Case and Research Letters
Autochthonous Cutaneous Myiasis Due to Chrysomya bezziana
Miasis cutánea no importada por Chrysomya bezziana
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Aguado Lobo, A. Hernández-Núñez, M. Isabel García-Arata, J. Borbujo" "autores" => array:4 [ 0 => array:4 [ "nombre" => "M." "apellidos" => "Aguado Lobo" "email" => array:1 [ 0 => "martaaguadolobo@yahoo.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "A." "apellidos" => "Hernández-Núñez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "M." "apellidos" => "Isabel García-Arata" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "J." "apellidos" => "Borbujo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Microbiología, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Miasis cutánea no importada por <span class="elsevierStyleItalic">Chrysomya bezziana</span>" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 667 "Ancho" => 1002 "Tamanyo" => 190006 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Ulcer on the left calf. Note the erythematous surface, which is papilliform in appearance, and abundant exudate. Several larvae can be seen on the surface of the lesion.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Myiasis is a parasitic infestation of the tissues or organs of vertebrates (including humans) produced by the larvae of different species of fly (Diptera).<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–3</span></a> It is classified according to the association between the parasite and the host and is described as obligatory, facultative, or accidental. It can also be classified according to the anatomic site of infestation as cutaneous, intestinal, or cavitary myiasis.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–3</span></a> Clinically, cutaneous myiasis is divided into furuncular, migratory, and wound forms.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–3</span></a> Incidence is higher in tropical countries with a humid climate and a low socioeconomic level.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We present a case of autochthonous cutaneous myiasis caused by <span class="elsevierStyleItalic">Chrysomya bezziana</span>, a species that is exceptional in Europe.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The patient was a 56-year-old man with a personal history of obesity, occasional alcohol consumption, arterial hypertension, sleep apnea-hypopnea syndrome, and extrinsic asthma. He was a heterozygous carrier of the PT20210A mutation, although he had no history of thrombosis. He had a vascular ulcer on the left leg that first appeared 10 months previously. Live larvae were detected during local care of the ulcer at his health center, from where he was referred to the emergency department. The patient had a good general status and denied having traveled abroad, recent contact with animals, or trips to the countryside. Physical examination revealed signs of chronic lymphedema in both legs. An ulcer was observed on his left calf. It measured 15<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>8<span class="elsevierStyleHsp" style=""></span>cm, had an erythematous surface, and was papilliform in appearance. It was also friable, with malodorous exudate (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Several mobile Diptera larvae were identified on the lesion. These were whitish in color and in 1<span class="elsevierStyleHsp" style=""></span>cm in length. They were eliminated mechanically and sent to the microbiology service for identification. The lesion was washed with saline solution and treated with an occlusive dressing of unscented pure petroleum jelly, and the patient was referred to the vascular surgery service. Macroscopically, the larvae extracted were identified as <span class="elsevierStyleItalic">C bezziana</span>; microscopically, subtle spine bands were visible around the body and the peritreme of the open posterior spiracle.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">In developed countries, cutaneous wound myiasis is associated with poor hygiene, advanced age, psychiatric conditions, alcoholism, diabetes mellitus, and occlusive vascular disease.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–3</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The 3 species that produce this form of myiasis throughout the world are <span class="elsevierStyleItalic">Cochliomyia hominivorax</span> (New World screw-worm), and <span class="elsevierStyleItalic">C bezziana</span> (Old World screw-worm)—both from the Calliphoridae family—and <span class="elsevierStyleItalic">Wohlfahrtia magnifica</span>, which belongs to the Sarcophagidae family.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–3</span></a> Most cases of autochthonous myiasis reported in Spain involve various species of the Sarcophagidae family (flesh fly).<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The parasite <span class="elsevierStyleItalic">C bezziana</span> is distributed in tropical and subtropical areas of Africa, southeast Asia, India, and the Middle East.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–4</span></a> It produces an obligatory form of myiasis that affects various domestic animals (cattle, horses, and pets) and, occasionally, humans.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,4</span></a> An adult female can deposit hundreds of eggs on the margin of wounds. The eggs hatch in 16<span class="elsevierStyleHsp" style=""></span>hours, and the resultant numerous larvae feed for a week on the host's tissue. They then fall to the ground and complete their biological cycle to become adults.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,4</span></a> Under optimal conditions, the biological cycle lasts approximately 20 days.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,4</span></a> In humans, <span class="elsevierStyleItalic">C bezziana</span> produces wound infestations,<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> skin tumors<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>, and cavities (orbit,<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> mouth,<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> and ear<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a>), all of which have high morbidity. In severe cases, the patient can present with fever, a sensation of poor temperature regulation, pain, bacterial superinfection, leukocytosis with neutrophilia, or hypereosinophilia.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">In a review from the year 2000, the 47 species of Diptera responsible for myiasis in Spain did not include <span class="elsevierStyleItalic">C bezziana</span>.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> In the Spanish scientific literature, we found only 3 cases of human myiasis caused by this species: the first involved a 41-year-old Spanish man with a personal history of chronic alcoholism who developed cutaneous myiasis on chronic ulcers on the left leg that were secondary to rhabdomyolysis<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>; the second involved a 65-year-old Spanish woman with myiasis of the ear who reported no recent trips abroad<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a>; and the third involved a 54-year-old Spanish man with myiasis on a supraglottic squamous cell carcinoma of the larynx that manifested as a tumor mass on the anterior aspect of the neck.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> International migration and climate change can explain, at least in part, why this species of fly is identified in countries that are not its natural habitat.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">In conclusion, we present a case of cutaneous myiasis on an ulcer in which <span class="elsevierStyleItalic">C bezziana</span> was identified as the causal agent. To our knowledge, this is the second case of autochthonous cutaneous myiasis caused by this species of fly. We wish to draw attention to this uncommon entity and to the importance of correct conservation and identification of larvae as part of routine clinical practice, since this condition is probably under-reported.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Aguado Lobo M, Hernández-Núñez A, Isabel García-Arata M, Borbujo J. Miasis cutánea no importada por <span class="elsevierStyleItalic">Chrysomya bezziana</span>. Actas Dermosifiliogr. 2014;105:529–530.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 667 "Ancho" => 1002 "Tamanyo" => 190006 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Ulcer on the left calf. Note the erythematous surface, which is papilliform in appearance, and abundant exudate. Several larvae can be seen on the surface of the lesion.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Myiasis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "F. Francesconi" 1 => "O. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 9 | 12 | 21 |
| 2024 Octubre | 86 | 55 | 141 |
| 2024 Septiembre | 62 | 39 | 101 |
| 2024 Agosto | 85 | 57 | 142 |
| 2024 Julio | 86 | 59 | 145 |
| 2024 Junio | 100 | 34 | 134 |
| 2024 Mayo | 78 | 55 | 133 |
| 2024 Abril | 76 | 45 | 121 |
| 2024 Marzo | 81 | 42 | 123 |
| 2024 Febrero | 76 | 45 | 121 |
| 2024 Enero | 58 | 47 | 105 |
| 2023 Diciembre | 71 | 35 | 106 |
| 2023 Noviembre | 70 | 38 | 108 |
| 2023 Octubre | 84 | 54 | 138 |
| 2023 Septiembre | 87 | 31 | 118 |
| 2023 Agosto | 46 | 32 | 78 |
| 2023 Julio | 56 | 51 | 107 |
| 2023 Junio | 61 | 24 | 85 |
| 2023 Mayo | 56 | 32 | 88 |
| 2023 Abril | 41 | 21 | 62 |
| 2023 Marzo | 53 | 32 | 85 |
| 2023 Febrero | 60 | 31 | 91 |
| 2023 Enero | 53 | 33 | 86 |
| 2022 Diciembre | 47 | 35 | 82 |
| 2022 Noviembre | 41 | 33 | 74 |
| 2022 Octubre | 24 | 20 | 44 |
| 2022 Septiembre | 24 | 45 | 69 |
| 2022 Agosto | 31 | 37 | 68 |
| 2022 Julio | 23 | 46 | 69 |
| 2022 Junio | 26 | 29 | 55 |
| 2022 Mayo | 32 | 51 | 83 |
| 2022 Abril | 58 | 43 | 101 |
| 2022 Marzo | 44 | 54 | 98 |
| 2022 Febrero | 74 | 40 | 114 |
| 2022 Enero | 67 | 42 | 109 |
| 2021 Diciembre | 42 | 46 | 88 |
| 2021 Noviembre | 55 | 55 | 110 |
| 2021 Octubre | 48 | 57 | 105 |
| 2021 Septiembre | 30 | 38 | 68 |
| 2021 Agosto | 24 | 26 | 50 |
| 2021 Julio | 27 | 39 | 66 |
| 2021 Junio | 36 | 27 | 63 |
| 2021 Mayo | 18 | 26 | 44 |
| 2021 Abril | 64 | 49 | 113 |
| 2021 Marzo | 51 | 28 | 79 |
| 2021 Febrero | 50 | 17 | 67 |
| 2021 Enero | 44 | 15 | 59 |
| 2020 Diciembre | 24 | 14 | 38 |
| 2020 Noviembre | 23 | 10 | 33 |
| 2020 Octubre | 18 | 12 | 30 |
| 2020 Septiembre | 44 | 12 | 56 |
| 2020 Agosto | 26 | 15 | 41 |
| 2020 Julio | 28 | 18 | 46 |
| 2020 Junio | 32 | 19 | 51 |
| 2020 Mayo | 23 | 21 | 44 |
| 2020 Abril | 26 | 17 | 43 |
| 2020 Marzo | 35 | 14 | 49 |
| 2020 Febrero | 3 | 5 | 8 |
| 2020 Enero | 6 | 11 | 17 |
| 2019 Diciembre | 9 | 1 | 10 |
| 2019 Noviembre | 4 | 8 | 12 |
| 2019 Octubre | 0 | 7 | 7 |
| 2019 Septiembre | 4 | 9 | 13 |
| 2019 Agosto | 4 | 5 | 9 |
| 2019 Julio | 4 | 10 | 14 |
| 2019 Junio | 4 | 11 | 15 |
| 2019 Mayo | 6 | 27 | 33 |
| 2019 Abril | 2 | 20 | 22 |
| 2019 Marzo | 4 | 10 | 14 |
| 2019 Febrero | 2 | 6 | 8 |
| 2019 Enero | 3 | 2 | 5 |
| 2018 Diciembre | 2 | 8 | 10 |
| 2018 Noviembre | 1 | 0 | 1 |
| 2018 Octubre | 4 | 0 | 4 |
| 2018 Septiembre | 2 | 0 | 2 |
| 2018 Abril | 0 | 2 | 2 |
| 2018 Marzo | 9 | 7 | 16 |
| 2018 Febrero | 28 | 3 | 31 |
| 2018 Enero | 36 | 2 | 38 |
| 2017 Diciembre | 46 | 11 | 57 |
| 2017 Noviembre | 39 | 3 | 42 |
| 2017 Octubre | 30 | 2 | 32 |
| 2017 Septiembre | 37 | 8 | 45 |
| 2017 Agosto | 60 | 11 | 71 |
| 2017 Julio | 66 | 12 | 78 |
| 2017 Junio | 53 | 7 | 60 |
| 2017 Mayo | 45 | 14 | 59 |
| 2017 Abril | 42 | 11 | 53 |
| 2017 Marzo | 37 | 13 | 50 |
| 2017 Febrero | 32 | 7 | 39 |
| 2017 Enero | 33 | 15 | 48 |
| 2016 Diciembre | 59 | 8 | 67 |
| 2016 Noviembre | 52 | 25 | 77 |
| 2016 Octubre | 68 | 16 | 84 |
| 2016 Septiembre | 73 | 13 | 86 |
| 2016 Agosto | 49 | 5 | 54 |
| 2016 Julio | 49 | 7 | 56 |
| 2016 Junio | 8 | 5 | 13 |
| 2016 Mayo | 7 | 19 | 26 |
| 2016 Abril | 7 | 6 | 13 |
| 2016 Marzo | 7 | 7 | 14 |
| 2016 Febrero | 8 | 8 | 16 |
| 2016 Enero | 12 | 8 | 20 |
| 2015 Diciembre | 9 | 6 | 15 |
| 2015 Noviembre | 8 | 7 | 15 |
| 2015 Octubre | 12 | 11 | 23 |
| 2015 Septiembre | 10 | 1 | 11 |
| 2015 Agosto | 11 | 4 | 15 |
| 2015 Julio | 36 | 6 | 42 |
| 2015 Junio | 38 | 7 | 45 |
| 2015 Mayo | 32 | 8 | 40 |
| 2015 Abril | 14 | 10 | 24 |
| 2015 Marzo | 16 | 2 | 18 |
| 2015 Febrero | 24 | 6 | 30 |
| 2015 Enero | 23 | 4 | 27 |
| 2014 Diciembre | 28 | 9 | 37 |
| 2014 Noviembre | 23 | 10 | 33 |
| 2014 Octubre | 22 | 10 | 32 |
| 2014 Septiembre | 13 | 9 | 22 |
| 2014 Agosto | 15 | 9 | 24 |
| 2014 Julio | 25 | 8 | 33 |
| 2014 Junio | 16 | 1 | 17 |
| 2014 Mayo | 2 | 1 | 3 |
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