A case on novel treatment protocol for difficult to treat foot myiasis

Foot myiasis is a rare condition, with only a few reported cases and no treatment consensus. We proposeda conservative and unique treatment approach with VAC dressing method. The patient administered in the hospital with presentation of deep tissue injury from a sharp stone, from 3 months back which was maggot infested. The patient had approached local physicians before been admitted in our facility. The wound was severe with maggot infestation. The patient was non diabetic with no other comorbid conditions. We had the aim of infection free wound with faster rate of healing, which was fulfilled by the noveltreatment protocol using vacuum-assisted closure (VAC®) dressing method. Culture sensitivity tests ruled out infection and maggot infestation. The wound was closed surgically after healthy uninfected granulation tissue confirmed with culture sensitivity report. No recurrence of maggot or any other infection were found. The protocol performed was safe and effective in critical case of myiasis.

Acceleration of cutaneous wound healing by Lucilia sericata maggots in diabetic Wistar rats

@#The study was aimed to evaluate the effectiveness of maggot therapy in healing of cutaneous infected wound in streptozotocin (STZ) induced diabetic Wistar rat. For live maggots, the sterilized eggs of Lucilia sericata were obtained from colonies established in laboratory. Diabetes model was established in 48 male Wister rat by intra-peritoneal injection of STZ at the dose of 60 mg/kg body-weight. Cutaneous wounds exposed with mixed colonies of bacteria like Staphylococcus aureus, E. coli and Pseudomonas aeruginosa were prepared in all rat. The animals equally divided in 4 groups with 12 rats each being presented as treatment group of control, antibiotic, maggot and maggot with antibiotic in combination. All treatments were done once and hold for 24 hours. Wound kinetics and bacterial bio burden were measured at weekly interval to till complete healing. Significant reduction in wound area with maximum contraction was found (>95%) in maggot treated group when compared to antibiotic treated (79%) and control (72%). In maggot as well as maggot and antibiotic in combination group showed early elimination of bacterial bio-burden 7.88±0.03log CFU/ml to 1.12±0.65log CFU/ml and 7.86±0.04) log CFU/ml to 1.54±0.52log CFU/ml respectively in three weeks of time. Early healing indication was also experienced on histomorphological examination of wounded tissue of maggot treated groups by early and better epithelialization, collagenation and neovascularization with complete healing of wound in three weeks in comparison to antibiotic and control respectively. However, the present study did not show any difference in healing of wound with use of maggot alone or in antibiotic combination. Live maggot of Lucilia sericata effectively lower bacterial bioburden and and accelerate healing of infected cutaneous wound in diabetic conditions.

TERAPIA LARVAL CON Musca domestica EN EL TRATAMIENTO DE LA ÚLCERA LEISHMÁNICA EN UN MODELO MURINO / Larval therapy with Musca domestica in the treatment of leishmanian ulcer in a murine model

RESUMEN La leishmaniosis es una enfermedad con gran impacto en salud pública dado a las características de las lesiones tegumentarias. El tratamiento experimental con terapia larval (TL) ha mostrado su uso potencial para la cura de la leishmaniosis, sin embargo, se han utilizado especies de moscas para TL en heridas causadas por Leishmanial que no son de fácil colecta y cultivo bajo condiciones de laboratorio como Lucilia sericata o Calliphora vicina. El objetivo del presente trabajo fue usar una especie de mosca de fácil colecta, y de alta fecundidad como la Musca domestica para aplicarlas en TL de úlceras leishmánicas. Se realizó un estudio cuali-cuantitativo, de tipo descriptivo, mediante un diseño experimental empleado un modelo animal (Mesocricetus auratus), infectado con Leishmania amazonensis para evaluar el efecto terapéutico de la TL y comparar los resultados con el tratamiento químico antimonial de la droga experimental "Ulamina". Se evidencia cicatrización y cura de la úlcera leishmánica en el 66,66 % de los animales tratados con TL en aplicación simple y del 100 % en TL combinada con Ulamina. El uso combinado de TL+Ulamina, muestra un efecto potenciador de la cura clínica de las úlceras, pero con persistente inflamación. Se observó una efectividad óptima de la TL con M. domestica, sobre las úlceras, aunque no se evidenció un efecto sobre L. amazonensis dado a la presencia de amastigotes en los frotis y a los amplicones obtenidos de 480 bp desde las improntas de los animales.

ABSTRACT Leishmaniasis is a disease with significant impact on public health, given the characteristics of the tegumentary lesions. Experimental treatment with larval therapy (LT) has shown its potential use for the cure of leishmaniosis. However, fly species not easy to collect and/or colonize have been used. The objective of the present work was to use a fly of accessible collection and high fecundity, not a producer of human myiasis, such as Musca domestica. A qualitative-quantitative study of a descriptive type was carried out through an experimental design with an animal model (Mesocricetus auratus) with infection by Leishmania amazonensis to evaluate the therapeutic effect of LT and compare the results with the antimonial chemical treatment of the drug experimental "Ulamina". Scarring were observed with the use of LT in 66.66 % with TL-simple and 100 % with TL-combined. However, the combined use of LT + Ulamina, shows an enhancing effect of the clinical cure of the lesions, but with persistent inflammation. Optimal effectiveness of TL with M. domestica was observed on the ulcers; however, an effect on L. amazonensis was not observed given the presence of amastigotes in the smears and the 480 bp amplicons from the tissue of the ulcers of animals.

Advances in the research of application of maggot therapy in chronic wounds / 中华烧伤杂志

Maggot therapy is a kind of biological therapy that uses maggot to eat and remove the necrotic tissue of wounds, while it has no adverse effect on living tissue with blood supply. Besides, maggot therapy can promote wound healing through various mechanisms, which has been used for debridement and treatment of wounds as early as hundreds of years ago. With the discovery and application of antibiotics, maggot therapy faded out of the medical field once. However, with the abuse of antibiotics and increasing drug resistance of bacteria in recent years, maggot therapy attracts widespread attention of clinicians again. This article reviews the advances in the application of maggot therapy in chronic wounds.

Study on the Effects of Maggot Oil on the Healing of Rat with Acute Skin Trauma and Infection and Its Mechanism / 中国药房

OBJECTIVE:To study the effects of maggot oil on the healing of rat with acute skin trauma and infection and its mechanism,in order and to provide reference for further development of maggot oil. METHODS:SD rats were randomly divided into normal group,model group,maggot oil group and Jingwanhong treatment group (positive control),with 70 mice in each group. Except for normal group,acute skin trauma and infection model was induced in other groups by smearing Staphylococus aureus suspension at the wound. After modeling,normal group and model group were given normal saline,and maggot oil group and Jingwanhong treatment group were given relevant medicine 0.3 mL/100 g,at 9:00 and 17:00,for consecutive 15 d. Wound and wound healing time of rats were observed in each group. The content of hydroxyproline in wound was determined in 10 rats of each group after 1,2,4,6,8 d of administration. The content of water in wound was determined after 2,4,6,8 d after administration. 2 h after last administration,the content of lysozyme,the levels of inflammatory factors (TNF-α,IL-6),the expression of NF-κB p65(in cytoplasm and nucleus)and p-IκB-α(in cytoplasm)protein were determined in 10 rats of each group. RESULTS:Compared with normal group,wound edema of model group was obvious,and wound healing time was(14.3±2.1)d. After 4,6,8 d of medication,the content of hydroxyproline in wound of rats was decreased significantly in model group (P<0.05 or P<0.01). After 2,4,6,8 d of medication,the content of water in wound was increased significantly in model group(P<0.01). After 15 d of medication,the serum contents of lysozyme,TNF-α and IL-6 in rats were increased significantly in model group (P<0.01). The expression of NF-κB p65 (in cytoplasm) in wound was decreased significantly (P<0.01),while the expressions of NF-κB p65 (in nucleus) and p-IκB-α(in nucleus) protein were increased significantly (P<0.01). Compared with model group,above indicators of administration groups were improved significantly (P<0.05 or P<0.01). CONCLUSIONS:Maggot oil could protect tissue injury induced by acute skin wound infection,promote wound healing. The possible mechanism might play anti-inflammatory effect through promoting collagen production,increasing lysozyme content,regulating NF-κB signal pathway.

Effects of Chloroprocta sp. maggot filtrates on extracellular matrix reduction and embedded Staphylococcus epidermidis viability

Aims: The objective of the study was to analyze the activity of local maggot filtrates from Chloroprocta sp. green flies in diminishing the embedded Staphylococcus epidermidis viability through destruction (reduction) of the biofilm of extracellular matrix and analyzes the precence of protease, a compound of maggot filtrates. Methodology and results: A microtiter plate biofilm assay with crystal violet staining was used to measure the effects of various maggots filtrates concentrations on the S. epidermidis biofilm matrix reduction. Maggot filtrates reduced the biofilm extracellular matrix of both S. epidermidis ATCC 35984 and ATCC 35983 significantly up to 80% (p < 0.05). Scanning electron microscopy which was performed to confirm the reduction effects indicated in line with the results. Both embedded S. epidermidis strains viability was meassured by using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) assay. Embedded cells viability decreased significantly by up to 50% (p < 0.05) after 3 h and 24 h at the different concentrations. Finally, there were very strong and significant correlations (r = 1, p < 0.0001) between biofilm reduction and embedded cells viability of both strains. Furthermore, Chloroprocta sp. maggot filtrates containing gelatinase, a protease enzyme metalloproteinase classes, with the protein content is 358 µg/mL and protease activity of 3.3 U/mg. Conclusion, significance and impact of study: Chloroprocta sp. maggot filtrates, containing gelatinase has an antibacterial activity that increase the reduction of the extracellular matrix and decrease the viability of embedded S. epidermidis. These results may have the implications in therapeutic fields in the future.

Evaluation of the chitosan from flies maggots shell / 国际生物医学工程杂志

Objective Chitosan has been widely studied in the fields of biomedical materials and tissue engineering,due to its good water solubility,biocompatibility,biodegradability,film-forming property,hemostasis,wound healing and anti-inflammatory effects.Flies maggot shell contains much chitosan,which is one of the excellent raw materials.The aim of this study is to provide integral biological assessment on chitosan trauma dressing.Methods Chitosan samples were subjected to physicochemical analysis (relative molecular mass,degree of deacetylation,and content of heavy metal),bacteriostatic test,skin sensitization,cytotoxicity tests as well as hemolysis test according to national standard of China.Results The relative molecular mass of chitosan was 266 ku,the degree of deacetylation of chitosan was 75％,and the content of heavy metal was less than 10-5.The cytotoxicity level was evalnated at the first level which indicating the low cell toxicity.Skin sensitization test showed that no sensitization reaction was practically detected.The hemolysis rate was 0.769％,which was less than 5％,indicating zero hemolysis.Conclusions Chitosan has good character,which may meet the requirements of biological and medical application.

Incapability of Formalin Based Fixative to Kill Maggot in Mutilated Human Carrion.

Background: Embalming is a process used to temporarily preserve a human cadaver to forestall decomposition and make it suitable for display at funerals; thus, are agents that prevent autolysis and putrefaction. The outbreak of maggots from a heap of inadequately embalmed bodies due to deep cuts and bodies involved in inferno, necessitated the need to re-investigate the efficacy of formalin based embalming fluid and its inability to kill maggots. Methodology: Various strength of Formaldehyde, Xylene, Kerosene, and, Lime fluid, Isopropanol, Gamalin 20, Potassium ferrocyanide, and Physiological saline as control were used in the investigation. In the present investigation, Two maggots under the same atmospheric condition were put in each of the ten selected chemical reagents/solutions, including Lime, Kerosene, and the Gamalin 20 that are naturally available were initially dispensed into ten glass universal containers. Maggot movements in each reagent solution were critically observed. Result: Maggots death occurred within the first ten minutes in test number three groups III that contains Concentrated Formalin and Xylene andMaggots died after fifteenminute of the experiment, butmaggots did not died until about eight hours after the test in two of the experiment. Discussion: Results of this investigation showed clearly thatMaggots were not killed as soon as expected by the embalmerwhen ordinary ten percent alcoholic formalin embalming fluid is used. Equal volume of concentrated formalin plus Xylene was found out to be effective at killing maggot instantly. Conclusion: It is therefore advisable to use Xylene plus Conc. Formalin when preserving cadaver infested with Maggot and this could at the same time prevent the occurrence ofMaggots Infestation and better preservation of mass of burnt mutilated corpses in our Mortuary.

A Case of Endoscopic Removal of Nasal Myiasis in Cerebral Infarction Patient

Infestation of tissue by fly larvae is termed myiasis, and it is unusual in humans. Nasal myiasis is common in low socioeconomic status individuals due to poor nasal hygiene. It commonly affects the skin and rarely the nasal and paranasal sinuses. Recently an 82-year-old female was admitted to the emergency department because of discharge of live maggots from the nasal cavity. She had been diagnosed with brain infarction and Alzheimer's disease several years previous. We successfully removed all the maggots from the patient's nasal cavity and sinuses via endoscopic surgery under local anesthesia. Subsequently, the patient's nasal problem resolved completely.

Ophthalmomyiasis externa by Musca domestica in a case of orbital metastasis.

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.

Nosocomial Oral Myiasis– A Rare Case Report

Nosocomial oral myiasis, though a rare entity, do occur under certain circumstances. Early diagnosis and treatment of such conditions prevent further damage/complication, especially in patients who are in intensive care. Dentists, in co-ordination with other medical faculty, play an important role in managing such infections. Further, a greater emphasis should be paid for maintaining better hygiene in public places and in the vicinity of the hospital. This paper is an attempt to illustrate the rare occurrence of oral myiasis that was hospital acquired. Only one case has been reported till now following a search through pubmed.

Desvelando a terapia larval como alternativa no tratamento de lesões de pele: revisão integrativa / Descubriendo la terapia de larvas como alternativa en el tratamiento de lesiones de la piel: una revisión integradora / Unveiled the larval therapy as alternative in the treatment of skin lesions: an Integrative review

Objetivo: identificar nas evidências científicas da literatura quais os benefícios que a terapia larval proporciona aos pacientes com lesões de pele através de uma revisão sistemática da literatura, na modalidade de revisão integrativa.Método: para a busca dos artigos e a análise dos dados, foram utilizados dois instrumentos de avaliação. A pesquisa foi realizada entre julho de 2009 a julho de 2010. Resultado: a terapia larval mostrou-se positiva na maior parte dos estudos selecionados tanto em relação à restauração rápida dos tecidos como nos custos. Conclusão: os resultados apresentados proporcionaram um maior conhecimento sobre a terapia larval e mostraram que, apesar de não haver indícios de seu uso no Brasil, pode ser uma opção eficaz, principalmente quando os tratamentos convencionais não funcionam mais

Objective: to identify evidence in the literature in which the benefits of larval therapy provides patients with skin lesions through a systematic literature review in the form of an integrative review. Method: For search of articles and data analysis, we used two assessment tools. The survey was conducted between July 2009 and July 2010. Result: larval therapy was positive in most studies selected in relation to a rapid restoration of tissues such as the costs. Conclusion: the results presented have provided a better understanding of larval therapy and showed that, although there was no evidence of its use in Brazil, can be an effective option, especially when conventional treatments not working

Objetivo: identificar en evidencias en la literatura que los beneficios de la terapia con larvas a los pacientes con lesiones en la piel a través de una revisión sistemática de la literatura, en la forma de una revisión integradora. Método: Para la búsqueda de artículos y análisis de datos, se utilizaron dos instrumentos de evaluación. La encuestafue realizada entre julio de 2009 a julio de 2010. Resultado: la terapia de larvas fue positiva en la mayoría de los estudios seleccionados en relación a una rápida restauración de los tejidos, tales como los costos. Conclusión: los resultados presentados proporcionan una mejor comprensión de la terapia larval y demostraron que, aunque no hay evidencia de su uso en Brasil, puede ser una opción eficaz, especialmente cuando los tratamientos convencionales han ya no funcionan

Laboratory colonization of Lucilia sericata Meigen (Diptera: Caliphoridae) strain from Hashtgerd, Iran.

Background & objectives: The treatment of wounds with live green bottle fly larvae is receiving considerable attention in many countries. Laboratory rearing of Lucilia sericata is crucially important for the treatment of wounds. Study design: The study was carried out for mass rearing of green bottle flies from April to November 2010. Hand catch and net trap baited with beef and cattle liver were used to collect adult flies from the field. The collected samples were placed in appropriately labeled tubes and sent to the laboratory. Adult stage flies reared in the insectary were used for species identification using specific keys. Results: A total of 89 flies (55 females and 34 males) were collected from Hashtgerd area. In the first generation, 299 flies were produced in the laboratory including 105 (35.12%) males, and 194 (64.88%) females. The female/ male sex ratio was 1.61 for parents, whereas it was 1.84, 1.30 for F1 and F2 generations respectively. In total, 432 flies were reared in F3 generation including 173 (40.04%) males, and 259 (59.96%) females, and the sex ratio was 1.49. Conclusion: Setting up the mass rearing of sheep blowfly at the School of Public Health, Tehran University of Medical Sciences is an important step in producing candidate flies for the treatment of myiasis by maggot therapy in future.

Biologic Maggot Therapy in Cutaneous Wounds and Postoperative Defects / 대한피부과학회지

BACKGROUND: Maggots are larva of Phaenicia Sericata, the Green Blowfly, and treatments with maggot have recently become widespread revealing their effectiveness in the treatment of chronic wounds, such as diabetic ulcers and pressure sores, by removing necrotic tissue selectively and avoiding damage of healthy tissue. OBJECTIVE: The aim of this study was to evaluate the usefulness and the adverse effects of maggot therapy in dermatology for the treatment of chronic wounds and rapid granulation tissue formation at postoperative defects before reconstruction. METHODS: Fourteen patients with various kinds of skin wounds were included and applied a biobag containing therapeutic maggots on their wounds. RESULTS: Four cases were included for treatment of acute and chronic skin wounds; 10 cases of surgical defects were included for reduction of the treatment period. Maggot therapy periods ranged from 4 to 17 days (mean: 8.3 days). Complete elimination of necrotic tissue was achieved in 7 cases (50%) and partial elimination was achieved in 7 cases (50%). There weren't any cases of incomplete elimination or no response. Eight cases (57.1%) were in the 'excellent' group which had shown rapid granulation tissue formation and 3 cases (21.4%) were in the 'good' group, which had shown relatively rapid granulation tissue formation. But, there were 3 cases (21.4%) which had shown no difference from the previous time. Acute complications such as pain and bleeding had occurred in a few cases after maggot therapy. CONCLUSION: We suggest that the maggot therapy is a useful and effective method to use in the field of dermatology.

Antibacterial activity of house fly-maggot extracts against MRSA (Methicillin-resistant Staphylococcus aureus) and VRE (Vancomycin-resistant enterococci).

The principal objective of this study was to determine the in vitro antibacterial activity of the water-soluble protein enzymatic hydrolysates and the ethanol (EtOH)-extracted fraction obtained from fly-maggots (Musca domestica L.) against MRSA (methicillinresistant Staphylococcus aureus) strains and VRE (Vancomycin-resistant enterococci) 5117 strain. The water soluble protein enzymatic hydrolysates were prepared via 4 or 8 hr of incubation after mixing with the water-soluble protein extracted from the fly-maggots plus thermolysin. The EtOH-extracts A was prepared by homogenizing after mixing with the fly-maggots plus pure EtOH at room temperature. The EtOH-extracts B and C was obtained via filtering after stationing for 24 hr at 4-20oC using the EtOH-extracts A, respectively. The growth inhibition curves for MRSA strain 3595 and VRE strain 5117 in the water-soluble protein enzymatic hydrolysates were increased and evidenced concentration-dependent inhibition in the 8-hr hydrolysate as compared with the 4-hr hydrolysate (p<0.05). The growth inhibition curves for MRSA and VRE strains in the EtOH-extracted fraction obtained from the fly-maggots were high in EtOH-extract C as compared with EtOH-extracts A and B (p<0.05). The minimum inhibitory concentrations (MIC) in the EtOH-extracts C, in which the growth inhibition of MRSA and VRE strains was increased, were determined to be 40, 50, 50, 60, 40 and 60 μg ml-1 in MRSA strains 3598, 3595, 3601, 3589, 3597 and 3595, respectively. While the butanol fraction obtained from EtOH extract C evidenced profound antibacterial activity against the MRSA and VRE strains, the antibacterial activity of the hexane, ethyl acetate, and water layers could not be adequately confirmed.

Lucilia eximia (Diptera: Calliphoridae), una nueva alternativa para la terapia larval y reporte de casos en Colombia / Lucilia eximia (Diptera: Calliphoridae), a new alternative for maggot therapy: case series report

La terapia larval es utilizada desde los años 30 del siglo pasado para la remoción del tejido necrótico en el tratamiento de úlceras crónicas infectadas logrando con ello promover la formación de tejido granuloso para el crecimiento de piel sana; especialmente a partir de la aparición de la resistencia a los antibióticos se la reconoce como una alternativa eficaz. Se presentan los resultados de la aplicación de la terapia larval en 42 pacientes con úlceras de diferentes orígenes, utilizando, como una nueva alternativa en larviterapia, la especie Lucilia eximia. Se presenta documentación fotográfica de la aplicación de esta terapia en cuatro casos.

Larval therapy is used in the treatment of infected chronic wounds by allowing the removal ofnecrotic tissue, which induces the formation of granular tissue and the growth of healthy skin.Considering the increasing prevalence of antibiotic resistance, this type of therapy may be an effectivealternative in the management of infected chronic wounds. In this article we report the use ofmaggot therapy using the Lucilia eximia species in 42 patients with chronic skin wounds associatedto different pathologies including: venous and arterial ulcers, diabetic foot, sickle cell disease,vasculopathy, elephantiasis, Berger disease, pyoderma gangrenosum (PG), traumatic wounds, erysipelas, and hospital acquired infections. Four cases are depicted photographically.

Surgical Maggots

Surgical maggots have been used successfully for wound debridement over the past millennium. At Johns Hopkins University in 1929, Baer introduced maggots into the wounds of 21 patients with chronic intractable osteomyelitis. The development of methicillin-resistant Staphlococcus aureus has been a major impetus to resurgent interest in maggot debridement. In January of 2004, the US Food and Drug Administration gave Dr. Ronald Sherman permission to produce and market surgical maggots for debriding non-healing necrotic skin and soft tissue wounds. Given an uncooperative patient with non-healing wounds, our medical team obtained insectary-reared sterile surgical maggots, Phaenicia sericata, to promote debridement of necrotic tissue and development of granulation tissue.

Clinical Application of Maggots in Chronic Difficult Wounds

PURPOSE: Since ancient times, larval therapy has been applied to help wound healing. Its use has recently been rediscovered, and the interest in this therapy has been increased in clinical practice, as well as in research. The objective of this study is to assess the efficacy of maggot therapy for the treatment of intractable, chronic wounds. METHODS: Twenty patients, suffering mostly from chronic wounds were treated using maggots of greenfly (Phaenicia sericata). Sterile maggots were administered to the wound twice a week. The causes of the development of wounds were diabetic foot(14), trauma(3), plate exposure(1), and unknown origin(2). RESULTS: Complete debridement was achieved in 10 wounds; in 8 wounds, the debridement was partially achieved; 2 patients escaped. Four patients were healed without any additional surgical procedures but fourteen patients were treated with skin graft. Pain, reported by six patients, was relatively well controlled with oral analgesics. CONCLUSION: We found larval therapy to be effective for chronic wounds. Maggot therapy is a relatively rapid and effective treatment, particularly in necrotic wounds or the wounds resistant to conventional treatment.