Myiasis

Myiasis is usually caused by flies of the Calliphoridae family is the etiological agent most frequently found in myiasis. The first case of myiasis in a diabetic foot of a 54-year-old male patient in Argentina is reported. The patient attended the hospital of the capital city of Tucumán Province for a consultation concerning an ulcer in his right foot. The identification of the immature larvae was based on their morpho logical characters, such as the cylindrical, segmented and tracheas with strong pigmentation.

A retrospective observational study of patients who presented with myiasis was conducted between 1999 and July 2014 in the post-travel clinics in Israel. Data regarding exposure history, travel duration, clinical presentation, treatment, and parasitological identification were collected and analyzed.Among 6,867 ill returning Israeli travelers, 1,419 (21%) had a dermatologic complaint, 90 (6.3%) of them were diagnosed with myiasis. Myiasis was acquired in Latin America by 72 (80%) patients, mainly (54%) in the Madidi National Park, 18 cases (20%) were acquired in Africa. 

This applies once an infestation is established. In many circles the first response to cutaneous myiasis once the breathing hole has formed, is to cover the air hole thickly with petroleum jelly. Lack of oxygen then forces the larva to the surface, where it can more easily be dealt with. In a clinical or veterinary setting there may not be time for such tentative approaches, and the treatment of choice might be more direct, with or without an incision. First the larva must be eliminated through pressure around the lesion.

In the US, demand for these fly larvae doubled after the FDA ruling. Maggot therapy is now used in more than 300 sites across the country.The American Medical Association and Centers for Medicare and Medicaid Services recently clarified the reimbursement guidelines to the wound care community for medicinal maggots, and this therapy may soon be covered by insurance.The larvae of the green bottle fly are now used exclusively for this purpose, since they preferentially devour only necrotic tissue.