From open wound treatment to primary soft-tissue non-Hodgkin lymphoma diagnosis; a challenging case report.

Primary soft-tissue extranodal lymphomas are rare clinical entities. By their natures, they can cause significant swelling around the affected extremities, and they can be easily misdiagnosed with other conditions like sarcomas. We share an unfortunate experience of a young male patient who was admitted to another clinic with complaints of a large mass in his right thigh, the patient has been diagnosed with anaplastic pleomorphic sarcoma, and he was scheduled for surgery. The patient refused the operation and was admitted to our emergency clinic with an open wound on his right thigh. Successful open wound management was achieved with antibiotic therapy, tissue debridement, larvae therapy, and Vacuum-assisted closure. Meanwhile, the pathologic re-examination revealed diffuse large B-cell lymphoma. After an uneventful follow-up, the patient was referred to the hematology clinic. This case highlights the importance of considering alternative diagnoses before making surgical intervention decisions that may result in unpleasing consequences.

Microbiological effects in patients with leg ulcers and diabetic foot treated with Lucilia sericata larvae.

Lucilia sericata bottle fly worms can be used to heal infected, chronic, or necrotic wounds, including those associated with ulceration and diabetic foot. The study aimed to evaluate changes in the microflora in patients treated with L sericata larvae due to leg ulcers and diabetic foot. One hundred twenty-nine patients diagnosed with lower limb ulceration and diabetic foot were enrolled in the study, of which 80 of them met the eligibility criteria for maggot debridement therapy (MDT). On the contrary, 49 unqualified patients were offered ozone therapy (22 with leg ulcers; 27 with diabetic foot). In each of these patients, a microbiological swab was performed before and after the start of therapy. The group of 80 patients was further divided into four equal groups in terms of the treated area (lower leg vs foot) and the number of larvae/cm2 (5 vs 10). Twenty-three particular species of bacteria in the infected wound were studied microbiologically in terms of presence/absence within the wound environment before and after treatment of patients with diabetic foot and lower limb ulceration. It was noted that there was a more intensive bacterial accumulation in the feet of patients compared to legs; furthermore, this applies to almost all analysed species. Diabetes status is also a clinical factor that generates a lower chance of bacterial appearance in the wound environment. Densification of MDT larvae per wound area unit also reduced the chance of the presence of Corynebacterium species, Enterobacteriaceae, Pseudomonas aeruginosa, Staphylococcus aureus MSSA, and Streptococcus coagulase negativa; however, it increased the likelihood of occurrence for Proteus mirabilis and the Proteus species. A microbiological analysis in this non-reference study shows the efficacy of larval therapy for leg and foot ulcers. Rearrangement of the microflora within the wound has been reported as a result of the therapy.

Antibacterial and anti-biofilm effects of fatty acids extract of dried Lucilia sericata larvae against Staphylococcus aureus and Streptococcus pneumoniae in vitro.

Development of new effective antimicrobial drugs is still a big challenge to date due to microbial infection remains an inevitable problem against human health. In this study, fatty acids extract of Lucilia sericata larvae (LFAs) was obtained and evaluated by gas chromatograph-mass spectrometry (GC-MS), and its antibacterial activity against Staphylococcus aureus (S. aureus) and Streptococcus pneumoniae (S. pneumoniae) was investigated. We found that LFAs exhibited effective antibacterial activity against S. aureus and S. pneumoniae with minimal inhibitory concentrations (MICs) of 125 µg/mL and 100 µg/mL, respectively. The bacterial wall and membrane were the main targets, which was confirmed by fluorescence microscopy, scanning electron microscopy and transmission electron microscopy. Furthermore, a notable anti-biofilm activity against S. aureus and S. pneumoniae was also observed, which was able to both prevent biofilm formation and eradicate mature biofilms of these bacteria. As a promising antibacterial agent, LFAs showed good application prospects in clinical practice.

A Survey on Inhibitory Effect of Whole-Body Extraction and Secretions of Lucilia sericata's Larvae on Leishmania major In vitro.

BACKGROUND: Leishmaniasis is a skin disease caused by Leishmania parasite. Despite being self-limiting, must be treated. Available drugs have side effects and drug resistance has also been seen. MATERIALS AND METHODS: Maggot debridement therapy (MDT) is using sterile fly larvae (maggots) of blow flies (Lucilia sericata) for the treatment of different types of tissue wounds. Larvae have excreted and secreted substances that have been proved to have antimicrobial effects, in addition to the some other specifications. RESULTS: In this study, the anti-leishmanial effects of extracts and secretions of sterile second- and third-instar larvae of L. sericata on the growth of Leishmania major promastigotes and amastigotes in the J774 macrophages have been evaluated in vitro. CONCLUSION: The results showed that extracts and secretions had almost the same leishmaniocidal effect on promastigotes and intracellular amastigotes without cytotoxic effect on macrophages.

Fatty acid extracts facilitate cutaneous wound healing through activating AKT, ERK, and TGF-ß/Smad3 signaling and promoting angiogenesis.

Fatty acids (FAs) are potential therapeutic agents for cutaneous wound healing; however, the mechanisms underlying this effect have not been clearly defined. In this study, we extracted and characterized FAs from dried Lucilia sericata larvae and investigated the molecular basis by which FAs promote cutaneous wound healing. We first confirmed that FA sodium salts (FASSs) stimulated proliferation, migration, and tube formation of cultured human umbilical vein endothelial cells (HUVECs) in a dose-dependent manner. We then showed that FASSs promoted endothelial-to-mesenchymal transition (EndMT), which plays an important role in stabilizing the neovasculature during angiogenesis. Mechanistically, FASSs up-regulated the expression of angiogenesis-related growth factors, platelet-derived growth factor (PDGF), transforming growth factor-ß1 (TGF-ß1), and vascular endothelial growth factor A (VEGFA), and activated angiogenesis-related signaling pathways, AKT, ERK, and TGF-ß/Smad3. In a rat acute cutaneous-wound model, FAs promoted wound healing. Following treatment, we further found that expression of anti-apoptosis-related factors (c-Myc and Bcl-2) was up-regulated and expression of apoptosis-related factors (p53 and Bad) was down-regulated. Our findings suggest that FAs can promote cutaneous wound healing by inducing angiogenesis, partly by activating AKT, ERK, and TGF-ß/Smad3 signaling.

Immunological evaluation of some antigens of Lucilia sericata larvae.

The present study aimed to select an antigen of Lucilia sericata larvae showing both high antigenicity and cross-reactive binding abilities with other related antigens of L. sericata larvae for obtaining a promising candidate vaccine antigen. The ELISA results primary concluded that among the excretory secretory (ES) and midgut (MG) antigens of the different larval instars of L. sericata, MGL2 could be characterized as antigen which was able to reflect the highest level of antigenicity and cross-reactivity with the other tested L. sericata antigens. The results were extended to spot the light on the relation between different protein bands in MGL2 and rabbit hyper- immune sera (HIS) raised against the other tested antigens using SDS-PAGE and Western blot technique. Analysis by SDS-PAGE of ES and MG antigens of the different larval instars of L. sericata revealed common protein bands at molecular weights of about 10, 12, 16, 20, 28, 33 and 46 kDa. Western blotting of MGL2 antigen transferred to nitrocellulose sheet revealed reaction by MGL2 HIS to five polypeptide bands; 20, 28, 33, 46 and 63 kDa. Three bands of 28, 33 and 63 kDa were the most prominent bands detected whereas; there was a weak reaction with bands of 20 and 46 kDa. But what was apparent in Western blot was a strong reaction of all tested HIS with a polypeptide band of 63 kDa. This band might be considered to be the main cause of cross reactive binding ability of MGL2 antigen that had been recorded previously in ELISA technique.

Treatment of pressure ulcers with larvae of Lucilia sericata.

OBJECTIVES: This study aims to investigate the use of the Lucilia sericata larvae in patients with decubitus ulcers resistant to hyperbaric oxygen treatment, vacuum-assisted closure, surgical debridement, and other conventional therapies. PATIENTS AND METHODS: A total of 36 patients (21 females, 15 males; mean age 63.7 years; range 16 to 90 years) who were admitted to our hospital for decubitus ulcers between February 2011 and July 2016 were included in our study. All patients had one or more lesions in the sacral region, trochanteric area, dorsal region, or on the heel of the foot. Nine patients had spinal cord injuries, six of them were injured during a car accident, and three of them had spinal cord injuries due to gunshot. One patient had concomitant lung cancer, one had heart failure, and two patients had a diagnosis of multiple sclerosis. Thirty three of 36 patients were admitted to the wound therapy unit within the department of emergency medicine, and three were admitted to the physical therapy and rehabilitation clinic. For each patient, Lucilia sericata maggots were applied on the lesions for 72 hours and, then, washed away. This procedure was repeated two times a week. Twenty nine patients (78.9%) had four to six sessions and seven patients (21.1%) had eight to 12 sessions. RESULTS: Twenty nine lesions (78.9%) were Grade 2 and 3 and were completely healed after four to eight treatment sessions, while seven lesions (21.1%) were completely cured at the end of 10 to 14 sessions. There was complete clearance of necrotic debris at the end of two sessions within the first week for 15 lesions, whereas 10 lesions (27.8%) were cured after four sessions within two weeks, seven lesions (19.4%) within five sessions after three weeks, and four lesions (11.1%) were treated at the end of seven sessions for four weeks. All the necrotic crusts over the surface of the ulcers were cleaned and bad odor of the lesions disappeared. CONCLUSION: Lucilia sericata larvae debridement is a rapid and effective treatment option for the management of chronic decubitus ulcers which are resistant to conventional therapies and other treatment modalities such as hyperbaric oxygen, vacuum-assisted closure, and surgical debridement.