Rhinosinusal myiasis by Oestrus ovis third stage larva

Díez-González, Laura; Poncela-Blanco, María; Mayo-Yáñez, Miguel

doi:10.1016/j.medcli.2019.09.010

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The patient came from a rural area although without regular contact with livestock animals. The anterior rhinoscopy showed hyperemia, edema of the nasal mucosa and watery rhinorrhea. After the examination, and with a sneeze of the patient, a 17mm long larva with dorsal spots and spines that surrounded each segment of the body in its ventral face was expelled (<a class="elsevierStyleCrossRef" href="#fig1">Fig. 1</a>). The study by the microbiology department identified the specimen as Oestrus ovis. Computerized tomography (CT) showed a partial occupation of the right maxillary sinus and of both sphenoidal sinuses, characterized by a radio dense portion and a confluent, honeycombed microcystic component, in relation to sphenoidal colonization by larvae/eggs. The patient received oral treatment with a single dose of Ivermectin and intranasal nasal lavages and corticosteroids, obtaining complete remission of symptoms and normal sinonasal examination through fibronasoendoscopy and nasosinusal control CT. After six months of follow-up without evidence of recurrence, the patient was discharged.<elsevierMultimedia ident="fig1"></elsevierMultimedia>O. ovis is a parasite responsible for myiasis in sheep, in which the adult females deposit their larvae in the nostrils. It has a wide global distribution, with a higher prevalence in regions with warm and humid climates. The identification of the parasite is carried out through endoscopic examination, but the diagnosis of the myasis is microbiological. Also, computerized tomography can help complete the study, demonstrating the presence of larvae.<a class="elsevierStyleCrossRef" href="#bib0005">1</a>The larvae, in their first stage, are fixed to the mucosa through their buccal hooks, migrating to the paranasal sinuses, where after two molts they end their maturation, reaching the second and third larval stages in the host. The mature larvae, characterized by a robust and dark brown body divided into segments, creep towards the nostrils where they are usually expelled by sneezing, continuing its development until the adult form.<a class="elsevierStyleCrossRef" href="#bib0005">1</a>Occasionally, human can act as a guest, identifying themselves fundamentally among those with livestock activity or in patients with underlying diseases. In Europe, the incidence is greater in the Mediterranean countries, with several cases reported in Spain. In most of these cases, the affectation is in the conjunctival sac, being the most frequent cause of external ophthalmomyasis worldwide. Although with less incidence, O. ovis can also cause nasopharyngeal involvement. In these cases, the symptoms are nasal congestion, pruritus, rhinorrhea and sneezing, simulating a rhinosinusitis.<a class="elsevierStyleCrossRef" href="#bib0010">2</a>The first-choice treatment consists in its direct extraction, although another option is oral Ivermectin in a single dose.<a class="elsevierStyleCrossRefs" href="#bib0015">3,4</a> In cases with persistent symptoms, surgical exploration of the paranasal sinuses may be necessary. This manuscript presents the fourth case described in the literature of human nasal myiasis by O. ovis in third stage.<a class="elsevierStyleCrossRefs" href="#bib0015">3–5</a> In conclusion, O. ovis nasal myiasis is a rare occurrence in humans that most often causes a mild self-limited illness. Nonetheless, it can pose a diagnostic challenge to physicians unaware of this condition.Conflict of interestThere was no conflict of interest and authors have nothing to declare. This research involved human participants and was approved by the Hospital's Ethics Committee. Informed consent was obtained from all individual participants included in the study." 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Cabada" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1155/2016/2456735" "Revista" => array:5 [ "tituloSerie" => "Case Rep Infect Dis" "fecha" => "2016" "volumen" => "2016" "paginaInicial" => "2456735" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28116184" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Nasal myiasis by Oestrus ovis second stage larva in an immunocompetent man: case report and literature review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "H. Einer" 1 => "E. 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