Maggot Therapy Research Articles

1172 Maggot Debridement Therapy (MDT) In Treating Group A Streptococcus Necrotizing Fasciitis of The Lower Limb as A Part of Multimodal Therapy

Abstract Background Medical-grade maggots have been commercially available recently and today there is a resurge interest in MDT. They are approved for debridement of wounds with necrotic tissue, including pressure ulcers, venous ulcers. However, for necrotising fasciitis, it has been used with precaution due to the complexity of the disease. In our practice, Maggot debridement therapy (MDT) has been proven to be very effective in the treatment of gram-positive bacterial infections. Worldwide, Case reports on the results of 15 patients with necrotizing fasciitis treated with MDT have been reported. However, in current practice, Maggot Debridement therapy has not been widely applied. Case presentation A 63-year-old lady admitted to a general surgery ward with uncomplicated cellulitis of the right leg. After 2 days, the patient then was diagnosed with Necrotising fasciitis which was treated with wound debridement. Postoperative histopathology specimen confirmed necrotizing fasciitis V.A.C. VERAFLO™ Therapy was used postoperatively followed by two more debridement sessions. To reduce the need for further surgical debridement Maggot Debridement Therapy was started. Over the next 3 weeks, six sessions of Maggot Debridement therapy were applied to the infected area. Skin grafting then was performed 3 months later. The patient then discharged home with regular surgical fellow up. Conclusions NF is a complex disease, associated with high morbidity and mortality. Multimodal therapies are essential to achieve aggressive yet conservative wound debridement with preservation of viable tissue. This case report showed that MDT is a feasible, safe, cost-effective option that to be added to the other treatment modalities

Effectiveness of broad-spectrum antiseptics in production of disinfected maggots of Lucilia sericata for use in wound debridement therapy.

The establishment of low-cost, effective, safe and practical methods is necessary to increase the use of larval therapy in wound care. Although studies on external disinfection of calliphorid eggs have been reported, many studies lack data on the effect of disinfection on egg viability and the microorganisms found before disinfection. Therefore, the main objective of this study was to compare three antiseptic solutions, that is, chlorhexidine (5%), Dakin's solution (0.5% NaOCl) and povidone-iodine (10%), in terms of their ability to disinfect Lucilia sericata eggs. Egg viability after disinfection and microorganisms present on the eggs and larvae before and after treatment were also examined. None of the antiseptics had a significant effect on egg viability. Disinfection of L. sericata eggs with 0.5% NaOCl was the best method, as sterility tests showed no contamination. Escherichia coli, Bacillus subtilis and Proteus mirabilis were present in all cultures isolated from the non-disinfected eggs and larvae, while Enterococcus faecium, Enterococcus faecalis, Morganella morganii, Corynebacterium spp. and Providencia stuartii were isolated from more than half of the same cultures. Sterility testing of medicinal maggots after disinfection is crucial to prevent secondary infections and achieve a positive therapeutic outcome.

Genome and transcriptome sequencing of the green bottle fly, Lucilia sericata, reveals underlying factors of sheep flystrike and maggot debridement therapy

The common green bottle blow fly Lucilia sericata (family, Calliphoridae) is widely used for maggot debridement therapy, which involves the application of sterile maggots to wounds. The larval excretions and secretions are important for consuming necrotic tissue and inhibiting bacterial growth in wounds of patients. Lucilia sericata is also of importance as a pest of sheep and in forensic studies to estimate a postmortem interval. Here we report the assembly of a 565.3 Mb genome from long read PacBio DNA sequencing of genomic DNA. The genome contains 14,704 predicted protein coding genes and 1709 non-coding genes. Targeted annotation and transcriptional analyses identified genes that are highly expressed in the larval salivary glands (secretions) and Malpighian tubules (excretions) under normal growth conditions and following heat stress. The genomic resources will underpin future genetic studies and in development of engineered strains for genetic control of L. sericata and for biotechnology-enhanced maggot therapy.

Maggot Therapy for Snakebite Necrotic Wound in a Horse

Maggot therapy is the use of sterile fly larvae in the treatment of superficial wounds in humans and animals. Lucilia sericata (Diptera: Calliphoridae) larvae are most commonly used for this purpose. Nowadays, larval therapy is widely used in the treatment of diabetic and infectious human wounds. Larval therapy in veterinary medicine has been used in dogs, cats, horses, and even ruminants. A 5-year-old crossbreed (Arabian and Kurdish) stallion was referred to a veterinary private sector in Tabriz city that suffered from a necrotic wound on its forelimb skin following a snakebite injury. The owner had seen the snake in the horse stable. Skin necrosis was observed on the dorsal of the right forelimb which extended to the ventral of the adjacent neck and chest. Despite this extensive skin injury, the horse was alert with a normal appetite and no sign of lameness was detected. Intravenous fluid therapy, systemic anti-inflammatory, and antibiotics were used for the horse's general condition support and topical oxytetracycline and zinc oxide were administered but had no effect on healing of necrotic wounds. Maggot therapy was performed on the necrotic skin. Unfortunately, the larvae died after inserting less than 24 hours. The maggot therapy was unsuccessful in the treatment of skin necrosis in this experience and the larvae died in this short time. However, more clinical trials on the efficacy of maggot therapy for extensive skin necrosis and studies on the effects of snake venom on the maggots are needed.

A Parallel Randomized Clinical Trial for Comparison of Two Methods of Maggot Therapy, Free-Range Larvae and Larval-bag, in Diabetic Ulcer (Wagner 2).

In the present study, the efficiency of two formulations of maggot therapy: free-range larvae on the wounds and larvae in a special bag (larval-bag), was compared for healing diabetic ulcers with Wagner 2 diabetic ulcer. This study was conducted as a parallel randomized clinical trial. Out of 281 patients with Wagner grade 2 diabetic ulcers referred to the wound clinic, 54 patients who met the inclusion criteria were randomly assigned to intervention groups. The disinfected larvae of Lucilia sericata were put on the wounds with 2 methods, free-range larvae and larval-bag. Follow up was done at every 48 h interval until the full appearance of granulated tissues. The main measures were wound bed preparation, removing of necrotic tissues, appearing of granulated tissues, and removing of bacterial infections in the wounds. Statistical analysis based on the Kaplan-Meier curve and the Wilcoxon (Breslow) test showed a significant reduction in wound healing time by using free-range larvae in comparison with larval-bag (P = .03). The median time to debridement was 4 days in the free-range larval group (95% confidence interval: 3-9 days) while it was 9 days in the larval-bag group (95% confidence interval: 5-16 days). Debridement rate (proportion of removed necrotic tissue surfaces) at any time in the free-ranged larvae group was 1.78 times that of the bagged larvae group (95% confidence interval 1.01-3.15, P = .036). There was no significant difference between free-range larval use and larval-bag in the acceptability of maggot therapy by patients (P = .48). It can be concluded that both of two formulations of the larval therapy (free-range larvae and larval-bag) could be recommended for cleaning out and bed preparation of diabetic ulcers. However, using free-range larvae is hardly recommended on the wounds which are eligible to use.

Health professionals' perceptions of maggot debridement therapy.

Maggot debridement therapy (MDT), or the use of maggots in dead tissue removal, has been shown to be beneficial in wound healing. Yet MDT in the US is often only used once conventional debridement methods have failed. In this study, nine health professionals, experienced in MDT, were interviewed in order to identify and analyse the perceived societal barriers to MDT acceptance and usage in the US. Through qualitative analysis, using the grounded theory framework, this study found that among those interviewed, insurance reimbursement restrictions and stigmatisation of medicinal maggots were the factors driving resistance to MDT use. Specifically, the 'yuck' factor and the perception of MDT as an 'ancient' modality contributed towards MDT stigma; in addition, lack of outpatient insurance coverage deterred MDT use. These findings provide useful information regarding the perceptual and systemic barriers that prevent greater acceptance of MDT. Ultimately, these barriers must be understood if we are to facilitate MDT implementation and improve MDT usage in the future.

Clinical outcome of Maggot Debridement Therapy followed by Negative Pressure Wound Therapy for chronic hand wound with Multi-Drug Resistant Organism infection: Two cases and review of the literature.

The advancement in science and research has led to development of medical maggots which feed exclusively on dead tissue. Medical maggots have three important functions namely debridement, disinfection, and stimulation of wound healing. The modern use of medical maggots now goes by the term "Maggot Debridement Therapy" (MDT) for use in wound management. MDT is still used infrequently due to the effectiveness of surgical debridement and antibiotics for treatment of wound infection. Lately, there was emergence of Multi-Drug Resistant Organism (MDRO) likely due to inappropriate antibiotics usage. Maggot secretions have been shown to be effective in inhibiting some MDRO, for example, Methicillin-resistant Staphylococcus aureus, thus making MDT an attractive option for wounds with MDRO. We report two patients with multiple medical comorbidities, diagnosed with serious MDRO Diabetic Hand Infections treated with three cycles of MDT followed by Negative Pressure Wound Therapy.

Saving diabetic foot ulcers from amputation by surgical debridement and maggot therapy: A case report.

Introduction and importanceA diabetic foot ulcer (DFU) is one of the major diabetes complications that may lead to limb amputation. Amputation can have profound physical and psychological effects on an individual's life. Nowadays, the prevention of limb amputation and treatment of DFUs are known as the major health challenges.Case presentationThe present case report is of a 72-year-old woman with a 20-year history of type 2 diabetes who has had asymmetrical and superficial DFUs with sizes of 6 × 5 cm and 3 × 3 cm on the heel and the sole of the right foot, respectively. The ulcers were infected by S. aureus and E. coli. The patient had been hospitalized several times for receiving treatment, and not only the ulcers had not been healed, but also they had considerably extended so that the risk of foot amputation had been greatly increased. The patient was transferred to our wound care service. After conducting one session of surgical debridement, the patient underwent ten sessions of maggot therapy (one session every two days) using sterile Lucilia sericata. After about six months, the patient's DFUs were completely healed.Clinical discussionDFU can affect a patient's quality of life and lead to infection, sepsis, amputation, and even patient death. Therefore, using effective treatment approaches is very important for the management of DFUs.ConclusionThe combined use of surgical debridement and maggot therapy is a safe and effective method for improving diabetic foot ulcers and preventing amputation.

Terapia larval: protocolo básico de manutenção, desinfecção, transporte e aplicação de larvas de Chrysomya megacephala (Fabricius, 1794) (Diptera: Calliphoridae)

Chrysomya megacephala (Fabricius, 1794) (Diptera: Calliphoridae) is an exotic blowfly in Brazil and it is considered one of the main species of medical-forensic importance. Their larvae have a necrophagous habit with a high forensic potential and they are also considered an important tool for treating chronic wounds, a technique known as maggot therapy, which is not yet routinely used in Brazil despite proven efficacy. In this context, the present work aims to describe a protocol for carrying out the technique, with the complete description of colony maintenance, preparation and disinfection of eggs, packing and transportation of larvae for use, application and removal of the larvae on patients. Thus, with this protocol, the maggot therapy can be disseminated and performed by other research groups.

A molecular approach to maggot debridement therapy with Lucilia sericata and its excretions/secretions in wound healing

Chronic wounds caused by underlying physiological causes such as diabetic wounds, pressure ulcers, venous leg ulcers and infected wounds affect a significant portion of the population. In order to treat chronic wounds, a strong debridement, removal of necrotic tissue, elimination of infection and stimulation of granulation tissue are required. Maggot debridement therapy (MDT), which is an alternative treatment method based on history, has been used quite widely. MDT is an efficient, simple, cost-effective and reliable biosurgery method using mostly larvae of Lucilia sericata fly species. Larvae can both physically remove necrotic tissue from the wound site and stimulate wound healing by activating molecular processes in the wound area through the enzymes they secrete. The larvae can stimulate wound healing by activating molecular processes in the wound area through enzymes in their excretions/secretions (ES). Studies have shown that ES has antibacterial, antifungal, anti-inflammatory, angiogenic, proliferative, hemostatic and tissue-regenerating effects both in vivo and in vitro. It is suggested that these effects stimulate wound healing and accelerate wound healing by initiating a direct signal cascade with cells in the wound area. However, the enzymes and peptides in ES are mostly still undefined. Examining the molecular content of ES and the biological effects of these ingredients is quite important to illuminate the molecular mechanism underlying MDT. More importantly, ES has the potential to have positive effects on wound healing and to be used more as a therapeutic agent in the future, so it can be applied as an alternative to MDT in wound healing.

Evaluation of larval therapy effects on the progression of equine sarcoid

Background: The skin is the largest organ of the body and is of particular importance in the beauty and economic value of the horse. Equine sarcoid disease (ESD) is the most common skin tumor in horses. So far, various methods have been used to treat sarcoidosis, but no fully effective treatment has yet been proposed. The use of larval therapy in the treatment of human diabetic ulcers and horse hoof lesions is spreading. Reports of the use of larval therapy to treat the complications of tumor lesions have been promising.Objectives: This study was performed to evaluate the effect of larval therapy on equine sarcoid lesions. Methods: In this study, 4 cases were diagnosed with sarcoid by clinical examinations and pathological tests, and larval therapy was used to treat sarcoid lesions. To place the larvae on the lesion, the method of implantation in an artificial nest was used. The number of larvae used per square centimeter was about 10 larvae. Result: The result of treatment was satisfactory in 2 cases of horses and even in one case the lesion was largely limited and the emergence of healthy skin began. In the other two cases, no positive result was seen, which was probably due to the extent of the lesion and the instability of the larvae on it. Conclusions: According to the obtained results, it seems that larval therapy is effective for the treatment of sarcoid necrotic lesions, but more studies are needed in this field.

The biological debridement of bedsore with the larvae of Lucilia sericata: a case report

Bedsores are caused by decreased tissue perfusion due to prolonged pressure on the skin and represent one of the problems of immobilized patients, including hospitalized ones. This study reports the successful treatment of a patient with bedsore wounds using the larvae of the fly Lucilia sericata. The study focused on a 64-year-old man residing in Qom (a city in central Iran), who was hospitalized for 45 days at Qom Shahid Beheshti Hospital in November 2019 because of cardiovascular disease and chronic obstructive pulmonary disease (COPD). He had a pressure ulcer of about 9.5 cm in diameter on the skin overlying the sacrum. After showing resistance to honey dressing and conventionalantibiotic treatments, maggot therapy was recommended. This procedure was done by releasing the larvae of L. sericata 12 times every three days. The removal of necrotic tissues and the appearance of the granulated tissues were recorded using a ruler as an indicator of healing. After 12 sessions of larval treatment, the wound surface considerably reduced and was finally healed. Thus, it can be argued that maggot debridement therapy (MDT) is an effective treatment for bedsores and can be recommended to physicians as an adjuvant treatment for complex and resistant ulcers.

The Effect of Antibiotics on Lucilia sericata’s Maggot in the Treatment of Patients with Osteomyelitis

Objective: Applying antibiotics and maggot of Lucilia sericata, in our study, it was aimed to treat patients with osteomyelitis who had been treated with antibiotics, hyperbaric oxygen, vacuum, classical treatment methods and surgical debridement for a long time but did not show any improvement. Methods: Between July 2008 and September 2018, Maggot Debridement Therapy (MDT) was planned for 257 patients with osteomyelitis, 74 women and 183 men. Before starting the treatment, the material was taken from the wounds of the patients and sent to the microbiology laboratory. The antibiotic treatment that was initiated in the patients was continued and L. sericata maggot were placed in their wounds twice a week, and they were removed from the wound after being held for 48-72 hours. Results: From 165 patients with ongoing oteomyelitis treatment, 156 patients (94.5%) were treated, but 9 patients (5.5%) were untreated.

Microbiological effects in patients with leg ulcers and diabetic foot treated with Lucilia sericata larvae.

Lucilia sericata bottle fly worms can be used to heal infected, chronic, or necrotic wounds, including those associated with ulceration and diabetic foot. The study aimed to evaluate changes in the microflora in patients treated with L sericata larvae due to leg ulcers and diabetic foot. One hundred twenty‐nine patients diagnosed with lower limb ulceration and diabetic foot were enrolled in the study, of which 80 of them met the eligibility criteria for maggot debridement therapy (MDT). On the contrary, 49 unqualified patients were offered ozone therapy (22 with leg ulcers; 27 with diabetic foot). In each of these patients, a microbiological swab was performed before and after the start of therapy. The group of 80 patients was further divided into four equal groups in terms of the treated area (lower leg vs foot) and the number of larvae/cm2 (5 vs 10). Twenty‐three particular species of bacteria in the infected wound were studied microbiologically in terms of presence/absence within the wound environment before and after treatment of patients with diabetic foot and lower limb ulceration. It was noted that there was a more intensive bacterial accumulation in the feet of patients compared to legs; furthermore, this applies to almost all analysed species. Diabetes status is also a clinical factor that generates a lower chance of bacterial appearance in the wound environment. Densification of MDT larvae per wound area unit also reduced the chance of the presence of Corynebacterium species, Enterobacteriaceae, Pseudomonas aeruginosa, Staphylococcus aureus MSSA, and Streptococcus coagulase negativa; however, it increased the likelihood of occurrence for Proteus mirabilis and the Proteus species. A microbiological analysis in this non‐reference study shows the efficacy of larval therapy for leg and foot ulcers. Rearrangement of the microflora within the wound has been reported as a result of the therapy.

Surgical debridement, maggot therapy, negative pressure wound therapy, and silver foam dressing revive hope for patients with diabetic foot ulcer: A case report.

Introduction and importanceDiabetic foot ulcers (DFUs), as one of the most debilitating complications of diabetes, can lead to amputation. Treatment and management of d DFUs are among the most critical challenges for the patients and their families.Case presentationThe present case report is of a 63-year-old man with a 5-year history of uncontrolled type 2 diabetes who has had DFU for the past three years on three sites of the left external ankle in the form of two deep circular ulcers with sizes of 6 × 4 cm and 6 × 8 cm, the sole as a superficial ulcer with a size of 6 × 3 cm, and the left heel as a deep skin groove. Moreover, the left hallux was completely gangrenous. The patient's ulcers were infected with Staphylococcus aureus and multidrug-resistant Pseudomonas aeruginosa. The patient was transferred to our wound management team. DFU was treated and managed using a combination of surgical debridement, maggot therapy, the Negative Pressure Wound Therapy (NPWT), and silver foam dressing. After three months and ten days, the patient's ulcers completely healed, and he was discharged from our service with the excellent and stable condition.Clinical discussionDFUs are caused by various pathological mechanisms, the monotherapy strategy would lead to a very low level of recovery. Therefore, DFU management requires multimodal care and interdisciplinary treatment.ConclusionBased on the present case report study's clinical results, wound-care teams can use the combination therapy applied in this case report to treat refractory DFU.

Updated Use of Maggots for Debridement

Abstract Historical and modern-day use of maggots for debridement is described. Included are benefits of maggot therapy based on the evidence. This article also includes method for procurement.

Que informações são utilizadas durante o tratamento de feridas?

Durante o tratamento de feridas, profissionais de enfermagem precisam consultar várias informações para decidirem o que fazer e precisam registrar as informações produzidas. Este trabalho relata uma investigação sobre as necessidades informacionais de profissionais de enfermagem durante o tratamento de feridas. Foi aplicado um questionário com 14 perguntas para 50 participantes de um curso de Terapia Larval, um tipo de tratamento de feridas. O questionário abordava o perfil dos participantes e suas necessidades informacionais. Após a análise descritiva individual dos dados coletados em cada pergunta, analisou-se possíveis relações entre algumas respostas para verificar a influência do perfil do participante sobre sua necessidade informacional. Identificou-se informações importantes sobre o paciente, suas feridas, fontes de informação utilizadas, modos de registro de informações produzidas durante os atendimentos, e sobre os tipos de apoio informacional que um software poderia oferecer para apoiar o tratamento de feridas. Uma melhor compreensão das necessidades informacionais durante o tratamento serve de insumo para o oferecimento de um melhor suporte informacional aos profissionais e pacientes envolvidos.

Maggot debridement therapy for the treatment of diabetic foot ulcers: robbing the rich past to give to the sore

A diabetic foot ulcer (DFU) is a serious complication of diabetes mellitus that results in significant morbidity and mortality. The lifetime risk of a patient with diabetes developing a DFU is 15-25%1. Furthermore, the incidence of DFUs is increasing in line with the growing burden of diabetes worldwide. The number of lower limb amputations secondary to diabetes has reached an all-time high in England, with 26,378 recorded from 2014-2017, an increase of 19.4% from 2010-20132. Maggot debridement therapy (MDT) involves the application of sterile larvae, usually of the species Lucilla sericata (common green bottle fly), which remove devitalised tissue to promote wound healing. This historical therapy re-emerged in the 1990s to combat the increasing incidence of recalcitrant wounds, such as DFUs. Since its reintroduction, there has been ongoing debate in the medical literature regarding the efficacy of MDT in the treatment of DFUs and other chronic wounds. We present the case of a 57-year-old male admitted with diabetic foot sepsis and multiorgan failure and discuss how MDT was used to complement initial surgical and antibiotic management. A 14-day course of MDT improved wound debridement and decreased necrotic tissue burden, after which no further surgical interventions were needed. This case provides further evidence that MDT is effective in the selective debridement of necrotic tissue and can aid the preservation of limb length in DFU patients, thereby highlighting the importance of MDT in multispecialist diabetic foot care.

Maggot Therapy in Chronic Wounds: New Approaches to Historical Practices

Abstract Blowfly larvae of Lucilia sericata (Meigen) (Diptera: Calliphoridae) are well established as debridement agents in nonhealing wounds. Maggot therapy (MT) experienced reduced application following adoption of Penicillin and other antibiotics, but the advent of antibiotic resistance and the growing global wound burden have boosted demand for new therapies. The mechanisms of action are well accepted, with debridement, disinfection, biofilm destruction, and inhibition, as well as the stimulation of tissue growth uniformly acknowledged as a remarkable biotherapy. The mechanisms of action, while well-recognized, are still being examined. The efforts to understand isolated aspects of a complex system, have resulted in a tendency to approach the field from simplified viewpoints that remove the holistic system of the larvae. Furthermore, clinical studies have conflated wound debridement and healing in definitions of ‘success’. Thus, both in vitro and clinical studies have reported mixed results, presenting some uncertainty regarding the utility of MT that prohibits routine clinical adoption. This review builds from the generally accepted basic mechanisms to justify a future for MT that encompasses larval-bacterial symbioses as the basis to a holistic system. Symbioses are well documented in the Insecta, and literature in MT supports the existence of established symbiotic associations that provide enhanced debridement action. The future of MT requires consideration of a biological system that confers enhanced antimicrobial action on larvae when selective pre-exposure to carefully selected symbionts is adopted. In treating contemporary infections, there is much to be gained from reflecting on the natural biology of the organism, as MT was used with success long before we sterilized the system.

Acceleration of cutaneous wound healing by Lucilia sericata maggots in diabetic Wistar rats.

The study was aimed to evaluate the effectiveness of maggot therapy in healing of cutaneous infected wound in streptozotocin (STZ) induced diabetic Wistar rat. For live maggots, the sterilized eggs of Lucilia sericata were obtained from colonies established in laboratory. Diabetes model was established in 48 male Wister rat by intra-peritoneal injection of STZ at the dose of 60 mg/kg body-weight. Cutaneous wounds exposed with mixed colonies of bacteria like Staphylococcus aureus, E. coli and Pseudomonas aeruginosa were prepared in all rat. The animals equally divided in 4 groups with 12 rats each being presented as treatment group of control, antibiotic, maggot and maggot with antibiotic in combination. All treatments were done once and hold for 24 hours. Wound kinetics and bacterial bio burden were measured at weekly interval to till complete healing. Significant reduction in wound area with maximum contraction was found (>95%) in maggot treated group when compared to antibiotic treated (79%) and control (72%). In maggot as well as maggot and antibiotic in combination group showed early elimination of bacterial bio-burden 7.88±0.03log CFU/ml to 1.12±0.65log CFU/ml and 7.86±0.04) log CFU/ml to 1.54±0.52log CFU/ml respectively in three weeks of time. Early healing indication was also experienced on histomorphological examination of wounded tissue of maggot treated groups by early and better epithelialization, collagenation and neovascularization with complete healing of wound in three weeks in comparison to antibiotic and control respectively. However, the present study did not show any difference in healing of wound with use of maggot alone or in antibiotic combination. Live maggot of Lucilia sericata effectively lower bacterial bioburden and and accelerate healing of infected cutaneous wound in diabetic conditions.