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Periocular and orbital myiasis are rare, vision-threatening conditions characterized by the infestation of dipterous fly larvae into periorbital and orbital tissues. While it has been primarily reported in tropical and subtropical regions where the climate is ideal for fly larval breeding, any patient with inadequate wound care regardless of geography may be predisposed. Infestations can progress rapidly over the course of several days with significant risk of life-threatening intracranial extension. Despite this, there is a paucity of oculoplastic literature describing protocols to treat periocular and orbital myiasis in the acute setting. Here, the authors present a case of periocular and orbital myiasis seen at the Duke University Hospital in Durham, North Carolina (U.S.A.), and describe a protocol that was effective in the eradication of the infestation without surgical tissue debridement., Competing Interests: JAW is a speaker and consultant for Allergan (Irvine, CA), Galderma (Lausanne, Switzerland), and SkinCeuticals (New York, NY); a speaker for Prollenium (Ontario, Canada); and a consultant for Merz (Frankfurt, Germany) and Tarsus (Irvine, CA). The other authors have no financial disclosures or conflicts of interest to disclose., (Copyright © 2024 The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc.)

Abstract: Maggot therapy, also known as larval therapy or biosurgery, is the use of live, sterilized maggots to debride necrotic tissue. Alternatively, wound infestation by maggots, known as myiasis, can occur in patients with poor wound management, particularly in those living in poor socioeconomic conditions. In the case of myiasis, various maggot extraction solutions are used to encourage the live larvae to emerge from the wound on their own. Current recommendations include the use of hypochlorous acid, sodium hypochlorite solutions, isopropyl alcohol, betadine, and hydrogen peroxide for wound cleansing. This case report focuses on a unique utilization of commercial bacon strips for the extraction of maggots in an infested necrotic wound. The use of commercial bacon strips in selective patients as a noninvasive technique for the removal of maggots from necrotic wounds can be an additional tool for medical providers., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: Although today there is extensive scientific literature on aural myiasis, a historical study of the subject has yet to appear. This short article reports the first description of aural myiasis in the Western medical literature., Methods: Methods involved: (1) scholarship review of ear diseases within Ancient Greek and Roman medical texts ( L'Année philologique ); (2) linguistic analysis for text identification through the Library of Latin Texts, the Thesaurus Linguae Latinae and the Loeb Classical Library; and (3) translation of the Latin texts that described cases of aural myiasis with commentary., Results: To our knowledge, the earliest case of aural myiasis in Latin medical literature is reported by the Roman encyclopaedist Celsus (first century CE). In his De Medicina , he describes cases of Wohlfahrtia magnifica maggot infestation of the ear and how to treat affected patients., Conclusion: Despite present advances in otology, we believe that much insight can still be gained from this ancient example of medical history in ear diseases. A more comparative analysis of the subject is to be considered in the future, which will provide more data from different cultures and times.

Introduction: Myiasis is a disease caused by the infestation of fly larvae in the skin, which complete part of their life cycle by feeding on host tissues., Objective: To report a rare case of tongue myiasis in a patient admitted to a psychiatric ward, focusing on clinical management., Case Report: A dependent care and mentally challenged 55 years old male patient was hospitalized in a psychiatric ward. After 42 days, during the intraoral examination, it was noted numerous larvae peeking from inside of a wound on the dorsum of the tongue. The clinical diagnosis of myiasis was rendered. For the treatment, manual removal was performed initially and ivermectin (15 mg), metamizole sodium (500 mg/ml), and chlorhexidine digluconate (0.12%) were prescribed. After one week, larvae were no longer observed, and the wound was completely healed., Conclusion: Myiasis occurrence is uncommon in the mouth, however, its correct diagnosis and treatment are necessary to avoid further damage to patients, especially those who are hospitalized., Competing Interests: Declaration of Competing Interest The authors declare no conflicts of interest concerning this publication., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

We describe a case of nasal non-Hodgkin's lymphoma in a 79-year-old Chinese patient accompany with nasal myiasis. The first 2 biopsies in this case were false negative. Subsequently, nasal maggots developed in this patient. After removing all maggots under nasal endoscopy, the patient continued to have recurrent fever and was transferred to a higher hospital for further treatment, in which he received a third biopsy. Unfortunately, several hours after the biopsy, the patient died for severe nasal bleeding. The final biopsy result indicated the neoplasm of the left nasal cavity was non-Hodgkin's lymphoma. This case illustrates the importance of repeated biopsies for nasal non-Hodgkin's lymphoma if necessary. Nasal myiasis is a secondary disease of nasal non-Hodgkin's lymphoma in this case., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Myiasis is an ectoparasitic infestation caused by larvae of arthropods in the group Diptera. Cutaneous myiasis is the infection of skin and includes the following types: furuncular, migratory and wound myiasis. Out of all the organisms responsible for this disease, Wohlfahrtia vigil is the most common causative agent in Pakistan, usually seen from June to September with nearly all presentations occurring at a young age. In our case, a patient without a history of trauma, skin erosion or animal exposure has a unique presentation of cutaneous myiasis. Here, an effort was made to treat a 15- year-old otherwise healthy female with a multisegmented treatment modality. A follow up visit was conducted every three days for three months at the end of which a 60% decrease in the size of the open wound was observed.

Introduction: Myiasis is the infestation of living bodies of animals and humans with fly larvae or maggots. These accidental or obligatory parasites grow in three stages in the host while feeding on his tissues. Myiasis in a hospital area is a rare situation when flies accidentally lay their eggs on patients, mostly in open wounds or cavities. Case presentation. We report a case of a 72-year-old patient admitted to a general surgery department for peritonitis, then to an intensive care unit (ICU) for septic shock where he was intubated. Some maggots were seen moving in his nasal cavity a few days after his admission and were sent to our laboratory for examination. The larvae were identified as the third larval stage of Lucilia sp. They were removed entirely after intense nasal washing. A checking examination of his nasal cavities revealed no evidence of further infestation. After nasal washing, no other larvae were seen but unfortunately, the patient died of septic shock a few days later., Discussion: Few cases of nasal myiasis in hospitalized patients were reported. ICU myiasis, extremely rare, is caused by the patient's inability to fend off the flies because of their conscious state, presence of blood or odors caused by infections, and the warm humid environment., Conclusion: Myiasis in intensive care unit is a delicate situation that might be underreported. Preventing this infection is directly related to the control of the flies., (Copyright © 2022 SFMTSI.)

Myiasis is a type of parasitosis caused by the larvae of diptera. It commonly occurs in tropical and subtropical zones. The infestation of nose and ears can be extremely dangerous if the larvae destroy the bone and penetrate into the brain, in which case the fatality rate is reported to be as high as 8%. Here, we report a case of aural myiasis in a patient with congenital mental retardation. Twelve maggots were removed mechanically, and the patient was treated with appropriate antibiotics.

Myiasis refers to the infestation of living humans and vertebrate animals by dipterous larvae. Many organs can be infested by fly larvae, but cutaneous and wound myiases are the most frequently encountered clinical forms. Persistent ulcer or non-healing wound is one of the symptoms of squamous cell carcinoma which is the second most common skin cancer in the world. Here we report a case of an elderly man with a severe wound myiasis in a squamous cell carcinoma lesion of the scalp. The maggots were confirmed to be Lucilia sericata which are widespread flies in Japan. Human myiasis is rarely reported in Japan, but patients with necrotic, hemorrhaging, or pus-filled wounds are susceptible to infestation. It is necessary for doctors and nurses to ensure that their patients change their dressings daily and keep their wounds clean.

Head and neck cancer patients represent a risk group for the development of fly larvae infestation in neoplastic wounds. This condition can accelerate the disease progression and increase its lethality due to local or systemic complications. The aim of this study was to conduct a scoping review on head and neck cancer associated with myiasis in order to answer the focal question: what are the occurrence, diagnosis, aetiology, treatment and outcomes of head and neck cancer associated with myiasis? This paper was structured based on the five-steps methodology proposed by Arksey and O'Malley (Int J Soc Res Methodol 2005;1:19-32), and followed the PRISMA Extension for Scoping Reviews (PRISMA-ScR), OSF Registries protocol. The electronic search was performed in the MEDLINE/PubMed, Embase and SciELO.org databases for articles published up to 28 February 2021. In total, 38 articles and 56 patients were included. Most patients were male (66%), and the mean age was 66.63 years. Cases were predominantly associated with squamous or basal cell cancer. The most affected anatomical sites were the eyes, scalp, ears and oral cavity, and the most frequent type of larva was Crisomyia (13%). Manual removal of the larvae was considered the standard treatment, associated or not with antibiotics, analgesics and antiparasitic drugs., (Copyright © 2021. Published by Elsevier Inc.)

Introduction: Oral myiasis is a rare condition caused by Dipteran larvae that feed on living or dead tissues, ingested food or body fluids. It affects immunocompromised individuals with low socioeconomic status or those unable to maintain proper hygiene. Cases of oral myiasis are scarce but debilitating in children. We conducted a systematic review to understand the nature of disease, its causative factors, treatment and ways to prevent the occurrence of this condition among children., Methodology: The review was carried out in accordance with Preferred Reporting Items for Systematic Review and Meta-analysis guidelines. A systematic electronic literature search was conducted on major databases using keywords in combination with Boolean Operators. Manuscripts discussing cases of oral myiasis in paediatric patients were included in the review., Results: The exhaustive literature search and evaluation of full texts revealed 32 studies that fulfilled the inclusion criteria. A total of 68 cases of oral myiasis were reported from 2 to 16 years of children, majorly involving gingiva of maxillary anterior region and palate., Conclusion: The dreadful condition of myiasis can be prevented by decreasing the number of flies, maintenance of good hygiene and by educating the susceptible population. Affected children must be managed by following proper treatment regimens., Competing Interests: Declaration of Competing Interest Author has no interests to declare., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)

Background: Myiasis is an infection of the tissues and organs occurring in animals or humans by fly larvae, and human ophthalmic myiasis has been described worldwide., Methods: We report here a rare case of unilateral severe conjunctival ophthalmomyiasis due to the larvae of Oestrus ovis in Jixi city, Shaanxi province of west China, in which the climate is relatively dry and cold., Results: The larvae were verified as the first instar larvae of Oestrus ovis according to the previously described morphological criteria., Conclusions: For the first time, we present an optimal method to identify larvae under a microscope to make images sharper for accurate laboratory diagnosis and preserve the specimen for a long time so that laboratory staff can learn about the rare case, especially in the regions with dry and cold climate like ours, where laboratory staff are not familiar with the disease. Accurate laboratory identification and prompt treatment will provide remarkable benefit to the patients.

Cerebral myiasis is extremely rare, and surgical intervention is the primary treatment used. Successful conservative management alone, without surgical removal of the brain infestation has not yet been published. We report a case of a 24-year-old African homeless man who was found on the street in a state of decreased level of consciousness, with larvae exiting from the left supra and postauricular dirty wounds and from his left ear. The patient was diagnosed with post-traumatic cerebral myiasis of the left temporal lobe and cerebellum. It was treated successfully by debridement of the external wounds and administration of antibiotics, without surgical removal of the brain infestations. For the first time, this case illustrates the novelty and appropriateness of the conservative management of cerebral myiasis. This is also the first report of cerebral myiasis with cerebellar involvement and the second report of post-traumatic cerebral myiasis in literature.

Nasal myiasis is a rare parasitic disease. The growth of myiasis in the nasal cavity causes damage to the nasal cavity and paranasal sinuses. Once the dipeterous larvae are migrated, it causes damage to the surrounding structures such as eyes and skull cavity. Proper treatment and active prevention and control can reduce and avoid the occurrence of serious complications. On May 14, 2020, a patient with cerebral infarction and coma was admitted to Xiangya Hospital of Central South University and developed nasal myiasis. During the treatment of the primary disease, the patient was found to be infected with rhinomyiasis. The patient was treated with dehydration, cranial pressure reduction, brain protection, blood glucose control, blood pressure control, and anti-infection. Nasal endoscopy and nasal irrigation were carried out to treat nasal myiasis. The patient was properly placed and isolated for prevention and control so as to prevent the spread of myiasis in the ward. After 16 days, the patient regained consciousness, no worm was found in the nasal cavity, and was discharged from the hospital. The patient was followed-up for 6 months, no maggots were found in the nasal cavity of the patients, no complaints of nasal discomfort was occurred, and no other patients and medical staff were infected with myiasis. The prevention of myiasis is very important, and proper measures should be taken to reduce the risk of community and hospital infection.

Background: Cutaneous myiasis in patients with malignant wounds or skin cancer is a rare and undesirable event with limited epidemiological data. A subregister of reports, lack of education in the population, inadequate empirical treatments, and medical underestimation are components of a public health problem that threatens patients' lives., Methods: We conducted a systematic review of the literature of cutaneous myiasis associated with malignant wounds and skin cancer, characterizing sociodemographic variables, risk factors, clinical and histological features, and treatment. Additionally, we present a demonstrative case with the adequate taxonomic evaluation., Discussion: Cutaneous myiasis is an underestimated and poorly managed infestation, which can generate severe complications in oncological patients. This is the first systematic review in the literature about this clinical scenario, which provides information to the physician and clinical researcher about the epidemiological gaps and what has been published so far., Conclusions: Findings from the current review have helped to display the sociodemographic, epidemiological, and clinical behavior of myiasis in skin cancer and malignant wounds. Its contribution to the greater tumor tissue destruction is clear; however, more studies are required. The therapeutic management in these patients is equally clarified., (© 2021 the International Society of Dermatology.)

Suction aspiration, which has not yet been described in the treatment for myiasis in the periorbital and facial regions, was used to achieve rapid resolution of maggot burden in a 78-year-old patient who presented with a large ulcerated squamous cell carcinoma of the face. This technique also facilitates submission of parasite samples for further analysis. Suction aspiration had no complications, such as significant residual ruptured maggots in the wound or eye injury. Suction aspiration is a safe and efficient technique to reduce maggot burden that has advantages over classic myiasis treatments, especially near the eyes and airway., Competing Interests: The authors have no financial or conflicts of interest to disclose., (Copyright © 2021 The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc.)

Myiasis is a skin infection caused by developing larvae (maggots) of various Diptera fly species. The two most frequent flies that cause human infestations around the world are Dermatobia hominis (human botfly) and Cordylobia anthropophaga (tumbu fly). Maggots have been found to infest the nose, ear, orbit, tracheostomy wound, face, gums, and serous cavities, among other places. Maggots at the colostomy site are an uncommon occurrence. We report a case of maggots infestation surrounding the colostomy site. We came across a rather rare finding in a patient with advanced inoperable rectum cancer who initially complained of persistent nonspecific pain, discomfort, and foul-smelling discharge from the colostomy site. The issue at hand was identified to be maggots, and their removal alleviated the patient's symptoms. We underline the importance of regularly monitoring stoma sites to avoid maggot infestation, especially in tropical regions.

Infestation of any dead or necrotic tissues by the larvae of flies (maggots) is myiasis. This form of habitation is not restricted to any particular tissues in the body and can occur anywhere. However, myiasis at the surgical stoma site is very rare. We present a 55-year-old woman diagnosed with metastatic carcinoma of the oesophagus who underwent feeding gastrostomy (FG). The patient later presented with worms at the FG site. We removed the FG tube, cleared all the maggots, thoroughly cleaned the wound and placed a new FG tube. Although its occurrences have been reported enough in medical history, there are only two documented cases of percutaneous endoscopic gastrostomy stoma site myiasis. Hence, we present the first case in the literature of cutaneous myiasis around an FG stoma site., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2021. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Myiasis is an emerging disease caused by tissue invasion of dipteran larvae. In Uruguay, Cochliomyia hominivorax and Dermatobia hominis are the most frequent species. This study aimed to describe the epidemiological and clinical characteristics and the follow-up of children < 15 years hospitalized for myiasis in a reference center in Uruguay between 2010 and 2019., Methods: We conducted a descriptive and retrospective study by reviewing medical records. We analyzed the following variables: age, sex, comorbidities, origin, the month at admission, clinical manifestations, other parasitoses, treatments, complications, and larva species identified., Results: We found 63 hospitalized children: median age of 7 years (1 month-14 years), 68% of females. We detected risk comorbidities for myiasis (33%), of which chronic malnutrition was the most frequent (n = 6); 84% were from the south of the country; 76% were hospitalized during the summer. Superficial and multiple cutaneous involvements were found in 86%: of the scalp 50, furunculoid type 51, secondary to C. hominivorax 98.4%, and to D. hominis in 1.6%. As treatments, larval extraction was detected in all of them, surgical in 22%. Asphaltic products for parasites were applied in 94%, ether in 49. Antimicrobials were prescribed in 95%; cephradine and ivermectin were the most frequent. About 51% presented infectious complications, impetigo was found in 29, cellulitis in 2, and abscess in 1., Conclusions: Myiasis predominantly affected healthy schoolchildren during the summer months and was frequently associated with ectoparasites. Superficial infestation of the furuncle-like scalp by C. hominivorax was the most frequent form. Infectious complications motivated hospitalizations.

Myiasis is a parasitic infestation of live vertebrates with the dipteran larvae that grow within the host while feeding on its living or dead tissue. Human myiasis is prevalent among individuals in close association of domestic animals and those inhabiting the unhygienic conditions. Open neglected suppurative wounds are the favourable sites that attract and stimulate the gravid female flies for oviposition. However, the poor personal hygiene, ignorance and the mental illness further add to it. Tracheopulmonary myiasis involves the infestation of foul smelling nasal and oral orifices or neglected wounds like tracheostomal incisions with the parasitic dipteran larvae which may extend up to the trachea, bronchi and lungs leading to serious health complications. Despite the incidence of human tracheopulmonary infestation is rare, the severe medical impediments and heterogeneous worldwide distribution signify the medical importance of this condition. The present manuscript reviews and summarizes the worldwide reported cases of human tracheopulmonary myiasis and the predisposing risk factors for onset of the same, as future reference for parasitologists and medical professionals.

Competing Interests: Competing interests: None declared.

Myiasis is an infection caused by the deposition of fly larvae in tissues, and its involvement in the human oral cavity is uncommon. Herein, we have performed a data analysis of published cases of oral myiasis. A search was performed in PubMed, Ovid, Web of Science, Scopus, and LILACS. Geographic distribution, demographic data, associated factors, clinical features, fly types, treatment, and presence of sequelae were analyzed. A total of 122 articles reported the cases of 157 infected individuals. The most affected countries were India (41%) and Brazil (29.5%). Male predominance (67.5%) and a mean of 41.9 years of age were observed. The gingiva (29%) was the most affected site, followed by palate (25%) and lip (21%). There were different forms and combinations of treatments: manual removal of larvae and surgical debridement, application of asphyxiating substances, antibiotic therapy, and use of ivermectin. The condition predominantly affects individuals with neurological and/or locomotor disabilities, of low socioeconomic status, with poor oral hygiene and chemical dependence and individuals with previous injuries or with the absence of lip sealing. The establishment of a standard treatment protocol, enabling comparison in future studies and providing uniformity in treatment strategies offered by health services is strongly recommended., (© 2020 Special Care Dentistry Association and Wiley Periodicals LLC.)

Dermatobia hominis, also known as the human botfly, is native to tropical and subtropical Central and South America and seen in travelers from endemic to temperate regions including the United States and Europe. Cutaneous infestation botfly myiasis involves the development of D. hominis larvae in the skin and is common in tropical locations. The distinct appearance of a cutaneous D. hominis infestation facilitates early diagnosis and intervention where cases are common. However, the identification of D. hominis in temperate regions may prove challenging due to its rarity. D. hominis may be misdiagnosed as folliculitis, an epidermal cyst, or an embedded foreign object with secondary impetigo. One should have a heightened suspicion in someone returning from a vacation in an endemic area, such as Belize. Here we describe the presentation, differential diagnosis, and treatment and encourage enhanced preventative measures among tourists when visiting tropical and subtropical regions. Additionally, we propose a novel classification system for assessing the various stages of infestation and suggest that patients reporting travel to Latin America and experiencing pain disproportionate to an insect bite should lead physicians to consider myiasis caused by D. hominis.

In this article, we intend to discuss a case of cutaneous myiasis in a British child traveller who recently travelled to Somaliland. A Cordylobia anthropophaga larva was identified as the species that caused the disease. The case report, which contains a video illustration of the causative agent, proved a diagnostic challenge at presentation., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

Intubations are important live saving skills to maintain adequate ventilation and oxygenation. Common indications include impending upper airway obstruction, respiratory failure and impaired conscious level. Oral myiasis is an infrequently found disease which is characterised by ectoparasitic infestation of body tissues by fly maggots.We present a case report and share valuable experiences on a patient with massive airway myiasis causing upper airway obstruction which require emergency intubation., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

We present the rare case of a 12-year-old girl from Tennessee with domestically acquired aural myiasis.

Urogenital myiasis is a parasitic infestation caused by larvae of Psychoda spp. and it is very rare in humans. A 10- year old female was presented with urogenital myiasis and 4 th stage Larvae of Psychoda albipennis (Diptera: Psychodidae ) were found in urine. The patient was complained of painful sensation, discomfort and burning while urination. Urinary tract antiseptics were prescribed for the patient and advised to drink plenty of water for hydration. Local health authorities should take proper measures to maintain hygienic conditions for the people under risk.

Tropical regions receive a significant part of the traveling population. It is very important that health professionals are familiar with the main tropical skin diseases and able to advice patients appropriately. This article reviews the main tropical diseases of travelers, with an emphasis on diagnosis, management, and prevention. Among others, cutaneous larva migrans, myiasis, tungiasis, Chagas disease, Dengue fever, African trypanosomiasis, filariasis, and leishmaniasis are discussed. Increasing awareness among travelers and health care professionals can help reduce morbidity and mortality. Continued research on new drugs and vaccines is needed to reduce the risks of tropical diseases., (© 2018 Wiley Periodicals, Inc.)

We present the case of a young male patient who presented with pain, redness and foreign body sensation in his left eye. There was no associated decrease in vision. Three live larvae were removed from his left conjunctival sac and sent to the laboratory for identification. The patient was treated symptomatically and his symptoms were mostly resolved by the following day. The larvae were later identified as the first instar of the sheep nasal botfly. Poor sanitation and exposure to livestock were among the identified risk factors in this case. Physicians must have this as a differential diagnosis for conjunctivitis in patients with risk factors. This is the first reported case of ophthalmomyiasis from Jamaica.

Myiasis is a pathological condition in which there is a pestilence of fly larvae feeding on living or dead tissues. This disease is common in the tropics and subtropics of Africa and America and rarely affects humans. Our case report describes a five-year-old boy from Karachi, Pakistan with a history of extraction sockets and incisional biopsy of the left parotid lymph node. Lack of proper wound maintenance led to infestation of maggots both over the overlying skin of the left parotid region and the posterior oral cavity. The plan was wound debridement both outside and intra-orally under local anesthesia and the removal of maggots. A cotton swab impregnated with turpentine oil was placed on the wounds for a few minutes. The wounds were then properly debrided with pyodine and hydrogen peroxide. Around 15 to 16 maggots were extracted from the wound on the left parotid region using medical forceps whereas five maggots were extracted from the intraoral wound with the help of turpentine oil and forceps. This case demonstrates the importance of oral health and proper wound management, and also that myiasis, despite its distinctiveness, can be managed by promoting awareness of the disease and by suitable treatment methods.

Rationale: The presentation of sepsis and bacteremia in cutaneous and cavitary myiasis is uncommon. We present a patient, residing in a temperate region of the United States, with myiasis and sepsis from the emerging human pathogens Wohlfahrtiimonas chitiniclastica and Ignatzschineria indica., Patient Concerns: A 37-year-old male patient with an 8-month history of chronic lymphedema and ulcers of the lower left extremity presented with myiasis of the left foot and leg. The patient was initially seen by his family practitioner many times and was prescribed antibiotics which he could not afford. Debridement of the myiasis was not conducted by the family practitioner due to the belief that the patient's current state of myiasis would effectively debride and eventually heal the chronic ulcers along with multiple antibiotic regimens. Over the 8-month period, the patient developed a progressive, painful, necrotizing infection of his lower left extremity., Diagnoses: Physical examination clearly showed myiasis of the patient's lower left extremity, believed to be caused by Lucilia sericata (green bottle fly). Blood cultures revealed the presence of Providencia stuartii, W chitiniclastica, and I indica to be the underlying cause of sepsis and bacteremia., Interventions: All visible maggots were extracted, debridement of devitalized tissue was performed, and the leg ulcers were wrapped in pH neutral bleach. The patient was initially treated with a broad-spectrum antibiotic regimen of vancomycin, clindamycin, piperacillin, and tazobactam which, following clinical improvement, was de-escalated to cefepime., Outcomes: The fly larvae and maggots were removed from the extremity by scrubbing, pulse lavage, and filing away the callused tissue. Additionally, the patient's sepsis and bacteremia, caused by W chitiniclastica and I indica, were successfully treated through antibiotic intervention. Amputation was avoided., Lessons: The use of pulse lavage and chlorhexidine-soaked brushes for the removal of cavitary myiasis is an effective and minimally invasive procedure which does not cause additional damage to surrounding tissue. W chitiniclastica and I indica are emerging bacteria that have known association to parasitic fly myiasis in humans and are capable of causing sepsis and/or bacteremia if not accurately identified and treated promptly.

Furuncular myiasis is a cutaneous parasitosis that occurs in tropical regions. It is manifested by lesions with the appearance of pustules, because of the presence of the fly larva in the skin. This misleading appearance can delay diagnosis. The extraction of these Cayor worms can be facilitated by the use of a comedo-extractor.

Competing Interests: Competing interests: None declared.

Ocular myiasis is a rare disease with invasion of the lids, conjunctiva, cornea and, rarely, orbit or globe of the mammalian eye by dipteral larvae.We report a case of a 74-year-old woman with chronic, infiltrating, ulcerative lesion of the left lower eyelid, which was confirmed as basal cell carcinoma subsequently, having ophthalmomyiasis.She was a destitute, living in unhygienic environmental conditions and having poor general health. She developed permanent blindness as a result of ophthalmomyiasis of the left eye. Proper wound care, hygiene and adequate nutrition helped her recover from the illness., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)