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Fournier's Gangrene is a fulminating necrotizing fasciitis of the perineum and genitalia. Standard treatment involves immediate excision of all necrotic tissue, aggressive antibiotic coverage, and supportive medical care. Still, the infection is commonly fatal or disfiguring. Wound treatment with disinfected blowfly larvae (maggot debridement therapy or MDT) has been shown to be highly effective, with multiple studies demonstrating effective debridement, disinfection, and promotion of granulation tissue. MDT also has been associated with preservation of viable tissue and minimised blood loss. This report describes a prospective clinical study of MDT for Fournier's gangrene aimed to test the hypothesis that early use of maggots could decrease the number of surgical treatments required to treat Fournier's gangrene. Subjects were provided with one initial surgical excision, followed by debridement using only medical grade Lucilia sericata larvae. Only two subjects were enrolled, both diabetic men. Intensive care and culture-directed antimicrobial coverage were administered as usual. Maggot debridement was associated with the disappearance of necrotic tissue, control of infection and granulation tissue growth. In both subjects, wounds healed without requiring further surgical resection or anatomical reconstruction. Maggot therapy decreased the number of surgical procedures that otherwise would have been necessary, and led to favourable outcomes.

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Skin wounds have been extensively studied as their healing represents a critical step towards achieving homeostasis following a traumatic event. Dependent on the severity of the damage, wounds are categorized as either acute or chronic. To date, chronic wounds have the highest economic impact as long term increases wound care costs. Chronic wounds affect 6.5 million patients in the United States with an annual estimated expense of $25 billion for the health care system. Among wound treatment categories, active wound care represents the fastest-growing category due to its specific actions and lower costs. Within this category, proteases from various sources have been used as successful agents in debridement wound care. The wound healing process is predominantly mediated by matrix metalloproteinases (MMPs) that, when dysregulated, result in defective wound healing. Therapeutic activity has been described for animal secretions including fish epithelial mucus, maggot secretory products and snake venom, which contain secreted proteases (SPs). No further alternatives for use, sources or types of proteases used for wound healing have been found in the literature to date. Through the present review, the context of enzymatic wound care alternatives will be discussed. In addition, substrate homology of SPs and human MMPs will be compared and contrasted. The purpose of these discussions is to identify and propose the stages of wound healing in which SPs may be used as therapeutic agents to improve the wound healing process.

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RESUMEN La leishmaniosis es una enfermedad con gran impacto en salud pública dado a las características de las lesiones tegumentarias. El tratamiento experimental con terapia larval (TL) ha mostrado su uso potencial para la cura de la leishmaniosis, sin embargo, se han utilizado especies de moscas para TL en heridas causadas por Leishmanial que no son de fácil colecta y cultivo bajo condiciones de laboratorio como Lucilia sericata o Calliphora vicina. El objetivo del presente trabajo fue usar una especie de mosca de fácil colecta, y de alta fecundidad como la Musca domestica para aplicarlas en TL de úlceras leishmánicas. Se realizó un estudio cuali-cuantitativo, de tipo descriptivo, mediante un diseño experimental empleado un modelo animal (Mesocricetus auratus), infectado con Leishmania amazonensis para evaluar el efecto terapéutico de la TL y comparar los resultados con el tratamiento químico antimonial de la droga experimental "Ulamina". Se evidencia cicatrización y cura de la úlcera leishmánica en el 66,66 % de los animales tratados con TL en aplicación simple y del 100 % en TL combinada con Ulamina. El uso combinado de TL+Ulamina, muestra un efecto potenciador de la cura clínica de las úlceras, pero con persistente inflamación. Se observó una efectividad óptima de la TL con M. domestica, sobre las úlceras, aunque no se evidenció un efecto sobre L. amazonensis dado a la presencia de amastigotes en los frotis y a los amplicones obtenidos de 480 bp desde las improntas de los animales.

ABSTRACT Leishmaniasis is a disease with significant impact on public health, given the characteristics of the tegumentary lesions. Experimental treatment with larval therapy (LT) has shown its potential use for the cure of leishmaniosis. However, fly species not easy to collect and/or colonize have been used. The objective of the present work was to use a fly of accessible collection and high fecundity, not a producer of human myiasis, such as Musca domestica. A qualitative-quantitative study of a descriptive type was carried out through an experimental design with an animal model (Mesocricetus auratus) with infection by Leishmania amazonensis to evaluate the therapeutic effect of LT and compare the results with the antimonial chemical treatment of the drug experimental "Ulamina". Scarring were observed with the use of LT in 66.66 % with TL-simple and 100 % with TL-combined. However, the combined use of LT + Ulamina, shows an enhancing effect of the clinical cure of the lesions, but with persistent inflammation. Optimal effectiveness of TL with M. domestica was observed on the ulcers; however, an effect on L. amazonensis was not observed given the presence of amastigotes in the smears and the 480 bp amplicons from the tissue of the ulcers of animals.

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Factors contributing to the delay or prevention of the natural wound healing process include infection and ineffective conventional treatment. Alternative therapies, such as the maggot debridement therapy (MDT), may be helpful for successful treatment in these cases. Aiming to disseminate information about the possibility of using other species of flies for wound treatment, besides the best known Lucilia sericata Meigen, 1826 (Diptera, Calliphoridae), we report here a successful MDT case with the application of Cochliomyia macellaria (Fabricius, 1775) larvae to treat an infected wound with extensive area of necrotic tissue in a dog. Five sterile larvae were applied to each square-cm of lesion and kept on the animal for only 48 h. The healing was successful, from both qualitative and quantitative points of view. The ratio of wound healing (RWH) reached almost 50% on the 5th day and 100% on the 14th day after MDT. Although the overall animal prognosis had been unfavorable, mainly due to the sepsis, the patient began to recover and had improved clinical condition from the fifth day after MDT. This study shows the importance and effectiveness of MDT in promoting faster and more complete healing of a complex wound.

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Myiasis is a common travel-associated dermatosis. We describe a 52-year-old Italian man who acquired Dermatobia hominis when bitten by a mosquito during a visit to Argentina. He had a painful nodular lesion on the left cheek that had been present for about 3 weeks. The complete removal of the larva is the goal of medical treatment. Prescription of antibiotics to avoid secondary infections is not recommended. For psychological reasons and due to the failure of previous therapies, the lesion was excised. Travelers to endemic areas should be informed of preventive measures to reduce mosquito bites and transmission of the infestation.

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A total of 120 one-day-old broiler chicks (Ross 308) were randomly assigned to 12 pens of 10 birds in a completely randomized design (CRD). In four experimental diets, soya bean meal was replaced with a maggot meal at the rate of 0, 40, 50 and 60% designated as group A, B, C and D respectively. Body weight was significantly higher (p<0.05), whereas feed intake and feed conversion ratio (FCR) were significantly lower in group D than group A and B. Dressing percentage and apparent metabolizable energy were significantly (p<0.05) higher in group D than group A, B and C. Digestibility of dry matter, crude protein, ether extract and ash were significantly (p<0.05) higher, and crude fiber was significantly (p<0.05) lower in group D than group A. It was concluded that 60% soybean meal could be safely replaced by a maggot meal in broiler ration during the starter phase.

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A total of 120 one-day-old broiler chicks (Ross 308) were randomly assigned to 12 pens of 10 birds in a completely randomized design (CRD). In four experimental diets, soya bean meal was replaced with a maggot meal at the rate of 0, 40, 50 and 60% designated as group A, B, C and D respectively. Body weight was significantly higher (p<0.05), whereas feed intake and feed conversion ratio (FCR) were significantly lower in group D than group A and B. Dressing percentage and apparent metabolizable energy were significantly (p<0.05) higher in group D than group A, B and C. Digestibility of dry matter, crude protein, ether extract and ash were significantly (p<0.05) higher, and crude fiber was significantly (p<0.05) lower in group D than group A. It was concluded that 60% soybean meal could be safely replaced by a maggot meal in broiler ration during the starter phase.(AU)

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Maggot debridement therapy (MDT) consists on the intentional and controlled application of sterilized larvae of the order Diptera on necrotic skin lesions with the purpose of cleaning necrotic tissue and removing pathogenic bacteria. During MDT, a marked antimicrobial activity has been reported in literature specially associated with antibacterial substances from Lucilia sericata (Meigen); however, regarding Cochliomyia macellaria (Fabricius), little is known. This study aimed to evaluate in vitro inhibition of bacterial growth of Pseudomonas aeruginosa and Staphylococcus aureus in contact with excretions and secretions (ES) from C. macellaria larvae. Larval ES were extracted in sterile distilled water and divided in three groups: ES, containing 400 µL of autoclaved ES; ES+BAC, containing 400 µL of autoclaved ES+0.5-µL bacterial inoculum; and CONT-BAC, containing 400 µL of sterile distilled water +0.5 µL of bacterial inoculum. Aliquots of each experimental group were plated by spreading onto Petri dishes. Seedings were made at 0, 1, 2, 4, and 12 h after the extraction of ES. In ES+BAC groups, inhibition of S. aureus was verified between times 1 and 2 h and P. aeruginosa was inhibited between 0 and 4 h. There was no growth observed in any ES group. In the CONT-BAC groups, the number of colonies from time 4 h became countless for S. aureus and decreased for P. aeruginosa. As reported in the literature, we note here that ES have excellent bactericidal activity for both gram-positive and gram-negative bacteria, and this study shows for the first time the action of the bactericidal activity of exosecretions of C. macellaria against S. aureus and P. aeruginosa.

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Larval interactions of dipteran species, blow flies in particular, were observed and documented daily over time and location on five black bear carcasses in Gainesville, FL, USA, from June 2002 - September 2004. Cochliomyia macellaria (Fabricius) or Chrysomya megacephala (Fabricius) larvae were collected first, after which Chrysomya rufifacies (Macquart) oviposited on the carcasses in multiple locations (i.e., neck, anus, and exposed flesh) not inhabited already by the other blow fly larvae. Within the first week of decomposition, C. rufifacies larvae grew to ≥12 mm, filling the carcasses with thousands of larvae and replacing the other calliphorid larvae either through successful food source competition or by predation. As a result, C. macellaria and C. megacephala were not collected past their third instar feeding stage. The blow fly species, C. megacephala, C. macellaria, Lucilia caeruleiviridis (Macquart), Phormia regina (Meigen), Lucilia sericata (Meigen), and C. rufifacies, completed two developmental cycles in the 88.5-kg carcass. This phenomenon might serve to complicate or prevent the calculation of an accurate postmortem interval.

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Objetivo: identificar nas evidências científicas da literatura quais os benefícios que a terapia larval proporciona aos pacientes com lesões de pele através de uma revisão sistemática da literatura, na modalidade de revisão integrativa.Método: para a busca dos artigos e a análise dos dados, foram utilizados dois instrumentos de avaliação. A pesquisa foi realizada entre julho de 2009 a julho de 2010. Resultado: a terapia larval mostrou-se positiva na maior parte dos estudos selecionados tanto em relação à restauração rápida dos tecidos como nos custos. Conclusão: os resultados apresentados proporcionaram um maior conhecimento sobre a terapia larval e mostraram que, apesar de não haver indícios de seu uso no Brasil, pode ser uma opção eficaz, principalmente quando os tratamentos convencionais não funcionam mais

Objective: to identify evidence in the literature in which the benefits of larval therapy provides patients with skin lesions through a systematic literature review in the form of an integrative review. Method: For search of articles and data analysis, we used two assessment tools. The survey was conducted between July 2009 and July 2010. Result: larval therapy was positive in most studies selected in relation to a rapid restoration of tissues such as the costs. Conclusion: the results presented have provided a better understanding of larval therapy and showed that, although there was no evidence of its use in Brazil, can be an effective option, especially when conventional treatments not working

Objetivo: identificar en evidencias en la literatura que los beneficios de la terapia con larvas a los pacientes con lesiones en la piel a través de una revisión sistemática de la literatura, en la forma de una revisión integradora. Método: Para la búsqueda de artículos y análisis de datos, se utilizaron dos instrumentos de evaluación. La encuestafue realizada entre julio de 2009 a julio de 2010. Resultado: la terapia de larvas fue positiva en la mayoría de los estudios seleccionados en relación a una rápida restauración de los tejidos, tales como los costos. Conclusión: los resultados presentados proporcionan una mejor comprensión de la terapia larval y demostraron que, aunque no hay evidencia de su uso en Brasil, puede ser una opción eficaz, especialmente cuando los tratamientos convencionales han ya no funcionan

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La terapia larval es utilizada desde los años 30 del siglo pasado para la remoción del tejido necrótico en el tratamiento de úlceras crónicas infectadas logrando con ello promover la formación de tejido granuloso para el crecimiento de piel sana; especialmente a partir de la aparición de la resistencia a los antibióticos se la reconoce como una alternativa eficaz. Se presentan los resultados de la aplicación de la terapia larval en 42 pacientes con úlceras de diferentes orígenes, utilizando, como una nueva alternativa en larviterapia, la especie Lucilia eximia. Se presenta documentación fotográfica de la aplicación de esta terapia en cuatro casos.

Larval therapy is used in the treatment of infected chronic wounds by allowing the removal ofnecrotic tissue, which induces the formation of granular tissue and the growth of healthy skin.Considering the increasing prevalence of antibiotic resistance, this type of therapy may be an effectivealternative in the management of infected chronic wounds. In this article we report the use ofmaggot therapy using the Lucilia eximia species in 42 patients with chronic skin wounds associatedto different pathologies including: venous and arterial ulcers, diabetic foot, sickle cell disease,vasculopathy, elephantiasis, Berger disease, pyoderma gangrenosum (PG), traumatic wounds, erysipelas, and hospital acquired infections. Four cases are depicted photographically.

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