Myasis

Tungiasis

Loiasis
Jaime Galarza
Jeremmy Erazo
Antonella Magaldi
Michelle Guerrero
Mateo López
MYASIS

Infestations related to the presence of larvae or

maggots of flies in human tissue. Dermatoses occur
mainly in tropical and subtropical regions

Myiasis most commonly presents as an

erythematous furuncle at the site of invasion with
botfly (Dermatobia hominis) and tumbu fly
(Cordylobia anthropophaga) as the most common
causative agents.
 In Ecuador, four species
of flies had been
described to cause hum
an myiasis: D. hominis,
Causal Agent Oestrus ovis, C. hominiv
orax and Sarcophaga
haemorrhoidali

Myiasis is infection with the larval stage (maggots) of

various flies.
Flies in several genera may cause myiasis in humans.
Dermatobia hominis is the primary human bot fly.

Cochliomyia hominovorax is the primary screwworm fly

in the New World and Chrysomya bezziana is the Old
World screwworm.

Cordylobia anthropophaga is known as the tumbu fly.

Flies in the genera Cuterebra, Oestrus and Wohlfahrtia

are animal parasites that also occasionally infect
humans.
Patogenic
Agent

Dermatobia hominis Oestrus ovis

Sarcophaga haemorrhoidalis
Cochliomyia hominivorax

VECTOR
 Epidemiology
Geographic distribution

Dermatobia hominis and Cochliomyia hominovorax are

Neotropical species, ranging from Mexico into South America.

The Congo floor maggot (Auchmeromyia luteola) and

Cordylobia anthropophaga are distributed in Africa south of
the Sahara

Wohlfahrtia magnifica occurs in the Mediterranean basin, Near

East, and Central and Eastern Europe.

W. vigil occurs in northern United States and Canada.

Cuterebra species are found in the New World.

Oestrus ovis is found throughout the world in areas where

sheep are tended.
 Epidemiology
Ecuador

Of the 2,187 cases registered by the

Ecuadorian MPH between 2013 and 2015,
1,006 (46%) were from the Pacific coastal
region, 651 (30%) from temperate regions of
the Andes, 525 (24%) from the Amazon
region, and 5 (0.2%) from the Galapagos
Islands.
Estimate the annual incidence as being
highest in the Amazon (23 cases/100,000
population), followed by Coastal
(5.1/100,000) and Andean (4.7/100.000)
regions
 Clinical
Presentation

Infestations with D. hominis

Infestations with C.
hominovorax
 Clinical
Presentation

Oestrus ovis

Flies in the genera

Phormia and Phaenicia
cause facultative
myiasis
 Associated health condition

Cancer (basal cell carcinoma)

Non-Hodgkin’s lymphoma
Other underlying health conditions included:
Diabetes
Malnutrition
Burns
Poor personal hygiene and low
socioeconomic status was reported in
some cases
 Diagnostic

It's important to know regions where this is prevalent

pathology.

The diagnosis should be made based:

Clinical characteristics
Evolution of skin lesions
Confirmed with the extraction of the larvae from the lesions.

Serological tests are not indicated.

 Diagnostic

Dermoscopy is used primarily as an important tool

for differential diagnosis of lesions pigmented; Its
use has been reported in furunculoid myiasis by D.
hominis because it allows a better visualization of
the parasite.
 Diagnostic

Ultrasound, especially color Doppler ultrasound, has

been reported to be used in patients with cutaneous
myiasis (D. hominis, C. anthropophaga), although
the diagnosis is usually made by clinical parameters,
in some cases it may be useful as a complementary
examination.

The use of mammography in breast myiasis has also

been reported.
 Diagnostic

For a specific diagnosis, the identification of the

larva is needed, for which the respiratory stigmas
(peritremos) located in the last segment of the third
instar larva are used. Based on the morphology of
the peritremal membrane, peritremal button, and
peritremal grooves, the myiasis-producing dipteran
species can be identified.
 Diagnostic

The blood count shows leukocytosis and

eosinophilia.

The etiological diagnosis through the laboratory is

carried out by identifying the parasites under the
stereoscopic microscope.
 Managment and tratment

Ivermectin (one topically, two intramuscularly,

and the others orally from 200 to 400 μg / kg
for 1 to 5 days). Ivermectin was observed to
kill the larvae in all cases.

Other treatments included surgical and

manual extraction, use of mechanical
aspiration, cleaning, and healing of wounds
 Control, erradication and
prevention

The disease can be reduced by the help of

cattle rancher and the cleaning of the feces
of the animals.

Use of the long clothes that cover almost all

the parts of the body.

As erradication way, some countries used

laboratory modificated infertile flies and
liberate them in the most prevalent zone.
 Tungiasis
Tungiasis is the result of female sand
fleas (Tunga penetrans) penetrating the
skin.
Also known as nigue, pique, jigger,
chogoe or chiger.
Penetration of the skin usually occurs
on the feet.
More superficial than myiasis
 Tungiasis
Epidemiology
Present in tropical and subtropical
regions.
The WHO estimates that around 20
million people are at risk in America.
It is more frequent in rural and poor
areas .
The prevalence is 60% in adults and
80% in children.
 Tungiasis
Reservoir

Rural areas: pigs and cows.

Urban areas: dogs, cats, rats.
For the infestation, contact with
animals is not necessary.
 Tungiasis
Penetration

Occurs through direct contact of

the female flea with the host's
skin.
The flea measures 1 mm, feeds
on blood and grows up to 1 cm in
2 weeks.
Excretes eggs and feces
Can live up to 6 weeks.
 Tungiasis
Skin injury

Lesions can be single or multipel.

After penetration, a whitish papule
or nodule develops with a dark
central spot.
When the flea grows to 1 cm, it
becomes a whitish nodule with a
central black point.
 Tungiasis
Symptoms

The penetration process is

asymptomatic.
In 2 weeks, nodular lesion causes
inflammation, itching and pain.
It can be complicated by a
secondary bacterial infection.
Chronic complications can be:
ulcers, fissures, lymphedema,
deformation, loss of nails and
tissue necrosis.
 Tungiasis
Diagnosis
Observation of the whitish nodular
lesion with a central black spot in
an endemic area.

Treatment

One or few injuries: remove the

flea through a sterilized needle .
Massive invasion: surgery and
reconstruction.
 Tungiasis
Prevention and Control
Wearing shoes.
Use coconut-based
repellants 2 times a day on
the feet .
 LOIASIS
Epidemiology and Risk
Factors
The main parasites that are Loa-Loa parasites
can be found mainly in West and Central
Africa, in which more than 40% of the people
reported that they have had eye worm in the
past.

The areas that are more endangered are the

ones that are rain forests or near areas.

The deer flies that can bite the humans are

usually active during the day and are more
common during the rainy season.
They are attracted by the
movement of people and by
smoke from wood fires, but they
are not attracted to houses.
Travelers are more likely to
become infected even if they are
in an affected area for less than
30 days.

Your risk of infection depends

on the number of bites received,
the number of infected deerflies
in the area you visit, and the
length of your stay in the area.
LOIASIS Biology

Causal Agent:
Nematodes (roundworm) Loa loa that can
inhabit the lymphatics and subcutaneous
tissues of humans.
Life Cycle:
The vector for Loa loa filariasis are flies from
two species of the genus Chrysops, C. silacea
and C. dimidiata.
The larvae develop into adults that commonly
reside in subcutaneous tissue .
Microfilariae have been recovered from spinal
fluids, urine, and sputum.
LOIASIS Disease

After 7–12 days the larvae develop the ability to infect

humans. Then the larvae move to the mouth parts of the
fly. When the deerfly breaks a human’s skin to eat blood,
the larvae enter the wound and begin moving through the
person’s body.

It takes about five months for larvae to become adult

worms inside the human body and five or more months
for microfilariae to be found in the blood after someone is
infected with Loa loa.

The adult worms live between layers of connective tissue.

Eventually they move into the lungs where they spend

most of their time.
LOIASIS Disease

The microfilariae can live up to one year in the

human body.
The most common manifestations of the
disease are Calabar swellings and eye worm.
Calabar swellings are localized, non-tender
swellings usually found on the arms and legs
and near joints.
Other rare manifestations include painful
swellings of lymph glands, scrotal swellings,
inflammation of parts of the lungs, fluid
collections around the lung, and scarring of
heart muscle.
 LOIASIS
Diagnosis

Identification of the adult worm by a specialists after taking a sample from under the
skin or eyes
Identification of the microfilariae on a blood smear made from blood taken from the
patient between 10AM and 2PM in which is shown that the pathogen is more active
Identification of antibodies against Loa loa on specialized blood test

Diagnosis of loiasis can be difficult, especially in light infections in which microfiliare

presence is low. The specialized blood test is not widely available.

A positive antibody blood test in someone with no symptoms doesn’t mean that the
person still has living parasites in his/her body. It means that they have it any time
before
 LOIASIS
Treatment
Most people with loiasis do not have any symptoms.
There are two medications that can be used to treat
the infection and manage the symptoms:
Diethylcarbamazine (DEC) which kills the microfilariae
and adult worms.
Anthelmintic
Specific for
certain filarial
parasites

 LOIASIS
lm in ti c
Treatment An tihe
t o tr e a t
a te d
Indic c tio n s
n in fe
Albendazole is sometimes used in patients who are certai o rm s
ed b y w
not cured with multiple treatment before. caus

Certain people with heavy infections are at risk of

brain inflammation when treated with DEC.
Surgical removal of adult worms moving under the
skin or across the eye can be done to relieve
anxiety.
Loiasis is not cured by surgery alone.
 LOIASIS
Prevention and Control

There are no programs to control or eliminate loiasis in

affected areas.
Infection may be less in areas where communities
receive regular treatment for onchocerciasis or
lymphatic filariasis.
No vaccines.
Avoiding areas where the deerflies are found, such as
muddy, shaded areas along rivers or around wood fires.
Insect repellants -DEET 25
Long sleeves and long pants during the day, which is
when deerflies bite.

 Bibliography
WHO. (2020). Tungiasis. World Health Organization. Recovered from:
https://www.who.int/es/news-room/fact-sheets/detail/tungiasis
Korzeniewski1, k., Juszczak2, D. and JerzemowskiK, D. (2015). Skin
lesions in returning travellers. Int Marit Health, 66 (3), 173–180
Wilson, M., Leder, K. and Baron, E. (2021). Skin lesions in the returning
traveler. UptoDate. Recovered from: https://www-uptodate-
com.bibliotecavirtual.udla.edu.ec/contents/skin-lesions-in-the-
returning-traveler?source=history_widget
CDC. (2020). Loiasis. Centers for Disease Control and Prevention.
Recovered from: https://www.cdc.gov/parasites/loiasis/index.html