Description, Causes and Risk Factors:
Infection of animals and humans with larvae of flies of the genus Wohlfahrtia (A genus of larviparous dipterous fleshflies (family Sarcophagidae), of which some species' larvae breed in ulcerated surfaces and flesh wounds of humans and animals. Important species include Wohlfahrtia magnifica, a widely distributed obligatory fleshfly whose tissue-destroying maggots invade wounds or head cavities of domestic animals and humans; Wohlfahrtia nuba, a facultative fleshfly of Old World distribution, also found in head wounds or head cavities but not in dermal sores; and Wohlfahrtia vigil (Wohlfahrtia opaca), which produces cutaneous myiasis in human infants in the northern U.S. and southern Canada by larvae that penetrate the skin and cause infected, boil-like, or furuncular lesions; mink and fox pups in fur farms, and probably rabbits and rodents, are attacked by this species).
Adult Wohlfahrtia flies lay their eggs directly in, or in the vicinity of, wounds on the host. Wohlfahrtia magnifica occurs in the Mediterranean basin, Near East, and Central and Eastern Europe; Wohlfahrtia vigil occurs in the northern United States and Canada. Adult Wohlfahrtia flies lay their eggs directly in, or in the vicinity of, wounds on the host. Larvae feed in the host for about a week, and may migrate from the subdermis to other tissues in the body, often causing extreme damage in the process.
Wohlfahrtiosis is more common in rural areas. In urban areas this pathological condition is usually found among people with poor personal hygiene and a low education level, and among children. This disease occurs mainly on uncovered parts of the body, such as on the arms, legs (furunculoid myiasis) and on the head (cavitary myiasis). Localization of the genital area is rare, with few reports in the literature.
Wohlfartia magnifica is an obligatory parasite, dependent on its host, without which it cannot Complete its development. The adult insect, when it is self-sufficient, has a flying period, which is limited to the hottest month of the year, that is from ]une to September and its egg-laying activities occur during the hottest hours of the day. The female is viviparous and can lay larvae on wounds and in the natural cavities of man and animals. Taking advantage of such wounds, the larvae invade the subcutaneous tissues of the host, at whose expense they develop into adulthood. Wohlfartia magnifica infests a great number of mammals (cows, horses, goats, sheep, pigs and birds) and man can be considered as only an occasional host. The distribution of this species is very extensive, including Europe, North Africa, Asia Minor, Asiatic Russia, Manchuria and China, with the exception of the coldest Northern areas.
Wohlfahrtia magnifica (Diptera: Sarcophagidae) was the only myiasis-causing fly species identified. It was assumed that unknown volatile chemicals might be responsible for the attraction of gravid females to the undamaged vulvar region. These odours are supposed to be produced during different physiological and/or pathological events associated with oestrus, prolonged puerperal period or inflammation of tissues.
How Wohlfahrtiosis affects the human body depends on where the larvae are located. Larvae may infect dead, necrotic (prematurely dying) or living tissue in various sites: the skin, eyes, ears, stomach and intestinal tract, or in genitourinary sites.They may invade open wounds and lesions or unbroken skin. Some enter the body through the nose or ears. Larvae or eggs can reach the stomach or intestines if they are swallowed with food and cause gastric or intestinal Wohlfahrtiosis.
The clinical symptoms depended on the age of infestation. Symptoms may include:
Obstruction of nasal passages and severe irritation. In some cases facial edema and fever can develop.
Crawling sensations and buzzing noises. Smelly discharge is sometimes present. If located in the middle ear, larvae may get to the brain.
Painful slow-developing ulcers or furuncle- (boil-) like sores that can last for a prolonged period.
Wohlfahrtiosis is often misdiagnosed in the United States because it is extremely rare and its symptoms are not specific. Intestinal Wohlfahrtiosis and urinary Wohlfahrtiosis are especially difficult to diagnose.
Clues that Wohlfahrtiosis may be present include recent travel to an endemic area, one or more non-healing lesions on the skin, itchiness, movement under the skin or pain, discharge from a central punctum (tiny hole), or a small, white structure protruding from the lesion.Serologic testing has also been used to diagnose the presence of botfly larvae in human.
This applies once an infestation is established. In many circles the first response to cutaneous Wohlfahrtiosis 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 and the use of forceps. Secondly the wound must be cleaned and disinfected. Further control is necessary to avoid further reinfestation.
The therapeutic procedures include the use of local disinfectants such as 70% ethyl alcohol, 10% chloroform or physiological saline, the surgical removal of the larvae and prevention of secondary bacterial or fungal infections. In case of tympanic membrane perforation, the irrigation of the ear cavity with physiological saline and continuous suction is indicated. In conclusion, in case of otalgia, otorrhea, perforation of the tympanic membrane, bleeding, itching, mechanical sound, tinnitus, furuncle of the external ear and hearing impairments, the patient should be also examined for aural myiasis, which if located in the middle ear could lead to intracranial complications and become dangerous.
NOTE: The above information is for processing purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.
DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.
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