THE NATIONAL MEDICAL JOURNAL OF INDIA VOL. 7, NO.3, 1994

Myiasis in filarial lymphoedema due toChrysomyia bezzianaR. RADHAKRISHNAN, R. SRINIVASAN,K. KRISHNAMOORTHY, S. SAB~AN, S. P. PANI

ABSTRACTIn patients with filarial lymphoedema of the limbs, infesta-tion by maggots is extremely rare. We saw three patientswith lymphoedema who harboured Chrysomyia bezziana inleg ulcers and in one of them 128 maggots were recovered.A course of local dressing, antibiotics and anti-inflammatorydrugs resulted in healing of the wounds. Ulcers in patientswith lymphoedema should be carefully tended with cleaningand dressing otherwise myiasis may supervene.Natl Med J India 1994;7:117-18

INTRODUCfIONInfestation by dipteran fly maggots of the Chrysomyiaspecies has been reported to cause myiasis in man anddomestic animals in the Orient.' Several other species of thisgenus are also known to produce human myiasis- but the bio-logy of only a few has been documented. 3,4 The occurrence ofmyiasis due to C. bezziana, the only known obligatoryproducer of myiasis in humans, is well known.> Recently, acase of aural myiasis in man caused by C. megacephala hasbeen reported." When patients with filarial lymphoedema donot take proper care of their limbs, secondary infection andulceration occur and discharge of fluid from the lesionsmakes them prone to myiasis. A single case due to C. rufifacieshas been reported in a patient with bancroftian filariasis? andwe report three cases of myiasis due to C. bezziana com-plicating filarial lymphoedema.

PATIENTS AND OBSERVATIONSThe Vector Control Research Centre runs two clinics forfilariasis, one at Pondicherry, an area endemic forWuchereria bancrofti; and the other at Shertallai in Kerala,which is endemic for Brugia malayi.

CaselA 33-year-old male who had grade IV lymphoedema in hisleft leg for 12 years presented with severe pain in the clinic atPondicherry. The patient had an open wound in the lateralpart of his left ankle for one week which was surrounded byreddish streaks and patches. He had seen maggots wrigglingout of the wound on the day before he came to us and hadcollected 20 fully grown ones. In the clinic, 20 more maggotswere removed using ether and a cotton pad; on the followingday, 22 more maggots and after a week 55 second instarmaggots were collected.

Vector Control Research Centre, Indira Nagar, Pondicherry 605006,India

R. RADHAKRISHNAN, R. SRINIVASAN,K. KRISHNAMOORTHY, S. SABESAN, S. P. PANI

Correspondence to S. P. PANI

© The National Medical Journal of India 1994

117

FIG 1. Spiracular plate of third-instar larva of Chrysomyiabezziana

Case 2A 65-year-old female patient from Shertallai with grade IVlymphoedema with dermatosclerosis and papillomatosis=!"presented with fever, chills and pain in the inguinal region.She had had a swollen left leg for 44 years. Changes in theskin had appeared 35 years ago, followed by ulceration andoozing of fluid five years later. She had noticed maggotscrawling out of the lesions for the previous two years. Exami-nation of a lesion on the lateral side of her left foot showedthe presence of maggots in the pus discharge.

Case 3A 60-year-old male patient from Shertallai with grade IVlymphoedema with ulceration in both right and left legs for25 and 30 years, respectively, presented with chills and fever.Lesions were seen in the left leg oozing fluid and 108third-stage maggots were removed from the wound afterinundating it with turpentine liniment. On the second day,20 more maggots were removed using the same technique.

A few maggots from each patient were washed in distilledwater and soaked in 10% NaOH for 12 hours. They werethen thoroughly washed in distilled water and treatedwith 5% acetic acid. The last segment of each maggot wasdissected out and their posterior spiracular plates mountedin gum chloral medium. The specimens were identified usingthe standard keys.t-'! Sample specimens of third-instarmaggots were reared on purified meat and the puparia weremaintained on moist cotton for emergence.

RESULTSA total of 10 third-instar maggots were maintained on moistcotton wool for pupation and emergence. Based on thecharacters of their posterior spiracles and the morphologicalfeatures of the adults, they were identified to be C. bezziana(Villeneuve; Fig. 1).

The patients were given a course of systemic antibioticstogether with anti-inflammatory and analgesic drugs, andwith local dressings the wounds healed within 3 to 4 weeks.

DISCUSSIONMyiasis due to C. bezziana in patients with lymphoedema

118

due to W. bancrofti or B. malayi has .....not been reportedpreviously. Isolation of maggots of uniform size in all thepatients suggests that each brood might have been the resultof a single female; Chrysomyia species are reported todeposit 150 to 500 eggs in each batch. 12 Recovery of as manyas 128 maggots from a single wound further suggests that agravid female deposited all her eggs at a suitable single site.Perhaps, the oozing of serous fluid from the woundsattracted the gravid females for oviposition. Manson-Bahralso reported that nasal discharge attracted Chrysomyiaspecies." The rarity of myiasis in cases with lymphoedemasuggests that they are only accidental hosts. If the ulcers inpatients with filarial lymphoedema are not managed withcareful cleaning and dressing, myiasis may occur.

ACKNOWLEDGEMENTSWe are thankful to Dr Vijai Dhanda, Director, Vector ControlResearch Centre, Pondicherry for a critical review ofthe manuscript andDr K. N. Panicker, Deputy Director, for his suggestions.

REFERENCES1 Harwood RF, James MT. Entomology in human and animal health. New

York:Macmillan, 1969:548.

THE NATIONAL MEDICAL JOURNAL OF INDIA VOL. 7, NO.3, 1994

2 Norris KR, Murray MD. Notes on the screw WOrmfly, Chrysomyia bezziana(Diptera: Calliphoridae) as a pest of cattle in New Guinea. Commonwealth SciInd Res Org Tech Paper 1964;6:1-26.

3 Zumpt F. Myiasis in man and animals in the old world. London:Butterworth,1965:267.

4 Oothaman P, Jeffery J. Human myiasis in Malaysia-a review. J MalaysianSoc Health 1984;4:53-{).

5 Lee HL. A case of human oral myiasis caused by Chrysomyia bezzianaVilleneuve, 1914(Diptera: Calliphoridae) in Malaysia. J Malaysian Soc Health1985;5:65-6.

6 Lee HL, Yong YK. Human aural myiasis. Southeast Asian J Trop Med PublicHealth 1991;22:274-5.

7 Srinivasan R, Pani SP. Myiasis in human filarial lymphedema. Southeast AsianJ Trop Med Public Health 1992;23:807-8.

8 World Health Organization Expert Committee on Lymphoedema. Filariasis.Fourth Report. WHO Tech Rep Ser 1984;702:16-24.

9 Pani SP, Krishnamoorthy K, Rao AS, Prathiba J. Clinical manifestations inMalayan filariasis with special reference to lymphoedema grading. Indian JMed Res 1990;91:200-7.

10 Informal consultation on evaluation of morbidity in lymphatic filariasis.TDRIFIRIMAD/92.31992;1-17.

11 Smith KGV. Insects and other arthropods of medical importance. London:British Museum (Natural History) and John Wiley, 1973:561.

12 Chopra A, Probert AJ, Beer WE. Myiasis due to Tumbu fly. Lancet 1985;1:1165.

13 Manson-Bahr PEC, Bell DR. Manson's textbook of tropical diseases. London:ELBS, 1987:1557.

Special interest group on medical informatics (SIGMI)

Those interested in any aspect of medical informatics(health information systems, hospital information systems,databases on medical measurements and health indicators,literature bases, biostatistical computation, graphics, expertsystems, networking for consultation, computerized equip-ment, etc.) and willing to contribute to the activities of theGroup are invited to join. For further information pleasecontact:

A Indrayan (Convenor SIGMI)Professor of Biostatistics and Officer Incharge, Computer CentreUniversity College of Medical SciencesDilshad GardenNew Delhi 110095Phone: (011)229-6637, (011)228-2971, 72, 73Telex:031-62032 UCMS INEmail:indrayanucms.ernet.in