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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.
External myasis
1.
2. 3.
Internal myasis
1. 2. 3.
Obligatory
Facultative
Accidental
Usually this happens when the host unknowingly ingested food or drinks contaminated with the egg of higher diptera
Dermatobia hominis
Cordylobia
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.
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
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
Cause deeper (subcutaneous), more painful eruption They release enzymes to break down tissue and ease their movement
Tissue travelled by them becomes greenish-yellow
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
Blue bottle
Chrysomya Bezziana (obligate parasite in wounds) :depositing 150-500 eggs at site of wound or body orifices
SARCOPHAGIDAE
~ 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
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.
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)
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).
larvae feeds the wound, their size will increase and will cause tissue destruction.
Drug : Ivermectin
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.
Additionally, good personal hygiene, proper sanitation, and correct hand washing techniques are also important practices to be observed.