LARVAE INFESTATION

Parasitology Department Medical Faculty of USU

Cutaneous larva migrans (CLM)

Due to: Ancylostoma ceylanicum, A.caninum Strongyloides stercoralis

Dewi M.Darlan

10/8/2013

Cutaneous larva migrans (CLM) Pathogenese

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This condition is caused by contact with soil containing infective larvae (filariform larvae) that are capable of penetrating the skin. This cant occur after first exposure but follows reinfection only after several weeks, this suggests that the disease is due to hypersensitivity to larval secretions (Provic and Croese, 1996) The larva produces a number of enzymes which may assist in dermal invasion; such as metaloprotease, minor protease and hyluronidase (Hotez, Hawdon and Capello, 1995)
Dewi M.Darlan 10/8/2013

Cutaneous larva migrans (CLM) Clinical features

The lower extremities are more often affected with eruption on the feet, making up almost of all cases. A pruritic erythematous papule develops initially at the site of each larvae entry. After 2-3 days, severely pruritic, serpiginous, reddish-brown lesions appear Larvae migrate at a rate of several mm/ day Lesions are intensely itchy, red, and oedematous and show a worm-like migratory pathway under the skin
Dewi M.Darlan

10/8/2013

Cutaneous larva migrans (CLM) Clinical features

Lesions may also become vesiculated, encrusted, or secondarily infected. The larvae eventually die and become absorbed without treatment. The cutaneous symptoms typically last For days to months. Only 29% of patients had lesions that persisted for 1 month, but in occasional patients had lesions in follicles and cause disease for as long as 2 years.
Dewi M.Darlan 10/8/2013

Cutaneous larva migrans (CLM) Diagnosis

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The diagnosis of CLM is made on the basis of the characteristic clinical features The laboratory has no role to play in diagnosis Eosinophilia is only a feature of minority of cases. Titer IgE is usually normal

Dewi M.Darlan

10/8/2013

Cutaneous larva migrans (CLM) Treatment

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CLM is readily treated by application of 15% thiabendazole paste for 5 days. In severe cases, systemic treatment with albendazole or ivermectin may also be used (Caumes et al.,1993) Biopsy, surgical excision or liquid nitrogen is contraindicated (Stephen H.Gillespie, in Principle and practice of clinical parasitology,2001)
Dewi M.Darlan 10/8/2013

Dewi M.Darlan

10/8/2013

DEFENITION
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An infestation of the organs and tissue of human or animal by fly larvae (maggots) that, at least for a period of time, feed on the hosts dead or living tissue, liquid bodysubstances or ingested food (Herms, 1971).

Dewi M.Darlan

10/8/2013

Epidemiology
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Distribution:
Myiasis is endemic throughout the African and American tropics and subtropics. It occurs more readily in warm and humid environments. In the tropics, cases present year round, but in more temperate zones, myiasis is generally restricted to the summer months.

Dewi M.Darlan

10/8/2013

CLASSIFICATION
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Based on Biology of Larvae:

Obligatory myiasis (Specific): are those larvae which must develop exclusively in or on living tissue of human and animal. e.g.: Callitroga macellaris Chrysomia bezziana

Dewi M.Darlan

10/8/2013

Classification
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Facultative myiasis (Semi specific):

are those which are normally free-living, but occasionally may gain access to body e.g. via wound. e.g.: - Wohlfahrtia magnifica - Cochliomyia hominivorax

Dewi M.Darlan

10/8/2013

Myiasis through wound skin

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Dewi M.Darlan

10/8/2013

Classification
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Accidental Myiasis (Pseudomyiasis):

Maggots are accidentally ingested by host and are not able to continue their development in the human intestinal tract. e.g.: Musca domestica Sarcophaga spp. Piophila casei
Dewi M.Darlan 10/8/2013

Classification
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Based on Clinical: Enteric Myiasis:

Urogenital Myiasis:

This does not occur in human, although it does affect horses, donkeys, elephants, etc. e.g.: Gastrophilus spp.

This occurs when persons may sleep without covering. e.g.: Musca domestica Chrysomia bezziana
Dewi M.Darlan 10/8/2013

Classification
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Dermal/ subdermal Myiasis:

Nasofaring Myiasis:
Usually occur in infant and children Chrysomia bezziana Hypoderma lineatum Oestris ovis

Maggots are put on the necrotic skin and make a burrow at the ulcer; e.g.: Wohlfahrtia vigil Chrysomia bezziana Cordylobia spp.

Ophthalmic Myiasis:
Usually occur in eyes (COA,COP, Palpebra):

Chrysomia bezziana
Dewi M.Darlan 10/8/2013

Classification
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Furuncular Cutaneous Myiasis:

Occurs on exposed sites such as the scalp, face, forearms and legs. e.g.: Cordylobia anthrophaga

Migratory Cutaneous Myiasis:

It generally occurs in human who used to close contact with cattle. e.g.: Hypoderma bovis Hypoderma lineatum
Dewi M.Darlan 10/8/2013

Management/ therapy
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Surgical debridgement:

Surgical incision & extraction of the larvae is usually done under local anasthesia. Suffocation approaches: Several substance which may used to block larvaes respiratory such as Vaseline, or similar material

Dewi M.Darlan

10/8/2013

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Dewi M.Darlan

10/8/2013

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Dewi M.Darlan

10/8/2013

Gambar 27. Struktur spirakel posterior larva lalat

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