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 Table of Contents  
CASE REPORT
Year : 2016  |  Volume : 22  |  Issue : 2  |  Page : 132-134

Unusual pseudomyiasis with Musca domestica (housefly) larvae in a child with chronic otitis media


1 Department of ENT, SRMSIMS, Bareilly, Uttar Pradesh, India
2 Department of ENT, JNMCH, AMU Campus, Bareilly, Uttar Pradesh, India
3 Department of Microbiology, SRMSIMS, Bareilly, Uttar Pradesh, India
4 Department of ENT, PGIMER, Chandigarh, India

Date of Web Publication11-May-2016

Correspondence Address:
Zafar Iqbal
F- Rehman Apartments, Hadi Nagar, Dhorra, Aligarh - 202 002, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-7749.182279

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  Abstract 

Myiasis is a disease caused by fly larvae and aural myiasis is a rare clinic condition often occurring in children or mentally retarded people. We report the case of an unusual presentation of a unilateral aural myiasis in a 3-year-old female child patient belonging to a slum with unilateral chronic otitis media caused by Musca domestica (housefly) larvae. Eight larvae were removed from the external auditory canal while five more larvae were located in the middle ear cavity and were removed through perforation of the tympanic membrane. Management of ear myiasis is based on removal of the maggots and cleansing of the ear with ethanol, chloroform, or physiological saline. Physiological saline is preferred in patients who have tympanic membrane perforation. Myiasis is related to personal hygiene. Therefore, to decrease the incidence of these infestations, care, and hygiene standards should be carried out for those at risk through information, education, and communication.

Keywords: Chronic otitis media, Musca domestica larvae, Myiasis


How to cite this article:
Iqbal Z, Sharma SC, Sami H, Kumar A. Unusual pseudomyiasis with Musca domestica (housefly) larvae in a child with chronic otitis media. Indian J Otol 2016;22:132-4

How to cite this URL:
Iqbal Z, Sharma SC, Sami H, Kumar A. Unusual pseudomyiasis with Musca domestica (housefly) larvae in a child with chronic otitis media. Indian J Otol [serial online] 2016 [cited 2019 Nov 20];22:132-4. Available from: http://www.indianjotol.org/text.asp?2016/22/2/132/182279


  Introduction Top


The term myiasis derives from the Greek muia (fly). German entomologist Zumpt described it as “the infestation of live human and vertebrate animals with dipterous larvae, which, at least for a period, feed on the host's dead or living tissue, liquid body substances, or ingested food.”[1] Myiasis is most common in hot and humid climates in tropical and subtropical regions, such as underdeveloped areas of the Indian subcontinent, Africa, and Southeast Asia, which provide favorable breeding grounds for flies.[2],[3] This parasitic infestation is the most prevalent in animals, but it is frequently seen in humans.[2],[3]

Myiasis is a serious problem for the livestock industry, and it causes severe economic losses worldwide.[4] The most common genera involved in myiasis are members of the families Sarcophagidae and Calliphoridae.[5] Myiasis-causing flies in India belong to the important genera Chrysomya and Lucilia (Phaenicia).[6] Cases of humanmyiasis caused by Chrysomya bezziana (screwworm) appear to be more common in India than in Africa.[1],[7],[8]

Myiasis is classified as specific, semi specific, or accidental (pseudomyiasis), depending on whether the fly larvaerequire a host in order to develop.[9] The literature on accidental myiasis caused by Musca domestica (housefly) larvae is fairly limited. Cases of M. domestica myiasis have been reported in the nose andears from time to time in the subtropical regions however its rarity advocates it being mentioned here.


  Case Report Top


A 3-year-old female child was brought to our outpatient department with complaints of discharge from ear, pain and itching of the left ear for the last 2 days [Figure 1]. In otoendoscopic examination of the left ear, a purulent secretion filling the external auditory canal was observed. Because of the low compliance and cooperation of the patient, she was taken to the operating room of Emergency Department for general anesthesia.
Figure 1: Patient with pseudomyiasis

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After the suction of the purulent secretion eight maggots which were located superficially were removed immediately [Figure 2], while five more maggots were removed from the middle ear cavity through the perforated tympanic membrane [Figure 3]. For this purpose, otomicroscopy was used [Figure 4], which also revealed that middle ear cavity was edematous and moistened. The removed maggots were fixed in 70% alcohol solution and sent for identification [Figure 5]. They were identified as M.domestica larvae. Mechanical irrigation was repeated twice daily for 3 days, during which time more debris and discharge were removed. The patient's condition improved and she remained under regular follow-up with no sign of recurrence or complication.
Figure 2: Retrieved maggots in kidney tray

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Figure 3: Left ear maggots

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Figure 4: Left ear canal maggots

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Figure 5: Maggot for identification

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  Discussion Top


The various forms of myiasis may be classified from an entomological point of view as: (a) Accidental myiasis, in which larvae ingested together with food produce infection; (b) facultative or semi specific myiasis, in which the larvae are laid on necrotic tissue in wounds; and (c) obligatory or specific myiasis, in which larvae affect undamaged skin. Clinically myiasis is classified as: Cutaneous myiasis, myiasis of external orifices (aural, ocular, nasal, oral, vaginal, and anal), and myiasis of internal organs (intestinal and urinary).[9] Aural myiasis is not a common manifestation in otorhinolaryngology.

The clinical symptoms of aural myiasis could show a wide spectrum of symptoms; from silent infestation to otalgia, otorrhea, perforation of the tympanic membrane, bleeding, itching, mechanical sound, tinnitus, furuncle of the external ear, and hearing impairment.[10],[11] In our case, the major symptom was the purulent and particularly hemorrhagic secretion, which is common in suppurative chronic otitis media, otalgia, and aural itching. Aural myiasis generally occurs in neglected chronic disease such as untreated chronic suppurative otitis media in patients with poor personal hygiene in the otolaryngological cavity.[12] In cases of aural myiasis, maggots can be found in the external auditory canal but also in the aural cavity.[12] In our patient, eight larvae were located in the outer ear canal whereas additional five in the middle ear cavity.

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.[13] In case of tympanic membrane perforation, the irrigation of the ear cavity with physiological saline and continuous suction is indicated.[3],[10] 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.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Zumpt F. Myiasis in Man and Animals in the Old World. London: Butterworth's; 1965. p. 267.  Back to cited text no. 1
    
2.
Verma L, Pakrasi S, Kumar A, Sachdev MS, Mandal AK. External ophthalmomyiasis associated with herpes zoster ophthalmicus. Can J Ophthalmol 1990;25:42-3.  Back to cited text no. 2
    
3.
Sachdev MS, Kumar H, Roop, Jain AK, Arora R, Dada VK. Destructive ocular myiasis in a noncompromised host. Indian J Ophthalmol 1990;38:184-6.  Back to cited text no. 3
[PUBMED]  Medknow Journal  
4.
Otranto D. The immunology of myiasis: Parasite survival and host defense strategies. Trends Parasitol 2001;17:176-82.  Back to cited text no. 4
    
5.
Sinton JA. Some cases of myiasis in India and Persia, with a descrip-tion of the larvae causing the lesions. Indian J Med Res 1921;9:132-62.  Back to cited text no. 5
    
6.
Rao S, Patton WS. Studies on the flagellates of the genera Herpe-tomonas, Crithidia and Rhynchoidomonas. Indian J Med Res 1920;8:593-602.  Back to cited text no. 6
    
7.
Patton WS. Notes on the myiasis-producing Diptera of man and animals. Bull Entomol Res 1921;12:239-61.  Back to cited text no. 7
    
8.
Patterson RL. An Indian screwworm. Ind Med Gaz 1909;44:1-7.  Back to cited text no. 8
    
9.
John DT, Petri WA. Markell and Voge's medical parasitology. 9th ed. St. Louis, USA: Saunders-Elsevier; 2006. p. 328-334.  Back to cited text no. 9
    
10.
Cho JH, Kim HB, Cho CS, Huh S, Ree HI. An aural myiasis case in a 54-year-old male farmer in Korea. Korean J Parasitol 1999;37:51-3.  Back to cited text no. 10
    
11.
Yuca K, Caksen H, Sakin YF, Yuca SA, Kiris M, Yilmaz H, et al. Aural myiasis in children and literature review. Tohoku J Exp Med 2005;206:125-30.  Back to cited text no. 11
    
12.
Uzun L, Cinar F, Beder LB, Aslan T, Altintas K. Radical mastoidectomy cavity myiasis caused by Wohlfahrtia magnifica. J Laryngol Otol 2004;118:54-6.  Back to cited text no. 12
    
13.
Garcia SL. Medically important arthropods. In: Diagnostic Medical Parasitology. 4th ed. Washington, D.C: American Society for Microbiology, ASM Press; 2001. p. 646-89.  Back to cited text no. 13
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]



 

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