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(TDO)
[1–2] [PREPRINTER stage]
Trop Doct OnlineFirst, published on March 3, 2015 as doi:10.1177/0049475515574965
Case Report
Vulvar myiasis following suction and evacuation for incomplete abortion
Tropical Doctor 0(0) 1–2 ! The Author(s) 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0049475515574965 tdo.sagepub.com
Anju Singh1, Bharti Goel1 and Shikha Rani2
Abstract Myiasis is caused by fly larva capable of penetrating healthy or necrotic tissue, usually in tropical and subtropical countries. The involvement of an exposed area is common; however it may very rarely involve the genital region. We present a rare case of vulvar myiasis which occurred after suction and evacuation performed for incomplete abortion.
Keywords Vulvar myiasis, poor hygiene, suction and evacuation
Introduction Myiasis is a parasitic infestation of human or animal skin, commonly seen where causative insects are abundant. It is common in rural areas and in urban areas among those with poor hygiene, psychiatric disorder or low level of education. Uncovered areas of the body, such as legs, arms and the head, are mostly effected.1 Genital myiasis is very rare and may be associated with sexually transmitted diseases, immunosuppression and genital malignancy.2,3 We report a rare occurrence of vulvar myasis after suction and evacuation where none of these predispositions were present.
Case Report A 24-year-old woman who had undergone suction evacuation for an incomplete abortion 5 days previously and had used unwashed cloths as pads after the procedure, presented complaining of foul smelling vaginal discharge for 4 days, pain in both lower limbs with the inability to walk and having to separate her legs when lying down for the past 2 days. There was no history of associated systemic illness or a genital lesion prior to the procedure. On examination a cavitating lesion (3 3 2 cm) filled with pus and maggots with surrounding erythema and oedema was seen over left labium majus (Figure 1(a)). The vagina and cervix were normal. Pus was sent for culture and sensitivity and broad spectrum antibiotics were started. The area was cleaned with turpentine oil. Dressing with turpentine oil twice daily made the maggots disappear from
the wound within 2 days (Figure 1(b)). Her serologic tests for HIV, syphilis and hepatitis were found negative.
Discussion Myiasis is due to infestation with dipterous larvae (maggots). There are two groups of myiasis for comparison of host location strategies. Group 1 (obligate parasites) are caused by those flies that deposit their larvae (viviparous) directly onto the host healthy tissue or clothes and are responsible for the cutaneous form (primary myiasis). This group comprises Dermatophobia homnis, Cochilomya hominovarus, Wohlfartia magnifica, Oestrus ovisc and Chrysomia bezzania. Group 2 (facultative parasites) are caused by those flies that deposit eggs/larvae onto necrotic tissue of the host. They are responsible for secondary or cavitory myiasis. This group includes Sacrophagidae, Lucilia, Calliphorida and Muscidae. Symptoms and signs of myiasis vary according to the affected body area and extent of the infestation. 1 Assistant Professor, Department of Obstetrics and Gynaecology, Government Medical College and Hospital, Chandigarh, India 2 Senior Reasearch Associate, Department of Obstetrics and Gynaecology, Government Medical College and Hospital, Chandigarh, India
Corresponding author: Anju Singh, Assistant Professor, Department of Obstetrics and Gynaecology, Government Medical College and Hospital, Chandigarh 32, India. Email: [email protected]
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(TDO)
[1–2] [PREPRINTER stage]
2
Tropical Doctor 0(0)
Figure 1. Valvar myiasis of labia majora. (a) Maggots marked with arrow. (b) After healing of lesion.
Primary myiasis may present with fever, pain and bleeding from the infested site that may be complicated by secondary infection. Human genital myiasis is usually secondary or cavitory myiasis. It may be seen in immunocompromised and/or patients with concomitant STD.2 Our patient had none of these risk factors. Poor hygiene may be another contributing factor; flies are attracted by the fetid odour and moist surroundings and lay eggs/larvae on the skin or in the existing lesion. Thereafter larvae invade the tissue and feed themselves on dead and/or living tissue. It may result in considerable pain and tissue damage as fly larvae leave necrotic tissue and invade healthy tissues. Larvae usually pupate within 1–2 days and emerge as adult flies 6 days later. Treatment of myiasis includes removal of the parasite and cleaning with antilarval, antiseptic lotion. The larvae removed may be preserved in strong alcohol to help determine the type of myasis. Antilarval measures include turpentine oil, a mixture of turpentine oil with chloroform or paraffin jelly – which is less toxic but as good as turpentine oil. Turpentine oil creates an anaerobic environment forcing the larvae to come up to the surface and expel out.3 Primary myiasis can be treated by occlusion of the fistula with Vaseline or nail enamel so that larvae cannot have access to oxygen. A completely different sort of fly larva, usually from green bottle flies, which only feeds on necrotic tissue, may be used therapeutically to clean infected wounds.
This case shows that there can be a relation between poor hygiene and myiasis, and highlights the need of education for good personal hygiene such as regular use of soap water for cleaning, use of clean dry pads and clean ironed cloths for prevention of vulvar myiasis. Even with proper washing, flies may deposit eggs on clothes as they hang on the washing line. The eggs are, however, destroyed by ironing. Declaration of conflicting interests All the authors have seen the manuscript and approve it for submission. The authors have no competing interest in the publication of the manuscript to declare.
Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
References 1. Yazar S, Ozcan H, Dincer S and Sahin I. Vulvar myiasis. Yonsei Medical Journal 2002; 43: 553–554. 2. Passos MRL, Carvalho AVV, Dutra AL, Filho RAG, Barreto NA, Salles RS, et al. Vulvar Myiasis. Infect Dis Obstet Gynecol 1998; 6: 69–71. 3. Baidya J. A rare case of genital myiasis in a woman with genital prolapse and malignancy and review of literature. Ann Trop Med Public Health 2009; 2: 29–30.
Downloaded from tdo.sagepub.com at UCSF LIBRARY & CKM on March 21, 2015
(TDO)
[1–2] [PREPRINTER stage]
Trop Doct OnlineFirst, published on March 3, 2015 as doi:10.1177/0049475515574965
Case Report
Vulvar myiasis following suction and evacuation for incomplete abortion
Tropical Doctor 0(0) 1–2 ! The Author(s) 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0049475515574965 tdo.sagepub.com
Anju Singh1, Bharti Goel1 and Shikha Rani2
Abstract Myiasis is caused by fly larva capable of penetrating healthy or necrotic tissue, usually in tropical and subtropical countries. The involvement of an exposed area is common; however it may very rarely involve the genital region. We present a rare case of vulvar myiasis which occurred after suction and evacuation performed for incomplete abortion.
Keywords Vulvar myiasis, poor hygiene, suction and evacuation
Introduction Myiasis is a parasitic infestation of human or animal skin, commonly seen where causative insects are abundant. It is common in rural areas and in urban areas among those with poor hygiene, psychiatric disorder or low level of education. Uncovered areas of the body, such as legs, arms and the head, are mostly effected.1 Genital myiasis is very rare and may be associated with sexually transmitted diseases, immunosuppression and genital malignancy.2,3 We report a rare occurrence of vulvar myasis after suction and evacuation where none of these predispositions were present.
Case Report A 24-year-old woman who had undergone suction evacuation for an incomplete abortion 5 days previously and had used unwashed cloths as pads after the procedure, presented complaining of foul smelling vaginal discharge for 4 days, pain in both lower limbs with the inability to walk and having to separate her legs when lying down for the past 2 days. There was no history of associated systemic illness or a genital lesion prior to the procedure. On examination a cavitating lesion (3 3 2 cm) filled with pus and maggots with surrounding erythema and oedema was seen over left labium majus (Figure 1(a)). The vagina and cervix were normal. Pus was sent for culture and sensitivity and broad spectrum antibiotics were started. The area was cleaned with turpentine oil. Dressing with turpentine oil twice daily made the maggots disappear from
the wound within 2 days (Figure 1(b)). Her serologic tests for HIV, syphilis and hepatitis were found negative.
Discussion Myiasis is due to infestation with dipterous larvae (maggots). There are two groups of myiasis for comparison of host location strategies. Group 1 (obligate parasites) are caused by those flies that deposit their larvae (viviparous) directly onto the host healthy tissue or clothes and are responsible for the cutaneous form (primary myiasis). This group comprises Dermatophobia homnis, Cochilomya hominovarus, Wohlfartia magnifica, Oestrus ovisc and Chrysomia bezzania. Group 2 (facultative parasites) are caused by those flies that deposit eggs/larvae onto necrotic tissue of the host. They are responsible for secondary or cavitory myiasis. This group includes Sacrophagidae, Lucilia, Calliphorida and Muscidae. Symptoms and signs of myiasis vary according to the affected body area and extent of the infestation. 1 Assistant Professor, Department of Obstetrics and Gynaecology, Government Medical College and Hospital, Chandigarh, India 2 Senior Reasearch Associate, Department of Obstetrics and Gynaecology, Government Medical College and Hospital, Chandigarh, India
Corresponding author: Anju Singh, Assistant Professor, Department of Obstetrics and Gynaecology, Government Medical College and Hospital, Chandigarh 32, India. Email: [email protected]
Downloaded from tdo.sagepub.com at UCSF LIBRARY & CKM on March 21, 2015
XML Template (2015) [24.2.2015–6:44pm] //blrnas3.glyph.com/cenpro/ApplicationFiles/Journals/SAGE/3B2/TDOJ/Vol00000/150006/APPFile/SG-TDOJ150006.3d
(TDO)
[1–2] [PREPRINTER stage]
2
Tropical Doctor 0(0)
Figure 1. Valvar myiasis of labia majora. (a) Maggots marked with arrow. (b) After healing of lesion.
Primary myiasis may present with fever, pain and bleeding from the infested site that may be complicated by secondary infection. Human genital myiasis is usually secondary or cavitory myiasis. It may be seen in immunocompromised and/or patients with concomitant STD.2 Our patient had none of these risk factors. Poor hygiene may be another contributing factor; flies are attracted by the fetid odour and moist surroundings and lay eggs/larvae on the skin or in the existing lesion. Thereafter larvae invade the tissue and feed themselves on dead and/or living tissue. It may result in considerable pain and tissue damage as fly larvae leave necrotic tissue and invade healthy tissues. Larvae usually pupate within 1–2 days and emerge as adult flies 6 days later. Treatment of myiasis includes removal of the parasite and cleaning with antilarval, antiseptic lotion. The larvae removed may be preserved in strong alcohol to help determine the type of myasis. Antilarval measures include turpentine oil, a mixture of turpentine oil with chloroform or paraffin jelly – which is less toxic but as good as turpentine oil. Turpentine oil creates an anaerobic environment forcing the larvae to come up to the surface and expel out.3 Primary myiasis can be treated by occlusion of the fistula with Vaseline or nail enamel so that larvae cannot have access to oxygen. A completely different sort of fly larva, usually from green bottle flies, which only feeds on necrotic tissue, may be used therapeutically to clean infected wounds.
This case shows that there can be a relation between poor hygiene and myiasis, and highlights the need of education for good personal hygiene such as regular use of soap water for cleaning, use of clean dry pads and clean ironed cloths for prevention of vulvar myiasis. Even with proper washing, flies may deposit eggs on clothes as they hang on the washing line. The eggs are, however, destroyed by ironing. Declaration of conflicting interests All the authors have seen the manuscript and approve it for submission. The authors have no competing interest in the publication of the manuscript to declare.
Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
References 1. Yazar S, Ozcan H, Dincer S and Sahin I. Vulvar myiasis. Yonsei Medical Journal 2002; 43: 553–554. 2. Passos MRL, Carvalho AVV, Dutra AL, Filho RAG, Barreto NA, Salles RS, et al. Vulvar Myiasis. Infect Dis Obstet Gynecol 1998; 6: 69–71. 3. Baidya J. A rare case of genital myiasis in a woman with genital prolapse and malignancy and review of literature. Ann Trop Med Public Health 2009; 2: 29–30.
Downloaded from tdo.sagepub.com at UCSF LIBRARY & CKM on March 21, 2015
