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Cuestas D, Pedraza J, Herrera H, Motta A, Cuestas A, Forero Y, Porras R, Urrea F, Galvis D, Galvis I, Bernal MA, Alvarado MV, Bula R, Velasquez O, Villalba D, Lamus S, Ariza G, Bayona N, Gutierrez A, Segura A, Patiño M, Perafan A, Ramirez-Rodriguez S, Rolon M. Cutaneous myiasis in skin cancer and malignant wounds: a systematic review. Int J Dermatol 2021; 60:1529-1546. [PMID: 34363696 DOI: 10.1111/ijd.15672] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 03/14/2021] [Accepted: 04/22/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Cutaneous myiasis in patients with malignant wounds or skin cancer is a rare and undesirable event with limited epidemiological data. A subregister of reports, lack of education in the population, inadequate empirical treatments, and medical underestimation are components of a public health problem that threatens patients' lives. METHODS We conducted a systematic review of the literature of cutaneous myiasis associated with malignant wounds and skin cancer, characterizing sociodemographic variables, risk factors, clinical and histological features, and treatment. Additionally, we present a demonstrative case with the adequate taxonomic evaluation. DISCUSSION Cutaneous myiasis is an underestimated and poorly managed infestation, which can generate severe complications in oncological patients. This is the first systematic review in the literature about this clinical scenario, which provides information to the physician and clinical researcher about the epidemiological gaps and what has been published so far. CONCLUSIONS Findings from the current review have helped to display the sociodemographic, epidemiological, and clinical behavior of myiasis in skin cancer and malignant wounds. Its contribution to the greater tumor tissue destruction is clear; however, more studies are required. The therapeutic management in these patients is equally clarified.
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Affiliation(s)
- Daniel Cuestas
- Dermatology Program, Universidad El Bosque, Bogotá, Colombia.,Dermatology Service, Hospital Simon Bolivar, Bogotá, Colombia.,ESTUDIODERMA®, Bogotá, Colombia
| | - John Pedraza
- Dermatology Program, Fundacion Universitaria Sanitas, Bogotá, Colombia
| | - Hugo Herrera
- Dermatology Program, Universidad El Bosque, Bogotá, Colombia.,Dermatology Service, Hospital Simon Bolivar, Bogotá, Colombia
| | - Adriana Motta
- Dermatology Program, Universidad El Bosque, Bogotá, Colombia.,Dermatology Service, Hospital Simon Bolivar, Bogotá, Colombia
| | - Andrés Cuestas
- ESTUDIODERMA®, Bogotá, Colombia.,Clinical and Enginnering Research-Statistical Analysis, Predicto Artificial Intelligence Techonologies LLC, Austin, TX, USA
| | - Yency Forero
- Internal Medicine Program, Universidad de La Sabana, Chía, Colombia
| | - Ricardo Porras
- Dermatology Program, Universidad El Bosque, Bogotá, Colombia.,Dermatology Service, Hospital Simon Bolivar, Bogotá, Colombia
| | - Fernando Urrea
- Clinical Research, Universidad de La Sabana, Chía, Colombia
| | - Dany Galvis
- Clinical Research, Universidad de La Sabana, Chía, Colombia
| | - Ingrid Galvis
- Special Training in Radiology, Universidad de La Sabana, Chía, Colombia
| | | | | | - Rosa Bula
- Clinical Research, Universidad del Sinú, Cartagena, Colombia
| | - Oscar Velasquez
- Dermatology Program, Universidad Nacional de Colombia, Bogotá, Colombia
| | | | - Sergio Lamus
- Clinical Research, Universidad de La Sabana, Chía, Colombia
| | - Gabriel Ariza
- Clinical Research, Universidad de La Sabana, Chía, Colombia
| | - Natalia Bayona
- Clinical Research, Universidad del Rosario, Bogotá, Colombia
| | - Ana Gutierrez
- Dermatology Program, Universidad El Bosque, Bogotá, Colombia.,Dermatology Service, Hospital Simon Bolivar, Bogotá, Colombia
| | - Alexandra Segura
- Grupo de Investigación en Ciencias Biomédicas UPTC - GICBUPTC, Grupo de Investigación en Medicina Veterinaria y Zootecnia GIDIMEVETZ, Universidad Pedagógica y Tecnológica de Colombia, Tunja, Colombia
| | - Monica Patiño
- Clinical Research, Universidad Pontificia Bolivariana, Medellin, Colombia
| | - Alejandra Perafan
- Dermatology Program, Universidad El Bosque, Bogotá, Colombia.,Dermatology Service, Hospital Simon Bolivar, Bogotá, Colombia
| | | | - Mariam Rolon
- Dermatology Program, Universidad El Bosque, Bogotá, Colombia.,Dermatology Service, Hospital Simon Bolivar, Bogotá, Colombia.,Dermatopathology Department, Hospital Simon Bolívar, Bogotá, Colombia
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Ruiz-Zapata JD, Figueroa-Gutiérrez LM, Mesa-Franco JA, Moreno-Gutierrez PA. Umbilical Myiasis by Cochliomyia hominivorax in an Infant in Colombia. Front Med (Lausanne) 2020; 6:292. [PMID: 32039212 PMCID: PMC6987426 DOI: 10.3389/fmed.2019.00292] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 11/28/2019] [Indexed: 11/20/2022] Open
Abstract
Myasis is the infestation by fly larvae (Diptera) in live vertebrates including humans. Myasis has been reported most commonly in tropical and subtropical areas around the world with poor sanitation and presence of cattle. Neonatal umbilical myiasis is an important cause of death in bovines and produces major economic losses in the livestock industry. However, its presentation in humans is rare, with a few cases reported worldwide. Moreover, umbilical myasis can be life-treating due to the risk of larvae migration to deeper tissues of the abdomen, omphalitis, and sepsis. We describe the case of a 7-day-old infant admitted to the hospital due to umbilical cord myiasis. In total, 55 larvae were removed from the wound and identified as Cochliomyia hominivorax. The patient recovered satisfactorily after treatment with ivermectin and amoxicillin. A literature search was performed in Pubmed, Medline, Lilacs and Google Scholar, with 64 cases of myasis by C. hominivorax being reviewed. Oral cavity, wounds, scalp and natural orifices are the main affected anatomical areas. Risk factors include the extremes of age, male sex, poor hygiene, alcohol and drug use, cancer, and mental disability. Programs for human myiasis prevention and surveillance are needed in neotropical areas where living conditions make it difficult to implement control strategies.
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Huang YL, Liu L, Liang H, He J, Chen J, Liang QW, Jiang ZY, He JF, Huang ML, Du Y. Orbital myiasis: A case report and literature review. Medicine (Baltimore) 2020; 99:e18879. [PMID: 31977893 PMCID: PMC7004749 DOI: 10.1097/md.0000000000018879] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
RATIONALE Myiasis is a parasitic disease caused by fly larvae of the Diptera order that infest human and other vertebrate animal tissues. Orbital myiasis is a potentially destructive infestation of the orbital tissues, which may affect individuals with previous ocular diseases or disorders of consciousness. PATIENT CONCERNS A 72-year-old man presented with a complaint of repeated pain for two years after trauma to his right eyelid and aggravated symptoms with larvae wriggling out for 2 days. An orbital computed tomography scan revealed right eyeball protrusion and periocular soft tissue edema. Two days later, magnetic resonance imaging showed that the shape of the right eyeball was changed and that the normal structure of the eyeball could not be identified. DIAGNOSES Due to the patient's symptoms and imaging examination results, the diagnosis of orbital myiasis was made. INTERVENTIONS The patient was treated by exenteration of the right orbit, and all necrotic tissues and larvae were removed. The defect was repaired via reconstruction with a pedicled musculocutaneous flap from the forehead region. Antibiotics and tetanus toxoid therapy were utilized to prevent potential bacterial infection. OUTCOMES The patient recovered well postoperatively and was discharged uneventfully. During the 6-month follow-up period, the wound healed well. LESSONS Advanced age and untreated eye trauma are risk factors for orbital myiasis. Timely removal of larvae and elimination of infections are important measures for protecting the eyeball.
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Affiliation(s)
| | - Lu Liu
- Guangxi Medical College, Nanning, Guangxi, China
| | | | | | | | | | - Zhi-Yuan Jiang
- Department of Hypertension division, the First Affiliated Hospital of Guangxi Medical University
| | | | | | - Yi Du
- Department of Ophthalmology
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Tay SY, Ramasamy BR, Watson DA, Montoya M. Treatment of nasal myiasis with ivermectin irrigation. BMJ Case Rep 2018; 2018:bcr-2017-224142. [PMID: 30077978 DOI: 10.1136/bcr-2017-224142] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
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.
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Affiliation(s)
- Sze Yen Tay
- Infectious Diseases Department, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Barathy Rani Ramasamy
- Department of General Medicine, The Northern Hospital, Epping, Victoria, Australia.,Department of General Medicine, Cabrini Hospital, Malvern, Victoria, Australia
| | - Donald Ashley Watson
- Infectious Diseases Department, Canberra Hospital, Canberra, Australian Capital Territory, Australia.,Australian National University School of Clinical Medicine Canberra Hospital Campus, Woden, Australian Capital Territory, Australia
| | - Manuel Montoya
- Faculty of Medicine, Universidad Nacional de San Antonio Abad, Cusco, Peru.,Departments of Medicine, Infectology and Pulmonology, Hospital Regional del Cusco, Cusco, Peru
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Soulsby H, Jones BL, Coyne M, Alexander CL. An unusual case of vaginal myiasis. JMM Case Rep 2016; 3:e005060. [PMID: 28348792 PMCID: PMC5343120 DOI: 10.1099/jmmcr.0.005060] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 07/05/2016] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Myiasis, a term used to describe the infestation of a live animal by fly larvae, is rarely reported in human subjects. The adult fly lays its eggs on living tissue that progresses to become larvae that feed on living tissue having gone through three developmental stages known as the first, second and third instar. The larvae become pupae before finally developing into adults. CASE PRESENTATION We describe an unusual case of a 79-year-old female who collapsed in her garden and lay there for several days before presenting to her local hospital Accident and Emergency department with an infestation of larvae in her vagina labia, identified as those from the Protophormia species northern blowfly. After complete removal of the larvae using tweezers followed by cleansing of the affected area and a course of antibiotics, the patient's condition improved. A follow-up review by the local gynaecology team revealed no evidence of further infestation. CONCLUSION It is our understanding that this is the first highly unusual case of a blowfly larvae infestation to be reported in a human within the UK.
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Affiliation(s)
- Hannah Soulsby
- Clinical Microbiology, Glasgow Royal Infirmary, Glasgow, Scotland
| | - Brian L Jones
- Scottish Parasite Diagnostic and Reference Laboratory, Glasgow, Scotland, UK
| | - Michael Coyne
- Scottish Parasite Diagnostic and Reference Laboratory, Glasgow, Scotland, UK
| | - Claire L Alexander
- Scottish Parasite Diagnostic and Reference Laboratory, Glasgow, Scotland, UK
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Miasis orbital severa causada por Cochliomyia hominivorax en la región andina de Ecuador. REVISTA MEXICANA DE OFTALMOLOGÍA 2016. [DOI: 10.1016/j.mexoft.2015.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Tomy RM, Prabhu PB. Ophthalmomyiasis externa by Musca domestica in a case of orbital metastasis. Indian J Ophthalmol 2014; 61:671-3. [PMID: 24145557 PMCID: PMC3959088 DOI: 10.4103/0301-4738.119318] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Infestation of the living tissues of the eye, ocular adnexae or orbit by larvae of flies of the order Diptera is known as ophthalmomyiasis. Ophthalmomyiasis externa is a limited superficial infestation of external ocular structures such as conjunctiva and adnexae. A case of follicular carcinoma thyroid with orbital metastasis presenting as ophthalmomyiasis externa is reported. The patient presented with foul smelling ulcers of the medial and lateral orbital walls of the right eye extending into the lids and nose, teeming with maggots. Computerized Tomography (CT) showed widespread bone destruction with extension into surrounding sinuses. Over 200 maggots were manually removed after immobilisation with turpentine oil instillation. Entomological examination showed it to be a case of accidental myiasis caused by the common housefly Musca domestica. The patient was managed conservatively and the ulcer cavities filled up with healthy granulation tissue. This case is presented on account of its rarity.
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Affiliation(s)
- Rose Mary Tomy
- Department of Ophthalmology, Government Medical College, Kozhikode, Kerala, India
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Villwock JA, Harris TM. Head and neck myiasis, cutaneous malignancy, and infection: a case series and review of the literature. J Emerg Med 2014; 47:e37-41. [PMID: 24910364 DOI: 10.1016/j.jemermed.2014.04.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Revised: 01/28/2014] [Accepted: 04/22/2014] [Indexed: 01/19/2023]
Abstract
BACKGROUND There is a paucity of literature on wound myiasis of the head and neck originating in the United States. To our knowledge, only three reports during the past 20 years exist in the literature. Even less common is a case of recurrent myiasis, with only one report published from India during the 1970s. There is often a preconceived notion that larvae are noninvasive and "only eat dead tissue." This mentality must be corrected; invasive larvae exist, there are unique myiasis-related infections, and serious complications can occur. We review the literature and describe recent cases of head and neck myiasis treated at our institution in upstate New York. CASE REPORTS Four cases, all initially presenting to the emergency department, were identified. Each case was superimposed on cutaneous malignancy and all patients presented with leukocytosis and positive blood or wound cultures. In the case of the recurrent myiasis, initial treatment was external beam radiation therapy for the malignancy, which had the added benefit of eradicating the larvae. Treatment for the other cases was limited to antibiotics and supportive care for medical comorbidities. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Serious complications can develop from head and neck myiasis and, in our experience, an underlying malignancy should be suspected. Proper management is critical and should include, at a minimum, empiric antibiotics, tetanus prophylaxis, biopsy of the surrounding tissue, and reporting to the appropriate health agency. Additional management can include bedside debridement, pharmacologic antiparasitics, and treatment of the underlying disorder.
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Affiliation(s)
- Jennifer A Villwock
- Department of Otolaryngology, State University of New York Upstate Medical University, Syracuse, New York
| | - Tucker M Harris
- Department of Otolaryngology, State University of New York Upstate Medical University, Syracuse, New York
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Clarke KJ. Myiasis (fly disease) and insectal disease generally are causing mental illness. Med Hypotheses 2013; 81:360-5. [PMID: 23726691 DOI: 10.1016/j.mehy.2013.04.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Revised: 04/02/2013] [Accepted: 04/08/2013] [Indexed: 10/26/2022]
Abstract
Mental illness by which psychosis is meant here is known to be caused mainly by imbalances of certain neurotransmitters in the brain. But, what is causing these imbalances? There has been a recent flurry of interest focusing on the possibility of parasitical disease. The appropriateness of this is based on the fact that organisms of the animal kingdom produce the same neurotransmitters. In fact stinging insects release them in their venoms. The proposal here is that insect larval parasites acting on the human brain and body may release such neurotransmitters and cause imbalances and altered mental states and is supported by the occurrence of previously unexplained physical symptoms such as; diarrhoea, constipation, spasms, anaemia, bloating, insomnia, headache, migraine, weight loss, low blood pressure, low grade fever, amnesia and signs of allergy which may accompany mental illness. Some of these symptoms have been previously attributed to the medications prescribed to alleviate the psychotic symptoms but, many are also parasitical signs. It is proposed that the minute larvae may make sudden movements and may be highly motile and may move from pressure, hence evading the phlebotomist's needle. There is also the testimony of those with delusional parasitosis and related addictions, I propose the regularity with which humans are bitten, stung and have their foods infected with insects at all stages as a demonstration of how insectal disease may have the potential for common infection and disease; mental and physical.
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Abstract
PURPOSE OF REVIEW Ivermectin was first discovered and used in veterinary medicine over 20 years ago. This review highlights some of the recent published research from 2005 through June 2006 on the use of ivermectin in both helminth and arthropod infection. RECENT FINDINGS In recent years, several published studies have detailed the expanding role for ivermectin in multiple endo and ectoparasitic infections, including scabies, pediculosis, soil transmitted helminths, gnathostomiasis and myiasis. In addition, there is increasing experience with parenteral ivermectin for the treatment of disseminated strongyloidiasis. The success of ivermectin in reducing Onchocerca volvulus and Wuchereria bancrofti transmission through universal treatment in disease control programs continues to be well documented, but recent epidemiologic data describe suboptimal response to ivermectin by O. volvulus in a minority of individuals, the molecular markers for which are currently under investigation. SUMMARY Over 20 years of research and clinical use have advanced ivermectin from its beginnings as a veterinary anthelmintic to its significant role in several successful disease control programs. Nevertheless, further research is needed to understand the basis for suboptimal response and to better define optimal drug regimens for varying diseases.
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Affiliation(s)
- Leanne M Fox
- Division of Infectious Diseases, Children's Hospital, Boston, Massachusetts 02115, USA.
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Abstract
Ectoparasitic infestations are highly prevalent in resource-poor populations throughout the world and are associated with considerable morbidity. Reliable data on the epidemiology, immunology, and therapy of ectoparasitic infestations and on the biology of the parasites remain scarce. The control of parasitic skin diseases, such as scabies, pediculosis, tungiasis, myiasis, and cutaneous larva migrans in endemic areas remains a challenge. Using appropriate study designs, it is imperative to increase further the knowledge on the various aspects of the parasites and the infestations they cause.
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Affiliation(s)
- Jörg Heukelbach
- Departamento de Saúde Comunitária, Faculdade de Medicina, Universidade Federal do Ceará, Rua Prof. Costa Mendes 1608, 5thandar, Fortaleza CE 60430-140, Brazil.
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