Letter to the Editor
Rhinosinusal myiasis by Oestrus ovis third stage larva
Miasis rinosinusal por larva de Oestrus ovis de tercer estadio
a Otorhinolaryngology – Head and Neck Surgery Department, Complejo Hospitalario de Palencia, 34005 Palencia, Castilla y León, Spain
b Otorhinolaryngology – Head and Neck Surgery Department, Complexo Hospitalario Universitario A Coruña (CHUAC), 15006 A Coruña, Galicia, Spain
c Clinical Research in Medicine, International Center for Doctorate and Advanced Studies (CIEDUS), Universidade de Santiago de Compostela (USC), 15782 Santiago de Compostela, Galicia, Spain
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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 17<span class="elsevierStyleHsp" style=""></span>mm 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 <span class="elsevierStyleItalic">Oestrus ovis</span>. 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.</p><elsevierMultimedia ident="fig1"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">O. ovis</span> 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"><span class="elsevierStyleSup">1</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">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"><span class="elsevierStyleSup">1</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">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, <span class="elsevierStyleItalic">O. ovis</span> 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"><span class="elsevierStyleSup">2</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The first-choice treatment consists in its direct extraction, although another option is oral Ivermectin in a single dose.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4</span></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 <span class="elsevierStyleItalic">O. ovis</span> in third stage.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3–5</span></a> In conclusion, <span class="elsevierStyleItalic">O. ovis</span> 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.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of interest</span><p id="par0030" class="elsevierStylePara elsevierViewall">There 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. 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Beristain" 1 => "M. Alkorta" 2 => "L. Egaña" 3 => "A. Lacasta" 4 => "G. Cilla" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/s0213-005x(01)72573-6" "Revista" => array:6 [ "tituloSerie" => "Enferm Infecc Microbiol Clín" "fecha" => "2001" "volumen" => "19" "paginaInicial" => "86" "paginaFinal" => "87" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11333582" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "[Myiasis caused by <span class="elsevierStyleItalic">Oestrus ovis</span>]" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "R. Salesa" 1 => "A. Rodríguez-Feijoo" 2 => "M.L. Cordón" 3 => "C. 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