Primary Oral Myiasis Due to Chrysomya bezziana Treated with Ivermectin. A Case Report

Abstract

Primary oral myiasis due to Chrysomya bezziana is a rare condition caused by invasion of tissues by larvae of the flies. A case of Oral myiasis is presented in a 12 year old boy with neuro-degenerative disease with seizures. Intra orally, a soft tissue pocket in the left buccal mucosa and a pocket under the palatal mucosa was seen containing maggots. Extra orally indurated erythematous swelling was present near the commisure of the mouth. Predisposing factors identified in the present case were mouth breathing, incompetent lips, low socioeconomic condition, malnutrition, and inability of the child to perform daily activities due to his neurodegenerative disease. Treatment consisted of manual removal of maggots following irrigation and application of turpentine oil along with a single dose Ivermectin 3 mg that was given systemically. Complete healing of the lesion was observed within 10 days without any recurrence for a follow up period of 1 year. Medical personnel taking care of old / debilitated / unconscious patients need to bear in mind the possibility of Chrysomya bezziana infestation in them.

Oral myiasis in a maxillofacial trauma patient

“…Secondary bacterial infection along the surrounding skin should be treated with antibiotics. [456] Patient's diet should be supplemented with multivitamins, mineral and nutrients. [4]…”

Flies and the mouth

“…The identification of causative species can be challenging, because of the complex morphological features of the larvae that can only be assessed by a trained entomologist. Species that have been reported to cause oral myiasis, however, include Cochliomyia hominivorax, 17,21,[29][30][31][32][33][34][35][36] Oestrus ovis, 37 Wohlfahrtia magnifica, 9,37 Chrysomya bezziana, 16,20,38,39,41 Hypoderma bovis, 42 Cordylobia anthropophaga, 24 Hypoderma tarandi, 27 Calliphora vicina, 43 Musca nebulo, 38 Musca domesticus, 44 and Lucilia sericata. 51…”

Oral myiasis is a potential risk in patients with special health care needs

“…The reason for the high occurrence in such patients relates to the many common predisposing factors of myiasis in these patients like poor oral hygiene, incompetent lips, halitosis, seizure disorders and trauma to oral tissues with wounds exposed to environment and hyper-salivation. [5]…”

“…It acts by blocking the nerve impulses on nerve endings through the release of gamma amino butyric acid (GABA) leading to palsy and death. [356] It has been found to be safe for human use. Most recently, nitrofurazone topical application with flushing of the wounds in gingiva has shown promising results without any surgical intervention.…”

“…Wounds should not be left open and oral hygiene care of medically compromised patients and those with special health care needs should be monitored by an attendant/guardian or parent. [5]…”