ReviewsMyiasis
Section snippets
Case I
This case report, a good example, concerns a 75-year-old patient. A paleontologist, she had just returned from Belize, where she was working in the archeological ruins in Central America. Within a week of return, on her shoulder, over the deltoid, the patient noted erythema, itching, and subsequent tenderness. She consulted dermatology and tropical medicine, and after, careful examination, the differential diagnosis of this erythematous macular lesion on the shoulder included an early
Case II
In a second case, a 27-year-old ornithologist was conducting field studies in Costa Rica. He noted that there were numerous insects, and he affirmed to having been bitten by insects in the field. Upon returning to the United States, he noted persistence of erythema in several of these areas of probable insect bites, and he sought medical help. On examination, these were found to be tumid furuncular lesions; and of the ten lesions, three of them already had an operculum, which on careful
The life cycle
The life cycle can be quite variable depending on the different species. In many instances, the ova from the fly are laid directly on the host, either in viable or necrotic tissue or tissue that has previously been infested with screw worms.4 Additionally, the indirect deposition by other arthropods has been documented, especially in the case of Dermatobia hominis, in which the female fly lays eggs on the cephalothorax of certain mosquitoes. The mosquitoes then bite the human host, and, at this
Clinical presentation—medical significance
Myiasis may have multiple presentations related to the different life cycles of the various Diptera genera. Of greatest medical significance is the evolution of the larva in various sites in the body, where serious sequelae can occur from pressure. The eyes, ears, nose, and throat areas are particularly problematic. Traditionally, this has related to close human-animal contact and the laying of the fly larvae on the keepers of the animals, especially sheep and, occasionally camels, with the
Environmental exposure
While the most usual larval infestations relate to direct arthropod mammal interaction, indirect infestation can also occur. Intestinal myiasis is one example; and it can occur when humans ingest food that is contaminated with the eggs or larvae of several flies. The larvae will survive in the stomach and mature in the intestine, and this is seen most often in Tubifera tenax, and also with Sarcophaga infections. Larva migrans (not to be confused with the Ancylostoma sp. cutaneous larva migrans)
Diagnosis
With increasing travel to exotic destinations, cutaneous myiasis is a diagnosis that is made more frequently, and it has recently been highlighted as an increasing problem in the emergency room.15 Dermatobia furunculoid myiasis is becoming a much more common clinical entity, as compared to two decades ago. The literature clearly reports this as a growing clinical diagnosis. Evaluation and diagnosis relates to an awareness of the clinical presentation and careful examination; and occasionally
Therapy
Our preferred approach to therapy on the mature and furunculoid presentation is direct excision. We generally prefer to primarily excise the organism in order to develop a clean wound that can be closed primarily with the best or most optimal cosmetic result. It is also possible to extrude the larva with pressure, and we have done this successfully using local infiltration of anesthetic, which will then deliver the larva directly to the surface. The resulting wound is then reevaluated for its
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Cited by (43)
Oral myiasis: Does an indication for surgical treatment still exist? Two case reports
2012, Oral Surgery, Oral Medicine, Oral Pathology and Oral RadiologyA skin lesion of rare origin
2012, Enfermedades Infecciosas y Microbiologia ClinicaCutaneous myiasis
2009, Journal of Plastic, Reconstructive and Aesthetic SurgeryCitation Excerpt :Direct and complete surgical extraction of larvae from the lesion is the favoured treatment modality due to the risks of secondary infection associated with retained larvae. Administration of lidocaine into the lesion will sedate the larvae and a 1 cm deep, cruciform incision is usually adequate to fully evacuate the subcutaneous lesion.8,13,15 Once removed, the larvae should be inspected to confirm identity and ensure that the larvae have been removed in their entirety.
Exotic human myiasis
2009, Travel Medicine and Infectious DiseaseCitation Excerpt :Efforts are underway to try to duplicate the eradication programme that has been so successful with the New World screwworm for Old World screwworm C. bezziana. By covering food and practising proper personal hygiene, accidental myiasis could be prevented.9,10 In conclusion, myiasis is generally self-limiting and in many cases not dangerous to the host.
An unusual furuncule
2008, Presse MedicaleMaggot infestation (myiasis) of external fixation pin sites in diabetic patients
2008, Transactions of the Royal Society of Tropical Medicine and Hygiene