Human myiasis cases originating and reported in africa for the last two decades (1998–2018): A review
Graphical abstract
Human myiasis: Factors that affect the disease and its distribution.
Introduction
Myiasis is a parasitic disease named from a Greek word “myia” meaning fly, caused by invasion of living or dead tissues of humans or other vertebrates by dipteran larvae. The larval parasites responsible for this disease may be obligate, facultative, or accidental (Villwock and Harris, 2014), and largely belong to four dipteran families Callipholidae, Sarcophagidae, Oestridae and Cuterebridae (Zumpt, 1963). Approximately 50 fly species are responsible for human myiasis (Karadag-Oncel et al., 2014). Natural hosts of these flies in human environment include cattle, sheep, goats, dogs, horses and rodents (Pandey et al., 2009; Ahmad et al., 2011), and humans are only accidental host. Human myiasis is a cosmopolitan disease, but is prevalent in Africa (McGarry, 2014) and South America (Onyeama and Njai, 2005; Graveriau and Peyron, 2017). The disease is classified either as internal or external myiasis, where external myiasis comprises cutaneous, ocular and aural myiasis (Abdellatif et al., 2011), while internal myiasis consists of gastric, intestinal and urogenital infestations (Markell et al., 1999). Other workers have categorized the disease based on the affected tissue, accidental myiasis (digestive tract), semi-specific myiasis (wounds), and obligatory myiasis (undamaged skin) (Yuca et al., 2005).
Myiasis cases reported in Africa and other parts of the world but having originated from the African continent for the last two decades include cutaneous, ocular, nasal, urogenital, gastral and intestinal myiasis (Table 1). In total, we reviewed 51 articles which reported 849 cases. Cutaneous myiasis had 805 cases accounting for 94.8% of all the reported cases. But 544 of these cases were reported in Nigeria in three articles, and one of the publications reported 500 cases (Table 1). The remaining cases comprised 36 ocular, 4 gastrointestinal, 3 urogenital, and 1 case each for nasal and ocular, and aural. In 39 articles out of the 51 that we reviewed, we were able to discern age and sex of patients. A total of 57 patients were reported in these articles. The number of males (32) infected was higher compared to that of females (25). We also found that a large proportion of cases that were described belonged to the ages below 15 years (13), and above the age of 45 years (21).
Furuncular myiasis affects cutaneous tissues of patients on different parts of the body. Left untreated, the larvae mature and eventually drop on the ground to pupate. However, most patients tend to seek treatment because of the painful nodules accompanied by serosanguineous discharge. In some instances, furuncular myiasis is misdiagnosed and treated as bacterial infection. Ultimately the infection fails to heal necessitating patients to keep seeking treatment until the right diagnosis is carried out. Consequently, a lot of time and money is wasted. Wound myiasis is usually a secondary infection of wounds which make them take longer to heal and respond to treatments. Consequently, a lot of resources and money are used resulting in a negative effect on the economy. In a few cases, myiasis is known to cause significant damage to patients, for instance ocular myiasis might result in patients becoming blind and cerebral myiasis could lead to death (Zumpt, 1963; Musa and Allah, 2008).
The disease is usually associated with poverty and poor living conditions and therefore affecting poor people. However, it is also known to affect other groups of people especially travellers when they visit endemic areas where myiasis causing dipteran species are known to thrive (Gigantesco et al., 2018; Pathania et al., 2018).
Section snippets
Human myiasis cases reported in africa for the last two decades
Only 10 African countries (Table 2) recounted cases of myiasis during the period under review. Most of these are countries located in the western and northern regions of the continent. Countries in the northern region include Tunisia, Egypt, Sudan, Libya and Algeria, while those in the western part comprise Nigeria, Gambia and Sierra Leone. Central and Southern Africa were represented by Central Africa and South Africa respectively. We did not come across any articles from the Eastern side of
Myiasis cases reported by international travellers
Myiasis is a rare disease in most regions of the world because dipteran species responsible for this condition cannot survive in those areas due to unfavourable climatic conditions. But because of human travel to endemic areas, it is not unusual to diagnose cases of myiasis from travellers returning from these areas (Romano et al., 2004; Ko et al., 2018). This review identified 16 countries outside the African continent which reported 148 cases of myiasis that had originated from Africa. The
Fly species and their distribution
Cordylobia anthropophaga (Tumbu fly) (Fig. 2A) and C. rodhaini (Lund's fly) occur only in the African continent, with the former restricted to Sub-Saharan Africa and the later to rain forests of tropical Africa. The two species were mainly responsible for cutaneous myiasis, but C. anthropophaga was reported to cause urinary myiasis (Table 1). Oestrus ovis (Sheep nasal botfly) (Fig. 2B) has a worldwide distribution, and we found it responsible for ocular and nasal myiasis. However, Clogmia
Life cycle of the fly species
Dipteran flies responsible for human myiasis encountered during the period under review in Africa belong to the following families Calliphoridae, Sarcophagidae, Fanniidae, Oestridae and Psychodidae. Family Calliphoridae had five species namely C. anthropopgaga, C. rodhaini, L. cuprina, P. regina and C. megacephala. Sarcophaga (Liosarcophaga) nodosa and S. haemorrhoidalis were the two species that belong in the family Sarcophagidae. Two species were also recorded for the family Oestridae namely
Predisposing factors, prevention and treatment
The predisposing factors for human myiasis comprises unsanitary living conditions, wearing improperly dried clothes, senility, immunocompromised individuals, psychological disorders, leprosy and diabetes mellitus (Chan et al., 2005; Tligui et al., 2007; Bayindir et al., 2012). People living in close contact with domestic animals such as sheep and goats are at a higher risk (Gour et al., 2018). However, the most affected are the immobile patients, elderly and those with exposed skin wounds (
Discussion
Cutaneous myiasis constitute the majority of the reported myiasis cases in Africa. Most of these cases are furuncular myiasis which is characterized by painful nodules in the skin with confined inflammation of the dermis and subcutaneous tissue. The inflamed tissue encloses a central punctum through which the mature larvae will emerge. In Nigeria, Ogbalu et al. (2013) reported more than 500 cases, Muneizel and Weshah (2003) described 87 cases in Sierra Leonne, and in Central Africa
CRediT authorship contribution statement
Simon K. Kuria: Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Validation, Visualization, Writing - original draft, Writing - review & editing. Adebola O. Oyedeji: Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Validation, Visualization, Writing - original draft, Writing - review & editing.
Declaration of competing interest
The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:
Acknowledgements
We are grateful to Kaczmarczyk and Adisa for allowing us to use pictures from their articles showing aural and furuncular myiasis respectively. We are also indebted to Strickland who gave us permission to use the picture of C. megacephala. We thank Heyns and Hjaija et al. for allowing us to use their pictures of C. albipunctata and C. megacephala respectively. We can also not forget to express our gratitude to Kuria et al. for giving us permission to use their pictures of wound myiasis and S. (
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