BrazDentJ(2004)15(1):7981 Oralmyiasistreatedwithivermectin:casereport ISSN0103644079

OralMyiasisTreatedwithIvermectin:CaseReport

ElioHitoshiSHINOHARA

MarceloZilloMARTINI

HumbertoGomesdeOLIVEIRANETO

AndrTAKAHASHI

DepartmentofOralandMaxillofacialSurgery,ConjuntoHospitalardoMandaqui,SUSSP,SoPaulo,SP,Brazil

Oralmyiasisisararepathologyandarisktothepatientslife.Conventionaltreatmentismechanicalremovalofthelarvae
(maggots)onebyone,whichispainful,distressing,andembarrassingbothtothepatientandtothedentist.Wepresentacasereport
ofapatientwithcerebralpalsythathadoralmyiasistreatedsuccessfullywithivermectin.Theuseofthisantibioticinhumans,its
mechanismofactionandindicationsarediscussed.

KeyWords:oralmyiasis,ivermectin,parasitosis.
signsofinflammation
Wepresentacasereport (Figure1).Oralexamina
INTRODUCTION ofapatientwithoral
myiasistreated
Myiasisisapathologycausedbythepresenceoffly successfullywithoral
larvaeinhumanoranimaltissuesthatevolvetoa ivermectin.
parasite(1).Thereisahigherincidenceinruralzones,
infectingdomesticanimalssuchascattleandpigs,as
wellashousepetssuchasdogsandcats,leadingto CASE REPORT
economiclossandhealthinjuriesoftheseanimals.They
canattackhumans,generallyelderlypeoplewhoareill A20yearoldCaucasian
ordebilitated(2,3),especiallyinthetropicsandthird femalepatientwith
worldcountries(4,5). hypotoniccerebralpalsy
wasreferredtothe
Clinically,theycanbeclassifiedasprimaryandsecondary. EmergencyServiceofthe
Primarymyiasisiscausedbybiophagouslarvae(feedon ConjuntoHospitalardo
livingtissue),whicharecommonincattle(calledbicheiras) Mandaqui,SUS/SP,with
andarerareinhumans.Nevertheless,whenthisoccurs,itis aclinicalhistoryoflarvae
generallyseriousandproducedbyCochliomyahominivorax comingoutofhermouth
larvae("varejeira"fly)thatlays20to400eggsonexposed foroneday.Onclinical
wounds.Hatchingofthelarvaeoccursin24h.Thelarvaeare examination,thepatient
voraciousanddestroyintegraltissues,andmaycauseserious wasfoundtobe
hemorrhageandbelifethreatening.Secondarymyiasisisthat dehydrated,presentingan
causedbythenecrobiophagousflies(feedondeadtissue). anteriorswellingonthe Figure1.Appearanceof
Thisisamorecommontypeandattackspatientswithnecrotic upperlipcoveredwith patientatpresentation.Note
cavitylesions(1,3). theanteriorswellingonthe
integralskinandwith upperlip.
Correspondence:Dr. Shinohara,Ruado 212,Torre3,04209000Ipiranga,SoPaulo,SP,
ElioHitoshi o Brasil.email:elioshinohara@apcd.org.br
Manifesto,198,apt
BrazDentJ15(1) 2004
80 E.H.Shinoharaetal.
Various
substances(ether,
tionfoundalarge chloroform,olive
numberoflarvaeonthe oil,calomel,
maxillarygingival Figure2. iodoform,phenol
labialsulcus,which Photographshowing mixture)have
werealreadydestroying themaxillary beenrecom
thegingivalsulcus gingivallabial mendedforthe
(Figure2)nearthe sulcusandthe treatmentof
nasalfossa.The maggots.
myiasis;
computerized however,they
tomographyshowedthe have
extensionoftissue controversial
destruction(Figure3). results(68).
Hematologicalanalysis
wasnormal.Antibiotic
Ivermectinisa
therapywasstarted(1g
semisynthetic
cefalotin,iv,every6h),
macrolideantibi
endovenous
otic,isolatedfrom
rehydration,and6mg
Streptomyces
ivermectinwasgiven
avermitilis,andits
orally,andrepeated
after24h.Onthefirst useiswell
day,amarkeddecrease documentedin
ofthelarvae(about largeanimalsfor
80%)wasobserved, thecontrolof
andtheremaining gastrointestinal
larvaewereimmobile. andpulmonary
Oralcleansingwas parasitosis,for
madedaily.After3 infestationby
daysofhospitalization, crablouseand
therewerenolarvaein larvaflies
thepatientsmouthand ("berne").
Figure3.
shewasdischarged.A Computerized
parasitologistlater In1993,
tomographywith
identifiedthelarvaas intravenouscontrast ivermectinwas
thefly,Cochliomyia ofthemaxilla.Gas reportedtobesafe
hominivorax. bubblesareseenin forhumanuse(9)
thesofttissueinthe andhasbeen
anteriormaxilla. indicatedforthe
treatmentof
filaria,scabiesand
strongyloidosisin
DISCUSSIO
humans(9,10).
N Evaluatingtheuse
oforalivermectin
Thestandard inhumancavity
treatmentfor infestations,
myiasisisthe Ribeiroetal.(3)
manualremoval, reportedthatno
associatedornot patientpresented
withtopicand alterationsin
systemic hepaticorrenal
asphyxiating functionafterthe
drugsthatforce oralingestionof
thelarvaeto ivermectin.Thus,
theyconcluded
comeout.
thatitisasafe Recently, efficientandsafe
medicationand indicationsfor methodof
presentsneitherside topicalandoral treatmentof
effectsnortoxicity. useforthe parasitosisand
treatmentof thepresentreport
Itisassumedthat myiasishave describesitsuse
ivermectinblocks beenfoundinthe inhumanoral
nerveimpulsesonthe literature(12 myiasis.
endingnervethrough 15).Duqueetal.
thereleaseofgamma (16)treatedoral RESUMO
aminobutyricacid myiasiswithsc
(GABA),linkingto ivermectin, Miasebucal
thereceptorsand although2ofthe patologiararamente
causingpalsyand 3caseswere descritaequeoferece
death(11).Acetylcho associatedwith riscodemorteao
paciente.O
line,whichisthemain phenolmixture tratamento
peripheral (10%creolin)as convencionala
neurotransmitterin alocalmeasure remoomecnica
mammalians,isnot forthecontrolof daslarvasumaauma
quedolorido,
affectedby larvae. constrangedore
ivermectin,maintain repugnantetantoao
ingasecuritymargin Thus,thecurrent pacientequantoao
whenitisusedatthe literature dentista.
Apresentamosrelato
recommendeddose describes
decasodepaciente
(3). ivermectinasan portadoradeparalisia
cerebralqueteve
BrazDentJ15(1) 2004
Oralmyiasistreatedwithivermectin:casereport
81

miasebucaltratadacom
ivermectina.Ousodeste
antibiticoemhumanos,o
mecanismodeao,assim
comosuasindicaesso
revisados.
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AcceptedAugust 11,2003

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