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SHORT COMMUNICATION
Year : 2018  |  Volume : 30  |  Issue : 4  |  Page : 439-441

Oral myiasis in brain hemorrhage


Department of Oral Medicine and Radiology, Mahatma Gandhi Dental College and Hospital, Jaipur, Rajasthan, India

Date of Submission06-Jul-2018
Date of Acceptance22-Oct-2018
Date of Web Publication17-Jan-2019

Correspondence Address:
Dr. Hemant Shakya
Department of Oral Medicine and Radiology, Mahatma Gandhi Dental College and Hospital, Jaipur - 302 022, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiaomr.jiaomr_115_18

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   Abstract 


Myiasis is a rare condition which arises from the invasion of body tissues or cavities of living animals or humans by maggots or larvae of certain species of flies. Oral myiasis is seen especially in individuals with neurologic deficit, secondary to oral wounds, suppurative lesions, and extraction wounds. The halitosis and neglected oral hygiene attracts flies to lay eggs in oral wounds which results in oral myiasis. We present a case of oral myiasis in a 63-year-old female patient who was medically compromised since 6 months.

Keywords: Ivermectin, larva, medically compromised


How to cite this article:
Parmar E, Shakya H, Jamdade A, Yadav N. Oral myiasis in brain hemorrhage. J Indian Acad Oral Med Radiol 2018;30:439-41

How to cite this URL:
Parmar E, Shakya H, Jamdade A, Yadav N. Oral myiasis in brain hemorrhage. J Indian Acad Oral Med Radiol [serial online] 2018 [cited 2019 Jun 25];30:439-41. Available from: http://www.jiaomr.in/text.asp?2018/30/4/439/250241




   Introduction Top


The term myiasis is derived from Greek word “muia” and “iasis” which means “fly” and “disease,” respectively. German entomologist Fritz Zumpt defined myiasis 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.”[1] Myiasis with a higher incidence observed in tropical and subtropical regions of America and Africa due to humidity and heat. The most common affected sites are skin, nose, ears, anus, vagina, and oral cavity.[2],[3] Oral myiasis is common in mentally disabled individuals and is associated with dental extractions.[4]


   Case History Top


A 63-year-old female patient with brain hemorrhage reported to our hospital accompanied by her family members with a chief complaint of worms in the mouth since 3-4 days. Patient was diagnosed with brain hemorrhage and revealed a medical history of degenerative mitral valve disease since 6 months and was hospitalized, bedridden, and semi-active. Past drug history, as per patient's relative revealed that patient was taking anti-coagulants and anti-hypertensive drugs since 6 months. Her caretaker (ward boy) used to clean her oral cavity with the help of a surgical instrument (forceps or scissor) and gauze pieces. As a result there was a trauma to the cheek while cleaning the oral cavity. She got discharged after 6-7 days of treatment.

One of the patient's family members suddenly noticed blood coming out from the mouth 3 days ago and live maggots inside the mouth on the right side of buccal mucosa. They also removed about 8-10 maggots of them by themselves.

On physical examination the patient was found to be semi-conscious, low socioeconomic status, poorly built, and un-cooperative as she was in supine position on stretcher with nasogastric feeding tube inside nose, presenting with mild, intermittent pain, and swelling over the right side of face which was diffuse extending superoinferiorly from the right side of upper lip to the periorbital region of the right eye and mediolaterally from the right ala nasal sulcus upto middle of the right side of the face, which was 3 cm × 4 cm in size approximately, soft in consistency, warm, and tender on palpation [Figure 1].
Figure 1: Appearance of patient at presentation

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Intraoral examination revealed poor oral hygiene with interproximal caries in maxillary anterior teeth and severe deposits of calculus and stains [Figure 2]. On soft tissue examination, a small fissure type structure was seen about 2 cm × 2 cm in size on the right buccal mucosa from where we could see the movement of living maggots [Figure 3].
Figure 2: Photograph showing poor oral hygiene

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Figure 3: Fissure on the right buccal mucosa

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Considering the patient's mental status, history of brain hemorrhage, poor oral hygiene, and presence of clinical findings i.e., living maggots, the case was diagnosed as oral myiasis.

About 3–4 maggots were removed with tweezer following the application of turpentine oil [Figure 4]. The area was irrigated with saline and betadine solution. The removed maggots were placed in a container and disposed off. Surgical debridement of wound was carried out under local anesthesia. The treatment was performed by oral surgeons in our hospital and the patient was hospitalized for 3 days. The treatment included flushing the affected area and manual removal of maggots with tweezer by use of turpentine oil. A systemic treatment with ivermectin, a semi-synthetic macrolid antibiotic isolated from Streptomyces Avermitilis was given orally 6 mg every 24 h for 3 days, along with 1 g cefalotin IV every 6 h.
Figure 4: Photograph showing removed maggots

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On the first day a marked decrease of the larvae (about 80%) was observed and the remaining larvae were immobile. Oral cleansing was made daily, after 3 days of hospitalization, there were no larvae in the patient's mouth and she was discharged. After 1 month, patient was recalled for follow up but because of long duration brain hemorrhage she passed away.


   Discussion Top


Myiasis is an infestation of live human and vertebrate animals with dipterous larvae that feed on the host's dead or living tissue, liquid body substance, or ingested food.[5],[6] The larvae infest several parts of the body which includes cutaneous, ophthalmic, oral, urogenital, nasopharyngeal, and intestinal myiasis.[7]

The main contributing factors responsible for myiasis are low socioeconomic status, immunocompromised state, debilitated, and unhygienic living conditions. Suppurative lesions, facial trauma, mouth breathers, extraction wounds, fumigating carcinomas, and other conditions constitute the risk factors for oral myiasis. Local factors include poor oral hygiene, periodontal disease, suppurative lesions, mouth breathing, incompetent lips, anterior open bite, thumb-sucking habit, halitosis and trauma, neglected mandibular fractures, and among infants who were breastfed by mothers with breast myiasis.[5],[6],[8],[9]

Myiasis is caused by dipterous larvae which require an intermediate host and the number of developing larvae depends on the number of viable eggs deposited. The diagnosis of myiasis is clinically based on the presence of the maggots but the classification of the larvae rarely has been made.[8]

In this case report it was not possible to identify a local condition in the right buccal mucosa, however, local trauma to the cheek while cleaning of oral cavity by wardboy was the probable local condition of the development of myiasis.

The traditional management for myiasis is the mechanical removal of the maggots when there are multiple larvae and in advanced stages of maggots. Local application of several substances have been used to ensure complete removal of all larvae like use of turpentine oil, mineral oil, chloroform, ethyl chloride, or mercuric chloride. These substances are called asphyxiation drugs creates anaerobic atmosphere within the wounds causing aerobic parasitic larvae to come to the surface making its removal easier.[10] Following the removal of the maggots surgical wound debridement should be performed. A systemic treatment with ivermectin, a semi-synthetic macrolide antibiotic isolated from Streptomyces Avermitlis is another choice which is given orally in one dose of 150–200 mg/kg of body weight. It activates the gamma-aminobutyric acid which induces the death of larvae and their spontaneous elimination.[1] It is very important to completely remove the larvae to treat myiasis successfully. Antibiotics are prescribed to prevent secondary bacterial infection.[1]

Myiasis is generally self-limiting and in many cases not dangerous to the host, however, complication can arise. As the old saying goes “Prevention is better than cure” the disease should be prevented by controlling fly population, maintaining good oral, and personal hygiene. However special care needs to be taken in medically compromised dependent patients as they are unable to maintain their basic oral hygiene, so such patients should be treated with dental surgeon only.

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.
Saravanan T, Mohan MA, Thinakaran M, Ahammed S. Oral myiasis. Indian J Palliat Care 2015;21:92-4.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Droma EB, Wilamowsky A, Schnur H, Yarom N, Scheuer E, Schwartz E. Oral myiasis: A case report and literature review. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007;103:92-6.  Back to cited text no. 2
    
3.
Gunbay S, Bicacki N, Canda T, Canda S. A case of myiasis gingiva. J Periodontol 1995;66:892-5.  Back to cited text no. 3
    
4.
Laurence SM. Dipterous larvae infection. Br Med J 1909;9:88.  Back to cited text no. 4
    
5.
Sharma J, Mamatha GP, Acharya R. Primary oral myiasis: A case report. Med Oral Patol Oral Cir Bucal 2008;13:E714-6.  Back to cited text no. 5
    
6.
Sanskari LS, Ramakrishnan K. Oral myiasis caused by Chrysoma bezziana. J Oral Maxillofac Pathol 2010;14:16-8.  Back to cited text no. 6
    
7.
Hakimi R, Yazdi I. Oral mucosa myiasis caused by Oestrus Ovis. Arch Iran Med 2002;5:1946.  Back to cited text no. 7
    
8.
Abdo EN, SetteDias AC, Comunian CR, Dutra CE, Aguair EG. Oral myiasis: A case report. Med Oral Patol Oral Cir Bucal 2006;11:E130-1.  Back to cited text no. 8
    
9.
Filho AO, Dias D, Miranda Á, Hebling E. Oral myiasis in older adult with severe Alzheimer's disease. Spec Care Dentist 2018;38:99-106.  Back to cited text no. 9
    
10.
Sharma H, Dayal D, Agarwal SP. Nasal myiasis: Review of 10 years experience. J Laryngol Otol 1989;103:489-91.  Back to cited text no. 10
    


    Figures

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



 

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