Microsoft Word - 11- Dr Salimi RTL.doc Iranian J Arthropod-Borne Dis, 2010, 4(1): 77–80 M Salimi et al.: First Report of Human … 77 Case report First Report of Human Nasal Myiasis Caused by Eristalis tenax in Iran (Diptera: Syrphidae) *M Salimi1, H Edalat 2, A Jourabchi 3, MA Oshaghi 2 1Department of Parasitology, School of Medicine, Arak University of Medical Science, Iran 2Department of Medical Entomology and Vector Control, School of Public Health, Tehran University of Medical Sciences, Iran 3Infectious disease Specialist, Tehran, Iran (Received 2 Feb 2010; accepted 22 Feb 2010) Abstract We report a case of human nasal myiasis caused by flower fly larva in a 14-year-old rural girl in Central Province of Iran. Entomological studies on larva showed the larva as Eristalis tenax which is a rarely cause of nasal myiasis. This is the first reported case of E. tenax larva causing human nasal myiasis in Iran. Keywords: Eristalis tenax, Nasal Myiasis, Iran Introduction Myiasis is a pathogenic condition found in live humans and animals caused by vari- ous species of dipteran larvae (Zumpt 1965). Myiasis is usually classified from an entomo- logical or a clinical point of view. Entomolo- gically, flies may be classified in to three my- iasis-producing groups: obligatory, facultative, and accidental. Clinically, myiasis can be clas- sified according to the part of the body af- fected (Langan et al. 2004). In Iran, many cases of human myiasis have been reported. The first case was re- ported by Minar when he recovered Oestrus ovis larva from the eye of an Iranian woman in Tehran (Minar 1976). Myiasis is repeated several times as ophthal myiasis (Janbakhsh et al.1977), urogenital myiasis (Jdalayer et al. 1978), orbit myiasis (Khataminia and El- yasi 1996), pharyngeal myiasis (Karimi and Vahidi 1999), ear myiasis (Talari et al. 2002), oral mucosa myiasis (Hakimi and Yazdi 2002), wound myiasis (Talari et al. 2004) and auricu- lar myiasis (Tirgarie et al. 1977, Yaghoobi et al. 2005). Recently, ophthalmomyiasis in a 62-yr old male Afghan from Isfahan Iran by Sar- cophaga (Razmjou et al. 2007), gingival my- iasis by Wohlfahrtia magnifica in a 4 yr old boy from Bushehr, Iran (Mohammadzadeh et al. 2008) and human extensive head skin myiasis by Chrysomya bezziana in 5 yr old boy in Iran (Soleimani et al. 2009). The pre- sent case is of nasal myiasis caused by larva of E. tenax for the first time in Iran. Case report The patient was a 14 yr old rural girl. She was suffering from myiasis since 5 months ago, who developed coryza, nasal grip, mild dyspenea and coughing. She had taken anti- biotic, antihistamine, and topical corticoster- oid, but none of them had sufficient effects. Radiographs have showed only minimal septal *Corresponding author: Ms Salimi, E-mail: m_salimi37@yahoo.com Iranian J Arthropod-Borne Dis, 2010, 4(1): 77–80 M Salimi et al.: First Report of Human … 78 deviation and minimal opacity in left frontal and maxillary sinuses. Finally during several sneezing pulpy mass of the left nasal, released and she referred to infectious specialist, the larva was preserved in 70% Methanol by physician and sent to the parasitological labo- ratory, Faculty of Medicine, University of Arak, for identification. Our precise identification in- dicated that the larva is the rat-tailed maggot (Eristalis tenax) according to the following morphological characters of larva: referring to the long telescopic, three- segmented respi- ratory tube at their posterior end. (Mullen et al. 2002). Fig. 1 is a picture of the larva of the relevant specimen. Fig. 1. Larva of Eristalis tenax isolated from the nose of the patient (original photo) Discussion Nasal myiasis is an infection of nasal cavities by larvae of Diptera. It is a common disease in tropical and developing countries (Aydin et al. 2006). Parasites are quite mo- bile and their clinical signs vary. Symptoms always appear abruptly. The main symptoms are a foreign body sensation and itching in the throat, being followed by cough and then other various respiratory and nasal manifestations such as nasal discharge, sneezing, laryngos- pasm, dyspnea and stridor (Wolfelschneider and Wiedemann 1996, Massodi and Hosseini 2004). Many cases of nasal myiasis have been reported world wide, caused by several differ- ent species including Oestrus ovis in Algeria (Favier 1958), and France (Delhaes et al. 2001), Phaenicia sericata in 2 comatose patients in Arizona (Beckendorf et al. 2002), Chryso- mya bezziana in a 80 yr old woman in Ma- laysia (Lee et al. 2005), Cochliomyia homi- nivorax in French Guiana (Coppie et al. 2005), Drosophila melanogaster in a 33 yr old in Turkey (Aydin et al. 2006), Sarcophaga in a 16 yr old girl in Turkey (Meral TÜRK et al. 2006), in a 70 yr old female patient pre- senting malignant nasal neoplasia and myi- asis (Manfrim et al. 2007) and in a 70 yr old female in Korea, caused by Lucilia sericata (Tae-soo Kim et al. 2009). The terms flower flies refer to their common habit of visiting flower for nectar and pollen and larvae of E. tenax called rat- tailed maggot referring to the long, telescopic, three-segmented respiratory tube at their pos- terior and by which they breathe at the water surface (Mullen et al. 2002). The larva of E. tenax develops in sewage, liquid, excrements and organic materials in decomposition, in- cluding carcasses, and occasionally, they can be found in relatively clean water (James 1947). The first case of myiasis by E. tenax was reported by Hall (Hall 1918).Since then, many more cases of human myiasis have been reported by E. tenax, which include intes- tinal myiasis (Lakshminaraynana et al. 1975), rectal myiasis (Hira 1977), gastrointestinal myiasis (Kun et al. 1998), intestinal myiasis (Aguilera et al. 1999, Whish- Wilson 2000, Dubois et al. 2004), human pseudomyiasis in Brazil (Garcia- Zapata et al. 2005), urinary myiasis in a 58 yr old woman in Turkey (Mum- cuoglu et al. 2005) human myiasis by E. te- nax in Brazil (Fernandes et al. 2009), and accidental genital myiasis by E. tenax in a 27 yr old woman in Chile (Gonzalez 2009). This current study, illustrates several in- teresting points. It shows that, our case lived in rural area, in a poor hygienic condition and lack of awareness was considered the predis- posing factors for larval infestation in this pa- Iranian J Arthropod-Borne Dis, 2010, 4(1): 77–80 M Salimi et al.: First Report of Human … 79 tient. It is also noteworthy that nasal myiasis caused by larva of E. tenax is uncommon in human. Myiasis of this type has not been re- ported previously from Iran and this case is the first report of human nasal myiasis caused by E. tenax in Iran. Acknowledgments We appreciate Dr MA Daneshmand from Sina Med Laboratory for sending this specimen. The authors declare that they have no conflicts of interest. References Aguilera A, Cid A, Regueiro Bj, Prieto JM, Noya M (1999) Intestinal myiasis caused by Eristalis tenax. J Clin Microbial. 37 (9): 3082. Aydin E, Uysal S, Akkuzu B, Can F (2006) Nasal myiasis by Fruit fly larvae: a case report. Eur Arch Otorhinolaryngol. 263 (12): 1142–1143. Beckendorf R, Klotzs A, Hinkle N, Barthe- lomew W (2002) Nasal myiasis in an intensive care unit Linked to hospital- wide mouse infestation. Arch Intern Med. 1626): 638–640. Couppie P, Roussel M, Rabarison P, Sockeel Mj, Sainte Marie D, Marty C, Carme B(2005) Nosocominal myiasis to Cochliomyia hominivorax: a case in French uiana. Int J Dermatol. 44(4): 302–303. Delhaes L, Bourel B, Pinatel F, Cailiez JC, Gosset D, Camus D, Dei- Cas E (2001) Human nasal myiasis due to Oestrus ovis. Parasite. 8(4): 289–296. Dubois E, Durieux M, Franchimont MM, Hermant P (2004) An unusual case in Belgium of intestinal myiasis due to Eri- stalis tenax. Acta Clin Belg. 59(3): 168– 170. Favier G (1958) A case of oculo-nasal myi- asis caused by Oestrus ovis and seen at saoura (southern Oran). Arch Inst Pas- teur Alger. 36 (2): 182–183. Fernades LF, Pimenta FC, Fernandes FF (2009) First report of human myiasis in Goias state, Brazil: frequency of dif- ferent types of myiasis, their Various etio- logical agents, and associated factors. J Parasitol. 5(1): 32–38. Garcia- Zapata Mt, Desouza Junior ES, Fer- nandes FF, Santos SF(2005) Human Pseudomyiasis caused by Eristalis tenax (Linnaeus) (Diptera: Syrphidae) in Goias. Revista Da Sociedade Brasileira De Medicina Tropical. 38(2):187–188. Hakimi R, Yazdi I (2002) Oral mucosa myi- asis caused by Oestrus ovis. Arch Ira- nian Med. 5(3): 194–196. Hall. M C (1918) A note regarding myiasis especially that due to Syrphid larvae. Arch Internal Med. 21(3): 309–312. Hira PR (1977) Rectal myiasis: first report on a case due to the rat-tailed Larva of Eristalis tenax in africa. East Afr Med J APR. 54 (4): 224–226. James MT (1947) The flies that cause myi- asis in man.US Department of Agricul- ture, Miscellaneous publication no 631 Washington, pp.148–150 Janbakhsh B, Pirous Ms, Tirgari S, Aghamo- hammadi A (1977) A case of ophthal- momyiasis in man by Oestrus ovis lin- neaeus in Tehran (Insecta: Diptera, Oes- tridae). Acta Medica Iranica.20: 19–26 Jdalayer T, Maleki M, Moghtader M (1978) Human urogenital myiasis cause by Chry- somyia Bezziana. Iranian J Public Health. 7(3): 116–118. Karimi Gh, Vahidi Mr (1999) A case report of pharyngeal myiasis. Journal of Sha- hid Sadoughi University of Medical Sci- ence and Health Services.1(7): 91–94. Khataminia Gh, Elyasi P (1999) Advanced orbital myiasis: A case report in Sina Hos- pital, Ahwaz. Scientific Journal of the Eye Bank of I.R. Iran. 1(5): 59–61. Kun M, Keriter A, Semenas L (1998) Gastro- Iranian J Arthropod-Borne Dis, 2010, 4(1): 77–80 M Salimi et al.: First Report of Human … 80 intestinal Human myiasis caused by Eri- stalis tenax. Rev Saude Publica. 32(4): 367–369. Lakshminarayana CS, Kanchana MV, Janaka Valli R, Mallika M (1975) Intestinal my- iasis due to Eristalis tenax. J Indian Med Assoc. 65 (8): 234–235. Langan SM, Dervan P, Loughlins O (2004) A moving scalp nodule in a returning traveler. Br J Dermatol. 151(6): 1270. Lee HL, Krishnasamy M, Jeffery J (2005) A case of Human nasopharyngeal myiasis caused by Chrysomya bezziana Vil- leneuve, 1914 (Diptera: Calliphoridae) in Malaysia. Tropical Bio Medicine. 22(1): 87–88. Masoodi M, Hosseini K (2004) External oph- thalmo myiasis causedc by sheep botfly (Oestrosovis) Larva: a report of 8 cases, Arch Iranian Med. 7 (2): 136–139. Meral Türk, Ilhan AFSAR, Yufuf OZBEL, Asli Gamze SENER, Ahmet ÜNER, Metin TÜRKER (2006) A case of naso myiasis whose agent was Sarcophaga SP. Turkey Parazitoloji Dergisi. 30 (4): 330–332. Minar J (1976) A case of eye myiasis in man caused by first instar larvae of Oestrus ovis L. (Diptera Oestridae) in Iran. Folia Parasitol. (23): 283. Mohammadzadeh T, Hadadzadeh R, Esfan- diari F, Sadjjadi SM (2008) A cause of gingival myiasis caused by Wohlfahr- tia magnifica. Iranian J Arthropod Borne Dis. 2(1): 53–56. Mullen Gary, Durden Lance (2002) Medical and Veterinary Entomology, Elsevier Science, UK. Mumcuoglu I, Akarsu GA, Balaban N, Keles L (2005) Eristalis tenax as a caused of urinary myiasis. Scand J Infect Dis. 37 (11–12): 942–943. Razmjou H, Mowlavi GH, Nateghpour M, Solaymani- Mohammadi S, Kia EB (2007) Opthalmomyiasis caused by Flesh fly (Diptera: Sarcophagidae) in a patient with eye melignancy in Iran. Iranian J Arthropod Borne Dis.1 (2): 53–56. Soleimani Ahmadi M, Nasirian H, Nazemi Ghesmi Am, Yaghoobi Ershadi MR (2009) Human extensive head Skin my- iasis. Iranian J Publ Health. 38: 134–138. Tae- Soo Kim, Pil- Wanseo, Jong- Wan Kim, Hai- Hyang GO, SOO- Cheol Jang, Hye-Jung lee, Min Seo (2009) A Nasal myiasis in a 70 yr old female in Korea. Korean J Parasitol. 47(4): 405–407. Talari SA., Yeganeh Moghadam A, Dehghani R (2002) Chryzomya bezziana infesta- tion. Arch Irn Med. 5 (1): 56–58. Talari SA, Sadr F, Doroodgar A, Talari MR, Gharabagh AS (2004) Wound myiasis caused by Lucilia sericata. Arch Ira- nian Med. 7 (2): 128–129. Tirgari S, Khalkhali K, Aghamohammadi A (1977) First case of auricular myiasis due to Sarcophaga. (Bercaea) haemor- rhoidalis (Fallen) (Dipt. Sarcophagiae). Ent Mon Mag. 112: 255–256. Tirgari S, Nateghpour M, Jahanian AH, Akbarzadeh K (2003) First record of Human myiasis caused by Chrysomya bezzinana (Villeneuve in Iran (Diptera, Calliphoridae). Iranian J Publ Health. 32 (3): 68–70. Whish-Wilson PB (2000) A possible case of intestinal myiasis due to Eristalis tenax. Med J Aust. 173 (11–12): 652. Wolfelschneider P, Wiedemann P (1996) Ex- ternal Opthalmic myiasis caused by Oes- trus ovis (sheep and goat bot fly) [in German]. Klin Monatsble Augen Heilkd. 209 (4): 256–258. Yaghoobi R, Tirgari S, Sina N (2005) Hu- man auricular myiasis caused by Lu- cilia Sericata: Clinical and Parasito- logical. Considerations Acta Med Iran. 43(2):155–157. Zumpt F (1965) Myiasis in Man and Animals in the Old World: A textbook for Phy- sicians, Veterinarians and Zoologists. But- terworths Publishing Company, London.