Vile bodies: an endoscopic approach to nasal myiasis

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.

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.

Nasal myiasis: A case report

Nasal myiasis is a rare condition, with only a few reported cases and no treatment consensus. We propose a conservative treatment approach with saline irrigation and debridement. Two patients in the ICU of Norfolk General Hospital, a tertiary academic referral center, presented simultaneously with nasal myiasis. Both patients were negative for necrotic masses or tumors, and neither patient had any contributory medical comorbidities. Both patients were treated conservatively with a single dose of pyrantel pamoate, daily sinus irrigation with saline, and daily bedside endoscopic debridement. After 2 days, the nasal myiasis resolved, and both patients recovered without sequelae. We conclude that this conservative, nonsurgical approach to management is both safe and effective.

Human Cutaneous Myiasis by the Australian Sheep Blowfly, Lucilia cuprina (Diptera: Calliphoridae), in Oklahoma

This case report describes an incident of myiasis in Oklahoma City, Oklahoma. Paramedics treated a 53-year-old man in the field when he suffered cardiac arrest. He was intubated by the paramedics and transported to an emergency room, where he received two stents and a balloon pump. He was found to have a GCS of three and remained in the hospital for 7 days before passing away. After his death, the breathing tube was removed, revealing the presence of several maggots. On closer inspection, the dipteran larvae were found in both the oral and nasal cavities. Four of these larvae were reared to adulthood and identified as Lucilia cuprina (Weidemann) (Diptera: Calliphoridae), commonly known as the Australian sheep blowfly, by the Biology Department of the University of Oklahoma. Based on the fly's life cycle and rate of development, the infestation is suspected to be hospital acquired.

Myiasis

Myiasis is defined as the infestation of live vertebrates (humans and/or animals) with dipterous larvae. In mammals (including humans), dipterous larvae can feed on the host's living or dead tissue, liquid body substance, or ingested food and cause a broad range of infestations depending on the body location and the relationship of the larvae with the host. In this review, we deeply discuss myiasis as a worldwide infestation with different agents and with its broad scenario of clinical manifestations as well as diagnosis techniques and treatment.

Nasal myiasis by Oestrus ovis second stage larva in an immunocompetent man: case report and literature review

OBJECTIVE

We report a case of an Oestrus ovis larva which developed into the second larval stage within a healthy, immunocompetent human, and we review the relevant literature.

METHODS

Clinical case report and Pubmed search of reports of human nasal myiasis due to Oestrus ovis, especially those describing the larval stage.

RESULTS

Humans are not normally hosts of the sheep nasal bot fly, but infestations by its larvae have been described. The eye is the most common site, but larvae have occasionally been found in the human nose. Transformation of larvae into the second and third stages, within the human nose, is even more uncommon.

CONCLUSION

To the best of our knowledge, we report the first Swedish case, and the third case world-wide, of Oestrus ovis larval development beyond the first larval stage, within an immunocompetent, healthy human.

Nasal and ophthalmomyiasis: case report

OBJECTIVE

We report a rare case of a 51-year-old woman with ocular and nasal infestation by Oestrus ovis.

METHOD

Clinical case report and review of current literature regarding nasal and ophthalmomyiasis.

RESULTS

Myiasis is infestation of the tissues and organs of vertebrates by certain dipteran fly larvae. Oestrus ovis myiasis is endemic in the region from North Africa to South Asia, but few cases are reported within the UK. A 51-year-old patient presented and was treated successfully in Sunderland Royal Hospital for combined ocular and nasal infestation with Oestrus ovis.

CONCLUSIONS

Oestrus ovis has a largely subtropical distribution; however, it is important to remember the diversity of disease which can present within the UK from an external source. This point is illustrated by this rare case, which highlights the fact that prompt treatment can avoid poor outcomes for our patients.

Nasal myiasis by fruit fly larvae: a case report

We report a case of human nasal myiasis caused by fruit fly larvae in a 33-year-old man who visited the south coast of Turkey. The fruit fly (Drosophila melanogaster) is endemic in the southern part of Turkey. Infestation with fruit fly larvae must be considered in patients who are visiting areas of the world where Drosophila is endemic. This is the first reported case of fruit fly larvae causing human nasal myiasis. The clinical presentation and treatment strategies are discussed.

Endoscopy in nasal myiasis

Nasal myiasis is a common disease in tropical and developing countries. The maggots cause extensive necrosis, sloughing and destruction of intranasal tissue and reach to deep and inaccessible areas of the nose and paranasal sinuses. In such a situation removal of maggots is difficult by manual extraction and several sittings are required. To overcome this problem nasal endoscope is being used for removal of maggots under direct vision. In comparing both methods nasal endoscopic procedure is found to be superior to the manual extraction method for removal of maggots. The maggots located in deep and inaccessible area can be approached more easily by endoscopic procedure. The disease is being controlled in shorter time and in few sittings. Thus quick and complete eradication of myiasis is possible before the maggots cause irreparable damage to the intranasal tissues.

Doctor, there are maggots in my nose

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