Clogmia albipunctata (Nematocera; Psychodidae) as the Etiologic Agent of Myiasis: True or False?

Clogmia albipunctata, known as drain fly, is a non-hematophagous insect of the Psychodidae family with worldwide distribution, particularly in tropical and temperate areas. It can be found near sewer drains, sewage treatment plants, plant pots, swamps, and any other place containing decaying or moist organic matter. It has been introduced in several publications as the causative agent of myiasis in humans. A case presentation, together with a compilation of findings from a database, including 51 scientific publications in the literature, allowed us to overview critically in detail the variable aspects of epidemiology, life cycle, biology, and medical importance of this insect and its probable role in human myiasis. The absence of a precise definition of myiasis and the lack of incontestable epidemiological, entomological, and clinical evidence in the articles introducing C. albipunctata as a causative agent led us to interrogate its role in human myiasis. It is necessary to take into account this misinterpretation and make an accurate diagnosis based on the isolation of insect larvae from the corresponding lesion.

A rare case of residual root myiasis caused by Clogmia albipunctata larvae (Diptera: Psychodidae)

Background

Dental injury caused by caries and trauma is the main cause of residual roots. Food trapped in the residual roots is difficult to clean. If the residual roots are not treated and cared for in time, flies can take advantage as soon as hygiene slips. Here, we present a rare case of human residual root myiasis caused by Clogmia albipunctata larvae, never previously reported.

Case presentation

A 26-year-old lady found two active, living larvae in her mouth while brushing her teeth. She did not present with fever, pain and any uncomfortable oral feeling. The intraoral examination revealed the right second mandibular molar was severely damaged as a result of caries, leaving a residual tooth root. The mucosa above it was mildly erythematous and edematous. No larvae and no inflamed gums were observed in her mouth. When normal saline was used to flush the area of the residual root with a syringe, four larvae appeared from the residual root. The larvae were observed by naked eye and under a light microscope. They were identified as the mature stage larvae of Clogmia albipunctata. Because the patient was in lactation, medication was not recommended. Treatment included the removal of all visible larvae followed by flushing the residual root with normal saline three times a day. The patient was followed-up weekly for one month. No more larvae were found and the erythematous and edematous mucosa healed completely.

Conclusions

The existence of a residual root can result in residual root myiasis. Myiasis caused by Clogmia albipunctata larvae or other fly larvae should be considered in cases of residual root infection.

Morphological and initial molecular characterization of Clogmia albipunctatus larvae (Diptera: Psychodidae) causing urinary myiasis in Egypt

Myiasis is the infestation of human tissues by dipterous fly larvae of the class Insecta. Clogmia albipunctatus, family Psychodidae, is one of the most medically important insects that cause human myiasis. The aim of the present study is the morphological identification and the molecular characterization of moth flies causing many cases of urinary myiasis in Egypt, based on sequencing of the mitochondrial DNA of the larvae. Seven urinary samples of patients complaining of urinary symptoms and giving a history of low socioeconomic level were examined. Recovered larvae were identified using light microscopy and SEM. For molecular identification, the mitochondrial genes Cytochrome B (cytB), NADH1, NADH1, and 16S were sequenced and phylogenetically analyzed. The morphological and molecular characterization could accurately diagnose our patients to have C. albipunctatus infestation. Such results provided the initial set of data on the molecular identification and phylogenetic analysis of moth flies based on DNA barcoding in Egypt.

Myiasis is an infestation of human tissues and other vertebrates by dipterous fly larvae. Urogenital myiasis is a rare type of myiasis that occurs primarily in poor people with low socioeconomic levels. Accurate diagnosis of this rare form of myiasis is sometimes difficult and requires a detailed study of unfamiliar morphological patterns of the larvae. Based on combined morphological and molecular approaches, our results provided the first set of data on the molecular identification and phylogenetic analysis of moth flies, causing myiasis based on the DNA barcoding in Egypt. Such results present more understanding of causative species epidemiology, the vectorial potentiality, and the proper pest management practices.

Urinary myiasis: not your typical urinary tract infection

A Canadian traveler returns from Irak and Afghanistan reporting larvae expulsion during micturition. We report the first case of urinary myiasis in Canada and discuss the differential diagnosis and clinical approach to this rare disease.