Human fly strike12/28/2023 ![]() 2, 3 Rarely, maggots can be found in the human intestinal or urinary tract. Obligatory myiasis-causing larvae infest living hosts and tend to be more invasive than the facultative parasites, which favor dead hosts or the necrotic tissue of living hosts. Species identification helps classify maggots as obligatory or facultative parasites. Species identification can be crucial, however, in determining the natural history and pathogenic potential of an infestation. Because of their immaturity, it is more difficult to differentiate the various species of maggots than it is to speciate adult flies. Maggots are the larvae of flies ( Figure 1 and Figure 2). Unlike almost any other clinical specimen, maggots are often discarded (in haste and with disgust), rather than submitted to the clinical laboratory for analysis. The court may not be the ideal venue for determining the pathophysiology of myiasis (maggot infestations), but most of us on the wards or in the clinics appear unprepared or unwilling to make this assessment ourselves. ![]() ![]() Yet in neither case were the maggots saved their identity, natural history, and pathogenic potential were unknown. In both cases, the existence of maggots was cited as a priori evidence of medical negligence. In both cases, determination of the maggots' responsibility for the clinical outcome and the timing of the infestation were pivotal factors in determining the defendants' culpability. Several days into her hospitalization, her son found maggots in her mouth, prompting litigation against the nursing home in which she had resided the previous week. After learning that maggots had been noted in the wound at the time of amputation, the patient sued the hospital, the doctors, and the county for negligence, alleging that hospital personnel had allowed maggots to infest his wound and cause the loss of his foot.Īn elderly, intubated, comatose woman was transferred from her nursing home to the local hospital for management of her acute pneumonia. Despite antibiotic therapy, repeated surgical debridements, and attempted revascularization, the necrotic foot could not be salvaged. Five percent of infestations were nosocomially acquired and not necessarily associated with patient neglect.Ī YOUNG man who fell overboard while drinking and boating was brought to the hospital with deep, infected lacerations of the foot and ankle caused by his boat's propeller. In 6 cases, 2 coinfesting species were identified.Ĭonclusions Results of this prospective study of myiasis differ significantly from those of our analysis of previously published reports and suggest that most cases of human myiasis are caused by noninvasive blowflies laying eggs in preexisting wounds. Other blowflies, flesh flies (Sarcophagidae), and humpbacked flies (Phoridae) also were identified. The most common species was Phaenicia sericata (green blowfly family: Calliphoridae). Two patients (5%) were hospitalized at the time of their infestation. Homelessness, alcoholism, and peripheral vascular disease were frequent cofactors. Host age averaged 60 years, with a male-female ratio of 5.5:1. No cases of tissue invasion were recorded. Most infestations occurred within preexisting wounds. Results Forty-two cases of US-acquired myiasis were collected from 20 participating centers. ![]() Methods Multicenter, prospective observational study of urban and suburban patients who were infested with maggots. Objective To describe the most common clinical conditions associated with human myiasis and the causative maggot species. Shared Decision Making and Communicationīackground The epidemiologic characteristics of human myiasis in the United States remain undefined.Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.Clinical Implications of Basic Neuroscience.Challenges in Clinical Electrocardiography.
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