1. Travel Alert
• By
• Dr.Ashok laddha
• Occupational Health
Physician
• MBBS, PGDC ,PGDD,
PGDEM, AFIH ,ACLS,BLS
• Diploma in Workplace
Health and safety. MBAHA(In –Progress)

2. 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

3. 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.

4. Causes
• common flies that cause the human
infestation are
• Dermatobia hominis (human botfly)
• and Cordylobia anthropophaga (tumbu fly)

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

6. 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

7. 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.

8. Risk Factors
•
•
•
•
Poor sanitation
Inadequate personal hygiene
Inadequate garbage disposal
Improper food inspection and washing

9. 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.

10. 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.

11. 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.

12. 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

13. 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.

14. 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.

15. Mainstay for prevention program
• Adequate sanitation can be reached only
when
• government, population, individual action
and education programs work together.