CUTANEOUS MYIASIS

DEFINITIO N OF CUTANEO US MYIASIS

Myiasis is a general term for pathological infection by parasitic fly larvae feeding on the host's living tissue. Myiasis is infestation by the larvae (maggots) of fly species within the arthropod order Diptera (two-winged adult flies).

The larvae feed on the host's dead or living tissue, body substances, or ingested food.

Myasis can be classified according to : I. Site of tissue invaded

II.

Biological habits of the larvae

External myasis
1.
2. 3.

Cutaneous Ocular and nasopharyngeal Aural

Gastric myasis Intestinal myasis Urogenital myasis

Internal myasis
1. 2. 3.

Obligatory

Acquired living host for developmental changes and growth

Facultative

Can grow with or without living in the host cell

Accidental

Usually this happens when the host unknowingly ingested food or drinks contaminated with the egg of higher diptera

Dermatobia hominis

Wohlfahrtia vigil & Wohlfahrtia opaca

Cordylobia

Female lays egg onto carrier insect Ex: mosquito

Human direct contact or during bite from the carrier.

The papule become a fruncular like (boil- like)

Once the egg hatch,the larvae burrow into the host skin, produce small red papule

Bacterial superinfection

Tetanus

Fatal cerebral myasis in infant due to infestation the skin covering frontanelles

Found in tropical Africa. Lay their eggs on object contaminated with urine or feaces,such as sandy soil or damp clothing laid dry on the ground.

First 2 days 6 days later

Late stages

Prickle heat sensation to severe pain Agitation and insomnia

Furuncular lesions with surrounding inflammation

Tail end of larvae may be seen in central pore. Multiple infestation may develop:enlarge lymph node and fever.

Infestation occur in young age because the larvae are unable to penetrate adult skin. Most active in shaded area, during late afternoon hours Most occur during months of June to September

A specific myiasis. Larva burrows and wanders under the skin. More difficult to diagnose. Causing flies: -Gasterophilus spp -Hypoderma spp -first instar larva of Cuterebra spp (invade the human skin directly - most probably where laceration occurred)

Characteristic Rash
Extreme itching

Starts as red bumps or blisters -Wiggly tracks that lengthen - Lesion typically begin on exposed skin part

Gasterophilus Intestinalis

Causes superficial myiasis

Intense itching

Characteristic lesion Raised, red, linear serpentine lesion that advances at one end and fades at the other end Lengthen of lesion Can extend up to 30 cm per day May continue for several months Ending of infestation Spontaneously, either with or without suppuration

Hypoderma Bovism and Hypoderma Lineatum

Cause deeper (subcutaneous), more painful eruption They release enzymes to break down tissue and ease their movement
Tissue travelled by them becomes greenish-yellow

Usually cause mild disease

Can also cause fever, muscle pain, joint pain, scrotal swelling, ascites, fluid around heart, discontinuous and transient skin swelling, and invasion of brain and spinal cord

Infestation of a surface wound or other open lesion b fly larvae of higher diptera 3 Major speciesof obligate parasites encountered: New World Screwworm Old World Screwworm Wohlfahrts wound myiasis 9 Genera belonging families of Calliphoridae

Sarcophagidae Muscidae

1)Cochliomyia species: 2 species of New World genus Cochliomyia: a)Cochliomyia Hominivorax b)Cochliomyia Macellaria

2)Phormia and protophormia species -Important species: Phormia Regina more northern Protophormia terraenova

Lucilia Cuprina

Lucilia Seracitahealing of deep wound in humans

Blue bottle

2 important species: Calliphora Vicina Calliphora Vomitoria

Attracted for oviposition to any decaying species.

Chrysomya Bezziana (obligate parasite in wounds) :depositing 150-500 eggs at site of wound or body orifices

SARCOPHAGIDAE

SARCOPHAGIDAE (Flesh Fly)

~ obligate parasite of warm blooded vertebrae ~ 2 genera sarchophaga sensu lata/wolfahrtria ~ females are larviparous deposite 1st instar rather than eggs ~ ex : wohlfahrtria nuba feed on dead tissue rather than live tissue. : wohlfahrtria vigil and wohlfahrtria opaca : -penetrate host skin individually producing furuncle

LIFE CYCLE :

occurs when wounds or ulcers are invaded by larvae of flies which will lay their egg in decaying flash

accidentally deposit their egg or larvae in neglected sores or wound.

Larvae damage the underlying tissue by burrowing in it. The head of this larvae is in the tissue while the back region is visualized as a small dot (breathing pores) larvae feeds wound, size increase ; tissue destruction Reach maturity in 5 days fall to the ground which they burrow and pupate

SUMMARY :

Clinical synopsis A 4-year-old girl, who had just arrived from Bolivia, was referred to Emergency Department, as a result of furunculous lesions on the scalp. The nodules had appeared 7 days before and the area was itchy and painful

Physical examination revealed a large inflammatory, nodular plaque that occupied the whole vertex of the scalp. There were several pores, each about 1 centimeter in diameter, from which exuded serosanguineous discharge. A great number of living larvae were observed (Fig. 1). Moreover, the child was febrile and exhibited regional lymphadenopathy. Complete blood count showed eosinophilia.

Figure 1 : a great number of living larvae were observed

An occlusive dressing with paraffin oil for 24 hours is applied. After the occlusive dressing is removed, the hair is cut, and the wounds are cleaned, the furunculous nodules were opened and the larvae extracted carefully (Fig. 2A).

Figure 2A : the furunculous nodules were opened and the larvae were extracted carefully

Partial approximation of the wound was performed by a pediatric surgeon, but the center closed by secondary intention. Microbiology analysis confirmed the diagnosis of myiasis and identified the larvae (Dermatobia hominis), and the subspecies (Cochliomyia hominivorax) (Fig 2B)

Figure 2B : Cochliomyia hominivorax

Larvae of Cochliomyia hominivorax

The diagnosis is made based on : - the clinical appearance of the lesions and associated symptoms. -travel history of the patient. Symptoms vary among the different agents of cutaneous myiasis.

One or more nonhealing boillike lesions with erythema. local symptoms of pain, tenderness, or pruritis. Ultrasonographic images. A small, white, worm-like organism protruding from the lesion when pressed laterally.

the y larvae may not be seen if no exit or breathing hole is yet present. Gasterophilus spp. present supercial and present clear, linear serpentine dark tunnels (creeping eruption).

The presents of maggots in the preexisting wound

larvae feeds the wound, their size will increase and will cause tissue destruction.

FURUNCULAR MYIASIS WOUND MYIASIS MIGRATORY MYIASIS

Digital pressure on both side of the lesions.

Block the skin opening by petroleum jelly, nail polish, bacon or paste of tobacco. Surgical incision

Drug : Ivermectin

Irrigate the area with saline or dilute antimicrobial.

Removed manually or surgery (deep)

Removed using needle for young larvae of Gasterophilus spp.

Thiabendazole

Ivermectin

1 ) eliminating or eradication the possible sources of infection. Any region that is warm and humid is ideal for the breeding of Myiasis flies. Such places must be destroyed by using insecticides and disposing waste materials in the proper manner.

Ironing clothing which are left outside to dry as to kill the Cordylobia eggs.
Covering wounds with proper dressing or by putting adequate of antiseptic to prevent infestation.

Avoidance sleeping outdoors especially babies in area infested by Wolfahtria.

Protection and washing of food stuff to prevent the accidental ingestion of larvae.

Using of nets, screens and repellants.

Additionally, good personal hygiene, proper sanitation, and correct hand washing techniques are also important practices to be observed.