Effect of Ivermectin on Wound Myiasis- A Hospital Based Study.

Abstract

Myiasis is infestation of tissues or body cavities of a live mammal by larvae of flies (maggots). It is a debilitating condition seen commonly in our part of the world and if unchecked would devour large amount of flesh undermining the skin creating flask like bone deep wounds. Most of the patients that reported to our emergency department were homeless, drunkards, mentally and physically disabled people. This data was compiled from the admission log book of our surgical emergency and OPD from January 2009 to March 2016. We treated and observed that the patients who received oral and topical ivermectin treatment showed almost complete resolution of myiasis with a very rapid recovery (3-4 days) as compared to the conventional use of turpentine oil at local site with regular debridement and picking up of live larvae from the wound site.

Ether for Wound Debridement of Wild Maggots

“…Although effective as described by Singh and colleagues, the ivermectin solution requires significant preparation by dissolving tablets in normal saline. 16 Our ether solution as compared to other solutions above is easy to prepare and results in 100% wild maggot mortality. Mechanical extraction and suction is available as another method to employ; however, it can be timeconsuming, costly, painful, and not necessarily superior to ether.…”

Myiasis (maggots) around nephrostomy tube

“…Singh et al . [ 7 ] reported a retrospective study of maggots at various sites. Twenty-seven patients were treated with topical turpentine oil and 80 patients were treated with oral and topical ivermectin.…”

Myiasis – Pathology or Treatment?

“…In some cases, the pain is absent because the sensitive nerve endings are destroyed during the invasion. (8) Most fly species involved in myiasis cause superficial ulcer infestations, but Cochliomyia hominivorax (blue-green fly, commonly found in Central and South America, with pink larvae that can reach 2 cm in length) and Chrysomya bezziana (blue-green fly), 18-22 mm in length, with 2 lines on the thorax, found in Africa, regions of Asia, including Indonesia and the Philippines, New Guinea) infest the deep tissues, mucous membranes, cavitary organs, with a more important pathological involvement. (9) Wohlfahrtia magnifica is responsible for the myiasis caused by several flies, causing significant local destruction.…”

“…Siddharth Singh et al highlighted the superiority of topical ivermectin over Turpentine oil, with Ivermectin-treated patients recovering faster (4-5 hours after application), having a shorter hospital stay, less pain, reduced use of staff resources because manual extraction was not required. (8) There is no consensus on the systemic treatment in ulcerative myiasis. Ivermectin 200 μg / kgc may be used in case of damage to other organs.…”