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Human myiasis in patients with diabetic foot: 18 cases

Serhat Uysal,a Anil Murat Ozturk,b Meltem Tasbakan,c Ilgin Yildirim Simsir,d Aysegul Unver,e Nevin Turgay,e Husnu Pullukcuc

From the aDiabetic Foot Clinic of Infectious Diseases, Buca SD State Hospital, Izmir, Turkey; bDepartment of Orthopedics and Traumatology, Ege University Faculty of Medicine, Izmir, Turkey; cDepartment of Clinical Microbiology, Ege University Medical Faculty, Izmir, Turkey; dDepartment of Endocrinology and Metabolism, Ege University Faculty of Medicine, Izmir, Turkey; eDepartment of Parasitology, Ege Universitesi Tip Fakultesi, Izmir, Turkey

How to cite this article:

Uysal S, Ozturk AM, Tasbakan M, Simsir IY, Unver A, Turgay N, Pullukcu H. Human myiasis in patients with diabetic foot: 18 cases. Ann Saudi Med 2018; 38(3): 208-213.


BACKGROUND: Myiasis complication of diabetic foot ulcer has only been presented in a few case reports. Therefore, there is a need for additional data on this infestation.


OBJECTIVE: Evaluate clinical characteristics of human myiasis in patients with diabetic foot.


DESIGN: Case series.


SETTINGS: A tertiary referral healthcare institution and a diabetic foot center.


PATIENTS AND METHODS: Patients with diabetic foot infection com.plicated by myiasis who were admitted between June 2012 and July 2017.


MAIN OUTCOME MEASURES: Bacterial infection rate, accompanying bacterial agents, amputation (morbidity) and mortality rate.




RESULTS: Eight (44.4%) of the patients were female. Sixteen (88.9%) had moderate-to-severe infections; 15 (83.3%) had necrotic tissue. Larval debridement therapy was performed on all patients at the bed.side in consecutive sessions. A third-stage larva of Calliphora was detected in one case (5.6%). Second- and third-stage larvae of Lucilia sericata were detected in 5 (27.8%) and 7 (38.9%) patients, respectively. All the patients had a bacterial infection with myiasis. Twelve (66.7%) patients underwent amputation. Three (16.7%) patients died. Myiasis was more frequent in the months of May, June and July.


CONCLUSION: To our knowledge, this is the largest reported series of cases of diabetic foot with myiasis. The most common parasitic agent was Lucilia sericata. Bacterial soft tissue infections were observed in all cases. Poor hygienic conditions were noteworthy and all patients were in need of radical surgery. Myiasis complication of diabetic foot is more frequently seen in the spring and summer. 


LIMITATIONS: Insufficient follow-up time for analysis of possible confounding factors.




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