Abstract
We review epidemiological and clinical data on human myiasis from Ecuador, based on data from the Ministry of Public Health (MPH) and a review of the available literature for clinical cases. The larvae of four flies, Dermatobia hominis, Cochliomyia hominivorax, Sarcophaga haemorrhoidalis, and Lucilia eximia, were identified as the causative agents in 39 reported clinical cases. The obligate D. hominis, causing furuncular lesions, caused 17 (43.5%) cases distributed along the tropical Pacific coast and the Amazon regions. The facultative C. hominivorax was identified in 15 (38%) clinical cases, infesting wound and cavitary lesions including orbital, nasal, aural and vaginal, and occurred in both subtropical and Andean regions. C. hominivorax was also identified in a nosocomial hospital-acquired wound. Single infestations were reported for S. haemorrhoidalis and L. eximia. Of the 39 clinical cases, 8 (21%) occurred in tourists. Ivermectin, when it became available, was used to treat furuncular, wound, and cavitary lesions successfully. MPH data for 2013–2015 registered 2,187 cases of which 54% were reported in men; 46% occurred in the tropical Pacific coast, 30% in the temperate Andes, 24% in the tropical Amazon, and 0.2% in the Galapagos Islands. The highest annual incidence was reported in the Amazon (23 cases/100,000 population), followed by Coast (5.1/100,000) and Andes (4.7/100,000). Human myiasis is a neglected and understudied ectoparasitic infestation, being endemic in both temperate and tropical regions of Ecuador. Improved education and awareness among populations living in, visitors to, and health personnel working in high-risk regions, is required for improved epidemiological surveillance, prevention, and correct diagnosis and treatment.
Highlights
Human myiasis is an ectoparasitic infestation of living or dead tissues by larvae or maggots of several species of flies of the order Diptera, and together with the ectoparasitic scabies and tungiasis, is classed as a neglected tropical disease [1]
Human myiasis is a neglected disease caused by ectoparasitic infestations of the skin, cavities and wounds by larvae of a wide variety of dipteran flies
Almost half clinical cases were cutaneous furuncular myiasis caused by Dermatobia hominis, which produced single lesions that were treated successfully with oral ivermectin followed by manual extraction
Summary
Human myiasis is an ectoparasitic infestation of living or dead tissues by larvae or maggots of several species of flies of the order Diptera, and together with the ectoparasitic scabies and tungiasis, is classed as a neglected tropical disease [1]. Human myiasis has a worldwide distribution but is more frequently reported from tropical regions, determined by the presence and geographic distribution of different fly species [2]. The Galapagos Islands, 1,000 km off the mainland in the Pacific, are part of Ecuador [4]. The total population of Ecuador in the 2010 census was 14,483,499 of which 53% live in the Pacific coastal, 42% in Andean, 5% in the Amazon region, and 0.2% in the Galapagos Islands [5]
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