40Background 41 Myiasis due to Old World screw-worm fly, Chrysomya bezziana, is an important obligate 42 zoonotic disease in the OIE-list of diseases and is found throughout much of Africa, the 43 Indian subcontinent, southeast and east Asia. C. bezziana myiases cause not only 44 morbidity and death to animals and humans, but also economic losses in the livestock 45 industries. Because of the aggressive and destructive nature of this disease in hosts, we 46 initiated this study to provide a comprehensive understanding of human myiasis caused 47 by C. bezziana.
48
Methods
49We conducted a systematic search of the databases in English (PubMed, Embase and 50 African Index Medicus) and Chinese (CNKI, Wanfang, and Duxiu), and international 51 government online reports to 6 th February, 2019, to identify studies concerning 52 Chrysomya bezziana. Another ten human cases in China and Papua New Guinea that our 53 team had recorded were also included.
54
Results
55We retrieved 1,048 reports from which 202 studies were ultimately eligible for inclusion 56 in the present descriptive analyses. Since the first human case due to C. bezziana was 57 reported in 1909, we have summarized 291 cases and found that these cases often 58 occurred in poor hygiene, low socio-economic conditions, old age, and underlying 59 diseases including infections, age-related diseases, and noninfectious chronic diseases. 60 But C. bezziana myiasis appears largely neglected as a serious medical or veterinary 61 condition, with human and animal cases only reported in 16 and 24 countries respectively, 62 despite this fly species recorded as present in 44 countries worldwide. 63 Conclusion 64 Our findings indicate that cryptic myiasis cases due to the obligate parasite, C. bezziana, 65 are under-recognized. Through this in-depth study to clarify the knowledge of human C. 66 bezziana myiasis including its etiology, clinical features, diagnosis, treatment, 67 epidemiology, prevention and control, we call for more vigilance and awareness of the 68 disease from governments, health authorities, clinicians, veterinary workers, nursing 69 homes, and also the general public. 70 Author summary 71 Chrysomya bezziana larvae are characterized by feeding aggressively on the living 72 tissues and body fluids of the host. The nightmare-like feelings of patients suffering from 73 this myiasis, severe tissues and bones destruction, even death, and enormous economic 74 loss in the livestock industries have been described in the previous reports. But our 75 findings indicate that C. bezziana myiases still appear to be under-recognized as a serious 76 medical or veterinary condition throughout the world. Both in China and the world at 77 large, it is probable that C. bezziana distribution could be greater than currently reported. 78 For the first time, we have therefore systematically investigated human myiasis caused by 79 C. bezziana. Our study provides an opportunity for clinicians and health authorities to 80 gain a better understanding of this disease fr...