chryzomya Iranian J Arthropod-Borne Dis, (2009), 3(1): 60-63 A Faramarzi et al: Chrysomya bezziana as … 60 Case report Chrysomya bezziana as a Causative Agent of Human Myiasis in Fars Province, Southern Iran A Faramarzi, AR Rasekhi, M Kalantari, *GR Hatam Department of Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Iran (Received 13 Jun 2009; accepted 1 Sep 2009) Abstract Myiasis is the invasion of body tissues of humans or animals by the larvae of the Diptera or two-winged flies. The various forms of myiasis may be classified from clinical or entomological point. This study describes the existence of Chrysomya bezziana (Diptera: Calliphoridae) cases as a causative agent of myiasis in 18 and 87 year-old men in two different regions in Fars Province. To our knowledge, this is the first observation of mentioned species in this province. Keywords: Chrysomya bezziana, Myiasis, Iran Introduction Myiasis can be defined as invasion of the organs and tissues of human or vertebrate animals with dipterous larvae (Rohela et al. 2006). Dipterous larvae belonging to the fam- ily Calliphoridae are able to invade to hu- mans’ tissues or cavities (Granz et al. 1975). They are usually saprophagous, feeding on car- casses, but the eggs can also be laid upon live- stock and humans, or either on wounds, sores or areas contaminated with faeces or urine, where the feeding of larvae causes debilitat- ing myiases (Green et al. 2004). They have been reported as a secondary myiasis producer in livestock operations (Byrd and Allen 2001). Myiasis appears to be fairly common but un- derestimated in many rural areas. In some areas of Fars Province in the south of Iran and, the cases of myiasis caused by this family spe- cially belonging to Chrysomya bezziana have been increased (Navidpour et al. 1996; Rad- manesh et al. 2000, Masoodi et al. 2004). This study presents two patient cases of myiasis in- fected by C. bezziana. The importance of this study was to report the new species of myiasis in Fars Province in the south of Iran. Case report Two cases with the following charac- teristics were investigated in this study. An 18 yr old boy from Lamerd County was one of the victims of variable myiasis cases causes in Fars Province. He was referred to Khalili Hospital (affiliated to Shiraz Univer- sity of Medical Sciences) by his mother. He was a known case of congenital cerebral palsy with quadriplegia and mental retardation asso- ciated with severe failure to thrive. He was referred due to an oral lesion and poor feed- ing because of his inability to feed orally. His family was in low economic status with poor hygiene. In physical examination, he looked like a 5 yr old boy due to severe failure to thrive. He had diffused erythematous, a tender hard palate and a superficial ulcerative mu- cosal lesion between the peripheral aspect of the palate and the upper gum, associated with odynophagia, lethargy and dehydration. A Total of 33 worm-like organisms were detected in the peripheral part of his palate (Fig. 1a). Dur- ing the hospital course, after local and suppor- tive therapy condition of the patient, he im- proved and was discharged from hospital. *Coresponding author: Dr Gholam Reza Hatam, E-mail: hatamghr@sums.ac.ir Iranian J Arthropod-Borne Dis, (2009), 3(1): 60-63 A Faramarzi et al: Chrysomya bezziana as … 61 Another case was an 87 yr old addict man with cardiovascular as well as peripheral vascular disease based on the longstanding dia- betes mellitus from Shiraz, southern Iran. He also referred to hospital with chief complaint of severe itching of both lower extremities. The patient had history of both feet vascular ulcers for which receiving pentoxiphiline at a dose of 1000 mg/day and also antianginal drugs. In both cases, the different stages of iso- lated larvae were cultured in Blood Agar (BA) medium. The growth rates of them were fol- lowed up at 37 oC incubator, and the metamor- phosis of the pupa to the adult stage were followed in glass flasks containing BA medium (Kalantari et al. 2006). Diagnosis of myiasis causing larvae is based on the form of spiracles, cephalopharyn- geal skeleton, shape and size of developed lar- vae: the posterior spiracles (Fig. 1c), do not have a distinct button and the numbers of lobes on the anterior spiracles are six, which would give a definitive identification of C. bezziana. Finally, the robust spine bands (Fig. 1b), are other indicative criteria of C. bezziana (Belding 196), as well as characteristics of reared adults. In the subfamily Chrysomyinae, body-length varies between 8 and 12 mm, abdomen and thorax is shining metallic, dorsum of the first and the second abdominal tergites are black. Body is metallic green or blue and abdomi- nal tergites include narrow dark bands along posterior margins. Legs are black or partly dark-brown; wings are hyaline with the infus- cated base (Fig. 2) (Whitworth 2006). Based on the mentioned diagnostic keys and comparing the whole shape of the larvae (Fig. 1b), posterior spiracles (Fig. 1c), cephalo- pharyngeal skeleton (Fig. 1d), and also adult characteristics, they were diagnosed as Chry- somya bezziana (Diptera: Calliphoridae). Fig.1. (a): The patient's mouth part infested by Chrysomya bezziana larva, (b): C. bezziana in the third stage of lar- vae (125×), (c): Posterior spiracle of C. bezziana in the third stage of larvae (125×), (d): Cephalopharyngeal skeleton of C. bezziana in the third larval stage (125×) (Original photos) Iranian J Arthropod-Borne Dis, (2009), 3(1): 60-63 A Faramarzi et al: Chrysomya bezziana as … 62 Fig. 2. Details of the adult of Chrysomya bezziana found in this study: (a): whole body (40×), (b): wing (100×), tho- rax (125×), (d): head (125×) (Original photos). Discussion A number of species in Calliphoridae fa- mily are responsible for causing myiasis in hu- man and animals (Zumpt 1965, Granz et al. 1975). Human myiasis due to this family have been reported from the United States of America (Hall et al. 1986; Alexis and Mittle- man 1988; Miller et al. 1990) and Canada (Ali- khan and Ali-khan 1975). They have also been reported as the agents of urogenital myiasis in Pakistan (Jabbar-khan and Jabbar-khan 1985). Lucilia sericata (Diptera: Calliphoridae) has caused wound (Talari et al. 2004) and auricular myiasis (Yaghoobi et al. 2005) in the central parts of Iran. A rare case of internal myiasis caused by Cynomyopsis cadaverina has been reported from Shiraz, Southern Iran (Kalantari et al. 2006). An oral mucosal myi- asis has been caused by Oestrus ovis in Ha- madan, situated 336 km south west of Te- hran (Hakimi and Yazdi. 2002). In Shiraz, A case of gingival myiasis due to Wohlfahrtia magnifica has been reported (Mohammadzadeh et al. 2008). C. bezziana (Diptera: Calliphori- dae) has been reported from Khoozestan Pro- vince, Southeastern, Iran (Navidpour et al. 1996; Radmanesh et al. 2000). However, to our knowledge this is the first observation of C. bezziana as the causative agent of oral and wound myiasis in Fars Province. 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