Treatment of oral myiasis in a patient with implant-supported fixed prosthesis

ABSTRACT Oral myiasis is a rare parasitic disease that requires immediate treatment once diagnosed. However, no standard treatment protocol can be found in the literature. Through a clinical-surgical report, we present the case of an 82-year-old man with lesions extending through the vestibule and alveolar ridge of the maxilla on both sides, in addition to occupying a large part of the palate, with a considerable number of larvae. The patient was initially treated with a single dose of systemic ivermectin (6 mg orally) and topical application of a tampon soaked in ether. The larvae were then surgically removed and debridement of the wound was performed. A crushed tablet of ivermectin 6 mg was applied topically for 2 days, the remaining larvae were again mechanically removed, and the patient received intravenous antimicrobial therapy. Treatment with systemic and topical ivermectin combined with antibiotic therapy and debridement proved to be effective in treating oral myiasis.

Actinomycotic Osteomyelitis and Myiasis in Oroantral Communication: Clinicopathological and Tomographic Findings

Actinomycotic osteomyelitis of the maxilla presenting with oroantral communication is very rare, herein we report the first case of this condition in association with myiasis. A 50-year-old man reported chronic sinusopathy and a non-healing maxillary lesion, with 30 years of evolution, presenting occasional nasal and intraoral purulent discharge, with foul smell, and recurrent episodes of larvae presence. Cone beam computed tomography showed a large hyperdense image inside the left maxillary sinus, with focal areas with soft tissue density, and extensive discontinuity of the maxillary sinus floor, confirming the oroantral fistula. The necrotic tissue curetted during surgery presented hard consistency, and dark greenish color, and was submitted for histopathological analysis. Microscopically, necrotic bone, masses of filamentous bacteria colonie s, compatible with actinomycosis, and large rhomboidal structures surrounded by eosinophilic capsule - suggestive of larvae, were observed. The diagnosis of actinomycotic osteomyelitis with presence of structures compatible with larvae was established.

La osteomielitis actinomicótica del maxilar que se presenta con comunicación oroantral es poco frequente. En este trabajo reportamos el primer caso de esta condición en asociación con miasis. Un hombre de 50 años que refiere sinusopatía crónica y lesión maxilar que no cicatriza, de 30 años de evolución, presenta secreción ocasional purulenta nasal e intraoral, con mal olor y episodios recurrentes de presencia de larvas. La tomografía computarizada de haz cónico mostró una gran imagen hiperdensa en el interior del seno maxilar izquierdo, con áreas focales con densidad de partes blandas y una extensa discontinuidad del piso del seno maxilar, lo que confirma la fístula oroantral. El tejido necrótico legrado durante la cirugía presentó consistencia dura, coloración verdosa oscura, y fue remitido para análisis histopatológico. Microscópicamente se observó hueso necrótico, masas de colonias de bacterias filamentosas compatibles con actinomicosis y grandes estructuras romboidales rodeadas de cápsula eosinofílica sugestiva de larvas. Se estableció el diagnóstico de osteomielitis actinomicótica con presencia de estructuras compatibles con larvas.

Miasis Genital. Presentación de un caso

Introducción: la miasis se define como la infestación de animales domésticos y salvajes, así como del hombre por estados larvarios de varias especies de dípteros que se alimentan de tejidos vivos o muertos o del alimento ingerido por el hospedero. Puede encontrarse en genitales, extremidades, cráneo, boca y párpados. Presentación de caso: se presenta el caso de un paciente, masculino de procedencia rural de 56 años de edad. Acude remitido de su área de salud por presentar varias ulceras a nivel del pene acompañado de aumento de volumen del mismo con secreciones fétidas, prurito y dolor. Se ingresa para estudio y tratamiento en sala. Se le diagnosticó miasis genital a nivel del glande. Tuvo una evolución satisfactoria en sala mediante curas locales y el tratamiento con antimicrobianos. Discusión: la miasis genital es poco común, probablemente por el aislamiento que ejerce la ropa al contacto con las moscas, sin embargo, la vestimenta corta predispone una mayor ovoposición en esta zona debido a una exposición más asequible, puede imitar lesiones inflamatorias o ulcerosas. De hecho, esta infestación parasitaria se ha asociado con determinadas enfermedades urogenitales de aspecto tumoral. Conclusiones: indiscutiblemente la inadecuada higiene de los genitales es un factor determinante en la aparición de la miasis.

Introduction: myiasis is defined as the infestation of domestic and wild animals, as well as man, by larval stages of various species of Diptera that feed on living or dead tissue or food ingested by the host. Genital myiasis is rare, of which there is little reference in the literature, specifically in the Caribbean. Case report: the case of a 56-year-old male patient of rural origin is presented. He was referred from his health area for presenting several ulcers on the penis accompanied by an increase in its volume with fetid secretions, itching and pain. He is admitted for study and treatment in the room. He was diagnosed with genital myiasis at the level of the glans. He had a satisfactory evolution in the room through local cures and treatment with antimicrobials. Discussion: genital myiasis is uncommon, probably due to the insulation exerted by clothing in contact with flies, however, short clothing predisposes a greater oviposition in this area due to more accessible exposure, it can mimic inflammatory or ulcerative lesions. In fact, this parasitic infestation has been associated with certain tumor-like urogenital diseases. Conclusions: unquestionably, inadequate genital hygiene is a determining factor in the appearance of myiasis.

Introdução: amiíase é definida como a infestação de animais domésticos e silvestres, assim como o homem, por fases larvais de várias espécies de Diptera que se alimentam de tecidos vivos ou mortos ou alimentos ingeridos pelo hospedeiro. Pode ser encontrado nos genitais, extremidades, crânio, boca e pálpebras. Apresentação do caso: apresenta-se o caso de um paciente do sexo masculino, 56 anos, de origem rural. Foi encaminhado de sua área de saúde por apresentar várias úlceras no pênis acompanhadas de aumento do seu volume com secreções fétidas, prurido e dor. Ele é admitido para estudo e tratamento na sala. Foi diagnosticado com miíase genital ao nível da glande. Teve evolução satisfatória na sala através de curas locais e tratamento com antimicrobianos. Discussão: amiíase genital é incomum, provavelmente devido ao isolamento exercido pelas roupas em contato com moscas, entretanto, roupas curtas predispõem uma maior oviposição nesta área devido à exposição mais acessível, podendo mimetizar lesões inflamatórias ou ulcerativas. De fato, essa infestação parasitária tem sido associada a certas doenças urogenitais semelhantes a tumores. Conclusões: inquestionavelmente, a higiene genital inadequada é um fator determinante no aparecimento da miíase.

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.

Miasis en pacientes con cáncer en el Instituto Nacional de Cancerología entre 2008 y 2018: Serie de Casos / Myiasis in cancer patients receiving medical care at a reference center in Bogotá, Colombia: 2008-2018. A case series

Resumen Introducción: La miasis puede ser considerada una enfermedad desatendida; corresponde a la infestación de larvas de dípteros en piel, heridas o cavidades naturales. La literatura para pacientes oncológicos con infestación es limitada para Colombia. Métodos: Se realizó una serie de casos de miasis en pacientes atendidos en el Instituto Nacional de Cancerología de 2008 a 2018; se obtuvieron datos de las historias clínicas con el fin de caracterizar variables sociodemográficas, oncológicas y tratamiento recibido. Resultados: Se encontraron 32 registros: 27 cumplieron con los criterios de inclusión, mediana de edad 69 años, 74% fueron hombres, 48% procedían de área rural, 33,3% de áreas con alturas superiores a 2000 msnm, 70% presentaban cáncer de cabeza y cuello, seguidos por cáncer de mama 14%; 40% ECOG 2-3; 77% visualizaron larvas antes de consultar; ningún paciente presentó sepsis al momento de consultar, 29% presentaban secreción en zona infestada, 85% recibieron ivermectina y curaciones por parte de enfermería; 70% recibió antibióticos sistémicos, y 60% otros tratamientos además de la remoción mecánica e ivermectina, la mediana de leucocitos al ingreso fue de 10280 y de eosinófilos 110. Conclusión: Ésta es la primera serie de casos informada de miasis en pacientes oncológicos para América. Es más frecuente en pacientes con neoplasias en áreas expuestas, aunque se puede presentar en zonas no expuestas; la infestación por larvas tiende a no ser purulenta. Se deben hacer estudios sobre el uso de ivermectina, otros antibióticos y las implicaciones pronósticas de esta patología en los pacientes con cáncer avanzado.

Abstract Introduction: Myiasis can be considered a neglected disease; it corresponds to the infestation of dipteran larvae in skin, wounds, or natural cavities. Literature for oncological patients with this infestation is limited for Colombia. Methods: A case series of myiasis was carried out in patients treated at the National Cancer Institute of Colombia from 2008 to 2018. Data were obtained from medical records in order to characterize sociodemographic and oncological variables and the treatment received. Results: Thirty-two records were found, 27 of them met the inclusion criteria. Median age was 69 years, 74% were men, 48% came from rural areas, 33.3% from areas with altitudes greater than 2,000 meters above sea level, 70% had head and neck cancer, followed by breast cancer in 14%; 40% had ECOG 2-3, and 77% visualized larvae before consulting. No patient presented with sepsis at the time of consultation, 29% presented with discharge in the infested area, 85% received ivermectin and treatment by the nursing staff; 70% received systemic antibiotics, and 60% other treatments in addition to mechanical removal and ivermectin. Median of leukocytes at admission was 10,280, while median of eosinophils was 110. Conclusion: This is the first reported case series of myiasis in cancer patients for Latin America. It is more common in patients with neoplasms in exposed areas, although it can occur in unexposed areas too. Larval infestation tends not to be purulent. Further studies are needed on the use of ivermectin, other antibiotics, and the prognostic implications of this pathology in patients with advanced cancer.

Furuncular myiasis by Wohlfahrtia magnifica (Diptera: Sarcophagidae) in a healthy child

Rationale: Human myiasis is the invasion of tissue or organs by fly larvae. This could be obligatory, facultative, or accidental. Patient concerns: A 4-year-old Saudi boy complained of fever over the past three days with multiple inflamed painful dermal furuncles and worms-like discharge. Diagnosis: Furuncular obligatory myiasis caused by Wohlfahrtia magnifica. Interventions: Maggots were removed for identification. The wounds were cleaned with antiseptic dressings. Topical and oral antibiotics were applied. Outcomes: Seven days later, the wounds completely healed. Lessons: Although several reports correlated human myiasis with old age, low health status, mental retardation, and low socioeconomic status, but the patient in our case was a healthy child from a family with good socioeconomic status, good hygiene, no history of diseases or mental disability, but traveled to a village where the climate is suitable for fly breeding.

Dermatobia hominis: una dermatosis inusual en zonas no endémicas / Dermatobia hominis: an unusual dermatosis in non-endemic areas

La miasis forunculoide es una parasitosis producida por la larva de una mosca endémica en las regiones tropicales y subtropicales de América y África. Se presenta un caso de la enfermedad en un residente de Mendoza y una breve revisión bibliográfica de esta parasitosis, poco frecuente en Argentina.

Furuncular myiasis is a parasitosis infestation caused by fly larvae, it is endemic in the tropical and subtropical regions of America and Africa. We present a case in a patient living in Mendoza. A review of the literature regarding this uncommon parasitosis in Argentina is also presented here.

Miasis foruncular causada por Dermatobia hominis en Ecuador / Furuncular myasis caused by Dermatobia hominis in Ecuador

Las miasis humanas son ectoparasitosis causadas por larvas de varias especies de moscas que producen distintas formas clínicas, afectan piel, cavidades y heridas. Estas prevalecen en regiones tropicales. Se presenta un caso de miasis foruncular en un hombre de 32 años, turista, infestado en una zona tropical húmeda de la región costera del Pacífico del Ecuador. Acude a consulta con un cuadro clínico de 30 días de evolución, y refiere picadura de insecto que creció hasta formar elevación indurada prurítica, no dolorosa, en piel de flanco izquierdo del abdomen. Al examen físico se observó una lesión foruncular de 3 x 2 cm rodeada de placa eritematosa con el centro abierto observándose un agujero central que descargaba un líquido sero-sanguinolento con movimientos. Por extracción manual se obtuvo una sola larva que por sus características externas se identificó como Dermatobia hominis. El resto del examen físico y exámenes de laboratorio fueron normales. Las actividades turísticas o de trabajo a estas zonas tropicales expone a las personas al riesgo de contraer miasis, por ende, es necesario información y medidas de prevención(AU)

Human myases are ectoparasitic infections caused by larvae of several fly species. They present various clinical manifestations, affecting the skin, cavities and wounds. Myases prevail in tropical regions. A case is presented of furuncular myasis in a male 32-year-old tourist infected in a humid tropical area from the Pacific coastal region of Ecuador. The patient presented with a clinical status of 30 days' evolution, reporting an insect bite that grew to form a painless indurated pruritic nodule on the skin of his left flank of the abdomen. Physical examination found a 3 x 2 cm furuncular lesion surrounded by erythematous plaque and an open center which discharged a serosanguineous fluid with movement. A single larva was obtained by manual extraction, which was identified as Dermatobia hominis based on its external characteristics. The remaining physical examination and laboratory tests were normal. Tourist and work activities in these tropical areas expose people to the risk of contracting myasis. Information and prevention measures are therefore necessary(AU)

Children hospitalized for myiasis in a reference center in Uruguay / Niños hospitalizados por miasis en un centro de referencia de Uruguay

Abstract Background: Myiasis is an emerging disease caused by tissue invasion of dipteran larvae. In Uruguay, Cochliomyia hominivorax and Dermatobia hominis are the most frequent species. This study aimed to describe the epidemiological and clinical characteristics and the follow-up of children < 15 years hospitalized for myiasis in a reference center in Uruguay between 2010 and 2019. Methods: We conducted a descriptive and retrospective study by reviewing medical records. We analyzed the following variables: age, sex, comorbidities, origin, the month at admission, clinical manifestations, other parasitoses, treatments, complications, and larva species identified. Results: We found 63 hospitalized children: median age of 7 years (1 month-14 years), 68% of females. We detected risk comorbidities for myiasis (33%), of which chronic malnutrition was the most frequent (n = 6); 84% were from the south of the country; 76% were hospitalized during the summer. Superficial and multiple cutaneous involvements were found in 86%: of the scalp 50, furunculoid type 51, secondary to C. hominivorax 98.4%, and to D. hominis in 1.6%. As treatments, larval extraction was detected in all of them, surgical in 22%. Asphyctic products for parasites were applied in 94%, ether in 49. Antimicrobials were prescribed in 95%; cephradine and ivermectin were the most frequent. About 51% presented infectious complications: impetigo was found in 29, cellulitis in 2, and abscess in 1. Conclusions: Myiasis predominantly affected healthy schoolchildren during the summer months and was frequently associated with ectoparasites. Superficial infestation of the furuncle-like scalp by C. hominivorax was the most frequent form. Infectious complications motivated hospitalizations.

Resumen Introducción: La miasis es una enfermedad emergente producida por la invasión tisular por larvas de dípteros. En Uruguay, Cochliomyia hominivorax y Dermatobia hominis son las especies más frecuentes. El objetivo de este estudio fue describir las características epidemiológicas y clínicas, y el seguimiento, de niños menores de 15 años hospitalizados por miasis en un centro de referencia del Uruguay entre 2010 y 2019. Métodos: Se llevó a cabo un estudio descriptivo y retrospectivo mediante la revisión de las historias clínicas. Se analizaron las siguientes variables: edad, sexo, comorbilidad, procedencia, mes al ingreso, cuadro clínico, otras parasitosis, tratamientos, complicaciones y especie de larva identificada. Resultados: Se encontraron 63 casos de niños hospitalizados, con una mediana de edad de 7 años (rango: 1 mes a 14 años) y el 68% de sexo femenino. Se identificó comorbilidad de riesgo para miasis (33%), siendo la desnutrición crónica la más frecuente (n = 6). El 84% eran procedentes del sur del país y el 76% fueron hospitalizados en los meses estivales. Se encontró afectación cutánea superficial y múltiple en el 86%: de cuero cabelludo en 50, de tipo forunculoide en 51, secundaria a C. hominivorax en el 98.4% y a D. hominis en el 1.6%. Se realizó extracción larvaria en todos los casos, que fue quirúrgica en el 22%. Se aplicaron productos asfícticos para parásitos en el 94%, con éter en 49 niños. Se prescribieron antimicrobianos en el 95%; los más usados fueron cefradina e ivermectina. El 51% presentaron complicaciones infecciosas: 29 impétigo, 2 celulitis y 1 absceso. Conclusiones: La miasis afectó predominantemente a escolares sanos y durante los meses estivales, y se encontró frecuentemente asociada con ectoparasitosis. La infestación superficial del cuero cabelludo de tipo forunculoide por C. hominivorax fue la forma más frecuente. Las complicaciones infecciosas motivaron las hospitalizaciones.

Oftalmomiasis / Ophthalmomiasis

La oftalmomiasis es una enfermedad poco frecuente, causada por artrópodos; en este caso por la mosca adulta. Presentamos el caso de una paciente femenina, de 44 años de edad, con antecedentes de inmunosupresión severa secundaria a VIH, quien fue atendida en el Servicio de Oftalmología por molestia ocular. Presentaba un aumento de volumen circunscrito en conjuntiva que se extendía sobre la córnea nasal del ojo izquierdo, de aspecto blanco nacarado, deslustrado. Se le realizó exéresis de la lesión y crioterapia. Posteriormente se le aplicó colirio de mitomicina C. A los siete meses la paciente regresó a la consulta con un cuadro de complicación franca y severa de la lesión, con destrucción de los tejidos de la órbita y múltiples cavernas ocupadas por cientos de larvas de moscas(AU)

Ophthalmomiasis is a rare disease, caused by arthropods; in this case by the adult fly. We present the case of a 44-year-old female patient, with a history of severe immunosuppression secondary to HIV, who was treated at the Ophthalmology Service for ocular discomfort. She presented a circumscribed increase in volume in the conjunctiva that extended over the nasal cornea of ​​the left eye, with a pearly white, tarnished appearance. Excision of the lesion and cryotherapy were performed. Subsequently, mitomycin C eye drops were applied. Seven months later, the patient returned to the consultation with a frank and severe complication of the lesion, with destruction of the tissues of the orbit and multiple caverns occupied by hundreds of fly larvae(AU)

Miasis por Dermatobia hominis: presentación de un caso clínico / Myiasis caused by Dermatobia Hominis: case report

RESUMEN Fundamento: la miasis es toda afección causada por estadios larvarios de diferentes tipos de dípteros, los cuales atacan a tejidos y órganos de animales vertebrados. El díptero Dermatobia hominis es localizado geográficamente en los territorios correspondientes a Sudamérica, Centroamérica y México. En el Caribe, Europa, Asia y África, los reportes otorgados no muestran data de origen local, más bien se conoce por medio de la anamnesis el viaje por parte de los individuos afectados a las zonas mencionadas. Objetivo: reportar el caso de un paciente diagnosticado con miasis causada por Dermatobia hominis, se describe la clínica, terapéutica y evolución del caso. Presentación del caso: paciente masculino, extranjero, procedente de la ciudad de Londres, que da a conocer dolor localizado en región lumbar y en miembro inferior izquierdo con aumento de volumen local. Al examen físico se constató presencia de lesión furunculoide. Se prescribe colocación de solución emoliente en lesiones y se procede a retirar por medio quirúrgico a larvas de díptero. Conclusiones: la miasis es una enfermedad que debe conocerse por parte del médico que labora en áreas donde la presencia de dípteros es alta. El conocimiento de las áreas de riesgo es fundamental en el tratamiento de pacientes que viajan a zonas endémicas.

ABSTRACT Background: myiasis is any condition caused by larval stages of different types of diptera, which attack tissues and organs of vertebrate animals. The diptera Dermatobia hominis is located geographically in the territories corresponding to South America, Central America and Mexico. In the Caribbean, Europe, Asia and Africa, the reports given do not show data of local origin, rather it is known through the anamnesis the trip by the affected individuals to the mentioned areas. Objective: to report the case of a patient diagnosed with myiasis caused by Dermatobia hominis, describing the clinical, therapeutic and evolution of the case. Case report: male patient, foreigner, coming from the city of London, who reveals pain located in the lower back and lower left limb with local volume increase. Physical examination revealed presence of furunculoid lesion. Emollient solution in lesions is prescribed and the larvae of Diptera are surgically removed. Conclusions: myiasis is an entity that must be known by the doctor who works in areas where the presence of diptera is high. The knowledge of risk areas is fundamental in the treatment of patients traveling to endemic areas.

Occurrence of Gasterophilus spp. in weanling foals in southern Brazil

The occurrence of gastrointestinal myiasis caused by Gasterophilus spp. larvae (Diptera: Oestridae) in adult horses has been widely characterized, however data on natural infestation in young foals have been lacking. This observation may be related to the absence of conclusive diagnosis in these individuals, most likely due to logistical or financial constraints. Gastric ulceration is a problem and a significant cause of morbidity in foals, particularly during the weaning stage; therefore, gasterophilosis should be included in the differential diagnosis. The primary purpose of this study was to determine the prevalence of gasterophilosis in 4- to 6-month-old weanling foals. Seventy-one healthy weanling foals were enrolled in the study. Physical assessment blood sampling and was completed in all foals before the commencement of the experiment. Gastroscopy examinations were performed under sedation (Detomidine 0.01 - 0.02 mg/kg) with a flexible endoscope inserted through nasogastric via. The lumen of the stomach was examined in order to search for botflies' larvae. Following gastroscopy, foals were classified into 2 groups based on the presence of Gasterophilus spp. larvae in their stomachs: 1) Infected and 2) Not Infected. Infected foals received a single dose of commercial trichlorfon and albendazole equine oral gel and were stalled for 24 h. The passed feces were thoroughly examined, searching for elimination of larvae. A total of 64% of the foals (n = 45/71) harbored Gasterophilus spp. larvae in the stomach. Mild hyperemia in the gastric mucosa was observed in the attachment sites of the parasites. Physical assessment and hematological parameters' data were analyzed with Shapiro-Wilk normality test. Comparison between groups for clinical signs, hematological parameters and Gasterophilus spp. infection rates were evaluated using the Kruskal-Wallis test or Student's t-test. Statistical significance was set at P < 0.05. There were no statistically significant variations in physical and hematological parameters between foals that were affected and those that were not infected. The larvae found in the feces were subjected to morphological examination, which confirmed the diagnosis of Gasterophilus intestinalis. No systemic clinical indications compatible with Gasterophilus spp. infestation were seen, as described in previous studies of horses infected with the parasite. No botfly eggs were observed in the hair of evaluated foals. During gastroscopy, mild hyperemic lesions in the gastric mucosa were observed in the larvae fixation sites. Although no changes in clinical or hematological parameters were noted, the confirmation of parasite presence is a cause for concern due to horses' tolerance for low infestation levels and poor diagnosis. Additionally, the presence of this myiasis in foals may be a significant stressor during the weaning period and should be included in the differential diagnosis of recurring abdominal pain. Furthermore, infected foals might be a reservoir for the parasite and, contribute to the elimination and spread of the larvae in the environment. Thus, inclusion of young horses in deworming protocols targeted to botfly larvae is needed. This is the first report of Gasterophilus intestinalis myiasis in foals in Brazil. Further research is necessary to fully understand the epidemiology and prevalence of this condition in young horses in Brazil, based on the findings of this study.(AU)

Urogenital myiasis - An atypical presentation

The infestation of the human body by maggots has been reported worldwide and occurs most commonly in people of lower socioeconomic status and poor personal hygiene. Urogenital is the rarest site of myiasis presentations. Here we report the case of a 20-year-old, sexually inactive female student who presented with a necrotic growth in the paraurethral region infested with numerous maggots. The lesion involved the urethra and the bladder base. She was treated with debridement and bladder irrigation. The cystoscopy and local examination performed 2 weeks after admission, confirmed the complete healing of the urogenital lesion. Managing this patient's unique challenge was to assess the extent of the involvement and removal of all maggots from the deepest wound portion. The female internal and external urogenital myiasis is a very occasional and under-reported health hazard. Reporting such cases increases the public and physician awareness about the mode of presentation, right diagnosis, and available treatment options.

Cranial osteomyelitis as a complication of furuncular myiasis / Osteomielite craniana como complicação de miíase furuncular

ABSTRACT Objective: To report the case of an infant with infrequent cranial osteomyelitis as a complication of furuncular myiasis. Case description: The patient was a 4-month-old male who presented to the emergency department with a nodular skull lesion with edema, tenderness, pain, and purulent drainage, as well as progress of the ulcerated lesion and evidence of larvae inside. Antibiotic treatment was initiated, and the patient was taken to the operating room to remove the larvae, but he had no symptomatic improvement. A skull radiograph was taken to visualize the osteolytic lesion, and a 3D computed tomography scan showed osteomyelitis of the external parietal surface. Antibiotic management readjustment continued for a total of six weeks, and a skin flap was used with clinical improvement. Comments: Myiasis is defined as the infestation of vertebrates with fly larvae. In mammals, larvae can feed on host tissue and cause a wide range of infestations depending on their location in the body. The cranial osteomyelitis as a complication of myiasis described in this report seems to be an exceptional case.

RESUMO Objetivo: Relatar um caso de criança com osteomielite craniana infrequente como complicação da miíase furuncular. Descrição do caso: Paciente do sexo masculino, com quatro meses de idade, que se apresentou no pronto-socorro com lesão nodular no crânio com edema, sensibilidade, dor e drenagem purulenta, com evolução da lesão ulcerada e evidência de larva no interior. O tratamento com antibióticos foi iniciado e o paciente foi levado à sala de cirurgia para remover as larvas, mas não houve melhora. Uma radiografia do crânio foi realizada para visualizar a lesão osteolítica e uma tomografia computadorizada em 3D mostrou osteomielite da superfície parietal externa. O reajuste do tratamento com antibióticos foi mantido por um total de seis semanas e um retalho cutâneo foi realizado com melhora clínica. Comentários: Miíase é definida como a infestação de vertebrados com larvas de moscas. Nos mamíferos, as larvas podem se alimentar do tecido hospedeiro e causar uma ampla variedade de infestações, dependendo da sua localização no corpo. A osteomielite como complicação da miíase, apresentada nesse caso, parece ser uma forma não usual de complicação dessa doença.

Enteral myiasis causing acute dysentery: A case report

@#Enteral myiasis or intestinal myiasis is acquired by ingesting food or water contaminated with dipteran fly eggs or larvae. Here, we describe a patient with intestinal myiasis presenting with acute dysentery caused by the larva of Hermetia illucens. The larva was identified morphologically, and its species confirmed through molecular analysis using polymerase chain reaction and sequencing based on mitochondrial cytochrome c oxidase subunit I gene (COI).

Miasis intestinal humana por Eristalis tenax en un niño de la zona urbana del municipio de Policarpa, Nariño, Colombia / Human intestinal myiasis by Eristalis tenax in a child from the urban area of the municipality of Policarpa, Nariño, Colombia

Resumen: La miasis se produce por la infestación con larvas de especies de moscas que afectan los tejidos u órganos de los vertebrados, incluido el ser humano. Puede clasificarse por caracterización entomológica o según el tropismo de las larvas en los tejidos. La miasis intestinal es poco frecuente y de difícil diagnóstico dada su sintomatología inespecífica, por lo que la única forma de confirmar el caso es mediante la identificación de las larvas expulsadas. Se presenta el primer caso reportado en el departamento de Nariño (Colombia) de miasis intestinal en un niño de seis años residente en la zona urbana del municipio de Policarpa, proveniente de una familia de nivel socioeconómico bajo, sin acceso a un adecuado tratamiento y sin disposición de aguas residuales y con insuficientes condiciones de saneamiento básico. El caso clínico se asoció con diarrea crónica, dolor abdominal y prurito anal, con la posterior expulsión de una larva cuyas características morfológicas correspondían a las de la mosca Eristalis tenax.

Abstract: 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.

DEPREDACION POR INSECTOS DE NIDOS Y NEONATOS PROTEGIDOS DE Podocnemis vogli (SABANAS INUNDABLES DEL CASANARE) / Prédation by insects of protected nests and hatchlings of Podocnemis vog/i (flooded savannas of Casanare)

RESUMEN La galápaga sabanera (Podocnemis vogli) es una tortuga de ambientes acuáticos, principalmente lénticos, que centra su época reproductiva en la temporada seca, en la que sus huevos son una importante fuente de alimento en la red trófica y para el hombre, de manera que frecuentemente son afectados por depredadores naturales. Con el propósito de reducir el efecto negativo de la depredación natural sobre las nidadas de P vogli en la Reserva Natural de la Sociedad Civil La Esperanza en Paz de Ariporo, se implementó una estrategia de protección directa con malla metálica y se realizó el seguimiento a las posturas durante tres periodos de anidación entre 2016 y 2018. Como resultado del uso de esta estrategia para proteger las nidadas, se evidenció el efecto de otros depredadores y parásitos menos conspicuos como las hormigas legionarias (Labidus) y las larvas de moscas parasitarias (Phoridae). En ambos casos la afectación se registró en los neonatos recién eclosionados de galápaga sabanera al interior de los nidos, algunos de ellos hallados en un estado de salud precaria o muertos. Este es el primer reporte de depredación de los neonatos de P. vogli por estas especies de insectos sobre las cuales las estrategias físicas convencionales de protección fueron ineficientes.

ABSTRACT The savanna side-necked turtle (Podocnemis vogli) is a river turtle of mainly lentic aquatic environments that centers its reproductive period in the dry season; its eggs are a significant source of nourishment in the food web that includes humans as well. Therefore, by monitoring and installing metal mesh we protected the nests during three spawning seasons (2016-2018). After using the mentioned protection strategy other possible predators or parasites, such as the insects, became evident. We observed that when monitoring clutches, organisms such as ants and parasitic flies took advantage of the newborn hatchlings inside the nests. In both cases, the affectations by both species caused considerable injuries in the neonates, which eventually showed a precarious state of health and even died rapidly. This is the first time that predation on P. vogli neonates by these insect species has been reported, in which physical protection strategies are not functional.

Caracterización clínica de los pacientes ingresados por miasis en el Hospital del Niño Dr. Francisco de Icaza Bustamante, Guayaquil, Ecuador / Clinical characterization of patients admitted for myiasis at Dr. Francisco de Icaza Bustamante Children's Hospital in Guayaquil, Ecuador

Introducción: La miasis constituye un importante problema de salud pública. En el Ecuador se atribuye su causa con mayor frecuencia a Cochliomyia hominivorax. Objetivo: Describir las características clínicas y el tratamiento de los pacientes ingresados por miasis en el Hospital del Niño Dr. Francisco de Icaza Bustamante, Guayaquil, Ecuador. Métodos: Se realizó un análisis retrospectivo de la información clínica de 84 pacientes con diagnóstico de miasis, ingresados entre 2011 y 2018. Las variables analizadas fueron: sexo, edad, número de casos por mes y año, forma de presentación, sintomatología y tiempo de hospitalización, además de factores meteorológicos. La base de datos fue procesada con el software MS Excel 2013. Resultados: La mediana de edad fue de 6 años (5 meses-14 años); 27,4 por ciento correspondía al sexo masculino y 72,6 por ciento al femenino. Se encontró mayor número de ingresos en la temporada de verano, de julio a diciembre. Se registró miasis cutánea (79,8 por ciento), ótica (17,9 por ciento) y oral (2,3 por ciento). El tiempo de hospitalización general tuvo una mediana de 6 días (1-36 días). Conclusiones: Es necesario realizar actividades encaminadas a la prevención de la enfermedad en la comunidad y la elaboración de adecuados protocolos de manejo en las unidades de salud. El personal de salud debe registrar adecuadamente la información clínica para elaborar información estadística pertinente que lleve a fundamentar la implementación de adecuadas políticas de salud(AU)

Introduction: Myiasis is an important public health problem. In Ecuador its cause is mainly attributed to Cochliomyia hominivorax. Objective: Describe the clinical characteristics and the treatment of patients admitted for myiasis at Dr. Francisco de Icaza Bustamante Children's Hospital in Guayaquil, Ecuador. Methods: A retrospective analysis was conducted of the medical data of 84 patients diagnosed with myiasis admitted from 2011 to 2018. The variables analyzed were sex, age, number of cases per month and year, form of presentation, symptoms, hospital stay duration, and meteorological factors. The database was processed with the software MS Excel 2013. Results: Mean age was 6 years (5 months-14 years); 27.4 percent were male and 72.6 percent were female. The largest number of admissions occurred in the summer season, from July to December. Records were found of cutaneous (79.8 percent), aural (17.9 percent) and oral (2.3 percent) myiasis. Mean hospital stay duration was 6 days (1-36 days). Conclusions: It is necessary to perform activities aimed at preventing the disease in the community as well as develop appropriate management protocols in health facilities. Health care providers should adequately record the clinical data required to develop relevant statistical information leading to the implementation of effective health policies(AU)

Update on parasitic dermatoses

Abstract These are cutaneous diseases caused by insects, worms, protozoa, or coelenterates which may or may not have a parasitic life. In this review the main ethological agents, clinical aspects, laboratory exams, and treatments of these dermatological diseases will be studied.

A Review of Human Myiasis in Iran With an Emphasis on Reported Cases

@#Myiasis is the invasion of organs and tissues of humans or other vertebrate animals by fly larvae. The first reported case of myiasis in Iran was ophthalmic myiasis, which was reported in 1975. Since then about 81 cases of human myiasis have been reported in Iran up till 2017. According to this study, all types of myiasis were reported from different parts of Iran. Vectors species of human myiasis in Iran are: Oestrus ovis, Chrysomya bezziana, Dermatobia hominis, Hypoderma bovis, Rinoestrus purpureus, Lucilia serricata, Eristalis tenax, Sarcophaga haemorrhoidalis, Sarcophaga fertoni, Wohlfahrtia magnifica, Wohlfahrtia nuba, Wohlfahrtia vigil, Cynomyopsis cadaverina, and Psychoda albipennis. There were two age peaks of myiasis infection in Iran: 21- 40 years old, and 65 years old . Specific and primary treatment is removal of larvae from infected tissues . Ironing is an effective way to eliminate eggs, also wearing long sleeve clothes to cover wounds and avoiding outdoor sleep are another way to prevent infection with flying larva. The aim of this review was to determine the prevalence of myiasis in different parts of Iran in order to determine and prioritize the methods of control based on the results.