae were morphologically identified as L3 of Dermatobia hominis. The BLAST analysis revealed a 98.81% nucleotide similarity to two D. hominis isolates from Brazil. The sequence was deposited in the GenBank database under the accession number MT364820. CONCLUSIONS: The travel history of dogs is an important part of the veterinary anamnesis questions and should be thoroughly conducted in the daily practice. Also, prior to and after the importation of dogs from tropical regions, a thorough check of the body surface to detect the presence of nodules is recommended.

Internal morphological changes during metamorphosis in the sheep nasal bot fly, Oestrus ovis.

During the larval stage, oestrid flies (Diptera: Oestridae) are obligate parasites, whereas during the adult stage they are free-living and do not feed. Like other cyclorrhaphous flies, oestrids undergo metamorphosis inside an opaque puparium, formed by the contracted and hardened cuticle of the third-instar larva. The present study documents the internal morphological changes taking place during metamorphosis of the sheep nasal bot fly, Oestrus ovis L., using non-invasive, micro-CT-based virtual histology and provides quantitative data of volumetric changes in specific organs. Virtual histological sections allowed visualisation of the progression and completion of the apolyses, which delimit the different intra-puparial stages, and the connection to the tracheal system of a large gas bubble, which plays an essential role during early metamorphosis. Overall, our results show that the sequence of morphological and volumetric changes in tissues and organs is similar to those found in other cyclorrhaphous flies, but they also reveal developmental differences that result in an adult vestigial digestive tract. Future studies could develop non-invasive, reliable methods for aging the intra-puparial forms of different oestrid species of veterinary importance, based on both qualitative and quantitative markers, thus improving our knowledge of their development and the efficiency of control strategies.

Hair Cortisol Concentration and Body Mass in Moose (Alces alces) Infested with Deer Keds (Lipoptena cervi).

The deer ked (Lipoptena cervi), a hematophagous ectoparasite of cervids, is currently spreading in Scandinavia, and the moose (Alces alces) is its main host. However, little is known about the impact of deer keds on moose. We analyzed the hair cortisol concentration (HCC) from 262 moose harvested in the fall in relation to age class, sex, body mass (BM), and deer ked infestation intensity, and BM in relation to age class, sex, and infestation intensity. We found that HCC decreased with increasing deer ked intensity at low ked intensities, but for the higher levels of ked intensities, there was a positive relationship between HCC and ked intensity. The HCC was higher in males than in females and lower in yearlings than in calves and adults. Our failure to find any association between BM and deer ked intensity suggested a negligible impact of deer ked infestation on moose foraging and metabolism at the level of infestation observed early in the infestation, but did not exclude an effect later in winter. Our findings suggested that moose generally tolerated moderate parasitism by keds. However, the increase in HCC at higher ked intensities suggested that the tolerance strategy could be disrupted with further increases in intensities and consequently may negatively affect animal health and welfare.

A world review of reported myiases caused by flower flies (Diptera: Syrphidae), including the first case of human myiasis from Palpada scutellaris (Fabricius, 1805).

Rat-tailed larvae of the syrphid species Palpada scutellaris (Fabricius, 1805) are documented causing an enteric human myiasis in Costa Rica. This is the first time that the genus Palpada is recorded as a human myiasis agent. We report a 68-year-old woman with intestinal pain and bloody diarrhea with several live Palpada larvae present in the stool. Using molecular techniques (DNA barcodes) and both electronic and optical microscopy to study the external morphology, the preimaginal stages of the fly were unambiguously identified. An identification key to all syrphid genera actually known as agents of human and animal myiases is provided for larvae, puparia, and adults. Moreover, a critical world review of more than 100 references of Syrphidae as myiasis agents is also given, with emphasis on the species with rat-tailed larvae.

Human ophthalmomyiasis caused by Oestrus ovis-first report from Croatia and review on cases from Mediterranean countries.

Oestrus ovis is the most common cause of human ophthalmomyiasis. So far, majority of ophthalmomyiasis cases have been reported from Mediterranean countries, but not from Croatia. In current study, we present first two cases of human ophthalmomyiasis in Croatia, caused by O. ovis larvae. Reviewing a PubMed database, additional 259 cases of human ophthalmomyiasis in countries of Mediterranean basin have been reported. A total of 260 (99.62%) cases had external, while 1 (0.38%) had internal form of ocular myiasis. In all cases, O. ovis larvae were identified as the causative agent. O. ovis infestation is usually reported in shepherds and farmers although there is a high prevalence of infection in urban areas as well. Various climatic factors influence O. ovis larvipositional activity. Air temperature is the most important factor affecting O. ovis larviposition, while humidity, wind speed, and time of the day play only a moderate role. Most common symptoms of ophthalmomyiasis are irritation and redness, and in more than half of cases infestation is multiple. Ophthalmomyiasis interna is eye-compromising condition. Since there is reduced awareness among patients and medical professionals, the real number of ophthalmomyiasis cases is probably significantly higher than published. Global warming predisposes future increase of O. ovis prevalence in humans, which emphasizes the need for mandatory reporting and surveillance of disease.

Histological and Immunohistochemical Study of Wounds in Sheep Skin in Maggot Therapy by Using Protophormia terraenovae (Diptera: Calliphoridae) Larvae.

A study was performed to evaluate the implication of Protophormia terraenovae larvae as a surgical therapy for wounded skin. Three groups of sheep (n = 25) were considered based on larval doses. Groups 1 and 2 were artificially infested with low and high concentrations of L1 stage P. terraenovae, respectively, and group 0 served as a control. Skin biopsies were taken at 4 and 14 d postinfestation (D.P.If). A histopathological study was carried out to evaluate the lesions with a score, numbers of eosinophils and mast cells, and an immunohistochemical analysis of CD3, CD79α, and CD68 as T lymphocytes, B lymphosytes, and macrophages, respectively. The results indicated that higher larval doses led to faster regeneration by 14 D.P.If. Furthermore, the higher larval doses showed a high number of the CD68 marker and eosinophils and a low number of CD3 and CD79α markers and mast cells. In addition, the number of mast cells, T lymphocytes, and macrophage markers increased when the lesion progressed; however, a low number of immunolabeled CD79α cells and eosinophils were observed. The results indicate a possible positive effect of larvae in the healing of certain wounds.

Case Report: Nasal Myiasis in an Elderly Patient with Atrophic Rhinitis and Facial Sequelae of Leprosy.

We describe a case of nasal myiasis in an 89-year-old Brazilian patient affected by leprosy with severe nasal sequelae. An initial treatment comprising sinusectomy combined with nasal endoscopy removed more than 300 larvae, supplemented by systemic treatment using oral and topical ivermectin and levofloxacin. Infestation recurred after 2 months, was treated similarly, and resolved completely. The case could be attributed to severe nasal leprosy sequelae, with a lack of sneezing reflex, painless ulceration, atrophic rhinitis (ozena), and inability to clean the nose properly due to hand and nose impairment. This case illustrates the importance of long-term medical follow-up of patients with leprosy sequelae.

Myiasis from Sarcophaga spp in a patient with cutaneous lymphoma.

Human autochthonous myiasis is uncommonly reported in Europe. This report describes a case of myiasis of a wound caused by Sarcophaga spp. Suffering from cutaneous lymphoma, the patient showed, at the level of his scalp lesions, the presence of larvae that were removed during curettage surgery; they were subsequently identified as belonging to the genus Sarcophaga. Preservation of these larvae in 10% formalin did not allow identification at the species level using molecular methods.

Miasis cutánea en mal perforante plantar de la lepra. A propósito de un caso / No disponible

La miasis cutanea es una zoonosis producida por la infestacion o invasion de tejidos vivos por larvas de diptera. Las miasis son mas frecuentes en paises tropicales, y subtropicales, especialmente si la actividad humana se desarrolla en ambientes con escasa higiene, pocos casos han sido reportados en Cuba. Se trata de una paciente blanca, femenina de 70 anos de edad con antecedentes de haber tenido lepra lepromatosa 20 anos atras por lo cual fue tratada con multidrogo- terapia y dada de alta. La paciente refiere que producto de la enfermedad le quedaron deformidades en nariz, en dedos de manos y pies y una ulcera en planta de pie derecho, desde hace aproximadamente una semana le aparecieron unos gusanos por lo cual fue remitida por su medico de familia a nuestro hospital para mejor tratamiento. Al examen dermatologico se observa cuadro cutaneo diseminado constituido por lesiones en placas exulceradas que tienden a reunirse y ocupar gran extension que abarca tercio inferior de ambas piernas, asi como lesiones cicatrizales y escamo - costrosas en la periferia de las placas, se constata ademas ulcera plantar derecha en el antepie donde se observan numerosos gusanos. Se realizo extraccion de las larvas con pinza y curacion de la ulcera. Se realiza la presentacion de un caso de una paciente femenina que presento lepra lepromatosa 20 anos atras con secuelas dadas fundamentalmente por mal perforante plantar donde asento la miasis cutánea

Cutaneous myiasis is a zoonosis caused by infestation or invasion of living tissues by diptera larvae. Myiasis are more frequent in tropical and subtropical countries, especially if human activity takes place in environments with poor hygiene. Only few cases are reported in Cuba. This is a white, female patient of 70 years of age with a history of having had lepromatous leprosy 20 years ago, for which she was treated with multidrug therapy and discharged. The patient reports that the disease caused deformities in the nose, fingers and toes, and an ulcer on her right foot. About a week ago, worms appeared and her family doctor referred her to our hospital for better treatment. Dermatological examination revealed disseminated cutaneous plaque consisting of lesions in ulcerated plaques that tend to meet and occupy a large area that covers the lower third of both legs as well as scarring and scaly lesions in the periphery of the plaques. In addition, there is a right plantar ulcer. in the forefoot where numerous worms were observed. The larvae were extracted with a clamp and the ulcer was cured. We present this case of a female patient treated for lepromatous leprosy 20 years ago with a remaining perforating plantar ulcer on her right foot where cutaneous myiasis was detected

Rare cutaneous myiasis of the face due to Lund's fly (Cordylobia rodhaini) in a British traveller returning from Uganda.

We present a rare cause for cutaneous furuncular myiasis in a 55-year-old British traveller returning from Uganda. Initially presenting with what appeared to be a cellulitic furuncle on her forehead, she returned to the emergency department 3 days later with extensive preseptal periorbital swelling and pain. Occlusive treatment with petroleum jelly was applied and one larva manually extracted and sent to London School of Tropical Medicine for examination. It was identified as Lund's Fly (Cordylobia rodhaini), a rare species from the rainforests of Africa with only one other case reported in the UK since 2015. Ultrasound imaging identified another larva, necessitating surgical exploration and cleaning. The lesion subsequently healed completely and the patient remains well.

Infestación masiva por larva migrans / Massive infestation with larva migrans

No disponible

Imported and Autochthonous Cases of Myiasis Caused by Dermatobia hominis: Taxonomic Identification Using the Internal Transcribed Spacer Region.

Dermatobia hominis is a fly endemic to and widely distributed throughout the Americas; it is found from the southern regions of Mexico to Argentina. However, because of widespread travel, myiasis has become common in countries where neither the disease nor the species that cause this infection are endemic. Central Mexico, for instance, is not a region where myiasis is endemic. We, thus, describe three cases of D. hominis myiasis: two autochthonous cases from the southern part of Mexico and one imported from Costa Rica. In addition, morphological and genetic identification was performed on the maggots extracted from the patients.

Considerations for Systemic and Topical Treatment of Morganella morganii Septicemia Arising from Maggot Infestation.

INTRODUCTION: Live maggot infestation (myiasis) of wounds can present a host of ailments. Loosely associated with maggot excreta, Morganella morganii is a widespread, gram-negative rod bacterium commonly found in the intestinal tracts of humans. M morganii has been observed as being pathogenic, particularly in nosocomial and postoperative environments, as well as in immunosuppressed and elderly populations. CASE REPORT: Herein, the authors present a rare, previously unreported case of M morganii septicemia (as confirmed by positive blood culture), secondary to myiasis of the lower extremities. The patient was successfully treated with both systemic and topical interventions. Posttreatment examination revealed resolution of myiasis and negative blood cultures. CONCLUSIONS: Myiasis can be invasive, leading to severe systemic infection. In these cases, a broad-spectrum antibiotic combined with systemic and topical antiparasitic therapy should be considered.