Nasal and ophthalmomyiasis: case report

Ophthalmomyiasis Externa and Importance of Risk Factors, Clinical Manifestations, and Diagnosis: Review of the Medical Literature

OBJECTIVE

This review aims to describe and compare the risk factors, clinical course, diagnosis, and parasitologic features of external ophthalmomyiasis. We also discuss the different preventive measures and the effect of global warming in a large case series reported from January 2000 to December 2022.

METHODS

We perform a literature review of reported cases of external ophthalmomyiasis to determine the clinical characteristics, therapeutic management, and information on the organisms that most commonly cause external ophthalmomyiasis.

RESULTS

A total of 312 cases of external ophthalmomyiasis were recorded. The most common causative organism was Oestrus ovis (Linnaeus) (Diptera: Oestridae), accounting for 72.1% of cases, followed by Dermatobia hominis (Linnaeus Jr. in Pallas, 1781) (Diptera: Oestridae) at 5.4%, Lucilia sericata (Meigen) (Diptera: Calliphoridae) at 0.96%, and Chrysomyia bezziana (Villeneuve) (Diptera: Calliphoridae) at 0.96%. Before experiencing symptoms, 43.6% of cases reported having direct contact with flies or being hit in the eye, 33% reported no associated risk factors, 9.3% reported living with sheep and goats, and 7.7% reported a history of foreign objects entering the eye. The most common symptoms for those affected by O. ovis were sudden onset, including a foreign body sensation and movement, redness, tearing, itching, swelling, irritation, photophobia, burning, and ocular secretion. In cases caused by D. hominis, symptoms included eyelid edema, pain, redness, itching, movement within the lesion, ocular irritation, and discharge. Regarding occupational or recreational activity, agriculture, and livestock had the highest incidence, followed by trades and technical activities, being a student, and having traveled to an endemic region for work or recreation.

CONCLUSION

Patients with red eyes may suffer from external ophthalmomyiasis, which requires a thorough examination to diagnose and treat it early. Moreover, as the temperature increases due to climate change, it is essential to consider how this will affect the spread of different pathogens.

External ophthalmomyiasis by Oestrus ovis in tourists visiting Italy. Report of three cases and a literature review

BACKGROUND

Oestrus ovis is a dipteran parasite responsible of myiasis in small ruminants and reported as the causative agent of myiasis in humans particularly in sheep farming areas. In recent years, several human cases had been reported without any previous history of exposure to livestock or visit to rural areas.

CASE PRESENTATION

We describe three clustered cases of ophthalmomyiasis externa in tourists in Sardinia and Sicily and discuss them in the light of the published literature. The patients presented ocular irritation, foreign body sensation, pain, redness, and lacrimation of the eyelids. After extraction, all the larvae were morphologically and molecularly confirmed as L1 instar of O. ovis larvae.

CONCLUSIONS

The present study points out the need to draw attention and awareness among the physicians, and to consider ophthalmomyiasis when consulted for conjunctivitis in the summer and spring seasons.

Rhinomyiasis: clinical and surgical management

Myiasis by Oestrus ovis, the zoonotic infestation with Diptera larvae, primarily diagnosed in goats and rams in tropical and Mediterranean countries, is an uncommon disease in humans; indeed, literature data are still lacking. Nevertheless, few cases of human myiasis have been reported, leading to benign or severe complications. Here, we report a rare case of human rhinomyiasis detected in Northern Italy. A 39-year-old Italian woman, returning from vacation in Corsica, showed several sinusal symptoms and progressive asthenia and was therefore admitted at the Otorhinolaryngology Unit of Biella Hospital, Italy. Endoscopic examination of the nasal cavity revealed some formations, morphologically identified as O. ovis larvae. The patient then underwent endoscopic sinus surgery, followed by complete resolution of symptoms. Clinical presentation, diagnostic work-up and therapeutic procedures have been compared with few other cases found in the literature.

Human intestinal myiasis by Eristalis tenax in a child from the urban area of the municipality of Policarpa, Nariño, Colombia

Myiasis is a pathology caused by the infestation of fly larvae species which affects vertebrates’ tissues or organs including humans. It can be classified entomologically or according to tissue tropism. Intestinal myiasis is rare and difficult to diagnose given its non-specific symptoms; the only way to confirm a case is by identifying the expelled larvae. This is the first case of intestinal myiasis reported in the department of Nariño (Colombia) in a 6-year-old child from a low-income family in the urban area of the municipality of Policarpa where there is no adequate treatment and no disposition of wastewater and basic sanitation conditions are insufficient. The clinical case was related to chronic diarrhea, abdominal pain, and anal pruritus with the subsequent expulsion of a larva identified by its morphological characteristics as Eristalis tenax fly larva.

Human myiasis cases originating and reported in africa for the last two decades (1998-2018): A review

The article reviews literature on myiasis in Africa and cases that originated in Africa over the last two decades (1998-2018). The relevant literature was obtained by using several databases (Science-Direct, JSTOR, Google Scholar, Ebscohost and PubMed). We searched for the following words or their combination myiasis, maggots, fly species responsible for myiasis found in Africa, and the different types of myiasis. References in several articles provided links to other relevant works. Only papers written in English were reviewed. In total, we reviewed 51 articles which covered a total of 849 myiasis cases. The review encompasses geographical distribution of the disease, dipteran species responsible, predisposing factors, sex of the patient, type of myiasis and treatment. Myiasis is found in most parts of the African continent, however only 18 articles reported myiasis cases in Africa during the period under review. The rest of the articles report cases from the rest of the world but acquired by travellers when visiting Africa. Cordylobia anthropophaga (Blanchard) was responsible for 93.28% of all the reported cases in this review. The low number of articles on human myiasis reported in Africa may be due to underreporting by physicians or most cases are not diagnosed. Therefore, the actual prevalence of myiasis in Africa is currently unknown.

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.

Rhinomyiasis by Oestrus ovis in a tourist returning from Corsica

In the Mediterranean basin, one of the most important agents of myiasis is Oestrus ovis Linnaeus 1758 (Diptera, Oestridae). Herein, we report a rare case of nasal myiasis with a secondary infection complication in a patient from northern Italy who had been visiting Corsica. A healthy, 39-year-old Italian woman spent 2 weeks of vacation in Corsica in June 2018. During her stay, she suddenly felt a foreign body inside her nose, followed by cough, pain, burning at the pharyngeal level, cephalalgia, and nasal congestion with secretions from the nostrils. The clinical examination showed a hyperemic and irritated mucosa and endoscopic examination of the patient's nose and right maxillary sinus revealed three tiny mobile larvae, morphologically and molecular identified as L1 instar larvae of Oestrus ovis. The patient's infestation was probably imported from Corsica, as Mediterranean islands are ideal geographical areas for the development of O. ovis, and the timing of infestation match with the period of O. ovis larviposition. Although rhinomyiasis is rare, it should be considered in people returning from abroad presenting with an acute-onset and foreign body sensation in the nose.

Treatment of nasal myiasis with ivermectin irrigation

We describe a case of nasal myiasis due to Musca domestica in a 97-year-old Peruvian farmer with a previously undiagnosed mucocutaneous leishmaniasis. Initial attempts to remove the fly larvae using manual extraction with a toothed forceps and normal saline irrigation were unsuccessful. On subsequent nasal irrigation with ivermectin solution, the patient self-expulsed approximately 50 larvae within 15 min. He also received a course of oral ivermectin. A post-treatment CT scan revealed clear sinuses. Here, we propose that ivermectin irrigation is a simple and effective treatment for nasal myiasis.

Diagnosis of ophthalmomyiasis externa by dermatoscopy

Ophthalmomyiasis in humans caused by the larvae of the sheep nasal botfly (Oestrus ovis) and is a rare phenomenon in Israel. We describe the utilization of the dermatoscope as a diagnostic tool for the facilitation of early diagnosis of conjunctivitis due to the infestation of the eyes by the sheep nasal botfly in two patients. After the physical removal of the larvae with the help of a cotton swab applicator under a slit lamp examination and the topical use of antibiotics, the clinical symptoms improved within 1-2 days. Undoubtedly the dermatoscope played a crucial role leading to the definitive diagnosis and immediate therapeutic intervention.

External ophthalmomyiasis: A case report

Ophthalmomyiasis is an infestation of the eye with larvae of most common sheep nasal botfly (Oestrus ovis). We describe a case of ophthalmomyiasis in a 50-year-old man who presented with ocular foreign body sensation, redness and tearing. The causative larvae were removed in the emergency room and sent to laboratory for identification. The patient symptoms improved after topical treatment with antibiotics-steroid combination therapy.

Oestrus ovis as a Cause of Red Eye in Aljabal Algharbi, Libya

Purpose:

To study the common presenting signs of external ophthalmomyiasis caused by Oestrus ovis larvae in Aljabal Algharbi province, Libya.

Materials and Methods:

A prospective non- comparative study was conducted from September 2009 to July 2010 at the Gharian outpatient clinic, Gharian, Aljabal Algharbi, Libya. The common presenting features of patients with external ophthalmomyiasis and data on the organism that caused the disease were collected.

Results:

Twenty one cases diagnosed with external ophthalmomyiasis were recorded. There were fourteen males (66.67%) and seven females (33.33%) in the cohort. The mean age was 14.29 ± 3.46 years (range, 8 years to 22 years: males; 13.39 ± 3.03 years and females; 16.67 ± 3.75 years). The main complaint was redness (100.00%), itching (71.43%) and tearing (57.14%). Twelve patients (57.14%) were from rural areas and 9 patients (42.9%) were from urban areas. The causative organism was found to be first instar of Oestrus ovis larvae.

Conclusion:

External ophthalmomyiasis caused by Oestrus ovis can cause red eye in patients from Aljabal Algharbi, Libya and requires careful examination to ensure early diagnosis and proper treatment.

Oestrus ovis infestation of a dog in the UK

In March 2011, a dog on a sheep farm in the Cotswolds, UK, expelled a mature live third-stage larva of the sheep nasal botfly, Oestrus ovis, after a violent and traumatic sneezing episode. The dog had been infected with first-stage larvae deposited by an adult fly the previous autumn; larval development had progressed throughout the winter and spring with few apparent clinical signs and possibly masked by ongoing immunotherapy for an unrelated condition. Identification of the parasite at the Liverpool School of Veterinary Science was made from a submitted puparium, the "chrysalis" stage to which the larva had progressed within days of its expulsion from dog's nose. To the authors' knowledge this is the first report of nasal botfly infestation of a dog in the UK.

Symblepharon secondary to ophthalmomyiasis externa in a dog

A 4-month-old crossbred female dog presented with complaints of poor vision and odd appearance of the eyes. At the age of a month, the animal was found lying in a railway road in a very bad condition and was rescued from death. At that time, the patient was presented with severe bilateral ocular discharge, and from both eyes, dipterous fly larvae were extracted. The dog was given symptomatic treatment (deworming, topical and systemic antibiotics, nutritional support) but never regained a normal eye appearance. At the time of the initial presentation, it had severe vision impairment because of bilateral cicatricial symblepharon, total in the left eye and occupying 3/4 of the cornea in the right eye. Surgery was proposed to attempt a resolution. Superficial keratectomy was performed in both eyes. After a midline incision in the cornea, the conjunctiva was dissected away. The conjunctiva was apposed to and sutured to the limbus and secured in the upper and lower conjunctival fornix. Additionally, in the left eye, a lateral canthotomy and canthoplasty were performed to enlarge the size of the eyelid opening. The corneal epithelium healed without complications, the patient regained vision, and after 36 months of follow-up, no recurrences were observed. To the authors' knowledge, this is the first report of symblepharon secondary to ophthalmomyiasis externa in a dog.