Travel Alert

• By

• Dr.Ashok laddha• Occupational Health

Physician

• MBBS, PGDC ,PGDD, PGDEM, AFIH ,ACLS,BLS

• Diploma in Workplace Health and safety. MBA-HA(In –Progress)

Myiasis-Occupational Diseases

• The distribution of human myiasis is worldwide• more species and greater abundance in poor

socioeconomic regions of tropical and subtropical countries.

• Increasing international travel, both for tourism and for business, raises the need for physicians to cover a large spectrum of diseases, especially those caused by infectious agents

• Skin diseases, together with systemic febrile illness and acute diarrhea, are the leading causes of health problems in travelers

Scenario

• Skin diseases, together with systemic febrile illness and acute diarrhea, are the leading causes of health problems in travelers and account more than 8% to 12% of all tourists medical problems.

• Myiasis is usually among the five most common dermatologic conditions, representing more than 7.3% to 11% of cases

• Myiasis, a noun derived from Greek (mya, or fly), was first proposed by Hope

• Occupational Dermal myiasis is common in livestock husbandary.

Causes

• common flies that cause the human infestation are

• Dermatobia hominis (human botfly) • and Cordylobia anthropophaga (tumbu fly)

THERAPEUTICAL Application

• Maggots have been used THERAPEUTICALLY to clean out necrotic wounds an application known as Maggot THERAPY

Types

• Cutaneous myiasis, the 2 main clinical types are wound myiasis and furuncular (follicular) myiasis.

• Nasopharyngeal myiasis, the nose, sinuses, and pharynx are involved.

• Ophthalmomyiasis affects the eyes, orbits, and periorbital tissue, and intestinal and urogenital myiasis involves invasion of the alimentary tract or urogenital system.

• A rare type of myiasis, hematophagous myiasis, is common in infants younger than 9 months, especially in those living in rural and endemic areas, and the furuncular lesions are usually on the face

Symptoms

• Symptoms Painful, slow-developing ulcers or furuncle- (boil-) like sores that can last for a prolonged period.

• Obstruction of nasal passages and severe irritation.• In some cases facial edema and fever can develop.

Death is not uncommon. • Crawling sensations and buzzing noises. Smelly

discharge is sometimes present. If located in the middle ear, larvae may get to the brain. Fairly common, this causes severe irritation edema, and pain.

Risk Factors

• Poor sanitation• Inadequate personal hygiene• Inadequate garbage disposal• Improper food inspection and washing

First-line treatment

• Surgical removal with local anesthesia is usually the preferred approach.

• The larva can then be removed carefully using toothed forceps .

• Furthermore, care should be taken to avoid lacerating the larva because retained larval parts may precipitate foreign body reaction.

Second-line treatment

• Occlusion/suffocation approaches• These treatments include petroleum jelly, liquid paraffin,

beeswax or heavy oil, or lard or bacon strips placed over the central punctum and have been used to coax the larva to emerge spontaneously head-first over the course of several hours, at which time, tweezers (or forceps) aid in the capture.

• These approaches take advantage of the larva's oxygen requirements, encouraging it to exit on its own. However, the covering should not be restrictive (eg, nail polish) because this may asphyxiate the larvae without causing them to migrate out of the skin.

Third-line treatment

• Systemic/topical ivermectin• An alternative treatment for all types of myiasis is oral

ivermectin (200 mcg/kg) ivermectin or topical ivermectin (1% solution), proven especially helpful with oral and orbital myiasis.

• Ivermectin, a semisynthetic agent of the macrolide family (derived from a natural substance. Introduced for medical use in the 1980s as a broad-spectrum antiparasitic drug,

• Different therapeutic schemes have been adopted for ivermectin use in the treatment of myiasis: just one oral dose of 150 to 200 μg/kg of body weight is the most commonly prescribed dose.

Prevention-1• Poor sanitation is probably the most important risk factor for

human myiasis. • Low socioeconomic status, especially in poor countries, has an

intimate relationship with the lack of basic sanitation and inadequate garbage disposal, leaving organic material exposed.

• Adequate sanitation can be reached only when government, population, and education programs work together.

• Individual actions should also be implemented and include emptying and steam cleaning dumpsters on a regular schedule,

• Washing food and making a visual inspection of the food before consumption, storing food in adequate receptacles,

• Making sure wounds are cleaned and dressed regularly, and more

Prevention-2• Good sanitation can avert many myiasis cases. • In regions of endemicity, sleeping nude, outdoors, and on the

floor should be avoided. Appropriate precautions will help avoid infestations.

• The use of screens and mosquito nets is essential to prevent flies from reaching the skin. D. hominis infestation may be thwarted by the application of insect repellents containing diethyltoluamide (DEET).

• Drying clothes in bright sunlight and ironing them are effective methods of destroying occult eggs laid in clothing, especially by C. anthropophaga).

• Other general precautions include wearing long-sleeved clothing, covering wounds, and avoiding falling asleep outdoors.

Field control of flies

• All available methods should be used, including aerial sprays, destruction of animal carcasses, elementary sanitary and hygiene practices, and clearing of debris and rubbish near houses.

• The inactivation of females by the release of large numbers of males previously sterilized by ionizing radiation has been highly successful. Reports on the control of Cochliomyia infestation in sheep with the use of ivermectin, which has been reported to be 100% effective in controlling existing infestations and as a prophylaxis, suggest that this may be the route of the future.

Mainstay for prevention program

• Adequate sanitation can be reached only when

• government, population, individual action and education programs work together.