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External ophthalmomyiasis by Oestrus ovis treated with tobacco: clinical case report and medical literature review
Jair García-Guerreroa, Jesús Garza-Quiñonesb, Jorge Reza-Caballerob, Juan Luis González-Treviñob
a School of Biological Science, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
b Division of Health Sciences, Universidad de Monterrey, Monterrey, Nuevo León, México
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    "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">Introduction </span></p><p class="elsevierStylePara"> Infestation with larvae &#40;maggots&#41; on human and animal tissues and organs is known as myiasis&#46; The most common site of infection is damaged skin&#44; however&#59; there are other less common places like the throat&#44; nose&#44; nostrils&#44; eyes and urogenital tract&#46; The infection of the eye caused by larvae is known as ophthalmomyiasis&#46;<span class="elsevierStyleSup">1</span> We present an external ophthalmomyiasis case by <span class="elsevierStyleItalic">Oestrus ovis</span> diagnosed and treated in a hospital in Monterrey&#44; Mexico&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Clinical case </span></p><p class="elsevierStylePara"> Female patient&#44; 16 years old&#44; without any significant medical or ophthalmological history&#46; The patient went to the ophthalmology department in a private hospital in Monterrey&#44; Mexico&#44; 3 h after suffering an impact in the left eye caused by a flying insect&#46; The patient was at school at the time of the accident and presented a sensation of a foreign body&#44; redness&#44; epiphora and burning in her left eye&#46; Upon examination&#44; the eyelids were found to be normal&#44; the conjunctive was congested and the patient retained eye movement&#46; In the biomicroscopy we observed transparent larvae moving over the bulbar conjunctive from the inferior towards the superior formix&#44; as well as on the cornea&#46; The larvae displayed a photophobic behavior since they moved away from the light from the slit lamp&#44; thus impeding photography &#40;figure 1&#41;&#46; We applied an anesthetic chloridium &#40;tetracaine&#41; in order to perform their extraction with a swab&#44; but it was difficult since they were strongly attached&#46; We used tweezers to remove the 32 larvae&#59; they were submitted to the microbiology department&#46; We prescribed antibiotic therapy and anti-inflammatory medication &#40;systemic and topical&#41;&#44; and hospitalization&#46; In addition&#44; we prepared a tobacco solution made from 10 cigarettes diluted in 100 mL of distilled water mixed with eyewash lubricant and prescribed 2 drops every hour&#46; There was no evidence of intraocular inflammation or inflammation of other organs in the eye&#46; The right eye was normal&#46; The patient remained hospitalized and was discharged on the third day given the fact she was no longer displaying symptoms&#46; In her follow-up appointments 3 and 6 weeks after the event&#44; she did not report any symptoms nor were abnormal signs found in the biomicroscopy&#46;</p><p class="elsevierStylePara"><img alt="Figure 1 Biomicroscopic photograph in which a non-pathognomonic conjunctival injection can be observed in the injury caused by the larvae&#44; which presented photophobic behavior&#44; which was why they could not be photographed&#46;" src="304v16n65-90367604fig1.jpg"></img></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Figure 1</span> Biomicroscopic photograph in which a non-pathognomonic conjunctival injection can be observed in the injury caused by the larvae&#44; which presented photophobic behavior&#44; which was why they could not be photographed&#46;</p><p class="elsevierStylePara"> The maggots &#40;larvae&#41; were studied with Lugol stain&#59; they were 1 mm long&#44; with a white-yellowish color&#44; and presented two dark horn-shaped buccal hooks attached to a cephalopharyngeal skeleton&#46; The body had 11 abdominal segments separated by another spiculed ventral&#46; The caudal pole presented a bulging with two terminal lobes and several hooks&#44; data compatible with first-stage <span class="elsevierStyleItalic">O&#46; ovis</span> larvae &#40;figures 2 and 3&#41;&#46;</p><p class="elsevierStylePara"><img alt="Figure 2 Photograph from an optical microscope &#40;&#215;100&#41; showing an Oestrus ovis larva&#46;" src="304v16n65-90367604fig2.jpg"></img></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Figure 2 </span>Photograph from an optical microscope &#40;&#215;100&#41; showing an <span class="elsevierStyleItalic">Oestrus ovis</span> larva&#46;</p><p class="elsevierStylePara"><img alt="Figure 3 Amplification of a photograph from an optical microscope &#40;&#215;400&#41; of the upper or buccal pole of Oestrus ovis&#46; Two horn-shaped buccal hooks &#40;A&#41; attached to a cephalopharyngeal skeleton &#40;B&#41; can be observed&#46;" src="304v16n65-90367604fig3.jpg"></img></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Figure 3</span> Amplification of a photograph from an optical microscope &#40;&#215;400&#41; of the upper or buccal pole of <span class="elsevierStyleItalic">Oestrus ovis</span>&#46; Two horn-shaped buccal hooks &#40;A&#41; attached to a cephalopharyngeal skeleton &#40;B&#41; can be observed&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Discussion </span></p><p class="elsevierStylePara"> Ophthalmomyiasis caused mainly by <span class="elsevierStyleItalic">O&#46; ovis</span> is a benign disease&#46;<span class="elsevierStyleSup">2&#44;3</span> It has a prevalence of &#60;5&#37; as a cause of myiasis in humans and it is classified as external or conjunctival if the larvae is on the conjunctiva&#44; and internal if it has penetrated the ocular eyeball&#46; External is the most common&#46;<span class="elsevierStyleSup">4</span></p><p class="elsevierStylePara"> Parasites from the <span class="elsevierStyleItalic">Cuteribridae</span><span class="elsevierStyleItalic">&#40;Dermatobia hominis&#41;</span> and <span class="elsevierStyleItalic">Oestridae &#40;Oestrus ovis&#41;</span> families inhabit the nasal cavities of goats and sheep and are the most common cause of ophthalmomyiasis in humans&#46; <span class="elsevierStyleItalic">O&#46; ovis</span>&#8217;s females are larviparous and capable of projecting fertilized eggs mid-flight&#44; which makes ovoposition easier&#46;</p><p class="elsevierStylePara"> Patients with this condition present similar symptoms to those of viral or bacterial conjunctivitis&#44; thus causing inaccurate diagnoses&#46;<span class="elsevierStyleSup">5</span> A study published by the United Kingdom documented a patient with external ophthalmomyiasis who developed nasal complications&#44; requiring nasal&#44; ear and throat endoscopic inspection&#46;<span class="elsevierStyleSup">2</span> On the other hand&#44; our patient did not present any complications&#46;</p><p class="elsevierStylePara"> Jenzeri et al reported a case of keratouveitis secondary to external ophthalmomyiasis in a 77-year-old adult&#44; thus recommended considering ophthalmomyiasis in the differential diagnosis of this disease&#46;<span class="elsevierStyleSup">6</span> Sreejith et al reported that <span class="elsevierStyleItalic">O&#46; ovis</span> larvae are incapable of secreting proteolytic enzimes&#44;<span class="elsevierStyleSup">7</span> therefore most of them refrain from invading other than the ocular surface&#46; However&#44; small hemorrhages may appear in the conjunctiva where the larvae attach themselves to the eye surface&#46; Our patient certainly presented tiny conjunctival hemorrhages which disappeared shortly after treatment was initiated&#46;</p><p class="elsevierStylePara"> Tropical zones with warm weather&#44; like Central America&#44; the southern United States&#44; Africa and southern Asia&#44; are the most common places to acquire this disease&#46;<span class="elsevierStyleSup">8</span> People exposed to animals&#44; or with a degree of immobility are at higher risk&#46;<span class="elsevierStyleSup">9</span> Diverse reports have proposed a treatment based on tobacco paste&#44; ether&#44; potassium permanganate&#44; chloroform&#44; pig&#8217;s fat&#44; basil&#44; chewing gum and ivermectin&#46; In our clinical case we successfully used a tobacco dilution&#46;</p><p class="elsevierStylePara"> Concerning the pharmacodynamics of tobacco plant leaves <span class="elsevierStyleItalic">&#40;Nicotiana tabacum&#41;&#44;</span> authors like Murillo10 have proved that nicotine mimicks the acetylcholine neurotrans-mission action&#44; joins the receptor of the neuromuscular union postsynaptic membrane and stimulates the generation of nervous impulses which can cause the insects&#8217; death&#46; The union of the alkaloid works through two ways&#58; contact with and ingestion of the larvae&#46; This larvacide effect has been exploited for a new generation of insecticides&#44;<span class="elsevierStyleSup">11</span> thus preventing new cases&#44; especially in emerging countries&#46;<span class="elsevierStyleSup">12 </span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conclusions </span></p><p class="elsevierStylePara"> External ophthalmomyiasis is an infrequent disease and generally benign&#46; Because <span class="elsevierStyleItalic">O&#46; ovis</span> larvae is deposited on the ocular surface without going through the egg stage&#44; all flies which impact the eye can deposit larvae directly&#44; accelerating conjunctival irritation&#46; The authors consider that one should act carefully in the diagnosis and management of this pathology due to all the possible complications which may be present&#44; such as internal ophthalmomyiasis with possible visual sequels&#46;</p><hr></hr><p class="elsevierStylePara"> Received&#58; November 2013&#59; <br></br> Accepted&#58; June 2014</p><p class="elsevierStylePara"> &#42;Corresponding author&#58; <br></br> Doctors Hospital Despacho 919&#44; <br></br> Ecuador 2331&#44; Colonia Balcones de Galer&#237;as&#44; <br></br> Monterrey&#44; 64620 Nuevo Le&#243;n&#44; M&#233;xico&#46; <span class="elsevierStyleItalic"><br></br> E-mail address&#58; </span><a href="mailto&#58;drjuanluisgonzalez&#64;prodigy&#46;net&#46;mx" class="elsevierStyleCrossRefs">drjuanluisgonzalez&#64;prodigy&#46;net&#46;mx</a> &#40;J&#46;L&#46; Gonz&#225;lez-Trevi&#241;o&#41;&#46;</p>"
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        "resumen" => "<p class="elsevierStylePara"> External ophthalmomyiasis is an infestation of conjunctiva with larvae or maggots of certain flies&#46; <span class="elsevierStyleItalic">Oestrus ovis</span> is the most common cause of human ophthalmomyiasis&#46; The case of a 16-year-old female is described&#44; who presented with foreign body sensation&#44; pain&#44; and redness in the left eye&#46; Slit-lamp biomicroscopy revealed 32 tiny larvae crawling around the conjunctival sac&#46; The larvae were mechanically removed under topical anesthesia&#44; and identified under a light microscope as first-stage larvae of <span class="elsevierStyleItalic">O&#46; ovis</span> causing external ophthalmomyiasis&#46; She was successfully treated with topical tobacco juice&#46;</p> <p class="elsevierStylePara"> Follow-up examination of these cases is recommended to avoid possible complications&#46;</p>"
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