Otorhinolaryngological myiasis: the problem and its presentations in the weak and forgotten.

INTRODUCTION: Myiasis is common in tropical regions, but now increasing incidence is seen in the west due to international travel. Otorhinolaryngological myiasis is uncommon and is seen in diabetics, alcoholics or patients unable in self-care. OBJECTIVES: To study presentations of otorhinolaryngological myiasis, identify associated risk factors and species of flies causing myiasis. METHODS: Clinical findings and co-morbidities of 67 myiasis cases were noted. Maggots were identified, manually removed, and patients were managed with topical treatment, systemic ivermectin and antibiotics. FINDINGS: Thirty-three nasal myiasis, 13 aural myiasis and 5 patients with oral myiasis were noted. Seven patients with head neck wounds myiasis and nine patients of tracheostome myiasis were recorded. DISCUSSION: Warm humid climate of tropical regions is a major concern along with co-existing conditions like poor sanitation, alcoholism, psychiatric diseases and neuropathies. Hesitancy is seen in attendants and health care professionals to deal with myiasis. CONCLUSION: Awareness about risk factors is important in avoiding myiasis along with prompt treatment which reduces morbidity. Tracheostome myiasis is an under-documented entity rather than a rare presentation. FUNDING: None.

Ear, nose and throat manifestations of mucocutaneous Leishmaniasis: a literature review.

Leishmaniasis comprises a group of diseases caused by a protozoan parasite belonging to the genus Leishmania and transmitted by the bite of infected female sand flies. Leishmaniasis is endemic in 88 countries and causes significant morbidity and mortality worldwide. Phenomena such as globalization and human migration, as well as the increased volume of international travel have extended its prevalence in developed countries. In addition, the incidence of leishmaniasis as an opportunistic disease has increased in recent years because of the growing number of patients with immune depression secondary to chronic illness, neoplasm, transplant and HIV infection, thereby constituting a public health problem. In humans, there are three possible clinical syndromes of leishmaniasis: cutaneous, mucocutaneous and visceral. Mucocutaneous disease is due to extension of local skin disease into the mucosal tissue via direct extension, bloodstream or lymphatics. Lesions interest mainly the oral and nasal mucosa and occasionally the laryngeal and pharyngeal mucosa. If not recognized and adequately treated, MCL may disfigure the patient because of the chronic local destruction of tissue of the nose, pharynx and palate. Because of the invariable involvement of the areas pertaining otorhinolaryngologists, it is important for ENT specialists and family physicians to have awareness of this condition and its clinical manifestations, particularly in presence of a history positive for travel to endemic areas. If mucocutaneous leishmaniasis is suspected, otorhinolaryngologic examination is very helpful in establishing a correct diagnosis, preventing inappropriate treatment.

Diagnostic dilemma of primary mucosal leishmaniasis.

Leishmaniasis is caused by Leishmania protozoa. It is widely present in more than 88 countries worldwide, resulting in up to 80,000 deaths annually. Leishmaniasis occurs as visceral, cutaneous, or mucocutaneous variants. Mucosal involvement can occur secondarily to the cutaneous or visceral varieties. However, primary mucosal leishmaniasis (PML) occurs without any present or past cutaneous and or visceral disease. It is extremely rare, and its diagnosis may present a serious challenge. It may be difficult to differentiate it from granulomatous conditions like tuberculosis, sarcoidosis, leprosy, fungal infections, Wegener's granuloma, and neoplasms. Here, we present a case of PML in Saudi Arabia.

Leech infestation and its association with water drinking habits.

OBJECTIVE: To assess the common presentations of leech infestation in leech endemic areas of Pakistan and to establish its association with unsafe water drinking habits of the individual. DESIGN: A cohort study. PLACE AND DURATION OF STUDY: CMH, Kohat, between 1st February 1997 and 30th April 2002. PATIENTS AND METHODS: Fourteen patients with leech infestation who reported to ENT department of CMH, Kohat, during the above period were selected for study. A specific comparison of their water drinking habits was made with a control group of 42 normal individuals who had come from the same leech endemic area as the first group and belonged to the same socioeconomic class. RESULTS: Twelve cases (83.4%) in the first group had unsafe water drinking habit i.e. they drank water directly from marshes without seeing its contents substituting cupped palm of hand for a drinking cup. This was in contrast to the control group where only 6 individuals (14%) gave a history of unsafe water drinking habits. Nose was the most common ENT site of leech infestation (71%) with epistaxis being the most prominent symptom. Other sites included hypopharynx (14%), nasopharynx (7 %) and oropharynx (7 %). All the 14 cases with leech infestation were males, 26.09 years being the mean age. The association between patient s unsafe water drinking habits and leech infestation in ENT region was statistically proved with odds ratio being 36. CONCLUSION: Epistaxis or any other related symptom must be taken with suspicion in leech endemic area. This condition is closely related to unsafe water drinking habits, therefore, the incidence of this infestation can be significantly reduced by educating the individuals to adopt safe water drinking habits.

The respiratory and allergic manifestations of human myiasis caused by larvae of the sheep bot fly (Oestrus ovis): a report of 33 pharyngeal cases from southern Iran.

Myiasis--the feeding of fly larvae on living mammals--may have various presentations, depending on the tissues or organs involved. The respiratory and non-respiratory manifestations of human pharyngeal myiasis caused by Oestrus ovis larvae in 33 patients from the Fars province, in southern Iran, are described here. All but one of the 33 cases were male and all lived in rural areas, in close contact with sheep and goats. The myiasis only occurred in spring and summer (April-September). Symptoms always appeared abruptly, all of the cases sensing the presence of foreign bodies in their throats, a burning sensation and itching in the throat being followed by cough and then various other respiratory, nasal, aural, and eye manifestations. Fly larvae were observed directly in the throats of five patients, and recovered in throat washings from all 33 cases. All of the larvae were identified as those of the sheep bot fly (Oestrus ovis). Removal of the larvae, by irrigation of the throat with a large volume of normal saline, provided an effective and fast treatment. In Iran at least, myiasis caused by Oestrus ovis larvae should be considered an occupational disease among farmers who keep sheep and goats.

[A curiosity in ORL pathology: myiasis of the otorhinolaryngologic cavities]. / Une curiosité de la pathologie O.R.L.: les myiases des cavités oto-rhino-laryngologiques.

The authors report a case of auricular myiasis with a review of literature. Diagnostic, therapeutic and prophylactic means established facing this parasitical disease are analysed.