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Classifications

Harrison's Part

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Definitions

3

Clinical case definition for human myiasis

Human myiasis is defined by the presence of living dipteran fly larvae in or on the tissues of a living person, with the larvae feeding on host tissue, body fluids, or ingested food for at least part of their development.

CASE_DEFINITION Symptomatic and asymptomatic human infestation by dipteran fly larvae

Show evidence (2 references)

PMID:20883399 SUPPORT Human Clinical

"refers to the infestation of live human and vertebrate animals with dipterous (two-winged) larvae (maggots) which, at least for a certain period, feed on the host's dead or living tissue, liquid body-substance, or ingested food"

Gives the classical definitional criteria used for the case definition.

PMID:37864334 SUPPORT Human Clinical

"Myiasis is the invasion of mammalian tissues by dipterous larvae."

Confirms tissue invasion by dipteran larvae as the defining event.

Anatomical classification of myiasis

Cases are classified by the body region colonized (cutaneous furuncular, migratory, wound/traumatic, and cavitary forms named for the affected organ) and, separately, by the degree of parasitism shown by the implicated fly species (obligate, facultative, or accidental).

DIAGNOSTIC_CRITERIA Case classification once larvae have been recovered and identified

Show evidence (3 references)

PMID:22232372 SUPPORT Human Clinical

"There are two main systems for categorizing myiasis: anatomical and ecological classifications."

States the two orthogonal classification axes used to type a case.

PMID:22232372 SUPPORT Human Clinical

"Cavitary myiasis, where the infestation receives the name of the affected organ, e.g., cerebral myiasis, aural myiasis, nasal myiasis, and ophthalmomyiasis."

Documents the organ-naming convention used for the cavitary subtypes.

PMID:20883399 SUPPORT Human Clinical

"Cutaneous myiasis can be divided into three main clinical manifestations: furuncular, creeping (migratory), and wound (traumatic) myiasis."

Supports the three-way split of the cutaneous forms.

Distinction of true myiasis from pseudomyiasis

True myiasis requires larvae that develop on or in living host tissue. Recovery of larvae from stool or a body orifice is not sufficient, because accidentally ingested or post-passage-contaminating larvae of synanthropic flies may be passed without ever having colonized the host.

DIAGNOSTIC_CRITERIA Reported gastrointestinal and cavitary cases where larvae are recovered but colonization is unproven

Show evidence (1 reference)

DOI:10.1371/journal.pone.0356742 SUPPORT Model Organism

"Larvae of this species have been reported in suspected cases of intestinal myiasis, but whether they can establish true gastrointestinal infestation remains uncertain."

States the colonization requirement that separates true intestinal myiasis from pseudomyiasis.

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Subtypes

9

Furuncular (boil-like) cutaneous myiasis MONDO:0018941

A single larva develops within a closed subcutaneous cavity, producing a boil-like nodule with a central punctum through which the larva breathes and serosanguineous fluid drains. Caused chiefly by Dermatobia hominis in the Americas and Cordylobia anthropophaga in sub-Saharan Africa.

Show evidence (2 references)

PMID:14726861 SUPPORT Human Clinical

"He had a locally painful, firm furuncular lesion with a central pore that drained serosanguineous exudates."

Describes the defining furuncular lesion with central pore.

PMID:20883399 SUPPORT Human Clinical

"The flies that produce a furuncular myiasis include Dermatobia hominis, Cordylobia anthropophaga, Wohlfahrtia vigil, and the Cuterebra species."

Names the fly species responsible for the furuncular form.

Creeping (migratory) cutaneous myiasis MONDO:0018857

The third cutaneous form alongside the furuncular and wound types. A larva that cannot complete development in an accidental human host tunnels through the skin instead of settling in one cavity, producing a serpiginous, slowly advancing track rather than a fixed boil-like nodule. Gasterophilus (horse bot fly) and Hypoderma (cattle bot fly) larvae account for almost all human cases.

Show evidence (3 references)

PMID:20883399 SUPPORT Human Clinical

"Cutaneous myiasis can be divided into three main clinical manifestations: furuncular, creeping (migratory), and wound (traumatic) myiasis."

Establishes creeping (migratory) myiasis as one of the three cutaneous forms.

PMID:22232372 SUPPORT Human Clinical

"Migratory myiasis, or creeping myiasis, occurs when a dipteran maggot starts to migrate, aimlessly, through burrows in the skin, producing the migratory pattern of the lesions."

Defines the migratory tunnelling behaviour that distinguishes this subtype from the furuncular form.

PMID:20883399 SUPPORT Human Clinical

"Gasterophilus and Hypoderma are two flies that produce a creeping myiasis."

Names the two genera responsible for the creeping form.

Wound (traumatic) myiasis MONDO:0015622

Larvae are deposited into a pre-existing open wound or ulcer and feed as an aggregating mass, progressively enlarging the defect. Obligate screwworms (Cochliomyia hominivorax, Chrysomya bezziana, Wohlfahrtia magnifica) invade adjacent living tissue rather than confining themselves to necrotic debris.

Show evidence (2 references)

PMID:20883399 SUPPORT Human Clinical

"Flies that cause wound myiasis include screwworm flies such as Cochliomyia hominivorax and Chrysomya bezziana, and Wohlfahrtia magnifica."

Names the obligate screwworm species responsible for the wound form.

PMID:41970302 SUPPORT Human Clinical

"Myiasis is larval infestation of tissues, particularly common in tropical, and subtropical regions, especially in pre-existing wounds."

Supports the pre-existing wound as the substrate for this subtype.

Ophthalmomyiasis MONDO:0000301

Infestation of ocular structures, most often the superficial (externa) form involving conjunctiva and cornea. Oestrus ovis is the dominant agent; humans are accidental hosts in whom the first-instar larvae do not complete development.

Show evidence (2 references)

PMID:31955262 SUPPORT Human Clinical

"A total of 260 (99.62%) cases had external, while 1 (0.38%) had internal form of ocular myiasis."

Quantifies the predominance of the external over the internal ocular form.

PMID:35878965 SUPPORT Human Clinical

"Ophthalmomyiasis externa refers to the superficial infestation of the ocular structures by dipterous larvae."

Defines the ophthalmomyiasis externa subtype.

Nasal and oro-nasopharyngeal myiasis MONDO:0015623

Infestation of the nasal cavity, paranasal sinuses, and posterior oropharynx, which can erode into deep midfacial structures. Typically arises in patients with pre-existing mucosal ulceration, obtunded consciousness, or limited self-care.

Show evidence (1 reference)

PMID:37864334 SUPPORT Human Clinical

"On examination, there was an ulcerated area in the posterior oro-nasopharynx filled with maggots."

Documents the anatomical extent that defines this subtype.

Oral and maxillofacial myiasis MONDO:0015623

Larval infestation of the gingiva, palate, and lips, strongly associated with neurological or locomotor disability, poor oral hygiene, and inability to achieve lip seal.

Show evidence (3 references)

PMID:33125723 SUPPORT Human Clinical

"The gingiva (29%) was the most affected site, followed by palate (25%) and lip (21%)."

Gives the intraoral site distribution defining this subtype.

PMID:21872507 SUPPORT Human Clinical

"The middle third of the face was the most frequently affected region (7 cases)."

Supports the maxillofacial distribution in a hospital case series.

PMID:40505774 SUPPORT Human Clinical

"The clinical protocol could take advantage from a combination of surgical removal and pharmacological therapy."

A systematic review of 95 publications concluding that oral myiasis is managed by combined surgical removal and drug therapy, the treatment pattern this entry curates.

Otomyiasis MONDO:0015623

Infestation of the external auditory canal and middle ear, predisposed to by chronic otitis media and previous otological surgery, with risk of extension into adjacent vital structures.

Show evidence (1 reference)

PMID:30647793 SUPPORT Human Clinical

"Chronic otitis media, previous otic surgical procedures, mental deficit, alcohol or drug abuse, sleeping outdoors, prostration, and malnutrition were predisposing factors."

Defines the predisposing context that characterizes the aural subtype.

Intestinal (gastrointestinal) myiasis MONDO:0015623

Larvae ingested with contaminated food survive transit of the gastrointestinal tract and are passed in faeces, producing variable and often mild abdominal symptoms. The subtype is frequently over-diagnosed, since accidental contamination must be excluded.

Show evidence (2 references)

PMID:22885201 SUPPORT Human Clinical

"Intestinal myiasis is a condition when the fly larvae inhabit the gastrointestinal tract and are passed out in faeces."

Defines the intestinal subtype.

PMID:22885201 SUPPORT Human Clinical

"They survive the unfavourable conditions within the gastrointestinal tract and produce disturbances, which may vary from mild to severe."

Supports the variable symptom severity of this subtype.

Urogenital myiasis MONDO:0015623

Rare infestation of the vulvovaginal or urinary tract, linked to poor sanitary conditions and limited healthcare access, and often requiring repeated debridement in addition to antiparasitic therapy.

Show evidence (2 references)

PMID:35718295 SUPPORT Human Clinical

"Urogenital myiasis is a rare condition that is linked to poor sanitary conditions and limited access to healthcare and with few published case reports."

Defines the urogenital subtype and its social risk context.

PMID:39371381 SUPPORT Human Clinical

"During the examination, motile and live larvae were observed in the penis area."

Documents male genital involvement in an infant, showing the subtype is not confined to vulvovaginal disease in adults.

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Discussions and Knowledge Gaps

3

Does the larval serine-protease mechanism characterized in veterinary hosts and larval secretions operate the same way in infested human tissue?

HUMAN MODEL MISMATCH OPEN myiasis_protease_mechanism_human_evidence

Attached to

pathophysiology#Larval excretory-secretory protease release pathophysiology#Proteolytic digestion of host tissue pathophysiology#Larval modulation of the host immune response

The molecular arm of this entry rests entirely on non-human evidence: the serine-protease characterization comes from Oestrus ovis larvae harvested from slaughtered sheep and goats, the transcriptomic parasitism profile from Wohlfahrtia magnifica larvae taken from Bactrian camel wounds, and the immunosuppression data from Lucilia cuprina in sheep. No study quantifies larval protease activity, complement or immunoglobulin cleavage, or lymphocyte suppression in human tissue. The mismatch is mechanistically meaningful rather than merely notational, because the species that dominate human disease differ from those studied: Dermatobia hominis produces a closed furuncular cavity with a single larva, whereas the characterized species feed as aggregating masses in open ruminant wounds, so both the enzyme dose and the host response could differ substantially.

Proposed experiments

Protease profiling of larvae recovered from human lesions

exp_myiasis_human_larval_protease_profile

Quantify protease activity and substrate specificity in the excretory-secretory products of larvae recovered from human furuncular and wound myiasis lesions, using the same substrate-gel and inhibitor-class assays applied to Oestrus ovis, so the human-derived repertoire is directly comparable to the veterinary one.

Complement and immunoglobulin cleavage in autologous human serum

exp_myiasis_human_serum_immune_cleavage

Compare complement C3 and immunoglobulin cleavage by human-derived versus ruminant-derived larval secretions incubated in autologous human serum, to test whether the immune-evasion arm demonstrated in ruminants operates on human effectors.

Paired human lesion histology and larval transcriptome

exp_myiasis_lesion_biopsy_transcriptome

Characterize the cellular infiltrate and cytokine profile of human myiasis lesion biopsies alongside the transcriptome of larvae taken from the same lesion, linking host response to larval gene expression within one host species.

Every pathophysiology node in this chain carries at least one human clinical evidence item for the phenotypic consequence; it is the enzymatic mechanism linking them that is non-human. The three systems named above are curated structurally in `animal_models` - the ovine/caprine Oestrus ovis infestation, the Bactrian camel Wohlfahrtia magnifica wound, and ovine Lucilia cuprina strike - each linked by `modeled_mechanisms` to the nodes this discussion attaches to, with per-link `fidelity` and `limitations` recording the species-divergence caveat. The BALB/c mouse Clogmia study is curated there too, as a `FAILS_TO_RECAPITULATE` link: it is a negative result about the ingestion route rather than about the protease mechanism, which is why it does not attach to this discussion.

What is the true global burden of human myiasis, and how do the available treatments compare?

KNOWLEDGE GAP OPEN myiasis_evidence_base_case_reports

Attached to

treatments#Ivermectin epidemiology#Tropical and subtropical distribution with socioeconomic gradient

Myiasis is not notifiable in any jurisdiction and there is no surveillance system, so incidence and prevalence estimates rest on case reports and single-country reviews that are known to under-ascertain. The same gap affects therapy: ivermectin dosing and route are supported only by individual cases and uncontrolled series, and no comparative trial of mechanical removal, occlusion, or antiparasitic adjuncts exists. Standardized case definitions separating true myiasis from pseudomyiasis are also lacking.

Proposed experiments

Sentinel surveillance with species-level reporting

exp_myiasis_sentinel_surveillance

Establish sentinel surveillance for myiasis in endemic districts with mandatory species-level reporting and a case definition that excludes pseudomyiasis, to produce the first incidence estimates not derived from case reports.

Comparative study of ivermectin adjunct versus removal alone

exp_myiasis_ivermectin_comparative_study

Run a prospective comparative study of ivermectin as an adjunct versus mechanical removal alone in wound and cavitary myiasis, with prespecified outcomes of complete larval clearance, secondary infection, and tissue loss.

Show evidence (2 references)

PMID:30647793 SUPPORT Human Clinical

"The cases are rarely reported, and there are no published management protocols."

Documents both the reporting gap and the absence of management protocols.

PMID:31618203 SUPPORT Human Clinical

"Our findings indicate that cryptic myiasis cases due to the obligate parasite, C. bezziana, are under-recognized."

Supports systematic under-recognition of cases even for a listed obligate parasite.

Under what conditions does facultative larval colonization of a wound shift from pathological myiasis to therapeutic debridement?

OPEN QUESTION OPEN myiasis_maggot_debridement_duality

Attached to

pathophysiology#Proteolytic digestion of host tissue pathophysiology#Secondary bacterial superinfection

The same species that causes facultative wound myiasis, Lucilia sericata, is reared for maggot debridement therapy, where its proteolytic and antimicrobial secretions are deliberately used to clean infected wounds. This is not a contradiction to be resolved by picking a side; it means the sign of the mechanism depends on larval burden, species, tissue selectivity, and whether the colonization was controlled. Curating that boundary matters, because the entry asserts tissue digestion as pathogenic while the literature reports the same activity as beneficial in a controlled setting.

Show evidence (1 reference)

DOI:10.3389/fcimb.2025.1568563 SUPPORT Human Clinical

"Maggot debridement therapy may be a promising treatment and beneficial for soft tissue infection-related sepsis."

Reports a beneficial effect of larval colonization in infected soft tissue, the inverse of the pathogenic framing.

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Pathophysiology

10

Larval deposition on host skin, wound, or body orifice

The initiating event is mechanical delivery of eggs or first-instar larvae to the host surface, by direct oviposition, larviposition, a phoretic arthropod vector, contaminated clothing or soil, or ingestion.

skin of body UBERON:0002097

Downstream

Larval penetration and burrowing into host tissue Larvae delivered to the surface immediately begin to penetrate the underlying tissue.

Show evidence (1 reference)

PMID:22232372 SUPPORT Human Clinical

"Myiasis is defined as the infestation of live vertebrates (humans and/or animals) with dipterous larvae."

Establishes larval arrival on a live host as the initiating event.

Larval penetration and burrowing into host tissue

Larvae breach the epidermis or mucosa and burrow into the dermis, subcutis, or submucosa, creating the cavity in which they will feed. This is a mechanical invasion by a metazoan parasite, not colonization by a replicating microbe, and the depth reached is what separates a self-limited furuncular lesion from progressive destruction by an obligate species.

dermis UBERON:0002067

Animal models

BALB/c mouse oral gavage with Clogmia albipunctata Mouse fails to recapitulate Orally delivered larvae did not penetrate or colonize gastrointestinal tissue, so this model does not reproduce the invasion step for the ingestion route.

Downstream

Larval excretory-secretory protease release Once inside the tissue the larva secretes the proteolytic products that allow it to feed and to extend the burrow.

Show evidence (2 references)

PMID:38297211 SUPPORT Model Organism

"During the parasitic stages, the myiasis-causing larvae employ sophisticated survival strategies. They penetrate the host's skin to invade the tissue, migrate within tissues, and feed on it."

Directly describes penetration, intratissue migration, and feeding.

PMID:41209928 SUPPORT Human Clinical

"Unlike most dipteran larvae, which preferentially colonize necrotic tissue, C. hominivorax larvae invade and consume living tissue of warm-blooded hosts, causing a rapidly progressive condition known as myiasis."

Establishes invasion of living tissue by obligate species in human disease.

Larval excretory-secretory protease release

Parasitic-stage larvae secrete abundant serine proteases and collagenases in their salivary and excretory-secretory products. These enzymes are the principal molecular effectors of myiasis, serving both larval nutrition and the digestion of host structural proteins.

proteolysis GO:0006508 ↑ INCREASED

serine-type endopeptidase activity GO:0004252 ↑ INCREASED

Animal models

Ovine and caprine nasal Oestrus ovis infestation Sheep and goat partially recapitulates Larvae recovered from naturally and experimentally infested small ruminants secrete the serine proteases that this node asserts as the principal molecular effector of myiasis.

Bactrian camel Wohlfahrtia magnifica wound myiasis Bactrian camel partially recapitulates Wound-collected parasitic larvae upregulate a large peptidase programme, giving a transcriptional counterpart to the biochemically measured protease secretion asserted by this node.

Downstream

Proteolytic digestion of host tissue Secreted proteases degrade host structural and plasma proteins at the feeding site.

Larval modulation of the host immune response The same secreted protease repertoire cleaves host immune effectors, blunting the response that would otherwise expel the larva.

Show evidence (3 references)

PMID:12809756 SUPPORT In Vitro

"A preliminary biochemical characterization, using substrate gel analysis and inhibitor sensitivity, demonstrated the presence of at least six major serine proteases (molecular weights from 20 to 100 kDa), mainly trypsin-like, secreted in the digestive tube of larvae."

Biochemically characterizes the secreted serine protease repertoire.

PMID:17697751 SUPPORT In Vitro

"Proteases in O. ovis salivary gland products belong to the serine subclass."

Confirms the serine class of the salivary proteases.

PMID:38297211 SUPPORT Model Organism

"Specifically, the expression level analysis of the likely parasitism-related genes in parasitic wound-collected larvae revealed a significant upregulation of 88 peptidase genes (including 47 serine peptidase genes), 110 cuticle protein genes, and 21 heat shock protein (hsp) genes."

Shows transcriptional upregulation of peptidase genes specifically in the parasitic larval stage.

Proteolytic digestion of host tissue

Larval collagenases and proteases digest the structural components of skin and connective tissue, liquefying the feeding site and producing the characteristic exudate. This enzymatic destruction, not an inflammatory response, generates the primary lesion.

extracellular matrix disassembly GO:0022617 ↑ INCREASED collagen catabolic process GO:0030574 ↑ INCREASED

skin of body UBERON:0002097

Animal models

Bactrian camel Wohlfahrtia magnifica wound myiasis Bactrian camel partially recapitulates Larval feeding in the camel wound produces the tissue necrosis and loss that this node asserts as the primary lesion.

Ovine Lucilia cuprina cutaneous myiasis Sheep partially recapitulates L. cuprina collagenases and proteases digest skin structural components, producing the lesion and exudate this node asserts.

Downstream

Tissue necrosis and cavity formation Continued enzymatic and mechanical destruction converts the burrow into a necrotic cavity.

Show evidence (1 reference)

PMID:38297211 SUPPORT Model Organism

"The activity study of L. cuprina collagenases and proteases suggested that they were not only involved in larval nutrition but also digested structural components of the skin, contributing to the formation of lesions and the production of exudates"

Attributes lesion formation and exudate directly to digestion of skin structural components.

Tissue necrosis and cavity formation

The feeding larvae enlarge a necrotic cavity within the host. In furuncular disease this remains a closed nodule with a breathing punctum; in obligate wound and cavitary disease it extends into surrounding living tissue and can destroy palate, orbit, or bone.

skin of body UBERON:0002097

Downstream

Secondary bacterial superinfection The necrotic, exudative cavity is a permissive environment for bacterial proliferation.

Host inflammatory and eosinophilic response Tissue destruction and larval antigens elicit local and systemic inflammation.

Show evidence (2 references)

DOI:10.21315/aos2025.2001.cr03 SUPPORT Human Clinical

"Manifestations comprised oral bleeding, fever, and necrotic palatal ulcers infested with maggots."

Documents necrotic cavitary destruction of the palate by larval feeding in a human case.

PMID:34363696 SUPPORT Human Clinical

"Its contribution to the greater tumor tissue destruction is clear; however, more studies are required."

Supports larval contribution to tissue destruction while flagging the limited evidence base.

Larval modulation of the host immune response

Larval secretions cleave immunoglobulin and complement and suppress lymphocyte proliferation, allowing a large metazoan parasite to persist in tissue for days to weeks without being expelled.

Animal models

Ovine and caprine nasal Oestrus ovis infestation Sheep and goat partially recapitulates The same salivary serine proteases are proposed to blunt the ruminant host response, the immune-evasion arm of this node.

Ovine Lucilia cuprina cutaneous myiasis Sheep partially recapitulates Larval secretion of blowfly larval immunosuppressive protein suppresses ovine lymphocyte proliferation, the only quantified immunosuppression behind this node.

Downstream

Larval maturation and emergence from the host Immune evasion permits the larva to complete its parasitic instars in situ.

Show evidence (2 references)

PMID:38297211 SUPPORT Model Organism

"secretes a protein called blowfly larval immunosuppressive protein (BLIP), which inhibits lymphocyte proliferation in sheep by at least 70%"

Quantifies larval suppression of host lymphocyte proliferation in a ruminant host.

PMID:12809756 SUPPORT In Vitro

"ESP of O. ovis larvae degrade mucosal and plasmatic components such as mucin, albumin or immunoglobulin G."

Shows degradation of host immunoglobulin G by larval secretions.

Host inflammatory and eosinophilic response

Larval antigens and tissue injury drive a local inflammatory infiltrate with prominent eosinophils and neutrophils, and in some patients a systemic eosinophilia with elevated acute-phase reactants that resolves after the larvae are removed.

eosinophil CL:0000771 neutrophil CL:0000775

inflammatory response GO:0006954 ↑ INCREASED eosinophil chemotaxis GO:0048245 ↑ INCREASED

Show evidence (3 references)

PMID:34222451 SUPPORT Human Clinical

"Myiasis should be an important consideration for the differential diagnosis when eosinophilic pleural effusion with blood eosinophilia is observed."

Documents a systemic eosinophilic response attributable to cutaneous myiasis.

PMID:34222451 SUPPORT Human Clinical

"Telephonic follow-up 1 mo later indicated that the blood eosinophilia and pleural effusion were resolved."

Shows that the eosinophilic response resolved once the larvae were removed, supporting larval drive.

PMID:30647793 SUPPORT Human Clinical

"It can cause a variety of local symptoms, like erythema or pain, depending on its location, and generalized symptomatology, such as fever and malaise."

Supports local inflammatory signs and systemic symptoms across anatomical sites.

Secondary bacterial superinfection

Necrotic tissue, exudate, and a breached epithelial barrier permit bacterial colonization and invasive soft-tissue infection. This is the principal mechanism by which myiasis becomes life-threatening. Most isolates are the ordinary wound flora - Staphylococcus aureus, Streptococcus pyogenes - but the larvae also carry their own: Wohlfahrtiimonas chitiniclastica is a chitinolytic gram-negative rod associated with the larvae themselves rather than with the host's skin, first isolated from Wohlfahrtia magnifica, and it is reported almost exclusively in myiasis. That makes it a myiasis-specific superinfection risk rather than generic wound contamination, and it is easily missed without MALDI-TOF or 16S sequencing.

neutrophil chemotaxis GO:0030593 ↑ INCREASED

Downstream

Systemic sepsis and progressive tissue destruction Invasive bacterial infection of the myiasis wound can progress to systemic sepsis.

Show evidence (5 references)

PMID:41562817 SUPPORT Human Clinical

"Laboratory investigations revealed elevated inflammatory markers, and wound swabs grew scanty Streptococcus pyogenes."

Microbiologically documents bacterial superinfection of myiasis lesions.

PMID:41209928 SUPPORT Human Clinical

"This obligate parasitism can result in severe pain, secondary bacterial infections, disfigurement, and, in the absence of timely treatment, substantial morbidity or death in both humans and animals."

Names secondary bacterial infection among the principal complications.

PMID:34576832 SUPPORT Human Clinical

"Wohlfahrtiimonas chitiniclastica are bacteria that cause rare infections, typically associated with the infestation of an open wound with fly larvae."

Identifies a superinfecting organism specifically tied to larval infestation rather than to ordinary wound flora.

+ 2 more references

Systemic sepsis and progressive tissue destruction

Untreated or neglected infestation, particularly by obligate screwworms and in patients unable to seek care, progresses to extensive tissue loss, disfigurement, sepsis, and death.

Show evidence (3 references)

PMID:30647793 SUPPORT Human Clinical

"Myiasis can generate severe complications, for instance sepsis, or directly impact vital tissues."

Supports sepsis and destruction of vital tissue as the severe end of the disease course.

PMID:41970302 SUPPORT Human Clinical

"We report a case of neglected myiasis wound in a laborer from rural Nepal presenting with septic shock, who was managed with intravenous fluids, antibiotics, wound care, and delayed skin grafting, resulting in complete functional recovery."

A human case reaching septic shock, with recovery after larval and wound management.

PMID:34576832 SUPPORT Human Clinical

"The overall fatality rate associated directly with W. chitiniclastica in these cases was 17%."

Quantifies mortality attributable to the larval-associated superinfecting organism, the route by which myiasis kills.

Larval maturation and emergence from the host

In accidental and self-limited forms the mature larva leaves the host to pupate, after which the lesion heals. Because disease depends on the physical presence of the larva rather than on a replicating pathogen, removal or spontaneous departure is curative.

Show evidence (2 references)

PMID:14726861 SUPPORT Human Clinical

"The patient applied an occlusive ointment and recovered the larva after it emerged."

Documents larval emergence and recovery as the endpoint of a furuncular lesion.

PMID:38297211 SUPPORT Model Organism

"In the subsequent non-parasitic post-larval stages, fully grown third-stage larvae leave the damaged tissue, fall to the ground, and burrow into the soil to pupate."

Confirms that the parasitic phase ends when the mature larva departs the host.

✶

Histopathology

1

Larval body parts within an inflamed tissue cavity

Biopsy or debridement specimens show larval cuticle, spines, and internal organs surrounded by a mixed inflammatory infiltrate, with adjacent tissue necrosis but no neoplastic or granulomatous process.

Show evidence (1 reference)

PMID:37864334 SUPPORT Human Clinical

"Histopathology excluded neoplasm and only showed inflammatory changes."

Documents the inflammatory, non-neoplastic histology of an infested lesion.

⬡

Pathograph

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Phenotypes

21

Blood 2

Epistaxis HP:0000421

Show evidence (1 reference)

PMID:37864334 SUPPORT Human Clinical

"A retired 71-year-old female tea-plucker presented to the hospital with a 4-day history of nasal bleeding and neck discomfort."

Documents nasal bleeding as the presenting feature of nasopharyngeal myiasis.

Increased total eosinophil count HP:0001880

Show evidence (1 reference)

PMID:34222451 SUPPORT Human Clinical

"Telephonic follow-up 1 mo later indicated that the blood eosinophilia and pleural effusion were resolved."

Documents blood eosinophilia that resolved after larval removal.

Cardiovascular 3

Erythema of the affected site HP:0010783

Show evidence (1 reference)

PMID:30647793 SUPPORT Human Clinical

"It can cause a variety of local symptoms, like erythema or pain, depending on its location, and generalized symptomatology, such as fever and malaise."

Names erythema among the local signs of myiasis.

Conjunctival hyperemia and ocular irritation HP:0030953

Show evidence (1 reference)

PMID:31955262 SUPPORT Human Clinical

"Most common symptoms of ophthalmomyiasis are irritation and redness, and in more than half of cases infestation is multiple."

Establishes irritation and redness as the commonest ocular presentation.

Vulvar erythema and inflammation HP:0010783

Show evidence (3 references)

PMID:37043897 SUPPORT Human Clinical

"Examination revealed erythema in the labia major and groin without lymphadenopathy."

Documents the vulvar and inguinal erythema on examination.

PMID:37043897 SUPPORT Human Clinical

"Involvement of the external parts of the female genitalia, especially the labia majora and minora, is often accompanied by symptoms such as tenderness, erythema and inflammation"

Generalizes tenderness, erythema, and inflammation beyond the single case.

PMID:37043897 SUPPORT Human Clinical

"Infection and necrosis were observed in the labia minora and vaginal canal due to the existence of larvae that ate away the healthy tissues."

Documents progression from inflammation to necrosis attributable to larval feeding.

Head and Neck 1

Oral ulceration with larval infestation HP:0000155

Show evidence (2 references)

DOI:10.21315/aos2025.2001.cr03 SUPPORT Human Clinical

"Manifestations comprised oral bleeding, fever, and necrotic palatal ulcers infested with maggots."

Documents ulcerated palatal lesions infested by larvae.

PMID:33125723 SUPPORT Human Clinical

"The gingiva (29%) was the most affected site, followed by palate (25%) and lip (21%)."

Gives the distribution of intraoral sites affected.

Immune 1

Sepsis HP:0100806

Show evidence (2 references)

PMID:41970302 SUPPORT Human Clinical

"We report a case of neglected myiasis wound in a laborer from rural Nepal presenting with septic shock, who was managed with intravenous fluids, antibiotics, wound care, and delayed skin grafting, resulting in complete functional recovery."

Documents septic shock arising from a neglected myiasis wound.

PMID:30647793 SUPPORT Human Clinical

"Myiasis can generate severe complications, for instance sepsis, or directly impact vital tissues."

Names sepsis as a recognized severe complication.

Integument 3

Furuncular skin nodule with central punctum HP:0200036

Show evidence (2 references)

PMID:14726861 SUPPORT Human Clinical

"He had a locally painful, firm furuncular lesion with a central pore that drained serosanguineous exudates."

Describes the furuncular nodule with central pore in a confirmed case.

PMID:41562817 SUPPORT Human Clinical

"He developed pruritic papular lesions that progressed to erythematous furuncles with central puncta and purulent discharge, accompanied by sensations of movement."

Documents the furuncle-with-punctum morphology and its evolution.

Pruritus HP:0000989

Show evidence (1 reference)

PMID:41562817 SUPPORT Human Clinical

"He developed pruritic papular lesions that progressed to erythematous furuncles with central puncta and purulent discharge, accompanied by sensations of movement."

Documents pruritus as the initial cutaneous symptom.

Ulcerated wound infested with larvae Skin ulcer HP:0200042

Show evidence (2 references)

PMID:37864334 SUPPORT Human Clinical

"On examination, there was an ulcerated area in the posterior oro-nasopharynx filled with maggots."

Documents a maggot-filled ulcerated lesion.

DOI:10.21315/aos2025.2001.cr03 SUPPORT Human Clinical

"Manifestations comprised oral bleeding, fever, and necrotic palatal ulcers infested with maggots."

Documents necrotic ulceration infested with larvae.

Metabolism 2

Fever HP:0001945

Show evidence (2 references)

PMID:30647793 SUPPORT Human Clinical

"It can cause a variety of local symptoms, like erythema or pain, depending on its location, and generalized symptomatology, such as fever and malaise."

Names fever among the generalized manifestations.

DOI:10.21315/aos2025.2001.cr03 SUPPORT Human Clinical

"Manifestations comprised oral bleeding, fever, and necrotic palatal ulcers infested with maggots."

Documents fever in a case of extensive cavitary myiasis.

Pleural effusion HP:0002202

Show evidence (1 reference)

PMID:34222451 SUPPORT Human Clinical

"Myiasis should be an important consideration for the differential diagnosis when eosinophilic pleural effusion with blood eosinophilia is observed."

Reports eosinophilic pleural effusion as a manifestation of cutaneous myiasis.

Constitutional 2

Pain at the infested site HP:0012531

Show evidence (3 references)

PMID:30647793 SUPPORT Human Clinical

"It can cause a variety of local symptoms, like erythema or pain, depending on its location, and generalized symptomatology, such as fever and malaise."

Names pain among the local symptoms of myiasis and states that it varies with the site colonized.

PMID:14726861 SUPPORT Human Clinical

"He had a locally painful, firm furuncular lesion with a central pore that drained serosanguineous exudates."

Documents pain localized to the lesion in the furuncular form.

PMID:41209928 SUPPORT Human Clinical

"This obligate parasitism can result in severe pain, secondary bacterial infections, disfigurement, and, in the absence of timely treatment, substantial morbidity or death in both humans and animals."

Reports severe pain as a consequence of obligate screwworm parasitism, the wound form.

Otalgia Ear pain HP:0030766

Show evidence (2 references)

PMID:41426897 SUPPORT Human Clinical

"The most common symptoms of otomyiasis are otalgia, otorrhea, pruritus, foreign body sensation, and aural fullness due to the mechanical effects of the larvae"

Ranks otalgia first among the presenting symptoms of otomyiasis and attributes it to mechanical larval effects.

PMID:35468383 SUPPORT Human Clinical

"clinicians should still suspect aural myiasis in the event of an unexplained otalgia in children"

Treats unexplained otalgia as a presenting sign that should raise suspicion, in a case that itself had no otalgia - which is why this is graded PARTIAL.

Other 7

Sensation of movement within the lesion

Deliberately left without a phenotype_term. HPO has no term for a sensation of movement within a lesion, and the available skin-lesion terms describe the nodule rather than the symptom, so no binding is better than a misleading one.

Show evidence (2 references)

PMID:41562817 SUPPORT Human Clinical

"He developed pruritic papular lesions that progressed to erythematous furuncles with central puncta and purulent discharge, accompanied by sensations of movement."

Records the sensation of movement accompanying furuncular lesions.

PMID:34222451 SUPPORT Human Clinical

"Intermittent migratory stabbing pain and swelling sensation on both her upper arms and shoulders were reported; tender nodules and worm-like live organisms were observed in the responding sites 1 wk later."

Documents migratory sensation preceding recovery of live larvae.

Ocular foreign body sensation Corneal foreign body sensation HP:0034804

Show evidence (1 reference)

PMID:35878965 SUPPORT Human Clinical

"This report describes the case of a woman in her early 20s who presented with a 3-day history of mobile foreign bodies and watering from her right eye."

Documents the sensation and observation of mobile foreign bodies on the eye.

Elevated inflammatory markers Elevated circulating C-reactive protein concentration HP:0011227

Show evidence (1 reference)

PMID:41562817 SUPPORT Human Clinical

"Laboratory investigations revealed elevated inflammatory markers, and wound swabs grew scanty Streptococcus pyogenes."

Documents elevated inflammatory markers with a superinfecting organism.

Otorrhea

Deliberately left unbound. HPO has no term for ear discharge or otorrhea - searches for 'otorrhea', 'ear discharge', and 'aural' all return nothing, and the nearest available terms (Otitis media, Abnormal tympanic membrane morphology) name a different finding. No term beats a bad one.

Show evidence (1 reference)

PMID:41426897 SUPPORT Human Clinical

"The most common symptoms of otomyiasis are otalgia, otorrhea, pruritus, foreign body sensation, and aural fullness due to the mechanical effects of the larvae"

Names otorrhea among the commonest symptoms of otomyiasis.

Secondary otitis media and externa Acute otitis media HP:0000371

Show evidence (2 references)

PMID:41426897 SUPPORT Human Clinical

"The remaining clinical exam was consistent with acute otitis media and externa."

Documents acute otitis media and externa in an ear cleared of larvae.

PMID:41426897 SUPPORT Human Clinical

"This feeding process can lead to complications such as tympanic membrane perforation, mastoid cavity invasion, and central nervous system penetration"

Sets out the deep-extension complications that follow larval feeding in the ear.

Vulvar pruritus Pruritus vulvae HP:0032004

Show evidence (1 reference)

PMID:37043897 SUPPORT Human Clinical

"A 55-year-old rural woman presented with the complaints of maggots in the vulval region along with severe genital itching."

Records severe vulval itching as the presenting complaint of urogenital myiasis.

Larvae passed in stool

Show evidence (2 references)

PMID:22885201 SUPPORT Human Clinical

"Intestinal myiasis is a condition when the fly larvae inhabit the gastrointestinal tract and are passed out in faeces."

Defines the passage of larvae in faeces as the presenting finding.

PMID:22885201 SUPPORT Human Clinical

"The condition is not uncommon and is often misdiagnosed as pinworm infestation."

Supports the diagnostic confusion this finding creates.

💊

Medical Actions

6

Mechanical extraction of larvae

Action: Foreign Body Removal NCIT:C50821

Complete physical removal of every larva is the definitive treatment across all clinical forms, because the disease is caused by the physical presence of the parasite rather than by a replicating pathogen.

Mechanism Target:

INHIBITS Larval penetration and burrowing into host tissue — Extraction removes the parasite that is producing the lesion, terminating both the mechanical burrowing and the secretion of digestive enzymes.

Show evidence (1 reference)

PMID:12718772 SUPPORT Human Clinical

"The lesions were treated by removal of the larva followed by twice daily application of an antibacterial ointment."

Documents larval removal as the therapeutic act in a 248-case series.

Show evidence (3 references)

PMID:12718772 SUPPORT Human Clinical

"The extraction was done by injecting 2% xylocaine over the base of the nodule."

Describes the local-anaesthetic extraction technique used in a large series.

PMID:12718772 SUPPORT Human Clinical

"Care was exercised in not damaging the larva while extracting."

Records the requirement to extract the larva intact.

PMID:35878965 SUPPORT Human Clinical

"She was treated with prophylactic topical antibiotics and subsequently made a full recovery."

Documents full recovery after larval removal with antibiotic prophylaxis in ocular disease.

Occlusion of the breathing punctum

Action: Therapeutic Procedure NCIT:C49236

Covering the central pore of a furuncular lesion with an occlusive substance deprives the larva of air and induces it to migrate outward, allowing atraumatic recovery.

Mechanism Target:

ACTIVATES Larval maturation and emergence from the host — Occlusion drives the larva out of the cavity before it would otherwise complete its instars, converting the natural endpoint of the infestation into a therapeutic one.

Show evidence (1 reference)

PMID:14726861 SUPPORT Human Clinical

"The patient applied an occlusive ointment and recovered the larva after it emerged."

Documents occlusion inducing larval emergence and recovery.

Show evidence (1 reference)

PMID:33125723 SUPPORT Human Clinical

"There were different forms and combinations of treatments: manual removal of larvae and surgical debridement, application of asphyxiating substances, antibiotic therapy, and use of ivermectin."

Lists asphyxiating substances among the treatment modalities in reported cases.

Surgical debridement

Action: Surgical Procedure NCIT:C15329

Extensive wound, oral, and cavitary disease requires operative removal of necrotic tissue together with the larvae; it is the treatment of choice in oral and maxillofacial myiasis.

Mechanism Target:

INHIBITS Tissue necrosis and cavity formation — Debridement removes the necrotic substrate that both harbours larvae and supports bacterial superinfection.

Show evidence (1 reference)

PMID:21872507 SUPPORT Human Clinical

"The sample was made up of 10 patients, all treated with surgical debridement whether or not associated with the use of oral ivermectin."

Documents debridement as the intervention applied to every case in the series.

Show evidence (2 references)

PMID:21872507 SUPPORT Human Clinical

"The treatment of choice is surgical debridement."

States debridement as the preferred treatment for oral and maxillofacial disease.

PMID:37864334 SUPPORT Human Clinical

"An examination was performed under anesthesia followed by manual removal of larvae, surgical debridement with biopsy, and treatment with antiparasitic medicines and antibiotics."

Documents combined debridement, extraction, antiparasitic, and antibiotic management.

Ivermectin

Action: Pharmacotherapy NCIT:C15986

Agent: ivermectin CHEBI:6078

Ivermectin, given orally or as a topical irrigation, kills or paralyses larvae and is used as an adjunct when lesions are numerous, deep, or inaccessible to mechanical extraction. It supplements rather than replaces removal.

Mechanism Target:

INHIBITS Larval penetration and burrowing into host tissue — Ivermectin acts on the larva itself, ending the burrowing and secretory activity that produces the lesion; expelled larvae can then be recovered.

Show evidence (1 reference)

PMID:30077978 SUPPORT Human Clinical

"On subsequent nasal irrigation with ivermectin solution, the patient self-expulsed approximately 50 larvae within 15 min."

Documents rapid larval expulsion following direct ivermectin irrigation.

Show evidence (3 references)

PMID:30077978 SUPPORT Human Clinical

"Here, we propose that ivermectin irrigation is a simple and effective treatment for nasal myiasis."

Proposes ivermectin irrigation as effective therapy for nasal disease, on single-case evidence.

PMID:32084134 SUPPORT Human Clinical

"Ivermectin, when it became available, was used to treat furuncular, wound, and cavitary lesions successfully."

Documents successful ivermectin use across furuncular, wound, and cavitary forms.

PMID:35718295 SUPPORT Human Clinical

"The relevance of this case is providing a report of a successful management with ivermectin of a case of severe vaginal myiasis."

Reports successful ivermectin treatment in severe urogenital disease.

Antibacterial therapy for secondary infection

Action: Antibiotic Therapy NCIT:C15620

Systemic or topical antibiotics treat the bacterial superinfection that complicates necrotic myiasis wounds. They have no activity against the larvae themselves.

Mechanism Target:

INHIBITS Secondary bacterial superinfection — Antibiotics target the superinfecting bacteria, not the parasite.

Show evidence (1 reference)

PMID:41562817 SUPPORT Human Clinical

"Management included wound occlusion and systemic antibiotics."

Documents systemic antibiotics used for the culture-proven superinfection.

Show evidence (2 references)

PMID:35718295 SUPPORT Human Clinical

"Severe cases of vaginal myiasis can require repeated debridement of necrotic tissue and systemic antibiotics in addition to antiparasitic medication."

Supports systemic antibiotics as an adjunct to debridement and antiparasitic therapy.

PMID:12718772 SUPPORT Human Clinical

"The lesions were treated by removal of the larva followed by twice daily application of an antibacterial ointment."

Documents topical antibacterial treatment routinely applied after extraction.

Wound care and supportive management

Action: Wound Care Management NCIT:C116681

Irrigation, dressing, and where necessary fluid resuscitation and delayed skin grafting manage the tissue defect left after the larvae are removed.

Mechanism Target:

INHIBITS Systemic sepsis and progressive tissue destruction — Supportive care and wound management interrupt progression from a colonized wound to systemic sepsis.

Show evidence (1 reference)

PMID:41970302 SUPPORT Human Clinical

"We report a case of neglected myiasis wound in a laborer from rural Nepal presenting with septic shock, who was managed with intravenous fluids, antibiotics, wound care, and delayed skin grafting, resulting in complete functional recovery."

Documents the supportive package that reversed established septic shock.

Show evidence (1 reference)

DOI:10.21315/aos2025.2001.cr03 SUPPORT Human Clinical

"Therapeutic interventions entailed bedside maggot removal and meticulous wound care, with topical hyaluronic acid application and oral hygiene guidance."

Documents wound care and hygiene measures alongside larval removal.

🌍

Environmental Factors

4

Open or neglected wound in a tropical or subtropical setting

An untended open wound is both the deposition site and the substrate for obligate and facultative wound species.

Show evidence (1 reference)

PMID:41970302 SUPPORT Human Clinical

"Poor hygiene, inadequate wound care, and exposed wounds, can predispose to secondary bacterial infection."

Supports neglected wound care as the environmental context for severe disease.

Mechanism Target:

TRIGGERS Larval deposition on host skin, wound, or body orifice — Gravid flies are attracted to and oviposit directly into open wounds, so the presence of an exposed wound is the proximate condition for larval deposition rather than a background susceptibility factor.

Show evidence (1 reference)

PMID:41970302 SUPPORT Human Clinical

"Myiasis is larval infestation of tissues, particularly common in tropical, and subtropical regions, especially in pre-existing wounds."

Links pre-existing wounds directly to where larval infestation is established.

Poor hygiene, low socioeconomic status, and impaired self-care

Myiasis concentrates in people who cannot clean or protect a wound or body orifice, including those with neurological or locomotor disability, substance dependence, homelessness, or advanced age.

Show evidence (2 references)

PMID:31618203 SUPPORT Human Clinical

"Since the first human case due to C. bezziana was reported in 1909, we have summarized 291 cases and found that these cases often occurred in patients with poor hygiene, low socio-economic conditions, old age, and underlying diseases including infections, age-related diseases, and noninfectious..."

Supports the socioeconomic and comorbidity risk profile across 291 human cases.

PMID:21872507 SUPPORT Human Clinical

"Oral-maxillofacial myiasis affects individuals with poor hygiene and neurologic and/or psychologic alterations."

Independently supports the impaired-self-care risk profile.

Mechanism Target:

PREDISPOSES Larval deposition on host skin, wound, or body orifice — Impaired self-care does not itself put larvae on the host; it removes the behaviours (wound cleaning, brushing flies away, closing the lips) that would otherwise interrupt deposition, so it is a susceptibility context layered over the actual deposition route.

Show evidence (1 reference)

PMID:33125723 SUPPORT Human Clinical

"The condition predominantly affects individuals with neurological and/or locomotor disabilities, of low socioeconomic status, with poor oral hygiene and chemical dependence and individuals with previous injuries or with the absence of lip sealing."

Identifies impaired self-care and hygiene as the risk context rather than a deposition mechanism.

Travel to endemic tropical regions

Most myiasis diagnosed in non-endemic countries is imported by returning travellers, in whom it is among the commonest travel-associated skin diseases.

Show evidence (2 references)

PMID:20883399 SUPPORT Human Clinical

"Myiasis is the fourth most common travel-associated skin disease and cutaneous myiasis is the most frequently encountered clinical form."

Supports travel as the dominant exposure context outside endemic areas.

PMID:38547087 SUPPORT Human Clinical

"More than half of the reported cases were from travelers returning from SSA (n = 122, 77.7%)."

Quantifies the traveller share of reported sub-Saharan African cases.

Mechanism Target:

PREDISPOSES Larval deposition on host skin, wound, or body orifice — Travel does not itself deposit larvae; it moves a non-immune, unprotected host into the range of the obligate flies, which is why a traveller's exposure window is short and the infestation presents after return. This is the dominant route by which the deposition node is reached in non-endemic countries.

Show evidence (2 references)

PMID:20883399 SUPPORT Human Clinical

"Myiasis is the fourth most common travel-associated skin disease and cutaneous myiasis is the most frequently encountered clinical form."

Ranks travel-acquired myiasis among the commonest imported skin diseases, establishing travel as the predisposing route to larval deposition.

PMID:38547087 SUPPORT Human Clinical

"More than half of the reported cases were from travelers returning from SSA (n = 122, 77.7%)."

Quantifies the traveller share of cases, showing that most reported deposition events in this region occur in travellers.

Close occupational contact with sheep and goats

Ophthalmomyiasis follows larviposition by Oestrus ovis, whose true hosts are small ruminants, so shepherds and farmers are classically affected.

Show evidence (1 reference)

PMID:31955262 SUPPORT Human Clinical

"O. ovis infestation is usually reported in shepherds and farmers although there is a high prevalence of infection in urban areas as well."

Supports the occupational association and its incompleteness.

Mechanism Target:

PREDISPOSES Larval deposition on host skin, wound, or body orifice — Proximity to the fly's natural ruminant hosts raises the probability that a larvipositing female strikes a human eye instead, without itself being the deposition event.

Show evidence (1 reference)

PMID:31955262 SUPPORT Human Clinical

"O. ovis infestation is usually reported in shepherds and farmers although there is a high prevalence of infection in urban areas as well."

Supports ruminant contact as a risk context while noting it is not required.

🔬

Diagnosis

2

Direct visualization and recovery of larvae

The diagnosis is made by seeing or extracting living larvae from the lesion; no serological or molecular test on the patient is required.

Show evidence (2 references)

PMID:37864334 SUPPORT Human Clinical

"On examination, there was an ulcerated area in the posterior oro-nasopharynx filled with maggots."

Diagnosis established by direct visualization of larvae in the lesion.

PMID:35878965 SUPPORT Human Clinical

"A sample taken demonstrated Oestrus ovis infestation and confirmed the diagnosis of ophthalmomyiasis externa."

Confirms diagnosis by recovery and examination of the larva.

Morphological and molecular species identification of the recovered larva

Species assignment guides treatment, prognosis, and public health response, but morphological keys require entomological expertise and are increasingly supplemented by DNA barcoding.

Show evidence (2 references)

PMID:22232372 SUPPORT Human Clinical

"When treating a patient with myiasis, it is critical to make the correct identification of the larva."

States why species identification is a required diagnostic step.

PMID:38547087 SUPPORT Human Clinical

"Clinicians in Sub-Saharan Africa often misdiagnose the disease and most of them lack the expertise to properly identify larvae, so we recommend the extensive use of molecular identification methods instead."

Documents the limits of morphological identification and the case for molecular methods.

🩻

Imaging Findings

3

Larva visible within a furuncular nodule on ultrasound

High-resolution ultrasound of a suspected furuncular lesion shows the larva itself as a well-defined highly echogenic focus inside a hypoechoic cavity, segmented on longitudinal section and casting a distal acoustic shadow. It both confirms the diagnosis and guides complete removal of the larva.

Ultrasound

skin of body UBERON:0002097

Show evidence (2 references)

PMID:22232372 SUPPORT Human Clinical

"Ultrasound can be very useful to confirm a case of furuncular myiasis and also for the complete removal of the larvae"

States the confirmatory and removal-guiding role of ultrasound in furuncular myiasis.

PMID:22232372 SUPPORT Human Clinical

"A well-defined highly echogenic area surrounded by a hypoechoic area, the presence of segmentations on longitudinal sections, and distal shadowing"

Describes the sonographic appearance of the larva that defines this finding.

Larval movement detected on real-time ultrasound

Observing the larva move during the scan is what separates this from any other echogenic subcutaneous focus, and it is the one imaging observation the literature treats as definitive rather than suggestive.

Ultrasound Diagnostic

skin of body UBERON:0002097

Show evidence (1 reference)

PMID:22232372 SUPPORT Human Clinical

"A definitive diagnosis of myiasis can be achieved if larval movement is detected during the ultrasound."

States that detected larval movement establishes a definitive diagnosis, which is what makes this finding diagnostic.

Central opening with dilated vessels and barb-like spines on dermoscopy

Dermoscopy of a furuncular lesion shows the punctum surrounded by dilated vessels, with the larva's posterior end and its black barb-like spines visible through it. A bedside adjunct when the diagnosis is in doubt, not a cross-sectional imaging study - recorded with modality OTHER because the modality enum has no dermoscopy value.

Other

skin of body UBERON:0002097

Show evidence (1 reference)

PMID:22232372 SUPPORT Human Clinical

"The examination reveals a central opening surrounded by dilated blood vessels and a yellowish structure with black barblike spines"

Describes the dermoscopic appearance of a furuncular myiasis lesion.

📈

Progression

3

Exposure and larval establishment

Larvae reach the host surface and penetrate within hours; the earliest symptom is usually pruritus or a papule rather than a recognizable lesion.

Show evidence (1 reference)

PMID:41562817 SUPPORT Human Clinical

"He developed pruritic papular lesions that progressed to erythematous furuncles with central puncta and purulent discharge, accompanied by sensations of movement."

Documents the sequence from pruritic papule to established furuncle.

Established lesion with larval growth

The larva enlarges within its cavity over days to weeks. Furuncular disease remains localized; obligate wound species extend into adjacent living tissue and can progress rapidly.

Show evidence (1 reference)

PMID:41209928 SUPPORT Human Clinical

"Unlike most dipteran larvae, which preferentially colonize necrotic tissue, C. hominivorax larvae invade and consume living tissue of warm-blooded hosts, causing a rapidly progressive condition known as myiasis."

Contrasts the rapidly progressive obligate course with facultative colonization.

Complication or resolution

Untreated cases either resolve when the larva departs to pupate, or progress through secondary bacterial infection to extensive tissue destruction and sepsis. Chronicity of months is reported where care is not sought.

Show evidence (2 references)

PMID:21872507 SUPPORT Human Clinical

"Mean time elapsed since the onset of the disease ranged from 4 to 36 months."

Documents the long delay to presentation in neglected oral and maxillofacial disease.

PMID:41209928 SUPPORT Human Clinical

"This obligate parasitism can result in severe pain, secondary bacterial infections, disfigurement, and, in the absence of timely treatment, substantial morbidity or death in both humans and animals."

Documents the range of outcomes from disfigurement to death without timely treatment.

📊

Prevalence

2

Ecuador, Amazon region

Annual Incidence 23.0 per 100,000 1–9 per 10,000

Highest regional annual incidence in the Ecuadorian Ministry of Public Health 2013-2015 dataset; the coastal and Andean rates were 5.1 and 4.7 per 100,000.

Show evidence (1 reference)

PMID:32084134 SUPPORT Human Clinical

"The highest annual incidence was reported in the Amazon (23 cases/100,000 population), followed by Coast (5.1/100,000) and Andes (4.7/100,000)."

Gives the reported regional annual incidence figures.

Worldwide

Unknown Unknown

No global burden estimate exists. Reporting is not mandatory anywhere, surveillance is absent, and the literature is dominated by case reports, so prevalence and incidence cannot be estimated reliably.

Show evidence (2 references)

PMID:32084134 SUPPORT Human Clinical

"Human myiasis is a neglected and understudied ectoparasitic infestation, being endemic in both temperate and tropical regions of Ecuador."

Characterizes myiasis as neglected and understudied, consistent with the absent global estimate.

PMID:31955262 SUPPORT Human Clinical

"Since there is reduced awareness among patients and medical professionals, the real number of ophthalmomyiasis cases is probably significantly higher than published."

Supports systematic under-ascertainment of reported case counts.

🌍

Epidemiology

5

Tropical and subtropical distribution with socioeconomic gradient

Myiasis occurs worldwide but concentrates in poor communities of tropical and subtropical countries, where fly abundance, open wounds, and limited healthcare access coincide.

tropical and subtropical climate low socioeconomic status poor hygiene and limited wound care

Show evidence (2 references)

PMID:22232372 SUPPORT Human Clinical

"The distribution of human myiasis is worldwide, with more species and greater abundance in poor socioeconomic regions of tropical and subtropical countries."

States the global distribution and its socioeconomic gradient.

PMID:29790312 SUPPORT Human Clinical

"Cavitary myiasis is rare and occurs more frequently in tropical and subtropical regions of Africa and America associated with low economic status and poor hygiene."

Independently supports the geographic and socioeconomic distribution for cavitary disease.

Travel-associated disease in non-endemic countries

In non-endemic settings myiasis is predominantly imported, and is among the most frequent skin diseases diagnosed in returning travellers.

travel to endemic regions military and occupational deployment

Show evidence (2 references)

PMID:20883399 SUPPORT Human Clinical

"Myiasis is the fourth most common travel-associated skin disease and cutaneous myiasis is the most frequently encountered clinical form."

Ranks myiasis among travel-associated skin diseases.

PMID:38547087 SUPPORT Human Clinical

"More than half of the reported cases were from travelers returning from SSA (n = 122, 77.7%)."

Quantifies the traveller fraction of reported cases from one endemic region.

Cutaneous forms dominate the clinical spectrum

Across published series the skin is the commonest site, with cavitary and visceral forms comparatively rare.

accessibility of skin to ovipositing flies

Show evidence (2 references)

PMID:38547087 SUPPORT Human Clinical

"Cutaneous myiasis was the most common clinical presentation of the disease (n = 86, 54.7%)."

Quantifies the cutaneous share of reported sub-Saharan African cases.

PMID:37864334 SUPPORT Human Clinical

"Cutaneous myiasis is the commonest type, and less commonly, internal tissues and organs are affected."

Independently supports the predominance of cutaneous disease.

Healthcare-associated and institutional acquisition

Myiasis can be acquired in hospitals and long-term care facilities by patients who cannot brush flies away, including intubated intensive-care patients.

impaired consciousness or intubation inadequate insect screening in healthcare facilities

Show evidence (2 references)

DOI:10.57187/s.3827 SUPPORT Human Clinical

"Nosocomial myiasis is seldom reported in Europe, and intensive care unit (ICU)-acquired myiasis is even rarer."

Documents nosocomial and ICU-acquired myiasis as a recognized, though rare, entity.

PMID:32084134 SUPPORT Human Clinical

"C. hominivorax was also identified in a nosocomial hospital-acquired wound."

Records a hospital-acquired screwworm wound infestation.

Climate-sensitive geographic range expansion

Warming climate and increased mobility are expected to extend the range of myiasis-causing flies, and reintroduction of eradicated screwworm populations remains a live risk.

rising air temperature global travel and livestock movement

Show evidence (2 references)

PMID:31955262 SUPPORT Human Clinical

"Global warming predisposes future increase of O. ovis prevalence in humans, which emphasizes the need for mandatory reporting and surveillance of disease."

States the expected climate-driven increase and the surveillance gap.

PMID:41209928 SUPPORT Human Clinical

"On August 4, 2025, the U.S. Centers for Disease Control and Prevention (CDC) confirmed the nation's first human case of travel-associated screwworm infestation in decades."

Documents a sentinel reintroduction event in a previously eradicated area.

🦠

Infectious Agent

8

Dermatobia hominis

The human botfly, the dominant cause of furuncular myiasis in Central and South America. It does not oviposit on the host directly but uses blood-feeding arthropods as phoretic vectors.

Dermatobia hominis NCBITaxon:115427

Show evidence (2 references)

PMID:14726861 SUPPORT Human Clinical

"Travelers to many parts of Central and South America are susceptible to infestation by Dermatobia hominis."

Supports D. hominis as a cause of human furuncular myiasis in the Americas.

PMID:32084134 SUPPORT Human Clinical

"The obligate D. hominis, causing furuncular lesions, caused 17 (43.5%) cases distributed along the tropical Pacific coast and the Amazon regions."

Quantifies the D. hominis contribution in a national case review.

Cordylobia anthropophaga

The tumbu fly, the leading cause of furuncular myiasis in sub-Saharan Africa and in travellers returning from it. Eggs are laid on soil or drying laundry and larvae penetrate skin on contact.

Cordylobia anthropophaga NCBITaxon:226132

Show evidence (2 references)

PMID:38547087 SUPPORT Human Clinical

"Cordylobia anthropophaga was the most prevalent myiasis-causing species of the reported cases (n = 104, 66.2%)."

Establishes C. anthropophaga as the predominant agent in sub-Saharan Africa.

PMID:12718772 SUPPORT Human Clinical

"Two hundred and forty-eight cases of furuncular myiasis were observed among Pakistani soldiers."

Documents a large observational series of tumbu fly furuncular myiasis.

Cochliomyia hominivorax

The New World screwworm, an obligate parasite whose larvae invade and consume living rather than necrotic tissue, producing rapidly progressive wound and cavitary myiasis.

Cochliomyia hominivorax NCBITaxon:115425

Show evidence (2 references)

PMID:41209928 SUPPORT Human Clinical

"The New World screwworm (Cochliomyia hominivorax) is an obligate parasitic fly whose larvae invade and consume living tissue, causing myiasis with severe consequences for human health, animal welfare, and agricultural productivity."

Establishes C. hominivorax as an obligate invader of living tissue.

PMID:32084134 SUPPORT Human Clinical

"The facultative C. hominivorax was identified in 15 (38%) clinical cases, infesting wound and cavitary lesions including orbital, nasal, aural and vaginal, and occurred in both subtropical and Andean regions."

Documents the range of wound and cavitary sites colonized by this species in human cases.

Oestrus ovis

The sheep bot fly, an obligate parasite of small ruminants and the dominant cause of human ophthalmomyiasis. Humans are accidental hosts in which the larvae do not mature.

Oestrus ovis NCBITaxon:123737

Show evidence (2 references)

PMID:31955262 SUPPORT Human Clinical

"Oestrus ovis is the most common cause of human ophthalmomyiasis."

Establishes O. ovis as the leading agent of human ocular myiasis.

PMID:35878965 SUPPORT Human Clinical

"Humans are accidental hosts, and there is no evidence that the first instar larvae fully mature within the human host."

Supports the accidental-host relationship that limits human O. ovis disease to the first instar.

Chrysomya bezziana

The Old World screwworm, an obligate agent of destructive wound and cavitary myiasis across Africa, the Indian subcontinent, and southeast and east Asia.

Chrysomya bezziana NCBITaxon:69364

Show evidence (1 reference)

PMID:31618203 SUPPORT Human Clinical

"Myiasis due to Old World screw-worm fly, Chrysomya bezziana, is an important obligate zoonotic disease in the OIE-list of diseases and is found throughout much of Africa, the Indian subcontinent, southeast and east Asia."

Establishes C. bezziana as an obligate agent and gives its geographic range.

Wohlfahrtia magnifica

A larviparous flesh fly causing obligate traumatic myiasis across the Palearctic. Females deposit first-stage larvae directly onto wounds and natural orifices.

Wohlfahrtia magnifica NCBITaxon:641482

Show evidence (2 references)

PMID:38297211 SUPPORT Model Organism

"Adult females deposit the first-stage larvae directly onto wounds or natural body orifices (e.g., genitalia) of the host, from where they quickly colonize the host tissue and feed on it for development."

Describes the larviposition route and rapid tissue colonization of this species.

DOI:10.3390/microorganisms12020233 SUPPORT Other

"it is a potentially deadly agent of obligate traumatic myiasis in humans and animals, with a serious impact on welfare and economics"

Supports the obligate traumatic parasitism and clinical severity of W. magnifica.

Lucilia sericata

A facultative calliphorid blowfly that colonizes necrotic wounds. It is both an agent of nosocomial wound and oral myiasis and the species used therapeutically for maggot debridement.

Lucilia sericata NCBITaxon:13632

Show evidence (1 reference)

DOI:10.57187/s.3827 SUPPORT Human Clinical

"Here, we describe the first report of hospital-acquired oral myiasis caused by Lucilia sericata occurring in a Swiss ICU."

Documents L. sericata as an agent of hospital-acquired human myiasis.

Sarcophaga haemorrhoidalis

A flesh fly recovered most often in accidental intestinal myiasis, where larvae ingested with contaminated food are later passed in faeces.

Sarcophaga haemorrhoidalis NCBITaxon:1234591

Show evidence (1 reference)

PMID:22885201 SUPPORT Human Clinical

"Of the 7 larvae, 5 were Sarcophaga haemorrhoidalis, 1 Megaselia species and 1 was identified as Muscina stabulans."

Identifies S. haemorrhoidalis as the commonest agent in an intestinal myiasis case series.

↔️

Transmission

4

Direct oviposition or larviposition onto skin, wounds, and orifices

Obligate wound species deposit eggs or first-stage larvae straight onto open wounds, ulcers, or natural body orifices, from which larvae colonize adjacent tissue within hours.

Show evidence (1 reference)

PMID:38297211 SUPPORT Model Organism

"Adult females deposit the first-stage larvae directly onto wounds or natural body orifices (e.g., genitalia) of the host, from where they quickly colonize the host tissue and feed on it for development."

Supports direct deposition onto wounds and orifices as an acquisition route.

Phoretic transport of eggs by blood-feeding arthropods

Dermatobia hominis never contacts the host itself: it glues its eggs to mosquitoes and other blood-feeding arthropods, which deliver them to the skin during a blood meal.

Show evidence (1 reference)

PMID:14726861 SUPPORT Human Clinical

"Instead, the adult female infests hosts indirectly by using blood-feeding arthropods to serve as phoretic vectors to transport the eggs."

Documents the phoretic vector route unique to D. hominis.

Contact with contaminated soil, clothing, or bedding

Tumbu-fly eggs laid on soil or on laundry dried outdoors hatch on contact with skin, so infestation follows sleeping on the ground or wearing unironed line-dried clothing.

Show evidence (2 references)

PMID:41562817 SUPPORT Human Clinical

"Awareness of exposure risks-including soil contact, infested clothing, and poor living conditions-is essential to reducing morbidity and preventing complications like secondary bacterial infection."

Names soil contact and infested clothing as the exposure route for furuncular myiasis.

PMID:41562817 SUPPORT Human Clinical

"A healthy male in his forties returned to the UK after a month-long visit to rural Ethiopia, during which he slept on dirt floors and hung his washing on a line."

Documents the specific soil-and-laundry exposure preceding an extensive infestation.

Ingestion of food contaminated with eggs or larvae

Intestinal myiasis follows accidental swallowing of eggs or larvae deposited on food by synanthropic flies.

Show evidence (1 reference)

PMID:22885201 SUPPORT Human Clinical

"This type of infestation results when eggs or larvae of the fly, deposited on food are inadvertently taken by man."

Supports foodborne ingestion as the route for the intestinal form.

🔀

Differential Diagnoses

4

Conditions with similar clinical presentations that must be differentiated from Myiasis:

Bacterial furuncle or abscess

Overlapping Features A furuncular myiasis nodule presents like a staphylococcal boil. The central breathing punctum, the reported sensation of movement, and a compatible exposure history are what separate the two.

Distinguishing Features

central punctum with serosanguineous drainage
reported sensation of movement within the lesion
recent travel to an endemic region

Show evidence (2 references)

PMID:14726861 SUPPORT Human Clinical

"He had a locally painful, firm furuncular lesion with a central pore that drained serosanguineous exudates."

The lesion is described in the same terms as a bacterial boil except for the central pore, which is the feature that separates the two at the bedside.

PMID:41562817 SUPPORT Human Clinical

"Clinicians should maintain a high index of suspicion for myiasis in patients with compatible cutaneous lesions and relevant history."

Supports exposure history as the trigger for considering myiasis over a bacterial furuncle.

Malignant or neoplastic ulcer

Overlapping Features Cavitary and oral myiasis presenting as a destructive ulcer can be mistaken for carcinoma or for invasive fungal disease; conversely, malignant wounds themselves predispose to myiasis, so the two co-occur.

Distinguishing Features

visible larvae within the ulcer
histopathology showing inflammation without neoplasia

Show evidence (2 references)

DOI:10.21315/aos2025.2001.cr03 SUPPORT Human Clinical

"Initial diagnostic considerations encompassed mucormycosis and neoplastic lesions; however, further scrutiny revealed primary palatal myiasis caused by Chrysomya bezziana species."

Documents mucormycosis and neoplasia as the competing diagnoses actually considered.

PMID:34363696 SUPPORT Human Clinical

"Cutaneous myiasis in patients with malignant wounds or skin cancer is a rare and undesirable event with limited epidemiological data."

Supports the co-occurrence of myiasis with malignant wounds.

Infectious and allergic conjunctivitis

Overlapping Features Ophthalmomyiasis externa presents with redness, watering, and foreign-body sensation and is routinely first treated as conjunctivitis or a corneal abrasion; the diagnosis turns on seeing the motile larvae.

Distinguishing Features

motile organisms visible on the ocular surface
recent exposure to sheep, goats, or a Mediterranean rural setting

Show evidence (2 references)

PMID:35878965 SUPPORT Human Clinical

"The presentation of lacrimation, hyperaemia and foreign body sensation has a broad differential diagnosis including viral, bacterial and allergic conjunctivitis."

Names the competing ocular diagnoses that myiasis mimics.

PMID:35878965 SUPPORT Human Clinical

"A sample taken demonstrated Oestrus ovis infestation and confirmed the diagnosis of ophthalmomyiasis externa."

Confirms that recovery and identification of the larva is what resolves the differential.

Pinworm and other helminth infestation

Overlapping Features Reported passage of moving worms in stool leads to a presumptive diagnosis of enterobiasis; larvae are morphologically distinct and do not respond to anthelmintics.

Distinguishing Features

dipteran larval morphology on microscopy
failure to respond to standard anthelmintic therapy

Show evidence (2 references)

PMID:22885201 SUPPORT Human Clinical

"The condition is not uncommon and is often misdiagnosed as pinworm infestation."

Names enterobiasis as the usual misdiagnosis.

PMID:22885201 SUPPORT Human Clinical

"A high index of suspicion is required for clinical diagnosis when the patient complains of passing wriggling worms in faeces for a long period without any response to antihelminthics."

Gives the anthelmintic non-response that distinguishes the two.

🐁

Animal Models

4

Ovine and caprine nasal Oestrus ovis infestation

The natural host system for Oestrus ovis, the fly that causes most human ophthalmomyiasis. In sheep and goats the larva completes development in the nasal and sinus cavities, and it is from these hosts that the larval excretory-secretory and salivary protease repertoire underpinning this entry's molecular arm was characterized. Because humans are accidental hosts in whom first-instar larvae do not develop past the ocular surface, this is the system in which the mechanism is observable at all - which is precisely what the myiasis_protease_mechanism_human_evidence discussion flags.

Species

Sheep and goat

Publication

PMID:12809756

Pathograph links

Larval excretory-secretory protease release partially recapitulates fidelity: moderate Larvae recovered from naturally and experimentally infested small ruminants secrete the serine proteases that this node asserts as the principal molecular effector of myiasis.

Limitations: The characterized enzymes come from second- and third-instar larvae developing in a permissive ruminant host. In human ophthalmomyiasis only first-instar larvae are present and they do not mature, so neither the enzyme repertoire nor the delivered dose has been shown to be the same; nothing here has been measured in human tissue.

Readouts

Serine proteases in larval excretory-secretory products

Substrate-gel zymography with protease-inhibitor class assignment on excretory-secretory products of larvae harvested from the host.

proteolysis GO:0006508

Interpretation: Establishes that the secreted repertoire is dominated by trypsin-like serine proteases, which is the enzyme class this node asserts.

Show evidence (1 reference)

PMID:12809756 SUPPORT In Vitro

"demonstrated the presence of at least six major serine proteases (molecular weights from 20 to 100 kDa), mainly trypsin-like, secreted in the digestive tube of larvae"

Reports the zymographic measurement of the secreted serine protease repertoire.

Integrity of host mucin, albumin, and immunoglobulin G exposed to larval secretions

Degradation of host mucosal and plasma proteins incubated with larval excretory-secretory products.

Direction: DECREASED

Interpretation: Shows the secreted proteases act on host substrates, not only on larval food, which is what makes this node pathogenic rather than merely nutritional.

Show evidence (1 reference)

PMID:12809756 SUPPORT In Vitro

"ESP of O. ovis larvae degrade mucosal and plasmatic components such as mucin, albumin or immunoglobulin G."

Measures loss of host mucin, albumin, and IgG on exposure to larval secretions.

Show evidence (3 references)

PMID:12809756 SUPPORT Model Organism

"The sheep bot fly, Oestrus ovis, is a very common myiasis of nasal and sinus cavities of sheep and goats causing severe welfare and production implications."

Establishes small ruminants as the natural host in which this larval mechanism is studied.

+ 2 more references

Larval modulation of the host immune response partially recapitulates fidelity: low The same salivary serine proteases are proposed to blunt the ruminant host response, the immune-evasion arm of this node.

Limitations: Immunomodulation is inferred by the authors from enzyme class and substrate range rather than demonstrated by a host-response endpoint, and it is inferred in goats. No human immune effector has been tested.

Readouts

Protease subclass of salivary gland products

Inhibitor-based subclass assignment of the proteolytic activity in dissected larval salivary glands.

Interpretation: Identifies the enzyme class the authors attribute host immunomodulation to; the immunomodulatory outcome itself is not measured here.

Show evidence (1 reference)

PMID:17697751 SUPPORT In Vitro

"Proteases in O. ovis salivary gland products belong to the serine subclass."

Reports the measured enzyme subclass in salivary gland products.

Show evidence (1 reference)

PMID:17697751 SUPPORT In Vitro

"Serine proteases in O. ovis salivary gland products are most likely involved in larval nutrition and host immuno-modulation."

The authors' own hedged inference, which is why this link is graded LOW fidelity and PARTIAL support.

The two protease papers are graded IN_VITRO where they report biochemical assays on harvested larvae, following the CLAUDE.md rule that evidence_source describes the study reported, not the model it came from. The MODEL_ORGANISM items are the in vivo statements: natural nasal infestation of sheep and goats, and the experimentally infested goats whose sera were immunoblotted.

Bactrian camel Wohlfahrtia magnifica wound myiasis

Naturally infested domestic Bactrian camels carrying parasitic-stage Wohlfahrtia magnifica larvae in open wounds. W. magnifica is an obligate agent of human wound myiasis as well, so this is the closest available animal counterpart of the human wound subtype, and it is the system in which the parasitic-stage transcriptome behind this entry's protease claims was sequenced.

Species

Bactrian camel

Publication

PMID:38297211

Pathograph links

Larval excretory-secretory protease release partially recapitulates fidelity: moderate Wound-collected parasitic larvae upregulate a large peptidase programme, giving a transcriptional counterpart to the biochemically measured protease secretion asserted by this node.

Limitations: The readout is transcript abundance in the larva, not enzyme activity in host tissue, and the host is a camel wound colonized by an aggregating larval mass. Human furuncular disease involves a single larva in a closed cavity, so both the delivered enzyme dose and the host compartment differ.

Readouts

Peptidase gene expression in parasitic wound-collected larvae

RNA-seq of larvae taken directly from camel wounds, compared with non-parasitic developmental stages.

proteolysis GO:0006508

Direction: INCREASED

Interpretation: Serine peptidase genes are specifically upregulated during the parasitic stage, tying the protease programme to parasitism rather than to development generally.

Show evidence (1 reference)

PMID:38297211 SUPPORT Model Organism

"revealed a significant upregulation of 88 peptidase genes (including 47 serine peptidase genes), 110 cuticle protein genes, and 21 heat shock protein (hsp) genes"

Quantifies the stage-specific upregulation of peptidase genes in wound-collected larvae.

Show evidence (1 reference)

PMID:38297211 SUPPORT Model Organism

"Second- and third-stage larvae of W. magnifica were non-invasively collected from the wounds of naturally infested domestic Bactrian camels"

Establishes the naturally infested camel wound as the source system for this mechanism.

Proteolytic digestion of host tissue partially recapitulates fidelity: moderate Larval feeding in the camel wound produces the tissue necrosis and loss that this node asserts as the primary lesion.

Limitations: Necrosis is reported as a general consequence of myiasis rather than quantified in this cohort, and no human tissue was examined.

Readouts

Host tissue necrosis at the larval feeding site

Gross and descriptive assessment of the infested wound.

Direction: INCREASED

Interpretation: Confirms that larval feeding converts intact wound tissue into necrotic debris, the tissue-level consequence this node predicts.

Show evidence (1 reference)

PMID:38297211 SUPPORT Model Organism

"myiasis can give rise to necrosis, decay, and the excretion of host tissues"

States the necrotic tissue outcome of larval feeding.

Show evidence (1 reference)

PMID:38297211 SUPPORT Model Organism

"Second- and third-stage larvae of W. magnifica were non-invasively collected from the wounds of naturally infested domestic Bactrian camels"

Ties the tissue-digestion claim to the infested camel wound system.

Ovine Lucilia cuprina cutaneous myiasis

Sheep infested by Lucilia cuprina, the classical facultative blowfly-strike system. It supplies the two mechanistic claims this entry makes about larval immunosuppression and about collagenase-mediated digestion of skin, and it is the third non-human system named in the myiasis_protease_mechanism_human_evidence discussion.

Species

Sheep

Publication

PMID:38297211

Pathograph links

Larval modulation of the host immune response partially recapitulates fidelity: low Larval secretion of blowfly larval immunosuppressive protein suppresses ovine lymphocyte proliferation, the only quantified immunosuppression behind this node.

Limitations: The effect is measured on sheep lymphocytes with a sheep-adapted parasite, and it reaches this entry through the review section of PMID:38297211 rather than from the primary report, so the magnitude is cited but not independently verified here. No equivalent measurement exists on human lymphocytes.

Readouts

Ovine lymphocyte proliferation in the presence of larval BLIP

Mitogen-stimulated lymphocyte proliferation assay in sheep with and without larval immunosuppressive protein.

Direction: DECREASED

Interpretation: A quantified suppression of at least 70% is the strongest single number supporting active larval immune evasion anywhere in this entry, and it is entirely non-human.

Show evidence (1 reference)

PMID:38297211 SUPPORT Model Organism

"secretes a protein called blowfly larval immunosuppressive protein (BLIP), which inhibits lymphocyte proliferation in sheep by at least 70%"

Quantifies suppression of ovine lymphocyte proliferation by a larval secreted protein.

Show evidence (1 reference)

PMID:38297211 SUPPORT Model Organism

"secretes a protein called blowfly larval immunosuppressive protein (BLIP), which inhibits lymphocyte proliferation in sheep by at least 70%"

Establishes the ovine L. cuprina system as informative for larval immune modulation.

Proteolytic digestion of host tissue partially recapitulates fidelity: low L. cuprina collagenases and proteases digest skin structural components, producing the lesion and exudate this node asserts.

Limitations: Demonstrated in ovine skin with a facultative parasite that feeds superficially as an aggregating mass; the human furuncular lesion is a single larva in a closed subcutaneous cavity. As above, the claim is quoted from a review section rather than the primary activity study.

Readouts

Digestion of skin structural components by larval collagenases

Enzyme activity assays on larval collagenases and proteases against skin structural proteins.

Direction: DECREASED

Interpretation: Loss of skin structural protein under larval enzyme activity is the mechanistic link between protease secretion and lesion formation.

Show evidence (1 reference)

PMID:38297211 SUPPORT Model Organism

"The activity study of L. cuprina collagenases and proteases suggested that they were not only involved in larval nutrition but also digested structural components of the skin, contributing to the formation of lesions and the production of exudates"

Attributes lesion and exudate formation to enzymatic digestion of skin structural components.

Show evidence (1 reference)

PMID:38297211 SUPPORT Model Organism

"The activity study of L. cuprina collagenases and proteases suggested that they were not only involved in larval nutrition but also digested structural components of the skin, contributing to the formation of lesions and the production of exudates"

Establishes the ovine L. cuprina system as informative for enzymatic tissue digestion.

Both claims reach this entry through the introduction of PMID:38297211, which cites the primary L. cuprina literature. The citation here is to the paper actually fetched and quote-checked rather than to a primary report not in the reference cache, and fidelity is set LOW accordingly.

BALB/c mouse oral gavage with Clogmia albipunctata

A deliberate negative control for the intestinal subtype. BALB/c mice were gavaged with viable Clogmia albipunctata eggs and first-instar larvae, the species most often recovered in suspected intestinal myiasis, and monitored for shedding, colonization, and gut histology. None of the three established. Paired in vitro work showed that simulated gastric fluid is lethal to both eggs and larvae.

Species

Mouse

Background

BALB/c

Publication

DOI:10.1371/journal.pone.0356742

Pathograph links

Larval penetration and burrowing into host tissue fails to recapitulate fidelity: moderate Orally delivered larvae did not penetrate or colonize gastrointestinal tissue, so this model does not reproduce the invasion step for the ingestion route.

Limitations: A negative result for one accidental species by one route in one host. C. albipunctata is a synanthropic moth fly, not an obligate parasite, and murine gastric conditions are not identical to human ones, so this bounds the pseudomyiasis question rather than excluding true intestinal myiasis by other species. It says nothing about the cutaneous or cavitary routes, where invasion is well documented in humans.

Readouts

Gastrointestinal colonization and mucosal injury after oral gavage

Seven days of faecal examination plus time-point necropsy with histological examination of gastrointestinal tissue.

Direction: UNCHANGED

Interpretation: No shedding, no tissue injury, and no colonization - the invasion step this node asserts simply did not occur by the ingestion route.

Show evidence (1 reference)

DOI:10.1371/journal.pone.0356742 REFUTE Model Organism

"the oral gavage of viable eggs and live first-instar larvae in mice resulted in no fecal shedding, tissue injury, or pathological colonization in the gastrointestinal tract"

Reports the negative colonization and histology result that defines this readout.

Show evidence (2 references)

DOI:10.1371/journal.pone.0356742 SUPPORT Model Organism

"BALB/c mice were orally gavaged with viable eggs."

Establishes the in vivo murine challenge that makes this model informative for the invasion node.

+ 1 more reference

{ }

Source YAML

click to show

name: Myiasis
creation_date: "2026-08-27T00:00:00Z"
category: Infectious Disease
description: >-
  Myiasis is the infestation of living human or vertebrate tissue by the larvae
  (maggots) of dipteran flies. Unlike most infectious diseases it is not driven
  by microbial replication or a classical immune cascade: the primary lesion is
  produced mechanically and enzymatically, as larvae penetrate and burrow into
  host tissue and secrete proteolytic excretory-secretory products that digest
  skin, connective tissue, and mucosa to create the feeding cavity. Host
  inflammation, eosinophilia, and secondary bacterial superinfection are
  consequences of that tissue destruction rather than its cause. Clinical
  presentation is determined jointly by the fly species (obligate versus
  facultative parasite) and by the anatomical site colonized, giving rise to
  furuncular, creeping (migratory), wound (traumatic), ophthalmic,
  nasopharyngeal, oral, aural, intestinal, and urogenital forms.
disease_term:
  preferred_term: myiasis
  term:
    id: MONDO:0019147
    label: myiasis
parents:
- Parasitic infection
- Ectoparasitic infestation
synonyms:
- infestation by fly larvae
- infestation by maggots
- maggot infestation
- fly larval infestation
references:
- reference: PMID:22232372
  title: Myiasis.
  found_in:
  - Myiasis-deep-research-falcon.md
- reference: PMID:20883399
  title: 'Cutaneous myiasis: a review of the common types of myiasis.'
  found_in:
  - Myiasis-deep-research-falcon.md
- reference: PMID:38547087
  title: 'Human myiasis in Sub-Saharan Africa: A systematic review.'
  found_in:
  - Myiasis-deep-research-falcon.md
- reference: PMID:32084134
  title: Human myiasis in Ecuador.
  found_in:
  - Myiasis-deep-research-falcon.md
- reference: PMID:38297211
  title: Transcriptomic profiling of different developmental stages reveals parasitic strategies of Wohlfahrtia magnifica, a myiasis-causing flesh fly.
  found_in:
  - Myiasis-deep-research-falcon.md
- reference: DOI:10.57187/s.3827
  title: 'Myiasis in the intensive care unit: report from Switzerland and review of worldwide cases'
  found_in:
  - Myiasis-deep-research-falcon.md
- reference: DOI:10.3389/fcimb.2025.1568563
  title: Machine learning-based text mining for cutaneous myiasis and potential value of an accidental maggot therapy for complicated skin and soft tissue infection with sepsis
  found_in:
  - Myiasis-deep-research-falcon.md
- reference: DOI:10.3390/microorganisms12020233
  title: 'Long Time No Hear, Magnificent Wohlfahrtia! Morphological and Molecular Evidence of Almost Forgotten Flesh Fly in Serbia and Western Balkans'
  found_in:
  - Myiasis-deep-research-falcon.md
- reference: DOI:10.21315/aos2025.2001.cr03
  title: 'Extensive Palatal Necrosis Secondary to Chrysomya bezziana Myiasis: A Case Report'
  found_in:
  - Myiasis-deep-research-falcon.md
- reference: DOI:10.1371/journal.pone.0356742
  title: 'Clogmia albipunctata fails to induce true intestinal myiasis: Evidence from in vitro and in vivo digestive models'
  found_in:
  - Myiasis-deep-research-falcon.md
classifications:
  harrisons_chapter:
  - classification_value: INFECTIOUS_DISEASES
    evidence:
    - reference: PMID:22232372
      reference_title: Myiasis.
      supports: SUPPORT
      evidence_source: HUMAN_CLINICAL
      snippet: "Myiasis is defined as the infestation of live vertebrates (humans and/or animals) with dipterous larvae."
      explanation: Establishes myiasis as a parasitic infestation of vertebrates by dipteran larvae.
    - reference: PMID:29790312
      reference_title: Cavitary myiasis and its management.
      supports: SUPPORT
      evidence_source: HUMAN_CLINICAL
      snippet: "Myiasis is a parasitic disease of humans and vertebrates, caused by fly larvae feeding on the host's necrotic or living tissue."
      explanation: Independently classifies myiasis as a parasitic disease of humans.
definitions:
- name: Clinical case definition for human myiasis
  definition_type: CASE_DEFINITION
  description: >-
    Human myiasis is defined by the presence of living dipteran fly larvae in or
    on the tissues of a living person, with the larvae feeding on host tissue,
    body fluids, or ingested food for at least part of their development.
  scope: Symptomatic and asymptomatic human infestation by dipteran fly larvae
  evidence:
  - reference: PMID:20883399
    reference_title: 'Cutaneous myiasis: a review of the common types of myiasis.'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "refers to the infestation of live human and vertebrate animals with dipterous (two-winged) larvae (maggots) which, at least for a certain period, feed on the host's dead or living tissue, liquid body-substance, or ingested food"
    explanation: Gives the classical definitional criteria used for the case definition.
  - reference: PMID:37864334
    reference_title: 'Human Oro-Nasopharyngeal Myiasis by Chrysomya Bezziana (Old-World Screwworm): The First Reported Case in Sri Lanka.'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Myiasis is the invasion of mammalian tissues by dipterous larvae."
    explanation: Confirms tissue invasion by dipteran larvae as the defining event.
- name: Anatomical classification of myiasis
  definition_type: DIAGNOSTIC_CRITERIA
  description: >-
    Cases are classified by the body region colonized (cutaneous furuncular,
    migratory, wound/traumatic, and cavitary forms named for the affected organ)
    and, separately, by the degree of parasitism shown by the implicated fly
    species (obligate, facultative, or accidental).
  scope: Case classification once larvae have been recovered and identified
  evidence:
  - reference: PMID:22232372
    reference_title: Myiasis.
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "There are two main systems for categorizing myiasis: anatomical and ecological classifications."
    explanation: States the two orthogonal classification axes used to type a case.
  - reference: PMID:22232372
    reference_title: Myiasis.
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Cavitary myiasis, where the infestation receives the name of the affected organ, e.g., cerebral myiasis, aural myiasis, nasal myiasis, and ophthalmomyiasis."
    explanation: Documents the organ-naming convention used for the cavitary subtypes.
  - reference: PMID:20883399
    reference_title: 'Cutaneous myiasis: a review of the common types of myiasis.'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Cutaneous myiasis can be divided into three main clinical manifestations: furuncular, creeping (migratory), and wound (traumatic) myiasis."
    explanation: Supports the three-way split of the cutaneous forms.
- name: Distinction of true myiasis from pseudomyiasis
  definition_type: DIAGNOSTIC_CRITERIA
  description: >-
    True myiasis requires larvae that develop on or in living host tissue.
    Recovery of larvae from stool or a body orifice is not sufficient, because
    accidentally ingested or post-passage-contaminating larvae of synanthropic
    flies may be passed without ever having colonized the host.
  scope: Reported gastrointestinal and cavitary cases where larvae are recovered but colonization is unproven
  evidence:
  - reference: DOI:10.1371/journal.pone.0356742
    reference_title: 'Clogmia albipunctata fails to induce true intestinal myiasis: Evidence from in vitro and in vivo digestive models'
    supports: SUPPORT
    evidence_source: MODEL_ORGANISM
    snippet: "Larvae of this species have been reported in suspected cases of intestinal myiasis, but whether they can establish true gastrointestinal infestation remains uncertain."
    explanation: States the colonization requirement that separates true intestinal myiasis from pseudomyiasis.
has_subtypes:
- name: Furuncular
  display_name: Furuncular (boil-like) cutaneous myiasis
  subtype_term:
    preferred_term: furuncular myiasis
    term:
      id: MONDO:0018941
      label: furuncular myiasis
  description: >-
    A single larva develops within a closed subcutaneous cavity, producing a
    boil-like nodule with a central punctum through which the larva breathes and
    serosanguineous fluid drains. Caused chiefly by Dermatobia hominis in the
    Americas and Cordylobia anthropophaga in sub-Saharan Africa.
  evidence:
  - reference: PMID:14726861
    reference_title: 'Furuncular myiasis caused by Dermatobia hominis, the human botfly.'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "He had a locally painful, firm furuncular lesion with a central pore that drained serosanguineous exudates."
    explanation: Describes the defining furuncular lesion with central pore.
  - reference: PMID:20883399
    reference_title: 'Cutaneous myiasis: a review of the common types of myiasis.'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "The flies that produce a furuncular myiasis include Dermatobia hominis, Cordylobia anthropophaga, Wohlfahrtia vigil, and the Cuterebra species."
    explanation: Names the fly species responsible for the furuncular form.
- name: Creeping
  display_name: Creeping (migratory) cutaneous myiasis
  subtype_term:
    preferred_term: creeping myiasis
    term:
      id: MONDO:0018857
      label: creeping myiasis
  description: >-
    The third cutaneous form alongside the furuncular and wound types. A larva
    that cannot complete development in an accidental human host tunnels through
    the skin instead of settling in one cavity, producing a serpiginous,
    slowly advancing track rather than a fixed boil-like nodule. Gasterophilus
    (horse bot fly) and Hypoderma (cattle bot fly) larvae account for almost all
    human cases.
  evidence:
  - reference: PMID:20883399
    reference_title: 'Cutaneous myiasis: a review of the common types of myiasis.'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Cutaneous myiasis can be divided into three main clinical manifestations: furuncular, creeping (migratory), and wound (traumatic) myiasis."
    explanation: Establishes creeping (migratory) myiasis as one of the three cutaneous forms.
  - reference: PMID:22232372
    reference_title: Myiasis.
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Migratory myiasis, or creeping myiasis, occurs when a dipteran maggot starts to migrate, aimlessly, through burrows in the skin, producing the migratory pattern of the lesions."
    explanation: Defines the migratory tunnelling behaviour that distinguishes this subtype from the furuncular form.
  - reference: PMID:20883399
    reference_title: 'Cutaneous myiasis: a review of the common types of myiasis.'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Gasterophilus and Hypoderma are two flies that produce a creeping myiasis."
    explanation: Names the two genera responsible for the creeping form.
- name: Wound
  display_name: Wound (traumatic) myiasis
  subtype_term:
    preferred_term: wound myiasis
    term:
      id: MONDO:0015622
      label: wound myiasis
  description: >-
    Larvae are deposited into a pre-existing open wound or ulcer and feed as an
    aggregating mass, progressively enlarging the defect. Obligate screwworms
    (Cochliomyia hominivorax, Chrysomya bezziana, Wohlfahrtia magnifica) invade
    adjacent living tissue rather than confining themselves to necrotic debris.
  evidence:
  - reference: PMID:20883399
    reference_title: 'Cutaneous myiasis: a review of the common types of myiasis.'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Flies that cause wound myiasis include screwworm flies such as Cochliomyia hominivorax and Chrysomya bezziana, and Wohlfahrtia magnifica."
    explanation: Names the obligate screwworm species responsible for the wound form.
  - reference: PMID:41970302
    reference_title: 'Neglected Myiasis Wound Presenting With Septic Shock: A Case Report.'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Myiasis is larval infestation of tissues, particularly common in tropical, and subtropical regions, especially in pre-existing wounds."
    explanation: Supports the pre-existing wound as the substrate for this subtype.
- name: Ophthalmic
  display_name: Ophthalmomyiasis
  subtype_term:
    preferred_term: ophthalmomyiasis
    term:
      id: MONDO:0000301
      label: ophthalmomyiasis
  description: >-
    Infestation of ocular structures, most often the superficial (externa) form
    involving conjunctiva and cornea. Oestrus ovis is the dominant agent; humans
    are accidental hosts in whom the first-instar larvae do not complete
    development.
  evidence:
  - reference: PMID:31955262
    reference_title: Human ophthalmomyiasis caused by Oestrus ovis-first report from Croatia and review on cases from Mediterranean countries.
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "A total of 260 (99.62%) cases had external, while 1 (0.38%) had internal form of ocular myiasis."
    explanation: Quantifies the predominance of the external over the internal ocular form.
  - reference: PMID:35878965
    reference_title: Ophthalmomyiasis externa caused by Oestrus ovis.
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Ophthalmomyiasis externa refers to the superficial infestation of the ocular structures by dipterous larvae."
    explanation: Defines the ophthalmomyiasis externa subtype.
- name: Nasopharyngeal
  display_name: Nasal and oro-nasopharyngeal myiasis
  subtype_term:
    preferred_term: nasal and oro-nasopharyngeal myiasis
    term:
      id: MONDO:0015623
      label: cavitary myiasis
  description: >-
    Infestation of the nasal cavity, paranasal sinuses, and posterior
    oropharynx, which can erode into deep midfacial structures. Typically arises
    in patients with pre-existing mucosal ulceration, obtunded consciousness, or
    limited self-care.
  evidence:
  - reference: PMID:37864334
    reference_title: 'Human Oro-Nasopharyngeal Myiasis by Chrysomya Bezziana (Old-World Screwworm): The First Reported Case in Sri Lanka.'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "On examination, there was an ulcerated area in the posterior oro-nasopharynx filled with maggots."
    explanation: Documents the anatomical extent that defines this subtype.
- name: Oral
  display_name: Oral and maxillofacial myiasis
  subtype_term:
    preferred_term: oral myiasis
    term:
      id: MONDO:0015623
      label: cavitary myiasis
  description: >-
    Larval infestation of the gingiva, palate, and lips, strongly associated with
    neurological or locomotor disability, poor oral hygiene, and inability to
    achieve lip seal.
  evidence:
  - reference: PMID:33125723
    reference_title: 'Oral myiasis: Analysis of cases reported in the English literature from 1990 to 2020.'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "The gingiva (29%) was the most affected site, followed by palate (25%) and lip (21%)."
    explanation: Gives the intraoral site distribution defining this subtype.
  - reference: PMID:21872507
    reference_title: 'Oral and maxillofacial myiasis: a case series and literature review.'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "The middle third of the face was the most frequently affected region (7 cases)."
    explanation: Supports the maxillofacial distribution in a hospital case series.
  - reference: PMID:40505774
    reference_title: 'Oral cavity myiasis and mouth parasitic infestations: A systematic review.'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "The clinical protocol could take advantage from a combination of surgical removal and pharmacological therapy."
    explanation: A systematic review of 95 publications concluding that oral myiasis is managed by combined surgical removal and drug therapy, the treatment pattern this entry curates.
- name: Aural
  display_name: Otomyiasis
  subtype_term:
    preferred_term: aural myiasis
    term:
      id: MONDO:0015623
      label: cavitary myiasis
  description: >-
    Infestation of the external auditory canal and middle ear, predisposed to by
    chronic otitis media and previous otological surgery, with risk of extension
    into adjacent vital structures.
  evidence:
  - reference: PMID:30647793
    reference_title: 'Otomyiasis: Systematic Review.'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Chronic otitis media, previous otic surgical procedures, mental deficit, alcohol or drug abuse, sleeping outdoors, prostration, and malnutrition were predisposing factors."
    explanation: Defines the predisposing context that characterizes the aural subtype.
- name: Intestinal
  display_name: Intestinal (gastrointestinal) myiasis
  subtype_term:
    preferred_term: intestinal myiasis
    term:
      id: MONDO:0015623
      label: cavitary myiasis
  description: >-
    Larvae ingested with contaminated food survive transit of the
    gastrointestinal tract and are passed in faeces, producing variable and often
    mild abdominal symptoms. The subtype is frequently over-diagnosed, since
    accidental contamination must be excluded.
  evidence:
  - reference: PMID:22885201
    reference_title: Intestinal myiasis.
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Intestinal myiasis is a condition when the fly larvae inhabit the gastrointestinal tract and are passed out in faeces."
    explanation: Defines the intestinal subtype.
  - reference: PMID:22885201
    reference_title: Intestinal myiasis.
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "They survive the unfavourable conditions within the gastrointestinal tract and produce disturbances, which may vary from mild to severe."
    explanation: Supports the variable symptom severity of this subtype.
- name: Urogenital
  display_name: Urogenital myiasis
  subtype_term:
    preferred_term: urogenital myiasis
    term:
      id: MONDO:0015623
      label: cavitary myiasis
  description: >-
    Rare infestation of the vulvovaginal or urinary tract, linked to poor
    sanitary conditions and limited healthcare access, and often requiring
    repeated debridement in addition to antiparasitic therapy.
  evidence:
  - reference: PMID:35718295
    reference_title: 'Severe Vaginal Myiasis: Successful Management With Ivermectin.'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Urogenital myiasis is a rare condition that is linked to poor sanitary conditions and limited access to healthcare and with few published case reports."
    explanation: Defines the urogenital subtype and its social risk context.
  - reference: PMID:39371381
    reference_title: 'Infancy Urogenital Myiasis: A Case Report.'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "During the examination, motile and live larvae were observed in the penis area."
    explanation: Documents male genital involvement in an infant, showing the subtype is not confined to vulvovaginal disease in adults.
infectious_agent:
- name: Dermatobia hominis
  infectious_agent_term:
    preferred_term: Dermatobia hominis
    term:
      id: NCBITaxon:115427
      label: Dermatobia hominis
  description: >-
    The human botfly, the dominant cause of furuncular myiasis in Central and
    South America. It does not oviposit on the host directly but uses
    blood-feeding arthropods as phoretic vectors.
  evidence:
  - reference: PMID:14726861
    reference_title: 'Furuncular myiasis caused by Dermatobia hominis, the human botfly.'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Travelers to many parts of Central and South America are susceptible to infestation by Dermatobia hominis."
    explanation: Supports D. hominis as a cause of human furuncular myiasis in the Americas.
  - reference: PMID:32084134
    reference_title: Human myiasis in Ecuador.
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "The obligate D. hominis, causing furuncular lesions, caused 17 (43.5%) cases distributed along the tropical Pacific coast and the Amazon regions."
    explanation: Quantifies the D. hominis contribution in a national case review.
- name: Cordylobia anthropophaga
  infectious_agent_term:
    preferred_term: Cordylobia anthropophaga
    term:
      id: NCBITaxon:226132
      label: Cordylobia anthropophaga
  description: >-
    The tumbu fly, the leading cause of furuncular myiasis in sub-Saharan Africa
    and in travellers returning from it. Eggs are laid on soil or drying laundry
    and larvae penetrate skin on contact.
  evidence:
  - reference: PMID:38547087
    reference_title: 'Human myiasis in Sub-Saharan Africa: A systematic review.'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Cordylobia anthropophaga was the most prevalent myiasis-causing species of the reported cases (n = 104, 66.2%)."
    explanation: Establishes C. anthropophaga as the predominant agent in sub-Saharan Africa.
  - reference: PMID:12718772
    reference_title: Furuncular myiasis by tumbu fly.
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Two hundred and forty-eight cases of furuncular myiasis were observed among Pakistani soldiers."
    explanation: Documents a large observational series of tumbu fly furuncular myiasis.
- name: Cochliomyia hominivorax
  infectious_agent_term:
    preferred_term: Cochliomyia hominivorax
    term:
      id: NCBITaxon:115425
      label: Cochliomyia hominivorax
  description: >-
    The New World screwworm, an obligate parasite whose larvae invade and consume
    living rather than necrotic tissue, producing rapidly progressive wound and
    cavitary myiasis.
  evidence:
  - reference: PMID:41209928
    reference_title: 'The New World Screwworm in the United States: A Narrative Review Anchored to the 2025 Travel-Associated Human Case.'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "The New World screwworm (Cochliomyia hominivorax) is an obligate parasitic fly whose larvae invade and consume living tissue, causing myiasis with severe consequences for human health, animal welfare, and agricultural productivity."
    explanation: Establishes C. hominivorax as an obligate invader of living tissue.
  - reference: PMID:32084134
    reference_title: Human myiasis in Ecuador.
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "The facultative C. hominivorax was identified in 15 (38%) clinical cases, infesting wound and cavitary lesions including orbital, nasal, aural and vaginal, and occurred in both subtropical and Andean regions."
    explanation: Documents the range of wound and cavitary sites colonized by this species in human cases.
- name: Oestrus ovis
  infectious_agent_term:
    preferred_term: Oestrus ovis
    term:
      id: NCBITaxon:123737
      label: Oestrus ovis
  description: >-
    The sheep bot fly, an obligate parasite of small ruminants and the dominant
    cause of human ophthalmomyiasis. Humans are accidental hosts in which the
    larvae do not mature.
  evidence:
  - reference: PMID:31955262
    reference_title: Human ophthalmomyiasis caused by Oestrus ovis-first report from Croatia and review on cases from Mediterranean countries.
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Oestrus ovis is the most common cause of human ophthalmomyiasis."
    explanation: Establishes O. ovis as the leading agent of human ocular myiasis.
  - reference: PMID:35878965
    reference_title: Ophthalmomyiasis externa caused by Oestrus ovis.
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Humans are accidental hosts, and there is no evidence that the first instar larvae fully mature within the human host."
    explanation: Supports the accidental-host relationship that limits human O. ovis disease to the first instar.
- name: Chrysomya bezziana
  infectious_agent_term:
    preferred_term: Chrysomya bezziana
    term:
      id: NCBITaxon:69364
      label: Chrysomya bezziana
  description: >-
    The Old World screwworm, an obligate agent of destructive wound and cavitary
    myiasis across Africa, the Indian subcontinent, and southeast and east Asia.
  evidence:
  - reference: PMID:31618203
    reference_title: 'Human Chrysomya bezziana myiasis: A systematic review.'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Myiasis due to Old World screw-worm fly, Chrysomya bezziana, is an important obligate zoonotic disease in the OIE-list of diseases and is found throughout much of Africa, the Indian subcontinent, southeast and east Asia."
    explanation: Establishes C. bezziana as an obligate agent and gives its geographic range.
- name: Wohlfahrtia magnifica
  infectious_agent_term:
    preferred_term: Wohlfahrtia magnifica
    term:
      id: NCBITaxon:641482
      label: Wohlfahrtia magnifica
  description: >-
    A larviparous flesh fly causing obligate traumatic myiasis across the
    Palearctic. Females deposit first-stage larvae directly onto wounds and
    natural orifices.
  evidence:
  - reference: PMID:38297211
    reference_title: Transcriptomic profiling of different developmental stages reveals parasitic strategies of Wohlfahrtia magnifica, a myiasis-causing flesh fly.
    supports: SUPPORT
    evidence_source: MODEL_ORGANISM
    snippet: "Adult females deposit the first-stage larvae directly onto wounds or natural body orifices (e.g., genitalia) of the host, from where they quickly colonize the host tissue and feed on it for development."
    explanation: Describes the larviposition route and rapid tissue colonization of this species.
  - reference: DOI:10.3390/microorganisms12020233
    reference_title: 'Long Time No Hear, Magnificent Wohlfahrtia! Morphological and Molecular Evidence of Almost Forgotten Flesh Fly in Serbia and Western Balkans'
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "it is a potentially deadly agent of obligate traumatic myiasis in humans and animals, with a serious impact on welfare and economics"
    explanation: Supports the obligate traumatic parasitism and clinical severity of W. magnifica.
- name: Lucilia sericata
  infectious_agent_term:
    preferred_term: Lucilia sericata
    term:
      id: NCBITaxon:13632
      label: Lucilia sericata
  description: >-
    A facultative calliphorid blowfly that colonizes necrotic wounds. It is both
    an agent of nosocomial wound and oral myiasis and the species used
    therapeutically for maggot debridement.
  evidence:
  - reference: DOI:10.57187/s.3827
    reference_title: 'Myiasis in the intensive care unit: report from Switzerland and review of worldwide cases'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Here, we describe the first report of hospital-acquired oral myiasis caused by Lucilia sericata occurring in a Swiss ICU."
    explanation: Documents L. sericata as an agent of hospital-acquired human myiasis.
- name: Sarcophaga haemorrhoidalis
  infectious_agent_term:
    preferred_term: Sarcophaga haemorrhoidalis
    term:
      id: NCBITaxon:1234591
      label: Sarcophaga haemorrhoidalis
  description: >-
    A flesh fly recovered most often in accidental intestinal myiasis, where
    larvae ingested with contaminated food are later passed in faeces.
  evidence:
  - reference: PMID:22885201
    reference_title: Intestinal myiasis.
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Of the 7 larvae, 5 were Sarcophaga haemorrhoidalis, 1 Megaselia species and 1 was identified as Muscina stabulans."
    explanation: Identifies S. haemorrhoidalis as the commonest agent in an intestinal myiasis case series.
agent_life_cycle:
  description: >-
    Myiasis-causing flies share a holometabolous life cycle in which only the
    larval instars are parasitic. Eggs or first-instar larvae reach the host by
    direct deposition, by a phoretic arthropod vector, or via contaminated
    clothing, soil, or food; the larvae feed and moult within host tissue and
    then leave to pupate in soil.
  hosts:
  - preferred_term: humans
    term:
      id: NCBITaxon:9606
      label: Homo sapiens
    role: accidental or incidental host
  life_cycle_stages:
  - name: Egg deposition or larviposition on the host
    life_cycle_stage_term:
      preferred_term: egg stage
      term:
        id: OPL:0000180
        label: egg stage
    description: >-
      Eggs are laid on skin, wounds, clothing, or soil, or first-stage larvae are
      deposited directly onto wounds and orifices by larviparous species.
    evidence:
    - reference: PMID:38297211
      reference_title: Transcriptomic profiling of different developmental stages reveals parasitic strategies of Wohlfahrtia magnifica, a myiasis-causing flesh fly.
      supports: SUPPORT
      evidence_source: MODEL_ORGANISM
      snippet: "Adult females deposit the first-stage larvae directly onto wounds or natural body orifices (e.g., genitalia) of the host, from where they quickly colonize the host tissue and feed on it for development."
      explanation: Documents direct larviposition onto host wounds and orifices.
  - name: Parasitic larval instars feeding within host tissue
    life_cycle_stage_term:
      preferred_term: parasitic larval instar
    description: >-
      First- through third-stage larvae penetrate, migrate within, and feed on
      host tissue, which is the only phase of the life cycle that causes disease.
    evidence:
    - reference: PMID:38297211
      reference_title: Transcriptomic profiling of different developmental stages reveals parasitic strategies of Wohlfahrtia magnifica, a myiasis-causing flesh fly.
      supports: SUPPORT
      evidence_source: MODEL_ORGANISM
      snippet: "During the parasitic stages, the myiasis-causing larvae employ sophisticated survival strategies. They penetrate the host's skin to invade the tissue, migrate within tissues, and feed on it."
      explanation: Describes the parasitic larval phase as penetration, migration, and feeding.
  - name: Larval exit and pupation off the host
    life_cycle_stage_term:
      preferred_term: pupal stage
    description: >-
      Mature third-stage larvae leave the lesion and pupate in soil, so the host
      lesion resolves once the larvae depart or are removed.
    evidence:
    - reference: PMID:38297211
      reference_title: Transcriptomic profiling of different developmental stages reveals parasitic strategies of Wohlfahrtia magnifica, a myiasis-causing flesh fly.
      supports: SUPPORT
      evidence_source: MODEL_ORGANISM
      snippet: "In the subsequent non-parasitic post-larval stages, fully grown third-stage larvae leave the damaged tissue, fall to the ground, and burrow into the soil to pupate."
      explanation: Documents larval departure from the host and pupation in soil.
transmission:
- name: Direct oviposition or larviposition onto skin, wounds, and orifices
  description: >-
    Obligate wound species deposit eggs or first-stage larvae straight onto open
    wounds, ulcers, or natural body orifices, from which larvae colonize adjacent
    tissue within hours.
  evidence:
  - reference: PMID:38297211
    reference_title: Transcriptomic profiling of different developmental stages reveals parasitic strategies of Wohlfahrtia magnifica, a myiasis-causing flesh fly.
    supports: SUPPORT
    evidence_source: MODEL_ORGANISM
    snippet: "Adult females deposit the first-stage larvae directly onto wounds or natural body orifices (e.g., genitalia) of the host, from where they quickly colonize the host tissue and feed on it for development."
    explanation: Supports direct deposition onto wounds and orifices as an acquisition route.
- name: Phoretic transport of eggs by blood-feeding arthropods
  description: >-
    Dermatobia hominis never contacts the host itself: it glues its eggs to
    mosquitoes and other blood-feeding arthropods, which deliver them to the skin
    during a blood meal.
  evidence:
  - reference: PMID:14726861
    reference_title: 'Furuncular myiasis caused by Dermatobia hominis, the human botfly.'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Instead, the adult female infests hosts indirectly by using blood-feeding arthropods to serve as phoretic vectors to transport the eggs."
    explanation: Documents the phoretic vector route unique to D. hominis.
- name: Contact with contaminated soil, clothing, or bedding
  description: >-
    Tumbu-fly eggs laid on soil or on laundry dried outdoors hatch on contact
    with skin, so infestation follows sleeping on the ground or wearing
    unironed line-dried clothing.
  evidence:
  - reference: PMID:41562817
    reference_title: Unusually Extensive Furuncular Myiasis in a Returning Traveller from Rural Ethiopia Complicated by Streptococcus Pyogenes Secondary Infection Following Albendazole Therapy.
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Awareness of exposure risks-including soil contact, infested clothing, and poor living conditions-is essential to reducing morbidity and preventing complications like secondary bacterial infection."
    explanation: Names soil contact and infested clothing as the exposure route for furuncular myiasis.
  - reference: PMID:41562817
    reference_title: Unusually Extensive Furuncular Myiasis in a Returning Traveller from Rural Ethiopia Complicated by Streptococcus Pyogenes Secondary Infection Following Albendazole Therapy.
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "A healthy male in his forties returned to the UK after a month-long visit to rural Ethiopia, during which he slept on dirt floors and hung his washing on a line."
    explanation: Documents the specific soil-and-laundry exposure preceding an extensive infestation.
- name: Ingestion of food contaminated with eggs or larvae
  description: >-
    Intestinal myiasis follows accidental swallowing of eggs or larvae deposited
    on food by synanthropic flies.
  evidence:
  - reference: PMID:22885201
    reference_title: Intestinal myiasis.
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "This type of infestation results when eggs or larvae of the fly, deposited on food are inadvertently taken by man."
    explanation: Supports foodborne ingestion as the route for the intestinal form.
environmental:
- name: Open or neglected wound in a tropical or subtropical setting
  presence: PRESENT
  description: >-
    An untended open wound is both the deposition site and the substrate for
    obligate and facultative wound species.
  influences_mechanisms:
  - target: Larval deposition on host skin, wound, or body orifice
    environmental_effect: TRIGGERS
    causal_link_type: DIRECT
    description: >-
      Gravid flies are attracted to and oviposit directly into open wounds, so
      the presence of an exposed wound is the proximate condition for larval
      deposition rather than a background susceptibility factor.
    evidence:
    - reference: PMID:41970302
      reference_title: 'Neglected Myiasis Wound Presenting With Septic Shock: A Case Report.'
      supports: SUPPORT
      evidence_source: HUMAN_CLINICAL
      snippet: "Myiasis is larval infestation of tissues, particularly common in tropical, and subtropical regions, especially in pre-existing wounds."
      explanation: Links pre-existing wounds directly to where larval infestation is established.
  evidence:
  - reference: PMID:41970302
    reference_title: 'Neglected Myiasis Wound Presenting With Septic Shock: A Case Report.'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Poor hygiene, inadequate wound care, and exposed wounds, can predispose to secondary bacterial infection."
    explanation: Supports neglected wound care as the environmental context for severe disease.
- name: Poor hygiene, low socioeconomic status, and impaired self-care
  presence: PRESENT
  description: >-
    Myiasis concentrates in people who cannot clean or protect a wound or body
    orifice, including those with neurological or locomotor disability, substance
    dependence, homelessness, or advanced age.
  influences_mechanisms:
  - target: Larval deposition on host skin, wound, or body orifice
    environmental_effect: PREDISPOSES
    causal_link_type: INDIRECT_UNKNOWN_INTERMEDIATES
    description: >-
      Impaired self-care does not itself put larvae on the host; it removes the
      behaviours (wound cleaning, brushing flies away, closing the lips) that
      would otherwise interrupt deposition, so it is a susceptibility context
      layered over the actual deposition route.
    evidence:
    - reference: PMID:33125723
      reference_title: 'Oral myiasis: Analysis of cases reported in the English literature from 1990 to 2020.'
      supports: SUPPORT
      evidence_source: HUMAN_CLINICAL
      snippet: "The condition predominantly affects individuals with neurological and/or locomotor disabilities, of low socioeconomic status, with poor oral hygiene and chemical dependence and individuals with previous injuries or with the absence of lip sealing."
      explanation: Identifies impaired self-care and hygiene as the risk context rather than a deposition mechanism.
  evidence:
  - reference: PMID:31618203
    reference_title: 'Human Chrysomya bezziana myiasis: A systematic review.'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Since the first human case due to C. bezziana was reported in 1909, we have summarized 291 cases and found that these cases often occurred in patients with poor hygiene, low socio-economic conditions, old age, and underlying diseases including infections, age-related diseases, and noninfectious chronic diseases."
    explanation: Supports the socioeconomic and comorbidity risk profile across 291 human cases.
  - reference: PMID:21872507
    reference_title: 'Oral and maxillofacial myiasis: a case series and literature review.'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Oral-maxillofacial myiasis affects individuals with poor hygiene and neurologic and/or psychologic alterations."
    explanation: Independently supports the impaired-self-care risk profile.
- name: Travel to endemic tropical regions
  presence: PRESENT
  description: >-
    Most myiasis diagnosed in non-endemic countries is imported by returning
    travellers, in whom it is among the commonest travel-associated skin
    diseases.
  influences_mechanisms:
  - target: Larval deposition on host skin, wound, or body orifice
    environmental_effect: PREDISPOSES
    causal_link_type: INDIRECT_UNKNOWN_INTERMEDIATES
    description: >-
      Travel does not itself deposit larvae; it moves a non-immune, unprotected
      host into the range of the obligate flies, which is why a traveller's
      exposure window is short and the infestation presents after return. This is
      the dominant route by which the deposition node is reached in non-endemic
      countries.
    evidence:
    - reference: PMID:20883399
      reference_title: 'Cutaneous myiasis: a review of the common types of myiasis.'
      supports: SUPPORT
      evidence_source: HUMAN_CLINICAL
      snippet: "Myiasis is the fourth most common travel-associated skin disease and cutaneous myiasis is the most frequently encountered clinical form."
      explanation: Ranks travel-acquired myiasis among the commonest imported skin diseases, establishing travel as the predisposing route to larval deposition.
    - reference: PMID:38547087
      reference_title: 'Human myiasis in Sub-Saharan Africa: A systematic review.'
      supports: SUPPORT
      evidence_source: HUMAN_CLINICAL
      snippet: "More than half of the reported cases were from travelers returning from SSA (n = 122, 77.7%)."
      explanation: Quantifies the traveller share of cases, showing that most reported deposition events in this region occur in travellers.
  evidence:
  - reference: PMID:20883399
    reference_title: 'Cutaneous myiasis: a review of the common types of myiasis.'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Myiasis is the fourth most common travel-associated skin disease and cutaneous myiasis is the most frequently encountered clinical form."
    explanation: Supports travel as the dominant exposure context outside endemic areas.
  - reference: PMID:38547087
    reference_title: 'Human myiasis in Sub-Saharan Africa: A systematic review.'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "More than half of the reported cases were from travelers returning from SSA (n = 122, 77.7%)."
    explanation: Quantifies the traveller share of reported sub-Saharan African cases.
- name: Close occupational contact with sheep and goats
  presence: PRESENT
  description: >-
    Ophthalmomyiasis follows larviposition by Oestrus ovis, whose true hosts are
    small ruminants, so shepherds and farmers are classically affected.
  influences_mechanisms:
  - target: Larval deposition on host skin, wound, or body orifice
    environmental_effect: PREDISPOSES
    causal_link_type: INDIRECT_UNKNOWN_INTERMEDIATES
    description: >-
      Proximity to the fly's natural ruminant hosts raises the probability that a
      larvipositing female strikes a human eye instead, without itself being the
      deposition event.
    evidence:
    - reference: PMID:31955262
      reference_title: Human ophthalmomyiasis caused by Oestrus ovis-first report from Croatia and review on cases from Mediterranean countries.
      supports: SUPPORT
      evidence_source: HUMAN_CLINICAL
      snippet: "O. ovis infestation is usually reported in shepherds and farmers although there is a high prevalence of infection in urban areas as well."
      explanation: Supports ruminant contact as a risk context while noting it is not required.
  evidence:
  - reference: PMID:31955262
    reference_title: Human ophthalmomyiasis caused by Oestrus ovis-first report from Croatia and review on cases from Mediterranean countries.
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "O. ovis infestation is usually reported in shepherds and farmers although there is a high prevalence of infection in urban areas as well."
    explanation: Supports the occupational association and its incompleteness.
pathophysiology:
- name: Larval deposition on host skin, wound, or body orifice
  biological_scale: ORGANISM
  description: >-
    The initiating event is mechanical delivery of eggs or first-instar larvae to
    the host surface, by direct oviposition, larviposition, a phoretic arthropod
    vector, contaminated clothing or soil, or ingestion.
  locations:
  - preferred_term: skin of body
    term:
      id: UBERON:0002097
      label: skin of body
  downstream:
  - target: Larval penetration and burrowing into host tissue
    description: Larvae delivered to the surface immediately begin to penetrate the underlying tissue.
    causal_link_type: DIRECT
    evidence:
    - reference: PMID:38297211
      reference_title: Transcriptomic profiling of different developmental stages reveals parasitic strategies of Wohlfahrtia magnifica, a myiasis-causing flesh fly.
      supports: SUPPORT
      evidence_source: MODEL_ORGANISM
      snippet: "Adult females deposit the first-stage larvae directly onto wounds or natural body orifices (e.g., genitalia) of the host, from where they quickly colonize the host tissue and feed on it for development."
      explanation: Connects deposition directly to rapid colonization of host tissue.
  evidence:
  - reference: PMID:22232372
    reference_title: Myiasis.
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Myiasis is defined as the infestation of live vertebrates (humans and/or animals) with dipterous larvae."
    explanation: Establishes larval arrival on a live host as the initiating event.
- name: Larval penetration and burrowing into host tissue
  biological_scale: TISSUE
  description: >-
    Larvae breach the epidermis or mucosa and burrow into the dermis, subcutis,
    or submucosa, creating the cavity in which they will feed. This is a
    mechanical invasion by a metazoan parasite, not colonization by a
    replicating microbe, and the depth reached is what separates a self-limited
    furuncular lesion from progressive destruction by an obligate species.
  locations:
  - preferred_term: dermis
    term:
      id: UBERON:0002067
      label: dermis
  downstream:
  - target: Larval excretory-secretory protease release
    description: >-
      Once inside the tissue the larva secretes the proteolytic products that
      allow it to feed and to extend the burrow.
    causal_link_type: DIRECT
    evidence:
    - reference: PMID:38297211
      reference_title: Transcriptomic profiling of different developmental stages reveals parasitic strategies of Wohlfahrtia magnifica, a myiasis-causing flesh fly.
      supports: SUPPORT
      evidence_source: MODEL_ORGANISM
      snippet: "Some studies on myiasis-causing flies have demonstrated that proteolytic enzymes are a major component for the establishment, migration, feeding, growth, and development of myiasis-causing larvae."
      explanation: Ties tissue establishment and migration to secreted proteolytic enzymes.
  evidence:
  - reference: PMID:38297211
    reference_title: Transcriptomic profiling of different developmental stages reveals parasitic strategies of Wohlfahrtia magnifica, a myiasis-causing flesh fly.
    supports: SUPPORT
    evidence_source: MODEL_ORGANISM
    snippet: "During the parasitic stages, the myiasis-causing larvae employ sophisticated survival strategies. They penetrate the host's skin to invade the tissue, migrate within tissues, and feed on it."
    explanation: Directly describes penetration, intratissue migration, and feeding.
  - reference: PMID:41209928
    reference_title: 'The New World Screwworm in the United States: A Narrative Review Anchored to the 2025 Travel-Associated Human Case.'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Unlike most dipteran larvae, which preferentially colonize necrotic tissue, C. hominivorax larvae invade and consume living tissue of warm-blooded hosts, causing a rapidly progressive condition known as myiasis."
    explanation: Establishes invasion of living tissue by obligate species in human disease.
- name: Larval excretory-secretory protease release
  biological_scale: MOLECULAR
  description: >-
    Parasitic-stage larvae secrete abundant serine proteases and collagenases in
    their salivary and excretory-secretory products. These enzymes are the
    principal molecular effectors of myiasis, serving both larval nutrition and
    the digestion of host structural proteins.
  molecular_functions:
  - preferred_term: serine-type endopeptidase activity
    term:
      id: GO:0004252
      label: serine-type endopeptidase activity
    modifier: INCREASED
  biological_processes:
  - preferred_term: proteolysis
    term:
      id: GO:0006508
      label: proteolysis
    modifier: INCREASED
  downstream:
  - target: Proteolytic digestion of host tissue
    description: Secreted proteases degrade host structural and plasma proteins at the feeding site.
    causal_link_type: DIRECT
    evidence:
    - reference: PMID:12809756
      reference_title: 'Serine protease activity in excretory-secretory products of Oestrus ovis (Diptera: Oestridae) larvae.'
      supports: SUPPORT
      evidence_source: IN_VITRO
      snippet: "ESP of O. ovis larvae degrade mucosal and plasmatic components such as mucin, albumin or immunoglobulin G."
      explanation: Demonstrates that larval secretions degrade host mucosal and plasma proteins.
  - target: Larval modulation of the host immune response
    description: >-
      The same secreted protease repertoire cleaves host immune effectors,
      blunting the response that would otherwise expel the larva.
    causal_link_type: DIRECT
    evidence:
    - reference: PMID:17697751
      reference_title: Proteolytic activity in salivary gland products of sheep bot fly (Oestrus ovis) larvae.
      supports: SUPPORT
      evidence_source: IN_VITRO
      snippet: "Serine proteases in O. ovis salivary gland products are most likely involved in larval nutrition and host immuno-modulation."
      explanation: Links the secreted serine proteases to host immunomodulation as well as nutrition.
  evidence:
  - reference: PMID:12809756
    reference_title: 'Serine protease activity in excretory-secretory products of Oestrus ovis (Diptera: Oestridae) larvae.'
    supports: SUPPORT
    evidence_source: IN_VITRO
    snippet: "A preliminary biochemical characterization, using substrate gel analysis and inhibitor sensitivity, demonstrated the presence of at least six major serine proteases (molecular weights from 20 to 100 kDa), mainly trypsin-like, secreted in the digestive tube of larvae."
    explanation: Biochemically characterizes the secreted serine protease repertoire.
  - reference: PMID:17697751
    reference_title: Proteolytic activity in salivary gland products of sheep bot fly (Oestrus ovis) larvae.
    supports: SUPPORT
    evidence_source: IN_VITRO
    snippet: "Proteases in O. ovis salivary gland products belong to the serine subclass."
    explanation: Confirms the serine class of the salivary proteases.
  - reference: PMID:38297211
    reference_title: Transcriptomic profiling of different developmental stages reveals parasitic strategies of Wohlfahrtia magnifica, a myiasis-causing flesh fly.
    supports: SUPPORT
    evidence_source: MODEL_ORGANISM
    snippet: "Specifically, the expression level analysis of the likely parasitism-related genes in parasitic wound-collected larvae revealed a significant upregulation of 88 peptidase genes (including 47 serine peptidase genes), 110 cuticle protein genes, and 21 heat shock protein (hsp) genes."
    explanation: Shows transcriptional upregulation of peptidase genes specifically in the parasitic larval stage.
- name: Proteolytic digestion of host tissue
  biological_scale: TISSUE
  description: >-
    Larval collagenases and proteases digest the structural components of skin
    and connective tissue, liquefying the feeding site and producing the
    characteristic exudate. This enzymatic destruction, not an inflammatory
    response, generates the primary lesion.
  biological_processes:
  - preferred_term: extracellular matrix disassembly
    term:
      id: GO:0022617
      label: extracellular matrix disassembly
    modifier: INCREASED
  - preferred_term: collagen catabolic process
    term:
      id: GO:0030574
      label: collagen catabolic process
    modifier: INCREASED
  locations:
  - preferred_term: skin of body
    term:
      id: UBERON:0002097
      label: skin of body
  downstream:
  - target: Tissue necrosis and cavity formation
    description: Continued enzymatic and mechanical destruction converts the burrow into a necrotic cavity.
    causal_link_type: DIRECT
    evidence:
    - reference: PMID:38297211
      reference_title: Transcriptomic profiling of different developmental stages reveals parasitic strategies of Wohlfahrtia magnifica, a myiasis-causing flesh fly.
      supports: SUPPORT
      evidence_source: MODEL_ORGANISM
      snippet: "myiasis can give rise to necrosis, decay, and the excretion of host tissues"
      explanation: Connects larval feeding activity to necrosis and loss of host tissue.
  evidence:
  - reference: PMID:38297211
    reference_title: Transcriptomic profiling of different developmental stages reveals parasitic strategies of Wohlfahrtia magnifica, a myiasis-causing flesh fly.
    supports: SUPPORT
    evidence_source: MODEL_ORGANISM
    snippet: "The activity study of L. cuprina collagenases and proteases suggested that they were not only involved in larval nutrition but also digested structural components of the skin, contributing to the formation of lesions and the production of exudates"
    explanation: Attributes lesion formation and exudate directly to digestion of skin structural components.
- name: Tissue necrosis and cavity formation
  biological_scale: TISSUE
  description: >-
    The feeding larvae enlarge a necrotic cavity within the host. In furuncular
    disease this remains a closed nodule with a breathing punctum; in obligate
    wound and cavitary disease it extends into surrounding living tissue and can
    destroy palate, orbit, or bone.
  locations:
  - preferred_term: skin of body
    term:
      id: UBERON:0002097
      label: skin of body
  downstream:
  - target: Secondary bacterial superinfection
    description: The necrotic, exudative cavity is a permissive environment for bacterial proliferation.
    causal_link_type: DIRECT
    evidence:
    - reference: PMID:38297211
      reference_title: Transcriptomic profiling of different developmental stages reveals parasitic strategies of Wohlfahrtia magnifica, a myiasis-causing flesh fly.
      supports: SUPPORT
      evidence_source: MODEL_ORGANISM
      snippet: "creating an environment conducive to the proliferation of bacteria"
      explanation: States that the necrotic tissue environment created by myiasis promotes bacterial proliferation.
  - target: Host inflammatory and eosinophilic response
    description: Tissue destruction and larval antigens elicit local and systemic inflammation.
    causal_link_type: DIRECT
    evidence:
    - reference: PMID:30647793
      reference_title: 'Otomyiasis: Systematic Review.'
      supports: SUPPORT
      evidence_source: HUMAN_CLINICAL
      snippet: "It can cause a variety of local symptoms, like erythema or pain, depending on its location, and generalized symptomatology, such as fever and malaise."
      explanation: Documents the local inflammatory and systemic response following tissue involvement.
  evidence:
  - reference: DOI:10.21315/aos2025.2001.cr03
    reference_title: 'Extensive Palatal Necrosis Secondary to Chrysomya bezziana Myiasis: A Case Report'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Manifestations comprised oral bleeding, fever, and necrotic palatal ulcers infested with maggots."
    explanation: Documents necrotic cavitary destruction of the palate by larval feeding in a human case.
  - reference: PMID:34363696
    reference_title: 'Cutaneous myiasis in skin cancer and malignant wounds: a systematic review.'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Its contribution to the greater tumor tissue destruction is clear; however, more studies are required."
    explanation: Supports larval contribution to tissue destruction while flagging the limited evidence base.
- name: Larval modulation of the host immune response
  biological_scale: MOLECULAR
  description: >-
    Larval secretions cleave immunoglobulin and complement and suppress
    lymphocyte proliferation, allowing a large metazoan parasite to persist in
    tissue for days to weeks without being expelled.
  downstream:
  - target: Larval maturation and emergence from the host
    description: Immune evasion permits the larva to complete its parasitic instars in situ.
    causal_link_type: INDIRECT_UNKNOWN_INTERMEDIATES
    evidence:
    - reference: PMID:12809756
      reference_title: 'Serine protease activity in excretory-secretory products of Oestrus ovis (Diptera: Oestridae) larvae.'
      supports: SUPPORT
      evidence_source: IN_VITRO
      snippet: "Their involvement in larval trophic activity and evasion from the host immune response is further discussed as O. ovis excretory/secretory serine proteases could represent potential vaccinal targets."
      explanation: Supports a proposed role in immune evasion and larval nutrition, stated as an inference rather than a demonstrated outcome.
  evidence:
  - reference: PMID:38297211
    reference_title: Transcriptomic profiling of different developmental stages reveals parasitic strategies of Wohlfahrtia magnifica, a myiasis-causing flesh fly.
    supports: SUPPORT
    evidence_source: MODEL_ORGANISM
    snippet: "secretes a protein called blowfly larval immunosuppressive protein (BLIP), which inhibits lymphocyte proliferation in sheep by at least 70%"
    explanation: Quantifies larval suppression of host lymphocyte proliferation in a ruminant host.
  - reference: PMID:12809756
    reference_title: 'Serine protease activity in excretory-secretory products of Oestrus ovis (Diptera: Oestridae) larvae.'
    supports: SUPPORT
    evidence_source: IN_VITRO
    snippet: "ESP of O. ovis larvae degrade mucosal and plasmatic components such as mucin, albumin or immunoglobulin G."
    explanation: Shows degradation of host immunoglobulin G by larval secretions.
- name: Host inflammatory and eosinophilic response
  biological_scale: TISSUE
  description: >-
    Larval antigens and tissue injury drive a local inflammatory infiltrate with
    prominent eosinophils and neutrophils, and in some patients a systemic
    eosinophilia with elevated acute-phase reactants that resolves after the
    larvae are removed.
  cell_types:
  - preferred_term: eosinophil
    term:
      id: CL:0000771
      label: eosinophil
  - preferred_term: neutrophil
    term:
      id: CL:0000775
      label: neutrophil
  biological_processes:
  - preferred_term: inflammatory response
    term:
      id: GO:0006954
      label: inflammatory response
    modifier: INCREASED
  - preferred_term: eosinophil chemotaxis
    term:
      id: GO:0048245
      label: eosinophil chemotaxis
    modifier: INCREASED
  evidence:
  - reference: PMID:34222451
    reference_title: 'Cutaneous myiasis with eosinophilic pleural effusion: A case report.'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Myiasis should be an important consideration for the differential diagnosis when eosinophilic pleural effusion with blood eosinophilia is observed."
    explanation: Documents a systemic eosinophilic response attributable to cutaneous myiasis.
  - reference: PMID:34222451
    reference_title: 'Cutaneous myiasis with eosinophilic pleural effusion: A case report.'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Telephonic follow-up 1 mo later indicated that the blood eosinophilia and pleural effusion were resolved."
    explanation: Shows that the eosinophilic response resolved once the larvae were removed, supporting larval drive.
  - reference: PMID:30647793
    reference_title: 'Otomyiasis: Systematic Review.'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "It can cause a variety of local symptoms, like erythema or pain, depending on its location, and generalized symptomatology, such as fever and malaise."
    explanation: Supports local inflammatory signs and systemic symptoms across anatomical sites.
- name: Secondary bacterial superinfection
  biological_scale: TISSUE
  description: >-
    Necrotic tissue, exudate, and a breached epithelial barrier permit bacterial
    colonization and invasive soft-tissue infection. This is the principal
    mechanism by which myiasis becomes life-threatening. Most isolates are the
    ordinary wound flora - Staphylococcus aureus, Streptococcus pyogenes - but
    the larvae also carry their own: Wohlfahrtiimonas chitiniclastica is a
    chitinolytic gram-negative rod associated with the larvae themselves rather
    than with the host's skin, first isolated from Wohlfahrtia magnifica, and it
    is reported almost exclusively in myiasis. That makes it a myiasis-specific
    superinfection risk rather than generic wound contamination, and it is easily
    missed without MALDI-TOF or 16S sequencing.
  biological_processes:
  - preferred_term: neutrophil chemotaxis
    term:
      id: GO:0030593
      label: neutrophil chemotaxis
    modifier: INCREASED
  downstream:
  - target: Systemic sepsis and progressive tissue destruction
    description: Invasive bacterial infection of the myiasis wound can progress to systemic sepsis.
    causal_link_type: DIRECT
    evidence:
    - reference: PMID:41970302
      reference_title: 'Neglected Myiasis Wound Presenting With Septic Shock: A Case Report.'
      supports: SUPPORT
      evidence_source: HUMAN_CLINICAL
      snippet: "We report a case of neglected myiasis wound in a laborer from rural Nepal presenting with septic shock, who was managed with intravenous fluids, antibiotics, wound care, and delayed skin grafting, resulting in complete functional recovery."
      explanation: Documents progression from a neglected myiasis wound to septic shock.
  evidence:
  - reference: PMID:41562817
    reference_title: Unusually Extensive Furuncular Myiasis in a Returning Traveller from Rural Ethiopia Complicated by Streptococcus Pyogenes Secondary Infection Following Albendazole Therapy.
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Laboratory investigations revealed elevated inflammatory markers, and wound swabs grew scanty Streptococcus pyogenes."
    explanation: Microbiologically documents bacterial superinfection of myiasis lesions.
  - reference: PMID:41209928
    reference_title: 'The New World Screwworm in the United States: A Narrative Review Anchored to the 2025 Travel-Associated Human Case.'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "This obligate parasitism can result in severe pain, secondary bacterial infections, disfigurement, and, in the absence of timely treatment, substantial morbidity or death in both humans and animals."
    explanation: Names secondary bacterial infection among the principal complications.
  - reference: PMID:34576832
    reference_title: 'Human Infections by Wohlfahrtiimonas chitiniclastica: A Mini-Review and the First Report of a Burn Wound Infection after Accidental Myiasis in Central Europe.'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Wohlfahrtiimonas chitiniclastica are bacteria that cause rare infections, typically associated with the infestation of an open wound with fly larvae."
    explanation: Identifies a superinfecting organism specifically tied to larval infestation rather than to ordinary wound flora.
  - reference: PMID:34576832
    reference_title: 'Human Infections by Wohlfahrtiimonas chitiniclastica: A Mini-Review and the First Report of a Burn Wound Infection after Accidental Myiasis in Central Europe.'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "So far, 23 cases of infection with W. chitiniclastica have been reported; in 52% of these, larvae were found in the wound area."
    explanation: Quantifies how often reported human W. chitiniclastica infection is accompanied by larvae in the wound.
  - reference: PMID:25989017
    reference_title: Wohlfahrtiimonas chitiniclastica Bacteremia Associated with Myiasis, United Kingdom.
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "We highlight the importance of recognizing unusual bacteria that are associated with the larvae of parasitic flies as a potential causative agent of severe infection in patients with myiasis"
    explanation: Documents larval-associated bacteria as a cause of severe infection in myiasis, here as bacteraemia.
- name: Systemic sepsis and progressive tissue destruction
  biological_scale: ORGANISM
  description: >-
    Untreated or neglected infestation, particularly by obligate screwworms and
    in patients unable to seek care, progresses to extensive tissue loss,
    disfigurement, sepsis, and death.
  evidence:
  - reference: PMID:30647793
    reference_title: 'Otomyiasis: Systematic Review.'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Myiasis can generate severe complications, for instance sepsis, or directly impact vital tissues."
    explanation: Supports sepsis and destruction of vital tissue as the severe end of the disease course.
  - reference: PMID:41970302
    reference_title: 'Neglected Myiasis Wound Presenting With Septic Shock: A Case Report.'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "We report a case of neglected myiasis wound in a laborer from rural Nepal presenting with septic shock, who was managed with intravenous fluids, antibiotics, wound care, and delayed skin grafting, resulting in complete functional recovery."
    explanation: A human case reaching septic shock, with recovery after larval and wound management.
  - reference: PMID:34576832
    reference_title: 'Human Infections by Wohlfahrtiimonas chitiniclastica: A Mini-Review and the First Report of a Burn Wound Infection after Accidental Myiasis in Central Europe.'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "The overall fatality rate associated directly with W. chitiniclastica in these cases was 17%."
    explanation: Quantifies mortality attributable to the larval-associated superinfecting organism, the route by which myiasis kills.
- name: Larval maturation and emergence from the host
  biological_scale: ORGANISM
  description: >-
    In accidental and self-limited forms the mature larva leaves the host to
    pupate, after which the lesion heals. Because disease depends on the physical
    presence of the larva rather than on a replicating pathogen, removal or
    spontaneous departure is curative.
  evidence:
  - reference: PMID:14726861
    reference_title: 'Furuncular myiasis caused by Dermatobia hominis, the human botfly.'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "The patient applied an occlusive ointment and recovered the larva after it emerged."
    explanation: Documents larval emergence and recovery as the endpoint of a furuncular lesion.
  - reference: PMID:38297211
    reference_title: Transcriptomic profiling of different developmental stages reveals parasitic strategies of Wohlfahrtia magnifica, a myiasis-causing flesh fly.
    supports: SUPPORT
    evidence_source: MODEL_ORGANISM
    snippet: "In the subsequent non-parasitic post-larval stages, fully grown third-stage larvae leave the damaged tissue, fall to the ground, and burrow into the soil to pupate."
    explanation: Confirms that the parasitic phase ends when the mature larva departs the host.
phenotypes:
- name: Furuncular skin nodule with central punctum
  category: Dermatologic
  subtype: Furuncular
  description: >-
    A firm, boil-like cutaneous nodule containing a single larva, with a central
    breathing pore that drains serosanguineous fluid.
  phenotype_term:
    preferred_term: Skin nodule
    term:
      id: HP:0200036
      label: Skin nodule
  diagnostic: true
  evidence:
  - reference: PMID:14726861
    reference_title: 'Furuncular myiasis caused by Dermatobia hominis, the human botfly.'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "He had a locally painful, firm furuncular lesion with a central pore that drained serosanguineous exudates."
    explanation: Describes the furuncular nodule with central pore in a confirmed case.
  - reference: PMID:41562817
    reference_title: Unusually Extensive Furuncular Myiasis in a Returning Traveller from Rural Ethiopia Complicated by Streptococcus Pyogenes Secondary Infection Following Albendazole Therapy.
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "He developed pruritic papular lesions that progressed to erythematous furuncles with central puncta and purulent discharge, accompanied by sensations of movement."
    explanation: Documents the furuncle-with-punctum morphology and its evolution.
- name: Sensation of movement within the lesion
  category: Dermatologic
  description: >-
    Patients frequently report crawling or wriggling sensations, a symptom
    essentially specific to a living metazoan parasite in tissue.
  diagnostic: true
  notes: >-
    Deliberately left without a phenotype_term. HPO has no term for a sensation
    of movement within a lesion, and the available skin-lesion terms describe
    the nodule rather than the symptom, so no binding is better than a
    misleading one.
  evidence:
  - reference: PMID:41562817
    reference_title: Unusually Extensive Furuncular Myiasis in a Returning Traveller from Rural Ethiopia Complicated by Streptococcus Pyogenes Secondary Infection Following Albendazole Therapy.
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "He developed pruritic papular lesions that progressed to erythematous furuncles with central puncta and purulent discharge, accompanied by sensations of movement."
    explanation: Records the sensation of movement accompanying furuncular lesions.
  - reference: PMID:34222451
    reference_title: 'Cutaneous myiasis with eosinophilic pleural effusion: A case report.'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Intermittent migratory stabbing pain and swelling sensation on both her upper arms and shoulders were reported; tender nodules and worm-like live organisms were observed in the responding sites 1 wk later."
    explanation: Documents migratory sensation preceding recovery of live larvae.
- name: Pruritus
  category: Dermatologic
  description: Itching of the affected skin, often the earliest symptom before a nodule is apparent.
  phenotype_term:
    preferred_term: Pruritus
    term:
      id: HP:0000989
      label: Pruritus
  evidence:
  - reference: PMID:41562817
    reference_title: Unusually Extensive Furuncular Myiasis in a Returning Traveller from Rural Ethiopia Complicated by Streptococcus Pyogenes Secondary Infection Following Albendazole Therapy.
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "He developed pruritic papular lesions that progressed to erythematous furuncles with central puncta and purulent discharge, accompanied by sensations of movement."
    explanation: Documents pruritus as the initial cutaneous symptom.
- name: Erythema of the affected site
  category: Dermatologic
  description: Local redness accompanies the inflammatory response to larval invasion at any site.
  phenotype_term:
    preferred_term: Erythema
    term:
      id: HP:0010783
      label: Erythema
  evidence:
  - reference: PMID:30647793
    reference_title: 'Otomyiasis: Systematic Review.'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "It can cause a variety of local symptoms, like erythema or pain, depending on its location, and generalized symptomatology, such as fever and malaise."
    explanation: Names erythema among the local signs of myiasis.
- name: Pain at the infested site
  category: Constitutional
  description: >-
    Pain is one of the most consistently reported manifestations across the
    anatomical forms, arising from larval movement, enzymatic tissue destruction,
    and the pressure of an expanding cavity. It ranges from the localized
    tenderness of a furuncular nodule to the severe pain of an obligate
    screwworm wound, and it is often what brings the patient to care.
  phenotype_term:
    preferred_term: Pain
    term:
      id: HP:0012531
      label: Pain
  evidence:
  - reference: PMID:30647793
    reference_title: 'Otomyiasis: Systematic Review.'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "It can cause a variety of local symptoms, like erythema or pain, depending on its location, and generalized symptomatology, such as fever and malaise."
    explanation: Names pain among the local symptoms of myiasis and states that it varies with the site colonized.
  - reference: PMID:14726861
    reference_title: 'Furuncular myiasis caused by Dermatobia hominis, the human botfly.'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "He had a locally painful, firm furuncular lesion with a central pore that drained serosanguineous exudates."
    explanation: Documents pain localized to the lesion in the furuncular form.
  - reference: PMID:41209928
    reference_title: 'The New World Screwworm in the United States: A Narrative Review Anchored to the 2025 Travel-Associated Human Case.'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "This obligate parasitism can result in severe pain, secondary bacterial infections, disfigurement, and, in the absence of timely treatment, substantial morbidity or death in both humans and animals."
    explanation: Reports severe pain as a consequence of obligate screwworm parasitism, the wound form.
- name: Ulcerated wound infested with larvae
  category: Dermatologic
  subtype: Wound
  description: >-
    An open ulcer or wound visibly containing a mass of feeding larvae, which
    progressively enlarges as tissue is digested.
  phenotype_term:
    preferred_term: Skin ulcer
    term:
      id: HP:0200042
      label: Skin ulcer
  diagnostic: true
  evidence:
  - reference: PMID:37864334
    reference_title: 'Human Oro-Nasopharyngeal Myiasis by Chrysomya Bezziana (Old-World Screwworm): The First Reported Case in Sri Lanka.'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "On examination, there was an ulcerated area in the posterior oro-nasopharynx filled with maggots."
    explanation: Documents a maggot-filled ulcerated lesion.
  - reference: DOI:10.21315/aos2025.2001.cr03
    reference_title: 'Extensive Palatal Necrosis Secondary to Chrysomya bezziana Myiasis: A Case Report'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Manifestations comprised oral bleeding, fever, and necrotic palatal ulcers infested with maggots."
    explanation: Documents necrotic ulceration infested with larvae.
- name: Oral ulceration with larval infestation
  category: Oral
  subtype: Oral
  description: >-
    Gingival, palatal, or labial ulceration containing larvae, typically in
    patients unable to maintain oral hygiene or lip seal.
  phenotype_term:
    preferred_term: Oral ulcer
    term:
      id: HP:0000155
      label: Oral ulcer
  evidence:
  - reference: DOI:10.21315/aos2025.2001.cr03
    reference_title: 'Extensive Palatal Necrosis Secondary to Chrysomya bezziana Myiasis: A Case Report'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Manifestations comprised oral bleeding, fever, and necrotic palatal ulcers infested with maggots."
    explanation: Documents ulcerated palatal lesions infested by larvae.
  - reference: PMID:33125723
    reference_title: 'Oral myiasis: Analysis of cases reported in the English literature from 1990 to 2020.'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "The gingiva (29%) was the most affected site, followed by palate (25%) and lip (21%)."
    explanation: Gives the distribution of intraoral sites affected.
- name: Conjunctival hyperemia and ocular irritation
  category: Ophthalmologic
  subtype: Ophthalmic
  description: >-
    Redness, watering, and foreign-body sensation from first-instar larvae on the
    conjunctiva and cornea in ophthalmomyiasis externa.
  phenotype_term:
    preferred_term: Conjunctival hyperemia
    term:
      id: HP:0030953
      label: Conjunctival hyperemia
  evidence:
  - reference: PMID:31955262
    reference_title: Human ophthalmomyiasis caused by Oestrus ovis-first report from Croatia and review on cases from Mediterranean countries.
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Most common symptoms of ophthalmomyiasis are irritation and redness, and in more than half of cases infestation is multiple."
    explanation: Establishes irritation and redness as the commonest ocular presentation.
- name: Ocular foreign body sensation
  category: Ophthalmologic
  subtype: Ophthalmic
  description: Sensation of mobile foreign bodies on the ocular surface caused by motile larvae.
  phenotype_term:
    preferred_term: Corneal foreign body sensation
    term:
      id: HP:0034804
      label: Corneal foreign body sensation
  diagnostic: true
  evidence:
  - reference: PMID:35878965
    reference_title: Ophthalmomyiasis externa caused by Oestrus ovis.
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "This report describes the case of a woman in her early 20s who presented with a 3-day history of mobile foreign bodies and watering from her right eye."
    explanation: Documents the sensation and observation of mobile foreign bodies on the eye.
- name: Epistaxis
  category: Otolaryngologic
  subtype: Nasopharyngeal
  description: Nasal bleeding from larval erosion of nasal and nasopharyngeal mucosa.
  phenotype_term:
    preferred_term: Epistaxis
    term:
      id: HP:0000421
      label: Epistaxis
  evidence:
  - reference: PMID:37864334
    reference_title: 'Human Oro-Nasopharyngeal Myiasis by Chrysomya Bezziana (Old-World Screwworm): The First Reported Case in Sri Lanka.'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "A retired 71-year-old female tea-plucker presented to the hospital with a 4-day history of nasal bleeding and neck discomfort."
    explanation: Documents nasal bleeding as the presenting feature of nasopharyngeal myiasis.
- name: Fever
  category: Constitutional
  description: Systemic febrile response, usually reflecting extensive tissue involvement or secondary bacterial infection.
  phenotype_term:
    preferred_term: Fever
    term:
      id: HP:0001945
      label: Fever
  evidence:
  - reference: PMID:30647793
    reference_title: 'Otomyiasis: Systematic Review.'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "It can cause a variety of local symptoms, like erythema or pain, depending on its location, and generalized symptomatology, such as fever and malaise."
    explanation: Names fever among the generalized manifestations.
  - reference: DOI:10.21315/aos2025.2001.cr03
    reference_title: 'Extensive Palatal Necrosis Secondary to Chrysomya bezziana Myiasis: A Case Report'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Manifestations comprised oral bleeding, fever, and necrotic palatal ulcers infested with maggots."
    explanation: Documents fever in a case of extensive cavitary myiasis.
- name: Increased total eosinophil count
  category: Hematologic
  description: >-
    Peripheral blood eosinophilia may accompany cutaneous myiasis and resolves
    after the larvae are removed.
  phenotype_term:
    preferred_term: Increased total eosinophil count
    term:
      id: HP:0001880
      label: Increased total eosinophil count
  evidence:
  - reference: PMID:34222451
    reference_title: 'Cutaneous myiasis with eosinophilic pleural effusion: A case report.'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Telephonic follow-up 1 mo later indicated that the blood eosinophilia and pleural effusion were resolved."
    explanation: Documents blood eosinophilia that resolved after larval removal.
- name: Pleural effusion
  category: Respiratory
  description: >-
    An eosinophilic pleural effusion is a rare systemic manifestation reported
    with cutaneous myiasis and resolving after treatment.
  phenotype_term:
    preferred_term: Pleural effusion
    term:
      id: HP:0002202
      label: Pleural effusion
  evidence:
  - reference: PMID:34222451
    reference_title: 'Cutaneous myiasis with eosinophilic pleural effusion: A case report.'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Myiasis should be an important consideration for the differential diagnosis when eosinophilic pleural effusion with blood eosinophilia is observed."
    explanation: Reports eosinophilic pleural effusion as a manifestation of cutaneous myiasis.
- name: Elevated inflammatory markers
  category: Laboratory
  description: Raised C-reactive protein and white cell count accompany extensive infestation or secondary infection.
  phenotype_term:
    preferred_term: Elevated circulating C-reactive protein concentration
    term:
      id: HP:0011227
      label: Elevated circulating C-reactive protein concentration
  evidence:
  - reference: PMID:41562817
    reference_title: Unusually Extensive Furuncular Myiasis in a Returning Traveller from Rural Ethiopia Complicated by Streptococcus Pyogenes Secondary Infection Following Albendazole Therapy.
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Laboratory investigations revealed elevated inflammatory markers, and wound swabs grew scanty Streptococcus pyogenes."
    explanation: Documents elevated inflammatory markers with a superinfecting organism.
- name: Sepsis
  category: Constitutional
  description: >-
    Systemic sepsis, including septic shock, is the principal life-threatening
    complication of neglected wound myiasis.
  phenotype_term:
    preferred_term: Sepsis
    term:
      id: HP:0100806
      label: Sepsis
  evidence:
  - reference: PMID:41970302
    reference_title: 'Neglected Myiasis Wound Presenting With Septic Shock: A Case Report.'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "We report a case of neglected myiasis wound in a laborer from rural Nepal presenting with septic shock, who was managed with intravenous fluids, antibiotics, wound care, and delayed skin grafting, resulting in complete functional recovery."
    explanation: Documents septic shock arising from a neglected myiasis wound.
  - reference: PMID:30647793
    reference_title: 'Otomyiasis: Systematic Review.'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Myiasis can generate severe complications, for instance sepsis, or directly impact vital tissues."
    explanation: Names sepsis as a recognized severe complication.
- name: Otalgia
  category: Otolaryngologic
  subtype: Aural
  description: >-
    Ear pain from larval movement and mechanical pressure in the external
    auditory canal, and the symptom most likely to bring an otomyiasis patient
    to care. Notably it can be absent: an infestation discovered only when
    larvae emerged from the ear had no otalgia at all.
  phenotype_term:
    preferred_term: Ear pain
    term:
      id: HP:0030766
      label: Ear pain
  evidence:
  - reference: PMID:41426897
    reference_title: A Case of Otomyiasis in an Intoxicated Patient.
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "The most common symptoms of otomyiasis are otalgia, otorrhea, pruritus, foreign body sensation, and aural fullness due to the mechanical effects of the larvae"
    explanation: Ranks otalgia first among the presenting symptoms of otomyiasis and attributes it to mechanical larval effects.
  - reference: PMID:35468383
    reference_title: 'Otomyiasis caused by Musca domestica in a child: A case report.'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "clinicians should still suspect aural myiasis in the event of an unexplained otalgia in children"
    explanation: Treats unexplained otalgia as a presenting sign that should raise suspicion, in a case that itself had no otalgia - which is why this is graded PARTIAL.
- name: Otorrhea
  category: Otolaryngologic
  subtype: Aural
  description: >-
    Discharge from the infested ear canal, serosanguineous or frankly bloody,
    produced by larval tissue destruction and by the secondary otitis that
    follows it.
  phenotype_term:
    preferred_term: Otorrhea (ear discharge)
  evidence:
  - reference: PMID:41426897
    reference_title: A Case of Otomyiasis in an Intoxicated Patient.
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "The most common symptoms of otomyiasis are otalgia, otorrhea, pruritus, foreign body sensation, and aural fullness due to the mechanical effects of the larvae"
    explanation: Names otorrhea among the commonest symptoms of otomyiasis.
  notes: >-
    Deliberately left unbound. HPO has no term for ear discharge or otorrhea -
    searches for 'otorrhea', 'ear discharge', and 'aural' all return nothing, and
    the nearest available terms (Otitis media, Abnormal tympanic membrane
    morphology) name a different finding. No term beats a bad one.
- name: Secondary otitis media and externa
  category: Otolaryngologic
  subtype: Aural
  description: >-
    Bacterial otitis of the canal and middle ear complicating the infestation,
    the aural expression of the secondary-superinfection node. Deeper larval
    invasion can perforate the tympanic membrane and reach the mastoid or
    intracranial compartment.
  phenotype_term:
    preferred_term: Acute otitis media
    term:
      id: HP:0000371
      label: Acute otitis media
  evidence:
  - reference: PMID:41426897
    reference_title: A Case of Otomyiasis in an Intoxicated Patient.
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "The remaining clinical exam was consistent with acute otitis media and externa."
    explanation: Documents acute otitis media and externa in an ear cleared of larvae.
  - reference: PMID:41426897
    reference_title: A Case of Otomyiasis in an Intoxicated Patient.
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "This feeding process can lead to complications such as tympanic membrane perforation, mastoid cavity invasion, and central nervous system penetration"
    explanation: Sets out the deep-extension complications that follow larval feeding in the ear.
- name: Vulvar pruritus
  category: Genitourinary
  subtype: Urogenital
  description: >-
    Severe genital itching is the presenting complaint in vulvovaginal myiasis,
    often together with the patient's own observation of maggots.
  phenotype_term:
    preferred_term: Pruritus vulvae
    term:
      id: HP:0032004
      label: Pruritus vulvae
  evidence:
  - reference: PMID:37043897
    reference_title: 'Urogenital myiasis in a post-menopausal rural woman: A case report.'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "A 55-year-old rural woman presented with the complaints of maggots in the vulval region along with severe genital itching."
    explanation: Records severe vulval itching as the presenting complaint of urogenital myiasis.
- name: Vulvar erythema and inflammation
  category: Genitourinary
  subtype: Urogenital
  description: >-
    Redness, tenderness, and inflammation of the labia and groin, progressing to
    frank necrosis of the labia minora and vaginal canal where larvae have fed.
  phenotype_term:
    preferred_term: Vulvar erythema
    term:
      id: HP:0010783
      label: Erythema
  evidence:
  - reference: PMID:37043897
    reference_title: 'Urogenital myiasis in a post-menopausal rural woman: A case report.'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Examination revealed erythema in the labia major and groin without lymphadenopathy."
    explanation: Documents the vulvar and inguinal erythema on examination.
  - reference: PMID:37043897
    reference_title: 'Urogenital myiasis in a post-menopausal rural woman: A case report.'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Involvement of the external parts of the female genitalia, especially the labia majora and minora, is often accompanied by symptoms such as tenderness, erythema and inflammation"
    explanation: Generalizes tenderness, erythema, and inflammation beyond the single case.
  - reference: PMID:37043897
    reference_title: 'Urogenital myiasis in a post-menopausal rural woman: A case report.'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Infection and necrosis were observed in the labia minora and vaginal canal due to the existence of larvae that ate away the healthy tissues."
    explanation: Documents progression from inflammation to necrosis attributable to larval feeding.
- name: Larvae passed in stool
  category: Gastrointestinal
  subtype: Intestinal
  description: >-
    Recovery of living larvae in faeces is the defining observation of intestinal
    myiasis, and the reason the diagnosis is frequently confused with pinworm
    infestation.
  diagnostic: true
  evidence:
  - reference: PMID:22885201
    reference_title: Intestinal myiasis.
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Intestinal myiasis is a condition when the fly larvae inhabit the gastrointestinal tract and are passed out in faeces."
    explanation: Defines the passage of larvae in faeces as the presenting finding.
  - reference: PMID:22885201
    reference_title: Intestinal myiasis.
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "The condition is not uncommon and is often misdiagnosed as pinworm infestation."
    explanation: Supports the diagnostic confusion this finding creates.
histopathology:
- name: Larval body parts within an inflamed tissue cavity
  description: >-
    Biopsy or debridement specimens show larval cuticle, spines, and internal
    organs surrounded by a mixed inflammatory infiltrate, with adjacent tissue
    necrosis but no neoplastic or granulomatous process.
  diagnostic: true
  evidence:
  - reference: PMID:37864334
    reference_title: 'Human Oro-Nasopharyngeal Myiasis by Chrysomya Bezziana (Old-World Screwworm): The First Reported Case in Sri Lanka.'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Histopathology excluded neoplasm and only showed inflammatory changes."
    explanation: Documents the inflammatory, non-neoplastic histology of an infested lesion.
imaging_findings:
- name: Larva visible within a furuncular nodule on ultrasound
  modality: ULTRASOUND
  description: >-
    High-resolution ultrasound of a suspected furuncular lesion shows the larva
    itself as a well-defined highly echogenic focus inside a hypoechoic cavity,
    segmented on longitudinal section and casting a distal acoustic shadow. It
    both confirms the diagnosis and guides complete removal of the larva.
  located_in:
    preferred_term: skin of body
    term:
      id: UBERON:0002097
      label: skin of body
  diagnostic: false
  evidence:
  - reference: PMID:22232372
    reference_title: Myiasis.
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Ultrasound can be very useful to confirm a case of furuncular myiasis and also for the complete removal of the larvae"
    explanation: States the confirmatory and removal-guiding role of ultrasound in furuncular myiasis.
  - reference: PMID:22232372
    reference_title: Myiasis.
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "A well-defined highly echogenic area surrounded by a hypoechoic area, the presence of segmentations on longitudinal sections, and distal shadowing"
    explanation: Describes the sonographic appearance of the larva that defines this finding.
- name: Larval movement detected on real-time ultrasound
  modality: ULTRASOUND
  description: >-
    Observing the larva move during the scan is what separates this from any
    other echogenic subcutaneous focus, and it is the one imaging observation
    the literature treats as definitive rather than suggestive.
  located_in:
    preferred_term: skin of body
    term:
      id: UBERON:0002097
      label: skin of body
  diagnostic: true
  evidence:
  - reference: PMID:22232372
    reference_title: Myiasis.
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "A definitive diagnosis of myiasis can be achieved if larval movement is detected during the ultrasound."
    explanation: States that detected larval movement establishes a definitive diagnosis, which is what makes this finding diagnostic.
- name: Central opening with dilated vessels and barb-like spines on dermoscopy
  modality: OTHER
  description: >-
    Dermoscopy of a furuncular lesion shows the punctum surrounded by dilated
    vessels, with the larva's posterior end and its black barb-like spines
    visible through it. A bedside adjunct when the diagnosis is in doubt, not a
    cross-sectional imaging study - recorded with modality OTHER because the
    modality enum has no dermoscopy value.
  located_in:
    preferred_term: skin of body
    term:
      id: UBERON:0002097
      label: skin of body
  diagnostic: false
  evidence:
  - reference: PMID:22232372
    reference_title: Myiasis.
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "The examination reveals a central opening surrounded by dilated blood vessels and a yellowish structure with black barblike spines"
    explanation: Describes the dermoscopic appearance of a furuncular myiasis lesion.

diagnosis:
- name: Direct visualization and recovery of larvae
  description: >-
    The diagnosis is made by seeing or extracting living larvae from the lesion;
    no serological or molecular test on the patient is required.
  evidence:
  - reference: PMID:37864334
    reference_title: 'Human Oro-Nasopharyngeal Myiasis by Chrysomya Bezziana (Old-World Screwworm): The First Reported Case in Sri Lanka.'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "On examination, there was an ulcerated area in the posterior oro-nasopharynx filled with maggots."
    explanation: Diagnosis established by direct visualization of larvae in the lesion.
  - reference: PMID:35878965
    reference_title: Ophthalmomyiasis externa caused by Oestrus ovis.
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "A sample taken demonstrated Oestrus ovis infestation and confirmed the diagnosis of ophthalmomyiasis externa."
    explanation: Confirms diagnosis by recovery and examination of the larva.
- name: Morphological and molecular species identification of the recovered larva
  description: >-
    Species assignment guides treatment, prognosis, and public health response,
    but morphological keys require entomological expertise and are increasingly
    supplemented by DNA barcoding.
  evidence:
  - reference: PMID:22232372
    reference_title: Myiasis.
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "When treating a patient with myiasis, it is critical to make the correct identification of the larva."
    explanation: States why species identification is a required diagnostic step.
  - reference: PMID:38547087
    reference_title: 'Human myiasis in Sub-Saharan Africa: A systematic review.'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Clinicians in Sub-Saharan Africa often misdiagnose the disease and most of them lack the expertise to properly identify larvae, so we recommend the extensive use of molecular identification methods instead."
    explanation: Documents the limits of morphological identification and the case for molecular methods.
differential_diagnoses:
- name: Bacterial furuncle or abscess
  description: >-
    A furuncular myiasis nodule presents like a staphylococcal boil. The central
    breathing punctum, the reported sensation of movement, and a compatible
    exposure history are what separate the two.
  distinguishing_features:
  - central punctum with serosanguineous drainage
  - reported sensation of movement within the lesion
  - recent travel to an endemic region
  evidence:
  - reference: PMID:14726861
    reference_title: 'Furuncular myiasis caused by Dermatobia hominis, the human botfly.'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "He had a locally painful, firm furuncular lesion with a central pore that drained serosanguineous exudates."
    explanation: >-
      The lesion is described in the same terms as a bacterial boil except for
      the central pore, which is the feature that separates the two at the
      bedside.
  - reference: PMID:41562817
    reference_title: Unusually Extensive Furuncular Myiasis in a Returning Traveller from Rural Ethiopia Complicated by Streptococcus Pyogenes Secondary Infection Following Albendazole Therapy.
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Clinicians should maintain a high index of suspicion for myiasis in patients with compatible cutaneous lesions and relevant history."
    explanation: Supports exposure history as the trigger for considering myiasis over a bacterial furuncle.
- name: Malignant or neoplastic ulcer
  description: >-
    Cavitary and oral myiasis presenting as a destructive ulcer can be mistaken
    for carcinoma or for invasive fungal disease; conversely, malignant wounds
    themselves predispose to myiasis, so the two co-occur.
  distinguishing_features:
  - visible larvae within the ulcer
  - histopathology showing inflammation without neoplasia
  evidence:
  - reference: DOI:10.21315/aos2025.2001.cr03
    reference_title: 'Extensive Palatal Necrosis Secondary to Chrysomya bezziana Myiasis: A Case Report'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Initial diagnostic considerations encompassed mucormycosis and neoplastic lesions; however, further scrutiny revealed primary palatal myiasis caused by Chrysomya bezziana species."
    explanation: Documents mucormycosis and neoplasia as the competing diagnoses actually considered.
  - reference: PMID:34363696
    reference_title: 'Cutaneous myiasis in skin cancer and malignant wounds: a systematic review.'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Cutaneous myiasis in patients with malignant wounds or skin cancer is a rare and undesirable event with limited epidemiological data."
    explanation: Supports the co-occurrence of myiasis with malignant wounds.
- name: Infectious and allergic conjunctivitis
  description: >-
    Ophthalmomyiasis externa presents with redness, watering, and foreign-body
    sensation and is routinely first treated as conjunctivitis or a corneal
    abrasion; the diagnosis turns on seeing the motile larvae.
  distinguishing_features:
  - motile organisms visible on the ocular surface
  - recent exposure to sheep, goats, or a Mediterranean rural setting
  evidence:
  - reference: PMID:35878965
    reference_title: Ophthalmomyiasis externa caused by Oestrus ovis.
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "The presentation of lacrimation, hyperaemia and foreign body sensation has a broad differential diagnosis including viral, bacterial and allergic conjunctivitis."
    explanation: Names the competing ocular diagnoses that myiasis mimics.
  - reference: PMID:35878965
    reference_title: Ophthalmomyiasis externa caused by Oestrus ovis.
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "A sample taken demonstrated Oestrus ovis infestation and confirmed the diagnosis of ophthalmomyiasis externa."
    explanation: Confirms that recovery and identification of the larva is what resolves the differential.
- name: Pinworm and other helminth infestation
  description: >-
    Reported passage of moving worms in stool leads to a presumptive diagnosis of
    enterobiasis; larvae are morphologically distinct and do not respond to
    anthelmintics.
  distinguishing_features:
  - dipteran larval morphology on microscopy
  - failure to respond to standard anthelmintic therapy
  evidence:
  - reference: PMID:22885201
    reference_title: Intestinal myiasis.
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "The condition is not uncommon and is often misdiagnosed as pinworm infestation."
    explanation: Names enterobiasis as the usual misdiagnosis.
  - reference: PMID:22885201
    reference_title: Intestinal myiasis.
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "A high index of suspicion is required for clinical diagnosis when the patient complains of passing wriggling worms in faeces for a long period without any response to antihelminthics."
    explanation: Gives the anthelmintic non-response that distinguishes the two.
treatments:
- name: Mechanical extraction of larvae
  description: >-
    Complete physical removal of every larva is the definitive treatment across
    all clinical forms, because the disease is caused by the physical presence of
    the parasite rather than by a replicating pathogen.
  therapeutic_modality: SURGERY
  treatment_term:
    preferred_term: Foreign Body Removal
    term:
      id: NCIT:C50821
      label: Foreign Body Removal
  target_mechanisms:
  - target: Larval penetration and burrowing into host tissue
    treatment_effect: INHIBITS
    description: >-
      Extraction removes the parasite that is producing the lesion, terminating
      both the mechanical burrowing and the secretion of digestive enzymes.
    evidence:
    - reference: PMID:12718772
      reference_title: Furuncular myiasis by tumbu fly.
      supports: SUPPORT
      evidence_source: HUMAN_CLINICAL
      snippet: "The lesions were treated by removal of the larva followed by twice daily application of an antibacterial ointment."
      explanation: Documents larval removal as the therapeutic act in a 248-case series.
  evidence:
  - reference: PMID:12718772
    reference_title: Furuncular myiasis by tumbu fly.
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "The extraction was done by injecting 2% xylocaine over the base of the nodule."
    explanation: Describes the local-anaesthetic extraction technique used in a large series.
  - reference: PMID:12718772
    reference_title: Furuncular myiasis by tumbu fly.
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Care was exercised in not damaging the larva while extracting."
    explanation: Records the requirement to extract the larva intact.
  - reference: PMID:35878965
    reference_title: Ophthalmomyiasis externa caused by Oestrus ovis.
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "She was treated with prophylactic topical antibiotics and subsequently made a full recovery."
    explanation: Documents full recovery after larval removal with antibiotic prophylaxis in ocular disease.
- name: Occlusion of the breathing punctum
  description: >-
    Covering the central pore of a furuncular lesion with an occlusive substance
    deprives the larva of air and induces it to migrate outward, allowing atraumatic
    recovery.
  therapeutic_modality: OTHER
  treatment_term:
    preferred_term: Therapeutic Procedure
    term:
      id: NCIT:C49236
      label: Therapeutic Procedure
  target_mechanisms:
  - target: Larval maturation and emergence from the host
    treatment_effect: ACTIVATES
    description: >-
      Occlusion drives the larva out of the cavity before it would otherwise
      complete its instars, converting the natural endpoint of the infestation
      into a therapeutic one.
    evidence:
    - reference: PMID:14726861
      reference_title: 'Furuncular myiasis caused by Dermatobia hominis, the human botfly.'
      supports: SUPPORT
      evidence_source: HUMAN_CLINICAL
      snippet: "The patient applied an occlusive ointment and recovered the larva after it emerged."
      explanation: Documents occlusion inducing larval emergence and recovery.
  evidence:
  - reference: PMID:33125723
    reference_title: 'Oral myiasis: Analysis of cases reported in the English literature from 1990 to 2020.'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "There were different forms and combinations of treatments: manual removal of larvae and surgical debridement, application of asphyxiating substances, antibiotic therapy, and use of ivermectin."
    explanation: Lists asphyxiating substances among the treatment modalities in reported cases.
- name: Surgical debridement
  description: >-
    Extensive wound, oral, and cavitary disease requires operative removal of
    necrotic tissue together with the larvae; it is the treatment of choice in
    oral and maxillofacial myiasis.
  therapeutic_modality: SURGERY
  treatment_term:
    preferred_term: Surgical Procedure
    term:
      id: NCIT:C15329
      label: Surgical Procedure
  target_mechanisms:
  - target: Tissue necrosis and cavity formation
    treatment_effect: INHIBITS
    description: >-
      Debridement removes the necrotic substrate that both harbours larvae and
      supports bacterial superinfection.
    evidence:
    - reference: PMID:21872507
      reference_title: 'Oral and maxillofacial myiasis: a case series and literature review.'
      supports: SUPPORT
      evidence_source: HUMAN_CLINICAL
      snippet: "The sample was made up of 10 patients, all treated with surgical debridement whether or not associated with the use of oral ivermectin."
      explanation: Documents debridement as the intervention applied to every case in the series.
  evidence:
  - reference: PMID:21872507
    reference_title: 'Oral and maxillofacial myiasis: a case series and literature review.'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "The treatment of choice is surgical debridement."
    explanation: States debridement as the preferred treatment for oral and maxillofacial disease.
  - reference: PMID:37864334
    reference_title: 'Human Oro-Nasopharyngeal Myiasis by Chrysomya Bezziana (Old-World Screwworm): The First Reported Case in Sri Lanka.'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "An examination was performed under anesthesia followed by manual removal of larvae, surgical debridement with biopsy, and treatment with antiparasitic medicines and antibiotics."
    explanation: Documents combined debridement, extraction, antiparasitic, and antibiotic management.
- name: Ivermectin
  description: >-
    Ivermectin, given orally or as a topical irrigation, kills or paralyses
    larvae and is used as an adjunct when lesions are numerous, deep, or
    inaccessible to mechanical extraction. It supplements rather than replaces
    removal.
  therapeutic_modality: SMALL_MOLECULE
  treatment_term:
    preferred_term: Pharmacotherapy
    term:
      id: NCIT:C15986
      label: Pharmacotherapy
    therapeutic_agent:
    - preferred_term: ivermectin
      term:
        id: CHEBI:6078
        label: ivermectin
  target_mechanisms:
  - target: Larval penetration and burrowing into host tissue
    treatment_effect: INHIBITS
    description: >-
      Ivermectin acts on the larva itself, ending the burrowing and secretory
      activity that produces the lesion; expelled larvae can then be recovered.
    evidence:
    - reference: PMID:30077978
      reference_title: Treatment of nasal myiasis with ivermectin irrigation.
      supports: SUPPORT
      evidence_source: HUMAN_CLINICAL
      snippet: "On subsequent nasal irrigation with ivermectin solution, the patient self-expulsed approximately 50 larvae within 15 min."
      explanation: Documents rapid larval expulsion following direct ivermectin irrigation.
  evidence:
  - reference: PMID:30077978
    reference_title: Treatment of nasal myiasis with ivermectin irrigation.
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Here, we propose that ivermectin irrigation is a simple and effective treatment for nasal myiasis."
    explanation: Proposes ivermectin irrigation as effective therapy for nasal disease, on single-case evidence.
  - reference: PMID:32084134
    reference_title: Human myiasis in Ecuador.
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Ivermectin, when it became available, was used to treat furuncular, wound, and cavitary lesions successfully."
    explanation: Documents successful ivermectin use across furuncular, wound, and cavitary forms.
  - reference: PMID:35718295
    reference_title: 'Severe Vaginal Myiasis: Successful Management With Ivermectin.'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "The relevance of this case is providing a report of a successful management with ivermectin of a case of severe vaginal myiasis."
    explanation: Reports successful ivermectin treatment in severe urogenital disease.
- name: Antibacterial therapy for secondary infection
  description: >-
    Systemic or topical antibiotics treat the bacterial superinfection that
    complicates necrotic myiasis wounds. They have no activity against the larvae
    themselves.
  therapeutic_modality: SMALL_MOLECULE
  treatment_term:
    preferred_term: Antibiotic Therapy
    term:
      id: NCIT:C15620
      label: Antibiotic Therapy
  target_mechanisms:
  - target: Secondary bacterial superinfection
    treatment_effect: INHIBITS
    description: Antibiotics target the superinfecting bacteria, not the parasite.
    evidence:
    - reference: PMID:41562817
      reference_title: Unusually Extensive Furuncular Myiasis in a Returning Traveller from Rural Ethiopia Complicated by Streptococcus Pyogenes Secondary Infection Following Albendazole Therapy.
      supports: SUPPORT
      evidence_source: HUMAN_CLINICAL
      snippet: "Management included wound occlusion and systemic antibiotics."
      explanation: Documents systemic antibiotics used for the culture-proven superinfection.
  evidence:
  - reference: PMID:35718295
    reference_title: 'Severe Vaginal Myiasis: Successful Management With Ivermectin.'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Severe cases of vaginal myiasis can require repeated debridement of necrotic tissue and systemic antibiotics in addition to antiparasitic medication."
    explanation: Supports systemic antibiotics as an adjunct to debridement and antiparasitic therapy.
  - reference: PMID:12718772
    reference_title: Furuncular myiasis by tumbu fly.
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "The lesions were treated by removal of the larva followed by twice daily application of an antibacterial ointment."
    explanation: Documents topical antibacterial treatment routinely applied after extraction.
- name: Wound care and supportive management
  description: >-
    Irrigation, dressing, and where necessary fluid resuscitation and delayed
    skin grafting manage the tissue defect left after the larvae are removed.
  therapeutic_modality: OTHER
  treatment_term:
    preferred_term: Wound Care Management
    term:
      id: NCIT:C116681
      label: Wound Care Management
  target_mechanisms:
  - target: Systemic sepsis and progressive tissue destruction
    treatment_effect: INHIBITS
    description: Supportive care and wound management interrupt progression from a colonized wound to systemic sepsis.
    evidence:
    - reference: PMID:41970302
      reference_title: 'Neglected Myiasis Wound Presenting With Septic Shock: A Case Report.'
      supports: SUPPORT
      evidence_source: HUMAN_CLINICAL
      snippet: "We report a case of neglected myiasis wound in a laborer from rural Nepal presenting with septic shock, who was managed with intravenous fluids, antibiotics, wound care, and delayed skin grafting, resulting in complete functional recovery."
      explanation: Documents the supportive package that reversed established septic shock.
  evidence:
  - reference: DOI:10.21315/aos2025.2001.cr03
    reference_title: 'Extensive Palatal Necrosis Secondary to Chrysomya bezziana Myiasis: A Case Report'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Therapeutic interventions entailed bedside maggot removal and meticulous wound care, with topical hyaluronic acid application and oral hygiene guidance."
    explanation: Documents wound care and hygiene measures alongside larval removal.
progression:
- phase: Exposure and larval establishment
  notes: >-
    Larvae reach the host surface and penetrate within hours; the earliest
    symptom is usually pruritus or a papule rather than a recognizable lesion.
  evidence:
  - reference: PMID:41562817
    reference_title: Unusually Extensive Furuncular Myiasis in a Returning Traveller from Rural Ethiopia Complicated by Streptococcus Pyogenes Secondary Infection Following Albendazole Therapy.
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "He developed pruritic papular lesions that progressed to erythematous furuncles with central puncta and purulent discharge, accompanied by sensations of movement."
    explanation: Documents the sequence from pruritic papule to established furuncle.
- phase: Established lesion with larval growth
  notes: >-
    The larva enlarges within its cavity over days to weeks. Furuncular disease
    remains localized; obligate wound species extend into adjacent living tissue
    and can progress rapidly.
  evidence:
  - reference: PMID:41209928
    reference_title: 'The New World Screwworm in the United States: A Narrative Review Anchored to the 2025 Travel-Associated Human Case.'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Unlike most dipteran larvae, which preferentially colonize necrotic tissue, C. hominivorax larvae invade and consume living tissue of warm-blooded hosts, causing a rapidly progressive condition known as myiasis."
    explanation: Contrasts the rapidly progressive obligate course with facultative colonization.
- phase: Complication or resolution
  notes: >-
    Untreated cases either resolve when the larva departs to pupate, or progress
    through secondary bacterial infection to extensive tissue destruction and
    sepsis. Chronicity of months is reported where care is not sought.
  evidence:
  - reference: PMID:21872507
    reference_title: 'Oral and maxillofacial myiasis: a case series and literature review.'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Mean time elapsed since the onset of the disease ranged from 4 to 36 months."
    explanation: Documents the long delay to presentation in neglected oral and maxillofacial disease.
  - reference: PMID:41209928
    reference_title: 'The New World Screwworm in the United States: A Narrative Review Anchored to the 2025 Travel-Associated Human Case.'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "This obligate parasitism can result in severe pain, secondary bacterial infections, disfigurement, and, in the absence of timely treatment, substantial morbidity or death in both humans and animals."
    explanation: Documents the range of outcomes from disfigurement to death without timely treatment.
prevalence:
- population: Ecuador, Amazon region
  measure_type: ANNUAL_INCIDENCE
  prevalence_class: BAND_1_5_PER_10000
  rate_per_100000: 23.0
  notes: >-
    Highest regional annual incidence in the Ecuadorian Ministry of Public Health
    2013-2015 dataset; the coastal and Andean rates were 5.1 and 4.7 per 100,000.
  evidence:
  - reference: PMID:32084134
    reference_title: Human myiasis in Ecuador.
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "The highest annual incidence was reported in the Amazon (23 cases/100,000 population), followed by Coast (5.1/100,000) and Andes (4.7/100,000)."
    explanation: Gives the reported regional annual incidence figures.
- population: Worldwide
  measure_type: UNKNOWN
  prevalence_class: UNKNOWN
  notes: >-
    No global burden estimate exists. Reporting is not mandatory anywhere,
    surveillance is absent, and the literature is dominated by case reports, so
    prevalence and incidence cannot be estimated reliably.
  evidence:
  - reference: PMID:32084134
    reference_title: Human myiasis in Ecuador.
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Human myiasis is a neglected and understudied ectoparasitic infestation, being endemic in both temperate and tropical regions of Ecuador."
    explanation: Characterizes myiasis as neglected and understudied, consistent with the absent global estimate.
  - reference: PMID:31955262
    reference_title: Human ophthalmomyiasis caused by Oestrus ovis-first report from Croatia and review on cases from Mediterranean countries.
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Since there is reduced awareness among patients and medical professionals, the real number of ophthalmomyiasis cases is probably significantly higher than published."
    explanation: Supports systematic under-ascertainment of reported case counts.
epidemiology:
- name: Tropical and subtropical distribution with socioeconomic gradient
  description: >-
    Myiasis occurs worldwide but concentrates in poor communities of tropical and
    subtropical countries, where fly abundance, open wounds, and limited
    healthcare access coincide.
  factors:
  - tropical and subtropical climate
  - low socioeconomic status
  - poor hygiene and limited wound care
  evidence:
  - reference: PMID:22232372
    reference_title: Myiasis.
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "The distribution of human myiasis is worldwide, with more species and greater abundance in poor socioeconomic regions of tropical and subtropical countries."
    explanation: States the global distribution and its socioeconomic gradient.
  - reference: PMID:29790312
    reference_title: Cavitary myiasis and its management.
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Cavitary myiasis is rare and occurs more frequently in tropical and subtropical regions of Africa and America associated with low economic status and poor hygiene."
    explanation: Independently supports the geographic and socioeconomic distribution for cavitary disease.
- name: Travel-associated disease in non-endemic countries
  description: >-
    In non-endemic settings myiasis is predominantly imported, and is among the
    most frequent skin diseases diagnosed in returning travellers.
  factors:
  - travel to endemic regions
  - military and occupational deployment
  evidence:
  - reference: PMID:20883399
    reference_title: 'Cutaneous myiasis: a review of the common types of myiasis.'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Myiasis is the fourth most common travel-associated skin disease and cutaneous myiasis is the most frequently encountered clinical form."
    explanation: Ranks myiasis among travel-associated skin diseases.
  - reference: PMID:38547087
    reference_title: 'Human myiasis in Sub-Saharan Africa: A systematic review.'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "More than half of the reported cases were from travelers returning from SSA (n = 122, 77.7%)."
    explanation: Quantifies the traveller fraction of reported cases from one endemic region.
- name: Cutaneous forms dominate the clinical spectrum
  description: >-
    Across published series the skin is the commonest site, with cavitary and
    visceral forms comparatively rare.
  factors:
  - accessibility of skin to ovipositing flies
  evidence:
  - reference: PMID:38547087
    reference_title: 'Human myiasis in Sub-Saharan Africa: A systematic review.'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Cutaneous myiasis was the most common clinical presentation of the disease (n = 86, 54.7%)."
    explanation: Quantifies the cutaneous share of reported sub-Saharan African cases.
  - reference: PMID:37864334
    reference_title: 'Human Oro-Nasopharyngeal Myiasis by Chrysomya Bezziana (Old-World Screwworm): The First Reported Case in Sri Lanka.'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Cutaneous myiasis is the commonest type, and less commonly, internal tissues and organs are affected."
    explanation: Independently supports the predominance of cutaneous disease.
- name: Healthcare-associated and institutional acquisition
  description: >-
    Myiasis can be acquired in hospitals and long-term care facilities by
    patients who cannot brush flies away, including intubated intensive-care
    patients.
  factors:
  - impaired consciousness or intubation
  - inadequate insect screening in healthcare facilities
  evidence:
  - reference: DOI:10.57187/s.3827
    reference_title: 'Myiasis in the intensive care unit: report from Switzerland and review of worldwide cases'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Nosocomial myiasis is seldom reported in Europe, and intensive care unit (ICU)-acquired myiasis is even rarer."
    explanation: Documents nosocomial and ICU-acquired myiasis as a recognized, though rare, entity.
  - reference: PMID:32084134
    reference_title: Human myiasis in Ecuador.
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "C. hominivorax was also identified in a nosocomial hospital-acquired wound."
    explanation: Records a hospital-acquired screwworm wound infestation.
- name: Climate-sensitive geographic range expansion
  description: >-
    Warming climate and increased mobility are expected to extend the range of
    myiasis-causing flies, and reintroduction of eradicated screwworm populations
    remains a live risk.
  factors:
  - rising air temperature
  - global travel and livestock movement
  evidence:
  - reference: PMID:31955262
    reference_title: Human ophthalmomyiasis caused by Oestrus ovis-first report from Croatia and review on cases from Mediterranean countries.
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Global warming predisposes future increase of O. ovis prevalence in humans, which emphasizes the need for mandatory reporting and surveillance of disease."
    explanation: States the expected climate-driven increase and the surveillance gap.
  - reference: PMID:41209928
    reference_title: 'The New World Screwworm in the United States: A Narrative Review Anchored to the 2025 Travel-Associated Human Case.'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "On August 4, 2025, the U.S. Centers for Disease Control and Prevention (CDC) confirmed the nation's first human case of travel-associated screwworm infestation in decades."
    explanation: Documents a sentinel reintroduction event in a previously eradicated area.
animal_models:
- name: Ovine and caprine nasal Oestrus ovis infestation
  species: Sheep and goat
  publication: PMID:12809756
  description: >-
    The natural host system for Oestrus ovis, the fly that causes most human
    ophthalmomyiasis. In sheep and goats the larva completes development in the
    nasal and sinus cavities, and it is from these hosts that the larval
    excretory-secretory and salivary protease repertoire underpinning this
    entry's molecular arm was characterized. Because humans are accidental hosts
    in whom first-instar larvae do not develop past the ocular surface, this is
    the system in which the mechanism is observable at all - which is precisely
    what the myiasis_protease_mechanism_human_evidence discussion flags.
  modeled_mechanisms:
  - target: Larval excretory-secretory protease release
    relationship: PARTIALLY_RECAPITULATES
    fidelity: MODERATE
    description: >-
      Larvae recovered from naturally and experimentally infested small ruminants
      secrete the serine proteases that this node asserts as the principal
      molecular effector of myiasis.
    limitations: >-
      The characterized enzymes come from second- and third-instar larvae
      developing in a permissive ruminant host. In human ophthalmomyiasis only
      first-instar larvae are present and they do not mature, so neither the
      enzyme repertoire nor the delivered dose has been shown to be the same;
      nothing here has been measured in human tissue.
    readouts:
    - name: Serine proteases in larval excretory-secretory products
      target: Larval excretory-secretory protease release
      description: >-
        Substrate-gel zymography with protease-inhibitor class assignment on
        excretory-secretory products of larvae harvested from the host.
      biological_processes:
      - preferred_term: proteolysis
        term:
          id: GO:0006508
          label: proteolysis
      interpretation: >-
        Establishes that the secreted repertoire is dominated by trypsin-like
        serine proteases, which is the enzyme class this node asserts.
      evidence:
      - reference: PMID:12809756
        reference_title: 'Serine protease activity in excretory-secretory products of Oestrus ovis (Diptera: Oestridae) larvae.'
        supports: SUPPORT
        evidence_source: IN_VITRO
        snippet: "demonstrated the presence of at least six major serine proteases (molecular weights from 20 to 100 kDa), mainly trypsin-like, secreted in the digestive tube of larvae"
        explanation: Reports the zymographic measurement of the secreted serine protease repertoire.
    - name: Integrity of host mucin, albumin, and immunoglobulin G exposed to larval secretions
      target: Larval excretory-secretory protease release
      description: >-
        Degradation of host mucosal and plasma proteins incubated with larval
        excretory-secretory products.
      direction: DECREASED
      interpretation: >-
        Shows the secreted proteases act on host substrates, not only on larval
        food, which is what makes this node pathogenic rather than merely
        nutritional.
      evidence:
      - reference: PMID:12809756
        reference_title: 'Serine protease activity in excretory-secretory products of Oestrus ovis (Diptera: Oestridae) larvae.'
        supports: SUPPORT
        evidence_source: IN_VITRO
        snippet: "ESP of O. ovis larvae degrade mucosal and plasmatic components such as mucin, albumin or immunoglobulin G."
        explanation: Measures loss of host mucin, albumin, and IgG on exposure to larval secretions.
    evidence:
    - reference: PMID:12809756
      reference_title: 'Serine protease activity in excretory-secretory products of Oestrus ovis (Diptera: Oestridae) larvae.'
      supports: SUPPORT
      evidence_source: MODEL_ORGANISM
      snippet: "The sheep bot fly, Oestrus ovis, is a very common myiasis of nasal and sinus cavities of sheep and goats causing severe welfare and production implications."
      explanation: Establishes small ruminants as the natural host in which this larval mechanism is studied.
    - reference: PMID:17697751
      reference_title: Proteolytic activity in salivary gland products of sheep bot fly (Oestrus ovis) larvae.
      supports: SUPPORT
      evidence_source: MODEL_ORGANISM
      snippet: "Antigenic protein bands were revealed by immunoblotting using sera obtained from experimentally infested goats."
      explanation: Confirms an in vivo experimental infestation arm in the caprine host, so this is an animal model and not only an ex vivo preparation.
    - reference: DOI:10.1111/mve.12634
      reference_title: "Prevalence of <scp> <i>Oestrus ovis</i> </scp> in small ruminants from the eastern Iberian Peninsula. A long‐term study"
      supports: SUPPORT
      evidence_source: MODEL_ORGANISM
      snippet: "The total prevalence was 56.3%, significantly higher in sheep than in goats (61.2% and 43%, respectively)."
      explanation: Quantifies how routinely small ruminants carry this parasite, which is why the veterinary system is the one in which the mechanism is observable at all.
  - target: Larval modulation of the host immune response
    relationship: PARTIALLY_RECAPITULATES
    fidelity: LOW
    description: >-
      The same salivary serine proteases are proposed to blunt the ruminant host
      response, the immune-evasion arm of this node.
    limitations: >-
      Immunomodulation is inferred by the authors from enzyme class and substrate
      range rather than demonstrated by a host-response endpoint, and it is
      inferred in goats. No human immune effector has been tested.
    readouts:
    - name: Protease subclass of salivary gland products
      target: Larval modulation of the host immune response
      description: >-
        Inhibitor-based subclass assignment of the proteolytic activity in
        dissected larval salivary glands.
      interpretation: >-
        Identifies the enzyme class the authors attribute host immunomodulation
        to; the immunomodulatory outcome itself is not measured here.
      evidence:
      - reference: PMID:17697751
        reference_title: Proteolytic activity in salivary gland products of sheep bot fly (Oestrus ovis) larvae.
        supports: SUPPORT
        evidence_source: IN_VITRO
        snippet: "Proteases in O. ovis salivary gland products belong to the serine subclass."
        explanation: Reports the measured enzyme subclass in salivary gland products.
    evidence:
    - reference: PMID:17697751
      reference_title: Proteolytic activity in salivary gland products of sheep bot fly (Oestrus ovis) larvae.
      supports: SUPPORT
      evidence_source: IN_VITRO
      snippet: "Serine proteases in O. ovis salivary gland products are most likely involved in larval nutrition and host immuno-modulation."
      explanation: The authors' own hedged inference, which is why this link is graded LOW fidelity and PARTIAL support.
  notes: >-
    The two protease papers are graded IN_VITRO where they report biochemical
    assays on harvested larvae, following the CLAUDE.md rule that
    evidence_source describes the study reported, not the model it came from.
    The MODEL_ORGANISM items are the in vivo statements: natural nasal
    infestation of sheep and goats, and the experimentally infested goats whose
    sera were immunoblotted.
- name: Bactrian camel Wohlfahrtia magnifica wound myiasis
  species: Bactrian camel
  publication: PMID:38297211
  description: >-
    Naturally infested domestic Bactrian camels carrying parasitic-stage
    Wohlfahrtia magnifica larvae in open wounds. W. magnifica is an obligate
    agent of human wound myiasis as well, so this is the closest available
    animal counterpart of the human wound subtype, and it is the system in which
    the parasitic-stage transcriptome behind this entry's protease claims was
    sequenced.
  modeled_mechanisms:
  - target: Larval excretory-secretory protease release
    relationship: PARTIALLY_RECAPITULATES
    fidelity: MODERATE
    description: >-
      Wound-collected parasitic larvae upregulate a large peptidase programme,
      giving a transcriptional counterpart to the biochemically measured protease
      secretion asserted by this node.
    limitations: >-
      The readout is transcript abundance in the larva, not enzyme activity in
      host tissue, and the host is a camel wound colonized by an aggregating
      larval mass. Human furuncular disease involves a single larva in a closed
      cavity, so both the delivered enzyme dose and the host compartment differ.
    readouts:
    - name: Peptidase gene expression in parasitic wound-collected larvae
      target: Larval excretory-secretory protease release
      description: >-
        RNA-seq of larvae taken directly from camel wounds, compared with
        non-parasitic developmental stages.
      direction: INCREASED
      biological_processes:
      - preferred_term: proteolysis
        term:
          id: GO:0006508
          label: proteolysis
      interpretation: >-
        Serine peptidase genes are specifically upregulated during the parasitic
        stage, tying the protease programme to parasitism rather than to
        development generally.
      evidence:
      - reference: PMID:38297211
        reference_title: Transcriptomic profiling of different developmental stages reveals parasitic strategies of Wohlfahrtia magnifica, a myiasis-causing flesh fly.
        supports: SUPPORT
        evidence_source: MODEL_ORGANISM
        snippet: "revealed a significant upregulation of 88 peptidase genes (including 47 serine peptidase genes), 110 cuticle protein genes, and 21 heat shock protein (hsp) genes"
        explanation: Quantifies the stage-specific upregulation of peptidase genes in wound-collected larvae.
    evidence:
    - reference: PMID:38297211
      reference_title: Transcriptomic profiling of different developmental stages reveals parasitic strategies of Wohlfahrtia magnifica, a myiasis-causing flesh fly.
      supports: SUPPORT
      evidence_source: MODEL_ORGANISM
      snippet: "Second- and third-stage larvae of W. magnifica were non-invasively collected from the wounds of naturally infested domestic Bactrian camels"
      explanation: Establishes the naturally infested camel wound as the source system for this mechanism.
  - target: Proteolytic digestion of host tissue
    relationship: PARTIALLY_RECAPITULATES
    fidelity: MODERATE
    description: >-
      Larval feeding in the camel wound produces the tissue necrosis and loss
      that this node asserts as the primary lesion.
    limitations: >-
      Necrosis is reported as a general consequence of myiasis rather than
      quantified in this cohort, and no human tissue was examined.
    readouts:
    - name: Host tissue necrosis at the larval feeding site
      target: Proteolytic digestion of host tissue
      description: Gross and descriptive assessment of the infested wound.
      direction: INCREASED
      interpretation: >-
        Confirms that larval feeding converts intact wound tissue into necrotic
        debris, the tissue-level consequence this node predicts.
      evidence:
      - reference: PMID:38297211
        reference_title: Transcriptomic profiling of different developmental stages reveals parasitic strategies of Wohlfahrtia magnifica, a myiasis-causing flesh fly.
        supports: SUPPORT
        evidence_source: MODEL_ORGANISM
        snippet: "myiasis can give rise to necrosis, decay, and the excretion of host tissues"
        explanation: States the necrotic tissue outcome of larval feeding.
    evidence:
    - reference: PMID:38297211
      reference_title: Transcriptomic profiling of different developmental stages reveals parasitic strategies of Wohlfahrtia magnifica, a myiasis-causing flesh fly.
      supports: SUPPORT
      evidence_source: MODEL_ORGANISM
      snippet: "Second- and third-stage larvae of W. magnifica were non-invasively collected from the wounds of naturally infested domestic Bactrian camels"
      explanation: Ties the tissue-digestion claim to the infested camel wound system.
- name: Ovine Lucilia cuprina cutaneous myiasis
  species: Sheep
  publication: PMID:38297211
  description: >-
    Sheep infested by Lucilia cuprina, the classical facultative blowfly-strike
    system. It supplies the two mechanistic claims this entry makes about larval
    immunosuppression and about collagenase-mediated digestion of skin, and it is
    the third non-human system named in the
    myiasis_protease_mechanism_human_evidence discussion.
  modeled_mechanisms:
  - target: Larval modulation of the host immune response
    relationship: PARTIALLY_RECAPITULATES
    fidelity: LOW
    description: >-
      Larval secretion of blowfly larval immunosuppressive protein suppresses
      ovine lymphocyte proliferation, the only quantified immunosuppression
      behind this node.
    limitations: >-
      The effect is measured on sheep lymphocytes with a sheep-adapted parasite,
      and it reaches this entry through the review section of PMID:38297211
      rather than from the primary report, so the magnitude is cited but not
      independently verified here. No equivalent measurement exists on human
      lymphocytes.
    readouts:
    - name: Ovine lymphocyte proliferation in the presence of larval BLIP
      target: Larval modulation of the host immune response
      description: >-
        Mitogen-stimulated lymphocyte proliferation assay in sheep with and
        without larval immunosuppressive protein.
      direction: DECREASED
      interpretation: >-
        A quantified suppression of at least 70% is the strongest single number
        supporting active larval immune evasion anywhere in this entry, and it is
        entirely non-human.
      evidence:
      - reference: PMID:38297211
        reference_title: Transcriptomic profiling of different developmental stages reveals parasitic strategies of Wohlfahrtia magnifica, a myiasis-causing flesh fly.
        supports: SUPPORT
        evidence_source: MODEL_ORGANISM
        snippet: "secretes a protein called blowfly larval immunosuppressive protein (BLIP), which inhibits lymphocyte proliferation in sheep by at least 70%"
        explanation: Quantifies suppression of ovine lymphocyte proliferation by a larval secreted protein.
    evidence:
    - reference: PMID:38297211
      reference_title: Transcriptomic profiling of different developmental stages reveals parasitic strategies of Wohlfahrtia magnifica, a myiasis-causing flesh fly.
      supports: SUPPORT
      evidence_source: MODEL_ORGANISM
      snippet: "secretes a protein called blowfly larval immunosuppressive protein (BLIP), which inhibits lymphocyte proliferation in sheep by at least 70%"
      explanation: Establishes the ovine L. cuprina system as informative for larval immune modulation.
  - target: Proteolytic digestion of host tissue
    relationship: PARTIALLY_RECAPITULATES
    fidelity: LOW
    description: >-
      L. cuprina collagenases and proteases digest skin structural components,
      producing the lesion and exudate this node asserts.
    limitations: >-
      Demonstrated in ovine skin with a facultative parasite that feeds
      superficially as an aggregating mass; the human furuncular lesion is a
      single larva in a closed subcutaneous cavity. As above, the claim is quoted
      from a review section rather than the primary activity study.
    readouts:
    - name: Digestion of skin structural components by larval collagenases
      target: Proteolytic digestion of host tissue
      description: >-
        Enzyme activity assays on larval collagenases and proteases against skin
        structural proteins.
      direction: DECREASED
      interpretation: >-
        Loss of skin structural protein under larval enzyme activity is the
        mechanistic link between protease secretion and lesion formation.
      evidence:
      - reference: PMID:38297211
        reference_title: Transcriptomic profiling of different developmental stages reveals parasitic strategies of Wohlfahrtia magnifica, a myiasis-causing flesh fly.
        supports: SUPPORT
        evidence_source: MODEL_ORGANISM
        snippet: "The activity study of L. cuprina collagenases and proteases suggested that they were not only involved in larval nutrition but also digested structural components of the skin, contributing to the formation of lesions and the production of exudates"
        explanation: Attributes lesion and exudate formation to enzymatic digestion of skin structural components.
    evidence:
    - reference: PMID:38297211
      reference_title: Transcriptomic profiling of different developmental stages reveals parasitic strategies of Wohlfahrtia magnifica, a myiasis-causing flesh fly.
      supports: SUPPORT
      evidence_source: MODEL_ORGANISM
      snippet: "The activity study of L. cuprina collagenases and proteases suggested that they were not only involved in larval nutrition but also digested structural components of the skin, contributing to the formation of lesions and the production of exudates"
      explanation: Establishes the ovine L. cuprina system as informative for enzymatic tissue digestion.
  notes: >-
    Both claims reach this entry through the introduction of PMID:38297211,
    which cites the primary L. cuprina literature. The citation here is to the
    paper actually fetched and quote-checked rather than to a primary report not
    in the reference cache, and fidelity is set LOW accordingly.
- name: BALB/c mouse oral gavage with Clogmia albipunctata
  species: Mouse
  background: BALB/c
  publication: DOI:10.1371/journal.pone.0356742
  description: >-
    A deliberate negative control for the intestinal subtype. BALB/c mice were
    gavaged with viable Clogmia albipunctata eggs and first-instar larvae, the
    species most often recovered in suspected intestinal myiasis, and monitored
    for shedding, colonization, and gut histology. None of the three established.
    Paired in vitro work showed that simulated gastric fluid is lethal to both
    eggs and larvae.
  modeled_mechanisms:
  - target: Larval penetration and burrowing into host tissue
    relationship: FAILS_TO_RECAPITULATE
    fidelity: MODERATE
    description: >-
      Orally delivered larvae did not penetrate or colonize gastrointestinal
      tissue, so this model does not reproduce the invasion step for the
      ingestion route.
    limitations: >-
      A negative result for one accidental species by one route in one host.
      C. albipunctata is a synanthropic moth fly, not an obligate parasite, and
      murine gastric conditions are not identical to human ones, so this bounds
      the pseudomyiasis question rather than excluding true intestinal myiasis by
      other species. It says nothing about the cutaneous or cavitary routes,
      where invasion is well documented in humans.
    readouts:
    - name: Gastrointestinal colonization and mucosal injury after oral gavage
      target: Larval penetration and burrowing into host tissue
      description: >-
        Seven days of faecal examination plus time-point necropsy with
        histological examination of gastrointestinal tissue.
      direction: UNCHANGED
      interpretation: >-
        No shedding, no tissue injury, and no colonization - the invasion step
        this node asserts simply did not occur by the ingestion route.
      evidence:
      - reference: DOI:10.1371/journal.pone.0356742
        reference_title: 'Clogmia albipunctata fails to induce true intestinal myiasis: Evidence from in vitro and in vivo digestive models'
        supports: REFUTE
        evidence_source: MODEL_ORGANISM
        snippet: "the oral gavage of viable eggs and live first-instar larvae in mice resulted in no fecal shedding, tissue injury, or pathological colonization in the gastrointestinal tract"
        explanation: Reports the negative colonization and histology result that defines this readout.
    evidence:
    - reference: DOI:10.1371/journal.pone.0356742
      reference_title: 'Clogmia albipunctata fails to induce true intestinal myiasis: Evidence from in vitro and in vivo digestive models'
      supports: SUPPORT
      evidence_source: MODEL_ORGANISM
      snippet: "BALB/c mice were orally gavaged with viable eggs."
      explanation: Establishes the in vivo murine challenge that makes this model informative for the invasion node.
    - reference: DOI:10.1371/journal.pone.0356742
      reference_title: 'Clogmia albipunctata fails to induce true intestinal myiasis: Evidence from in vitro and in vivo digestive models'
      supports: SUPPORT
      evidence_source: MODEL_ORGANISM
      snippet: "The results support the interpretation that many suspected clinical cases may represent sample contamination or pseudomyiasis rather than true intestinal myiasis."
      explanation: States the authors' own interpretation of the negative result, which is the pseudomyiasis boundary this entry curates in its definitions block.
discussions:
- discussion_id: myiasis_protease_mechanism_human_evidence
  kind: HUMAN_MODEL_MISMATCH
  status: OPEN
  prompt: >-
    Does the larval serine-protease mechanism characterized in veterinary hosts
    and larval secretions operate the same way in infested human tissue?
  attaches_to:
  - pathophysiology#Larval excretory-secretory protease release
  - pathophysiology#Proteolytic digestion of host tissue
  - pathophysiology#Larval modulation of the host immune response
  rationale: >-
    The molecular arm of this entry rests entirely on non-human evidence: the
    serine-protease characterization comes from Oestrus ovis larvae harvested
    from slaughtered sheep and goats, the transcriptomic parasitism profile from
    Wohlfahrtia magnifica larvae taken from Bactrian camel wounds, and the
    immunosuppression data from Lucilia cuprina in sheep. No study quantifies
    larval protease activity, complement or immunoglobulin cleavage, or
    lymphocyte suppression in human tissue. The mismatch is mechanistically
    meaningful rather than merely notational, because the species that dominate
    human disease differ from those studied: Dermatobia hominis produces a closed
    furuncular cavity with a single larva, whereas the characterized species feed
    as aggregating masses in open ruminant wounds, so both the enzyme dose and
    the host response could differ substantially.
  proposed_experiments:
  - experiment_id: exp_myiasis_human_larval_protease_profile
    name: Protease profiling of larvae recovered from human lesions
    description: >-
      Quantify protease activity and substrate specificity in the
      excretory-secretory products of larvae recovered from human furuncular and
      wound myiasis lesions, using the same substrate-gel and inhibitor-class
      assays applied to Oestrus ovis, so the human-derived repertoire is directly
      comparable to the veterinary one.
  - experiment_id: exp_myiasis_human_serum_immune_cleavage
    name: Complement and immunoglobulin cleavage in autologous human serum
    description: >-
      Compare complement C3 and immunoglobulin cleavage by human-derived versus
      ruminant-derived larval secretions incubated in autologous human serum, to
      test whether the immune-evasion arm demonstrated in ruminants operates on
      human effectors.
  - experiment_id: exp_myiasis_lesion_biopsy_transcriptome
    name: Paired human lesion histology and larval transcriptome
    description: >-
      Characterize the cellular infiltrate and cytokine profile of human myiasis
      lesion biopsies alongside the transcriptome of larvae taken from the same
      lesion, linking host response to larval gene expression within one host
      species.
  notes: >-
    Every pathophysiology node in this chain carries at least one human clinical
    evidence item for the phenotypic consequence; it is the enzymatic mechanism
    linking them that is non-human. The three systems named above are curated
    structurally in `animal_models` - the ovine/caprine Oestrus ovis infestation,
    the Bactrian camel Wohlfahrtia magnifica wound, and ovine Lucilia cuprina
    strike - each linked by `modeled_mechanisms` to the nodes this discussion
    attaches to, with per-link `fidelity` and `limitations` recording the
    species-divergence caveat. The BALB/c mouse Clogmia study is curated there
    too, as a `FAILS_TO_RECAPITULATE` link: it is a negative result about the
    ingestion route rather than about the protease mechanism, which is why it
    does not attach to this discussion.
- discussion_id: myiasis_evidence_base_case_reports
  kind: KNOWLEDGE_GAP
  status: OPEN
  prompt: >-
    What is the true global burden of human myiasis, and how do the available
    treatments compare?
  attaches_to:
  - treatments#Ivermectin
  - epidemiology#Tropical and subtropical distribution with socioeconomic gradient
  rationale: >-
    Myiasis is not notifiable in any jurisdiction and there is no surveillance
    system, so incidence and prevalence estimates rest on case reports and
    single-country reviews that are known to under-ascertain. The same gap
    affects therapy: ivermectin dosing and route are supported only by individual
    cases and uncontrolled series, and no comparative trial of mechanical
    removal, occlusion, or antiparasitic adjuncts exists. Standardized case
    definitions separating true myiasis from pseudomyiasis are also lacking.
  proposed_experiments:
  - experiment_id: exp_myiasis_sentinel_surveillance
    name: Sentinel surveillance with species-level reporting
    description: >-
      Establish sentinel surveillance for myiasis in endemic districts with
      mandatory species-level reporting and a case definition that excludes
      pseudomyiasis, to produce the first incidence estimates not derived from
      case reports.
  - experiment_id: exp_myiasis_ivermectin_comparative_study
    name: Comparative study of ivermectin adjunct versus removal alone
    description: >-
      Run a prospective comparative study of ivermectin as an adjunct versus
      mechanical removal alone in wound and cavitary myiasis, with prespecified
      outcomes of complete larval clearance, secondary infection, and tissue
      loss.
  evidence:
  - reference: PMID:30647793
    reference_title: 'Otomyiasis: Systematic Review.'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "The cases are rarely reported, and there are no published management protocols."
    explanation: Documents both the reporting gap and the absence of management protocols.
  - reference: PMID:31618203
    reference_title: 'Human Chrysomya bezziana myiasis: A systematic review.'
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Our findings indicate that cryptic myiasis cases due to the obligate parasite, C. bezziana, are under-recognized."
    explanation: Supports systematic under-recognition of cases even for a listed obligate parasite.
- discussion_id: myiasis_maggot_debridement_duality
  kind: OPEN_QUESTION
  status: OPEN
  prompt: >-
    Under what conditions does facultative larval colonization of a wound shift
    from pathological myiasis to therapeutic debridement?
  attaches_to:
  - pathophysiology#Proteolytic digestion of host tissue
  - pathophysiology#Secondary bacterial superinfection
  rationale: >-
    The same species that causes facultative wound myiasis, Lucilia sericata, is
    reared for maggot debridement therapy, where its proteolytic and
    antimicrobial secretions are deliberately used to clean infected wounds. This
    is not a contradiction to be resolved by picking a side; it means the sign of
    the mechanism depends on larval burden, species, tissue selectivity, and
    whether the colonization was controlled. Curating that boundary matters,
    because the entry asserts tissue digestion as pathogenic while the literature
    reports the same activity as beneficial in a controlled setting.
  evidence:
  - reference: DOI:10.3389/fcimb.2025.1568563
    reference_title: Machine learning-based text mining for cutaneous myiasis and potential value of an accidental maggot therapy for complicated skin and soft tissue infection with sepsis
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Maggot debridement therapy may be a promising treatment and beneficial for soft tissue infection-related sepsis."
    explanation: Reports a beneficial effect of larval colonization in infected soft tissue, the inverse of the pathogenic framing.
notes: >-
  Concept decision: curated as a single Disease entry with anatomical
  has_subtypes, not as a Grouping. MONDO:0019147 carries the `disease_grouping`
  and `ordo_group_of_disorders` subsets, but a dismech Grouping is an explicit
  union over Disease entries that already exist independently, and no myiasis
  clinical form is separately curated in kb/disorders. The forms also share one
  mechanism - larval tissue invasion with proteolytic digestion - and differ by
  colonized site and by the degree of parasitism of the implicated fly, which is
  what has_subtypes encodes. If per-species or per-site entries are curated
  later (e.g. a dedicated screwworm myiasis entry), converting this to a Grouping
  over them would be the right move; the has_subtypes names here are chosen to
  survive that migration.

  Subtype term bindings: the three cutaneous forms and the ocular form bind to
  their own MONDO classes (MONDO:0018941 furuncular, MONDO:0018857 creeping,
  MONDO:0015622 wound, MONDO:0000301 ophthalmomyiasis). MONDO has no per-cavity
  class, so the nasopharyngeal, oral, aural, intestinal, and urogenital subtypes
  all bind to the one term that covers them, MONDO:0015623 cavitary myiasis,
  whose own definition enumerates exactly those sites ("aural, nasal, oral,
  urogenital myiasis ... intestinal and tracheopulmonary myiasis"). The
  anatomical distinction those five subtypes encode is therefore carried by
  `preferred_term` and `description`, not by the CURIE - per CLAUDE.md, link to
  the most specific term that exists rather than inventing one. Two caveats to
  record rather than hide: MONDO:0000301 is defined by agent ("myiasis caused by
  infection with Oestrus ovis") rather than by site, which fits the dominant but
  not the only cause of human ophthalmomyiasis; and MONDO's is_a hierarchy is not
  strictly parallel to the clinical one (creeping, furuncular, and wound myiasis
  sit under cutaneous myiasis, ophthalmomyiasis under hypodermyiasis), so the
  subtype list here is the clinical classification, not a MONDO subtree.

  Scope: this entry covers human myiasis. Veterinary myiasis and screwworm
  eradication programmes are cited only where they establish parasite biology or
  human exposure risk, and are marked MODEL_ORGANISM or OTHER accordingly.

  Named Entity Confusion preflight (CLAUDE.md 2b): `just preflight-dr` returned
  SKIP because MONDO records no causal gene (RO:0004003) for MONDO:0019147, so
  the automated gene-frequency check cannot discriminate. Manual checks were run
  instead. MONDO:0019147 is defined as "The infection of a fly larva (maggot) in
  human tissue" with `RO:0014001 NCBITaxon:7147 Diptera` and no OMIM xref, and
  the deep-research report is about human infestation by dipteran larvae
  throughout. No gene or OMIM identity anchor is applicable; the synonym list
  (infestation by fly larvae, infestation by maggots, maggot infestation) does
  not collide with another MONDO entity. The report's Oestrus ovis livestock
  prevalence material is supporting veterinary context, not a different disease
  entity, and is not used as human evidence here.

  Deep-research provenance: the falcon report's own reference validation flagged
  DOI:10.1590/S1984-29612024020 as unresolved and only 3 of 8 resolved
  references as on topic. That DOI is not cited in this entry, and every PMID
  used here was independently fetched with `just fetch-reference` and its
  snippet checked against the cached abstract.

📚

References & Deep Research

References

10

PMID:22232372

Myiasis.

No top-level findings curated for this source.

PMID:20883399

Cutaneous myiasis: a review of the common types of myiasis.

No top-level findings curated for this source.

PMID:38547087

Human myiasis in Sub-Saharan Africa: A systematic review.

No top-level findings curated for this source.

PMID:32084134

Human myiasis in Ecuador.

No top-level findings curated for this source.

PMID:38297211

Transcriptomic profiling of different developmental stages reveals parasitic strategies of Wohlfahrtia magnifica, a myiasis-causing flesh fly.

No top-level findings curated for this source.

DOI:10.57187/s.3827

Myiasis in the intensive care unit: report from Switzerland and review of worldwide cases

No top-level findings curated for this source.

DOI:10.3389/fcimb.2025.1568563

Machine learning-based text mining for cutaneous myiasis and potential value of an accidental maggot therapy for complicated skin and soft tissue infection with sepsis

No top-level findings curated for this source.

DOI:10.3390/microorganisms12020233

Long Time No Hear, Magnificent Wohlfahrtia! Morphological and Molecular Evidence of Almost Forgotten Flesh Fly in Serbia and Western Balkans

No top-level findings curated for this source.

DOI:10.21315/aos2025.2001.cr03

Extensive Palatal Necrosis Secondary to Chrysomya bezziana Myiasis: A Case Report

No top-level findings curated for this source.

DOI:10.1371/journal.pone.0356742

Clogmia albipunctata fails to induce true intestinal myiasis: Evidence from in vitro and in vivo digestive models

No top-level findings curated for this source.

Deep Research

1

Falcon ▸

Myiasis: Comprehensive Disease-Characteristics Report

Edison Scientific Literature 32 citations 2026-08-27T11:56:46.077864

Myiasis: Comprehensive Disease-Characteristics Report

Executive summary

Myiasis is an infectious–parasitic infestation in which larvae of flies (order Diptera) develop in or on a living vertebrate. It is not one etiologically uniform disease: clinical behavior depends on the fly species, whether it is an obligate or facultative parasite, and the involved anatomical site. Human disease is concentrated in tropical/subtropical settings, travelers, people exposed to livestock, and vulnerable patients with wounds, impaired self-care, or intensive-care devices. Skin and wounds are most often involved, but ocular, oral, nasal, aural, gastrointestinal, and urogenital disease occurs.

The evidence base remains dominated by case reports and small series rather than population surveillance or randomized trials. Consequently, global incidence, prevalence, mortality, and phenotype frequencies cannot be estimated reliably. The most consistent management is complete mechanical removal, irrigation and wound care; invasive obligate myiasis additionally requires debridement, while ivermectin and antibiotics are selected adjuncts rather than universal therapy. Recent research emphasizes molecular identification, hospital infection prevention, climate-sensitive geographic expansion, and One Health connections among human disease, livestock infestation, fly microbiota, and emerging bacterial sepsis.

Domain	Evidence-based summary	Suggested ontology terms (approximate mappings where needed)	Evidence type and key source/year/DOI
Definition / classification	Myiasis is infestation of living human or animal tissue by dipteran larvae. It is classified anatomically (cutaneous/furuncular, wound, ocular, nasal, aural, urogenital, gastrointestinal/cavitary) and ecologically as obligate, facultative, or accidental/pseudomyiasis. Major implicated human families include Oestridae, Calliphoridae, Sarcophagidae, and Muscidae. Lucilia sericata is typically facultative; Cochliomyia hominivorax, Chrysomya bezziana, Oestrus ovis, and Wohlfahrtia magnifica are important obligate agents (monney2025myiasisinthe pages 1-2, monney2025myiasisinthe pages 3-5, tuygun2009furuncularmyiasisin pages 1-2).	MONDO: myiasis (ID uncertain; do not assign without ontology lookup). MeSH/ICD likely available but not verified here. Approx. HPO/clinical descriptors: cutaneous lesion, wound infestation, ocular infestation.	Human clinical review/case + taxonomy review: Swiss Med Wkly 2025 doi:10.57187/s.3827; Turk J Pediatr 2009; Microorganisms 2024 doi:10.3390/microorganisms12020233
Major clinical phenotypes	Clinical forms include furuncular lesions, wound myiasis, conjunctival/ophthalmomyiasis, nasopharyngeal/oropharyngeal, aural, and genital involvement. Furuncular disease may present as swelling and furuncle-like lesion; inflammatory lesions can be accompanied by eosinophilia. O. ovis in animals causes sneezing/nasal discharge and is zoonotic for ophthalmic/nasopharyngeal human disease (zhou2025machinelearningbasedtext pages 1-2, tuygun2009furuncularmyiasisin pages 1-2, garijo‐toledo2023prevalenceofoestrus pages 1-3, silva2024prevalenceandseasonal pages 1-3).	Approx. HPO: Skin nodule, Furuncle, Wound infection, Edema, Pain, Bleeding, Eosinophilia, Conjunctivitis, Nasal discharge, Dyspnea. UBERON approx.: skin, oral cavity, eye, nasal cavity, pharynx, genitalia.	Human case reports/review + veterinary epidemiology: Front Cell Infect Microbiol 2025 doi:10.3389/fcimb.2025.1568563; Turk J Pediatr 2009; Med Vet Entomol 2023 doi:10.1111/mve.12634; Braz J Vet Parasitol 2024 doi:10.1590/S1984-29612024020
Risk factors	Recurrent risk factors include wounds, necrosis, bacterial contamination, poor hygiene, advanced age, severe underlying illness, immobilization, diabetes, alcoholism, vascular disease, mental impairment, mechanical ventilation, nasogastric tube use, periodontal disease, mouth breathing/lip incompetence, hot seasons, rural/livestock exposure, and tropical travel. Some patients lack obvious predisposing factors (monney2025myiasisinthe pages 2-3, monney2025myiasisinthe pages 3-5, tuygun2009furuncularmyiasisin pages 1-2).	Approx. HPO/social-clinical descriptors: Impaired wound healing, Periodontitis, Immobility, Diabetes mellitus. UBERON approx.: oral cavity, skin wound.	Human clinical review/case: Swiss Med Wkly 2025 doi:10.57187/s.3827; Turk J Pediatr 2009
Pathophysiology	Causal chain: adult fly deposits eggs/larvae on wounds, body orifices, or intact skin (species-dependent) → larvae feed on living tissue, secretions, or necrotic material → mechanical/proteolytic injury and burrowing produce pain, bleeding, edema, ulceration, necrosis, and local inflammation → secondary bacterial infection may occur, rarely progressing to sepsis. Histologic inflammatory response can include lymphocytes, giant cells, neutrophils, eosinophils, and plasma cells; eosinophilia can occur in furuncular myiasis. In obligate species such as W. magnifica and C. bezziana, tissue destruction can be extensive (hou2025extensivepalatalnecrosis pages 5-6, tuygun2009furuncularmyiasisin pages 1-2, simin2024longtimeno pages 1-2, malekiravasan2020newinsightsinto pages 1-2).	GO approx.: inflammatory response; response to wounding; proteolysis; leukocyte migration. CL approx.: neutrophil, eosinophil, plasma cell, giant cell/macrophage. UBERON approx.: skin, mucosa, hoof/nasal cavities in veterinary disease.	Human case/pathobiology + veterinary review + fly microbiome study: Turk J Pediatr 2009; Microorganisms 2024 doi:10.3390/microorganisms12020233; Front Microbiol 2020 doi:10.3389/fmicb.2020.00505; Archives of Orofacial Sciences 2025 doi:10.21315/aos2025.2001.cr03
Diagnosis	Primary diagnosis is clinical visualization/removal of larvae, supported by species identification. Morphology of larval stages remains standard; molecular confirmation commonly uses mitochondrial COI barcoding. In ICU-associated cases, developmental stage and temperature can help estimate timing of infestation. For O. ovis and W. magnifica, detailed larval morphology and anatomic localization are used in veterinary/human investigations (monney2025myiasisinthe pages 1-2, simin2024longtimeno pages 1-2, simin2024longtimeno pages 2-3, simin2024longtimeno pages 3-5).	NCIT approx.: Clinical examination; Specimen collection; DNA barcoding; Polymerase chain reaction. UBERON approx.: lesion site-specific sampling.	Human/veterinary diagnostic reports: Swiss Med Wkly 2025 doi:10.57187/s.3827; Microorganisms 2024 doi:10.3390/microorganisms12020233
Treatment	Core management is prompt mechanical larval extraction plus cleansing/irrigation and local wound care. Debridement is important for invasive obligate wound myiasis. Antibiotics are used when secondary bacterial infection is suspected; systemic antiparasitic therapy such as ivermectin may be used in selected cutaneous/orbital/wound cases, but facultative ICU myiasis may derive limited added benefit once larvae are removed. Veterinary treatment includes antiseptics/insecticides, local antibiotic spray, macrocyclic lactones, and supportive care (monney2025myiasisinthe pages 2-3, monney2025myiasisinthe pages 3-5, simin2024longtimeno pages 2-3, zhou2025machinelearningbasedtext pages 2-5).	NCIT approx.: Debridement; Wound irrigation; Anti-infective therapy; Ivermectin therapy; Supportive care. CHEBI: ivermectin; diazinon (veterinary/environmental use).	Human review + veterinary case management + bibliometric synthesis: Swiss Med Wkly 2025 doi:10.57187/s.3827; Microorganisms 2024 doi:10.3390/microorganisms12020233; Front Cell Infect Microbiol 2025 doi:10.3389/fcimb.2025.1568563
Prevention	Prevention is mainly environmental and behavioral: fly control, sanitation, wound hygiene and coverage, oral care in debilitated/intubated patients, screening/windows/fumigation in healthcare settings, and traveler/livestock exposure education. ICU prevention emphasizes barriers against fly entry and better oral care for ventilated patients. Climate warming may expand risk windows/regions for some fly species (monney2025myiasisinthe pages 13-15, monney2025myiasisinthe pages 3-5, garijo‐toledo2023prevalenceofoestrus pages 1-3).	NCIT/Public health approx.: Infection prevention; Environmental control; Health education. GO not central.	Human infection-control review + veterinary climate-linked epidemiology: Swiss Med Wkly 2025 doi:10.57187/s.3827; Med Vet Entomol 2023 doi:10.1111/mve.12634
Epidemiology	Robust global incidence/prevalence in humans is not available; literature is dominated by case reports. Country-level review from Italy found 703 autochthonous human cases, 98.1% due to O. ovis; imported cases were mainly Cordylobia spp. (59.5%) and Dermatobia hominis (40.5%). ICU-acquired myiasis review identified 38 worldwide cases, 92% oro-/nasopharyngeal and 45% due to L. sericata. Seasonality and heat are recurrent epidemiologic themes (zammarchi2014humanoestriasisacquired pages 2-4, monney2025myiasisinthe pages 2-3, monney2025myiasisinthe pages 1-2).	MONDO approx.: myiasis. UBERON approx.: nasopharynx/oral cavity/eye/skin.	Human literature review: Parasitology Research 2014 doi:10.1007/s00436-014-3906-9; Swiss Med Wkly 2025 doi:10.57187/s.3827
Veterinary / One Health	Veterinary burden is substantial and supports One Health relevance. W. magnifica causes painful traumatic myiasis in sheep and other warm-blooded vertebrates and is associated with emerging bacterium Wohlfahrtiimonas chitiniclastica. Recent animal prevalence data: O. ovis prevalence 56.3% in 3476 small-ruminant heads from eastern Spain, with temperature association; 45.77% (319/697) in sheep from Mato Grosso, Brazil, with year-round infestation. Veterinary lesions include lameness, depression, inappetence, blindness, reproductive problems, and death if untreated (simin2024longtimeno pages 1-2, garijo‐toledo2023prevalenceofoestrus pages 1-3, silva2024prevalenceandseasonal pages 1-3).	CL approx.: epithelial cells, neutrophils/eosinophils in inflamed tissue. UBERON approx.: nasal cavity, sinuses, skin, hoof, genitalia. CHEBI: ivermectin/doramectin (control).	Veterinary field studies and One Health review: Microorganisms 2024 doi:10.3390/microorganisms12020233; Med Vet Entomol 2023 doi:10.1111/mve.12634; Braz J Vet Parasitol 2024 doi:10.1590/S1984-29612024020
Non-applicable genetics / omics	Myiasis is an infectious/parasitic infestation rather than a monogenic human disease. No established human causal genes, pathogenic variants, inheritance pattern, penetrance, or chromosomal abnormalities are known to define “myiasis.” Omics are mostly applied to the fly, not the host: COI sequencing for species ID and 16S/metagenetic studies of L. sericata microbiota. Experimental work on suspected intestinal myiasis suggests some reported cases may be pseudomyiasis rather than true colonization (malekiravasan2020newinsightsinto pages 1-2, zhan2026clogmiaalbipunctatafails pages 13-15, zhan2026clogmiaalbipunctatafails pages 1-2).	Mark as not applicable for OMIM-style causal gene fields. GO/CL/UBERON only for host response, not disease inheritance. NCIT approx.: DNA barcoding; microbiome analysis.	Insect microbiome and experimental model evidence: Front Microbiol 2020 doi:10.3389/fmicb.2020.00505; PLOS One 2026 doi:10.1371/journal.pone.0356742

Table: This table summarizes evidence-based disease characteristics of myiasis and maps them to cautious ontology suggestions where reliable. It is useful for populating a disease knowledge base while explicitly separating well-supported clinical/parasitologic facts from non-applicable human genetics fields.

1. Disease information

Definition and classification

Myiasis is infestation of living human or animal tissues by dipteran larvae (“maggots”). Important causative families are Calliphoridae, Sarcophagidae, Oestridae, and Muscidae. Ecologically, agents are:

Obligate parasites, which require a living host and may invade viable tissue—examples include Cochliomyia hominivorax, Chrysomya bezziana, Wohlfahrtia magnifica, and Oestrus ovis.
Facultative parasites, normally associated with carrion or decaying matter but able to colonize necrotic wounds—most notably Lucilia sericata.
Accidental myiasis/pseudomyiasis, in which ingested or contaminating larvae pass through a specimen or body compartment without sustained tissue infestation.

Anatomical categories are cutaneous (furuncular, migratory/creeping, and wound or traumatic), ocular, nasal/nasopharyngeal, oral/oropharyngeal, aural, gastrointestinal, and urogenital myiasis. Cutaneous myiasis itself comprises three major clinical patterns: furuncular, migratory, and traumatic/wound disease. (monney2025myiasisinthe pages 1-2, monney2025myiasisinthe pages 3-5, zhou2025machinelearningbasedtext pages 1-2, tuygun2009furuncularmyiasisin pages 1-2)

Identifiers and synonyms

ICD-10-CM: B87 — Myiasis, with anatomical subcodes such as B87.0 cutaneous, B87.1 wound, B87.2 ocular, B87.3 nasopharyngeal, B87.4 aural, B87.8 other, and B87.9 unspecified. Local ICD modifications should be checked before production use.
MeSH: Myiasis; commonly indexed under parasitic diseases/arthropod infestations.
ICD-11: represented within infestations by arthropods; the exact current browser code should be validated against the release used by the knowledge base.
MONDO: a myiasis concept is available, but its numerical identifier was not independently verified in the retrieved corpus and should not be populated without a direct MONDO release lookup.
OMIM: not applicable as a primary entry because myiasis is not a Mendelian disorder.
Orphanet: generally not applicable; it is not a defined rare genetic disease.
Synonyms include maggot infestation, fly-larval infestation, cutaneous myiasis, wound myiasis, traumatic myiasis, and species-specific terms such as oestriasis/oestrosis, wohlfahrtiosis, dermatobiosis, and screwworm myiasis.

This report synthesizes aggregated disease-level literature, including reviews, surveillance studies, and case reports. It is not derived from an individual EHR, although many primary evidence items describe individual patients.

2. Etiology, risk factors, and protective factors

Causal agents and exposure

The direct cause is deposition of eggs or larvae by a competent fly on intact skin, wounds, necrotic tissue, mucosa, or natural orifices; some larvae may instead be ingested. W. magnifica is larviparous and can deposit larvae in eyes, ears, mouth, genital openings, wounds, or occasionally intact skin. Larvae feed on tissue and body fluids until they leave the host to pupate. Its Palearctic distribution extends from Mediterranean Europe and North Africa through the Middle East and Eurasian steppe into Central and East Asia. (simin2024longtimeno pages 1-2)

Established or plausible risk factors

Human risk factors include:

open wounds, ulcers, necrosis, malignant wounds, infected dermatitis, and bacterial contamination;
poor wound or oral hygiene, periodontal disease, exposed body orifices, and inadequate fly barriers;
older age, frailty, impaired consciousness, immobility, neurologic disability, or inability to perform self-care;
diabetes, vascular occlusive disease, alcoholism, malignancy, malnutrition, and severe systemic illness;
mechanical ventilation, endotracheal or nasogastric tubes, mouth breathing, and lip incompetence;
homelessness or poor housing/sanitation, though disease also occurs in high-income settings without social neglect;
tropical/subtropical residence or travel, outdoor sleeping, livestock contact, shepherding, and warm seasons.

In a review of ICU-acquired disease, 92% of 38 cases were oro- or nasopharyngeal; ventilation, nasogastric tubes, and periodontal disease were recurring factors. Nevertheless, healthy people can develop furuncular or ocular disease, and an eight-year-old with W. magnifica furuncular myiasis had no identified risk factor beyond likely environmental exposure. (monney2025myiasisinthe pages 2-3, monney2025myiasisinthe pages 3-5, tuygun2009furuncularmyiasisin pages 1-2)

Protective factors

Protective factors are environmental rather than genetic: prompt wound cleaning and coverage, oral hygiene, protective clothing and repellents in fly-active areas, screened buildings, sanitation, fly control, early treatment of necrotic wounds, and regular inspection of dependent patients and livestock. No validated human protective allele, diet, supplement, or preventive medication is known.

Genetics and gene–environment interaction

No causal human gene, susceptibility locus, protective variant, modifier gene, or replicated gene–environment interaction has been established. Host comorbidities alter exposure and tissue vulnerability, but this is not evidence of genetic inheritance. There is no established role for penetrance, anticipation, mosaicism, founder variants, carrier status, or consanguinity.

3. Phenotypes

Phenotype expression depends strongly on anatomy and species; formal population frequencies are generally unavailable.

Furuncular cutaneous disease: one or several painful/pruritic papules or nodules with a central punctum, serous drainage, movement sensation, and intermittent lancinating pain. Onset follows larval inoculation and evolves over days to weeks. Suggested HPO mappings: Skin nodule, Papule, Pruritus, Pain, Abnormality of skin physiology.
Migratory/creeping disease: serpiginous or moving subcutaneous/epidermal lesions. Usually progressive over days until removal or larval exit. Suggested HPO: Abnormal skin morphology, Pruritus.
Wound/traumatic myiasis: visible larvae in an ulcer or wound, malodor, bleeding, serosanguineous or purulent drainage, edema, pain, friable tissue, and necrosis. Severity ranges from superficial facultative colonization to rapid destruction by obligate species. Suggested HPO: Skin ulcer, Necrosis, Edema, Bleeding, Pain.
Ocular disease: foreign-body sensation, acute conjunctivitis, lacrimation, photophobia, and visible motile larvae; internal or orbital invasion can threaten vision. Suggested HPO: Conjunctivitis, Photophobia, Visual impairment, Lacrimation.
Nasal/nasopharyngeal disease: nasal irritation, sneezing, obstruction, epistaxis, discharge, facial discomfort, and occasionally tissue destruction. Suggested HPO: Nasal discharge, Epistaxis, Nasal obstruction.
Oral/oropharyngeal disease: oral larvae, ulceration, bleeding, halitosis, swelling, dysphagia, and tissue necrosis. ICU disease often has little tissue injury when caused by facultative L. sericata. Suggested HPO: Oral ulcer, Dysphagia, Bleeding, Abnormal oral cavity morphology.
Aural disease: otalgia, discharge, tinnitus, hearing disturbance, and canal or middle-ear injury. Suggested HPO: Otalgia, Hearing impairment, Otorrhea.
Urogenital disease: vulvar, vaginal, urethral, or urinary symptoms, discharge, pain, ulceration, or larvae in urine; contamination must be distinguished from true infestation.
Laboratory abnormalities: peripheral eosinophilia and elevated IgE can occur but are neither common nor diagnostic. An eight-year-old had an absolute eosinophil count of 5,160/mm³ and IgE 667 IU/mL; both declined after removal of one larva. Tissue reactions may contain lymphocytes, macrophage-derived giant cells, neutrophils, eosinophils, and plasma cells. (tuygun2009furuncularmyiasisin pages 1-2)

Quality-of-life data using EQ-5D, SF-36, or PROMIS were not found. Pain, odor, social stigma, sleep disruption, impaired mobility, vision/hearing risk, and wound-care burden can substantially impair functioning. Veterinary disease similarly causes severe pain, lameness, impaired feeding, reproductive problems, and production loss. (simin2024longtimeno pages 1-2)

4. Genetic and molecular information

There are no recognized human causal genes, HGNC disease genes, pathogenic germline or somatic variants, chromosomal abnormalities, modifier genes, or disease-defining epigenetic changes. WES, WGS, gene panels, CMA, karyotyping, FISH, mitochondrial testing, and repeat-expansion testing therefore have no routine diagnostic role.

Molecular testing is directed at the parasite, not inherited host susceptibility. Mitochondrial cytochrome-c oxidase subunit I (COI) barcoding can confirm morphological identification. A 2024 W. magnifica investigation amplified a 710-bp COI barcode with LCO1490/HCO2198 primers, sequenced it bidirectionally, and compared it with GenBank using BLAST; sequences were deposited as MT027108–MT027114. (simin2024longtimeno pages 1-2, simin2024longtimeno pages 3-5)

5. Environmental, lifestyle, and infectious-agent information

Temperature, humidity, season, fly ecology, livestock density, sanitation, housing, and wound exposure determine risk. W. magnifica activity is greatest during hot summer months, although climatic conditions may permit a March–November season. A Spanish long-term veterinary study found temperature, but not rainfall, associated with O. ovis prevalence, supporting concern that warming may alter fly abundance and geographic risk. (simin2024longtimeno pages 1-2, garijo‐toledo2023prevalenceofoestrus pages 1-3)

Smoking and alcohol are not direct causes; alcohol use may act through neglect, impaired consciousness, or chronic wounds. Diet is not etiologic, although malnutrition may impair wound integrity and care.

Major infectious agents are Diptera larvae, especially Dermatobia hominis, Cordylobia anthropophaga, Cochliomyia hominivorax, C. macellaria, Chrysomya bezziana, Lucilia sericata, Wohlfahrtia magnifica, Oestrus ovis, Musca domestica, and several Sarcophagidae and Psychodidae. Larvae can carry bacteria. W. magnifica is associated with the emerging Gram-negative organism Wohlfahrtiimonas chitiniclastica, capable of local infection and sepsis. (simin2024longtimeno pages 1-2)

6. Mechanism and pathophysiology

Causal chain

Upstream exposure: an adult fly reaches exposed skin, wound, necrotic tissue, or mucosal opening and deposits eggs or larvae.
Establishment: larvae anchor by mouth hooks and body spines. Facultative species preferentially consume necrotic tissue; obligate species can invade viable tissue.
Tissue injury: movement and feeding cause mechanical disruption. Extracorporeal digestion releases salivary digestive enzymes that liquefy substrate before ingestion, providing a mechanistic basis for progressive tissue breakdown. (malekiravasan2020newinsightsinto pages 1-2)
Host response: epithelial injury induces acute and chronic inflammation, edema, bleeding, pain, and sometimes systemic eosinophilia. Relevant processes include inflammatory response, response to wounding, proteolysis, leukocyte migration, and tissue remodeling; relevant cell types include keratinocytes/epithelial cells, neutrophils, eosinophils, macrophages/giant cells, lymphocytes, and plasma cells. (tuygun2009furuncularmyiasisin pages 1-2)
Downstream complications: continuing invasion can cause ulceration, necrosis, destruction of cartilage or bone, secondary bacterial infection, bacteremia/sepsis, and—in anatomically dangerous sites—intracranial, orbital, or airway complications. C. bezziana larvae can penetrate wounds within approximately 24 hours after hatching and produce progressive bleeding, purulent discharge, and extensive soft-tissue or bone injury. (hou2025extensivepalatalnecrosis pages 5-6)

Suggested GO terms include inflammatory response, response to wounding, proteolysis, leukocyte migration, innate immune response, and tissue remodeling. Suggested Cell Ontology concepts include neutrophil, eosinophil, macrophage, lymphocyte, plasma cell, and site-specific epithelial cell. Exact ontology identifiers should be validated before ingestion.

Molecular profiling

Human transcriptomic, proteomic, metabolomic, lipidomic, single-cell, spatial-transcriptomic, or multi-omic signatures have not been clinically validated. Fly-associated metagenetics is more developed: a 2020 L. sericata study identified 265 bacterial records spanning 20 families, 28 genera, and 40 species; Gammaproteobacteria dominated, while Enterococcus faecalis, Proteus, Providencia vermicola, and Serratia marcescens showed transstadial transmission. These data concern insect ecology and maggot-debridement safety, not a human diagnostic biomarker. (malekiravasan2020newinsightsinto pages 1-2)

7. Anatomical structures affected

Primary sites include:

Skin and subcutis—suggested UBERON: skin, subcutaneous tissue;
open wounds, ulcers, malignant tissue, and exposed connective tissue;
eye, conjunctiva, eyelids, orbit;
external auditory canal, middle ear;
nasal cavity, turbinates, paranasal sinuses, nasopharynx;
oral cavity, gingiva, palate, tongue, pharynx;
urogenital tract, including vulva, vagina, urethra, bladder;
rarely gastrointestinal tract.

In animals, hoof/interdigital tissue, genital openings, nasal passages, ethmoid region, and frontal/maxillary sinuses are prominent. In O. ovis, first instars are concentrated in septum, meatus, and ventral conchae, whereas later stages occur in the nasopharynx, ethmoid labyrinth, dorsal conchae, and sinuses. (garijo‐toledo2023prevalenceofoestrus pages 1-3)

Disease may be unilateral, bilateral, focal, or multisite; no fixed lateralization exists. At subcellular level there is no disease-specific organelle lesion—the pathology is tissue-level mechanical, enzymatic, inflammatory, and microbial injury.

8. Temporal development

Myiasis can occur at any age and is acquired rather than congenital. Furuncular lesions usually evolve over days to weeks; wound and cavitary disease may appear acutely and progress rapidly when produced by obligate tissue-feeding species. In an ICU case, 13 third-instar L. sericata larvae were found 60 hours after intubation; developmental modeling indicated at least 30 hours to reach third instar at approximately 34°C, illustrating how temperature and stage can help estimate acquisition. (monney2025myiasisinthe pages 1-2)

There is no universal staging system. A pragmatic sequence is inoculation, larval establishment, progressive local injury, possible secondary infection/deep invasion, and either removal, spontaneous exit/pupation, or complications. Facultative superficial disease is often self-limited after complete extraction. Obligate myiasis can progress until every larva is removed and devitalized tissue is treated. Recurrence generally indicates retained larvae, continued exposure, or inadequately managed wounds rather than biological relapse.

9. Inheritance, epidemiology, and population

Myiasis is not inherited. Penetrance, expressivity, anticipation, germline mosaicism, carrier frequency, and founder effects are not applicable.

No reliable global incidence or prevalence per 100,000 exists. A bibliometric analysis recovered only 211 PubMed publications on cutaneous myiasis from 2001–2021 and found that case reports remained a defining feature, underscoring surveillance limitations. (zhou2025machinelearningbasedtext pages 2-5, zhou2025machinelearningbasedtext pages 1-2)

Available quantitative observations include:

An Italian review documented 703 autochthonous cases, of which 690 (98.1%) were attributed to O. ovis. Among 42 imported cases, 59.5% involved Cordylobia species and 40.5% D. hominis. Historically, 77% of recognized Italian O. ovis cases were in shepherds; old occupational surveys reported lifetime histories of approximately 80–87%, but these figures should not be extrapolated to modern populations. (zammarchi2014humanoestriasisacquired pages 2-4)
A worldwide ICU review identified 38 cases; 92% were oro-/nasopharyngeal and 45% involved L. sericata. Fourteen occurred in high-income countries and eight in Europe. (monney2025myiasisinthe pages 2-3)
Human cases occur in both sexes and all ages. No robust global sex ratio is available. Older, disabled, or critically ill people predominate in wound/nosocomial series, while travelers and otherwise healthy adults commonly develop furuncular disease.

Geography follows fly species: D. hominis in tropical America; Cordylobia in sub-Saharan Africa; New World screwworm in the Americas where not eradicated; C. bezziana across parts of Africa and Asia; and W. magnifica across the Palearctic. Imported disease occurs worldwide through travel.

10. Diagnostics

Clinical and laboratory diagnosis

Diagnosis is usually made by seeing or extracting larvae. Examination should determine lesion depth, larval number, necrosis, vascular or neurologic involvement, and proximity to the eye, airway, ear, skull, or major vessels. CBC may show eosinophilia, but no blood biomarker is sufficiently sensitive or specific. Culture blood or tissue when fever, cellulitis, sepsis, or bacteremia is suspected.

Species identification

Larvae should be preserved appropriately and referred to medical entomology or parasitology. Morphological diagnosis uses size and instar, posterior peritremes/spiracles, anterior spiracles, cephalopharyngeal skeleton, body spines, and anal division. Molecular COI barcoding is valuable when specimens are damaged, morphology is ambiguous, or epidemiological confirmation is important. (simin2024longtimeno pages 2-3, simin2024longtimeno pages 3-5)

Imaging and pathology

Ultrasound can demonstrate movement in furuncular lesions. CT or MRI is indicated for orbital, sinonasal, aural, intracranial, deep-tissue, or bone involvement. Endoscopy may assist nasal, oral, aural, or urogenital inspection. Histology is not usually required but may show mixed inflammatory infiltrates, necrosis, and larval structures.

Differential diagnosis

Differentials include bacterial furuncle/abscess, epidermoid cyst, arthropod bite, cutaneous larva migrans, tungiasis, leishmaniasis, pyoderma, foreign-body granuloma, cellulitis, malignancy, mucormycosis, allergic or bacterial conjunctivitis, rhinitis/sinusitis, otitis externa, and delusional infestation. True intestinal or urinary infestation must be distinguished from specimen contamination and pseudomyiasis.

No routine asymptomatic screening, newborn screening, carrier screening, genetic testing, or population screening is warranted.

11. Outcome and prognosis

Complete removal in uncomplicated furuncular or superficial facultative disease is usually curative. In the eosinophilic pediatric case, lymphadenopathy and swelling regressed rapidly without additional treatment, and the eosinophil count normalized after larval extraction. (tuygun2009furuncularmyiasisin pages 1-2)

Adverse outcomes include persistent ulceration, bleeding, pain, disfigurement, secondary bacterial infection, cellulitis, osteomyelitis, bacteremia/sepsis, airway compromise, visual loss, hearing injury, intracranial extension, and death. Risk is greatest with obligate tissue-feeding species, large burdens, delayed presentation, deep craniofacial or orbital location, severe comorbidity, and inadequate debridement. In veterinary W. magnifica disease, untreated infestation can produce lethargy, depression, inappetence, blindness, lameness, reproductive loss, wasting, and death. (simin2024longtimeno pages 1-2)

There are no validated survival curves, 5- or 10-year survival estimates, prognostic scores, or molecular prognostic biomarkers. Death usually reflects deep invasion, sepsis, or underlying illness rather than a chronic post-myiasis state.

12. Treatment and current applications

Clinical algorithm

Stabilize airway, bleeding, sepsis, and ocular or neurologic emergencies.
Mechanically remove all visible larvae with forceps and adequate analgesia/anesthesia.
Irrigate thoroughly; repeat inspection because deeply embedded larvae may be missed.
Debride necrotic tissue, particularly in obligate wound myiasis.
Obtain larvae for identification and cultures when infection is suspected.
Treat bacterial infection based on clinical findings and cultures—not simply because larvae are present.
Consider ivermectin for extensive, inaccessible, orbital, or invasive disease under specialist supervision.
Correct the predisposing wound, malignancy, hygiene deficit, or hospital fly-control breach.

Mechanical extraction is the primary intervention. Reviews suggest that antibiotics or antiparasitic agents add little after complete removal of uncomplicated facultative ICU myiasis, whereas obligate myiasis requires aggressive extraction and debridement. (monney2025myiasisinthe pages 2-3, monney2025myiasisinthe pages 3-5)

Pharmacotherapy and interventions

Ivermectin: a macrocyclic lactone used off-label in selected human myiasis cases; evidence is primarily case-based, and no universal dose or regimen is established across anatomical forms.
Antibiotics: indicated for cellulitis, bacteremia, osteomyelitis, or other secondary infection; they do not remove larvae.
Occlusive agents: petroleum jelly or similar occlusion may force air-breathing furuncular larvae toward the surface. Care is needed because larval rupture or death in situ may intensify inflammation.
Surgical/endoscopic extraction and debridement: required for deep, cavitary, orbital, sinonasal, or destructive lesions.
Supportive care: analgesia, antiseptic wound care, dressings, nutrition, and rehabilitation for functional injury.

Suggested NCIt intervention concepts are foreign-body removal, surgical debridement, wound irrigation, antibiotic therapy, antiparasitic therapy, ivermectin, and supportive care. Suggested chemical mappings include ivermectin and antiseptic/irrigation agents; exact CHEBI identifiers require release validation.

The ClinicalTrials.gov search retrieved no relevant interventional myiasis trial. Gene, cell, RNA, immune-checkpoint, or precision-genotype therapies have no role. Pharmacogenomic guidance specific to myiasis is unavailable.

Important distinction from maggot debridement therapy

Uncontrolled myiasis is not equivalent to regulated maggot debridement therapy (MDT). MDT uses sterile, laboratory-reared facultative larvae—commonly L. sericata—to remove necrotic tissue. A 2025 computational/bibliometric study proposed possible benefit in infected diabetic wounds, but this does not justify retaining wild larvae, whose species, burden, and microbiota are uncontrolled. (zhou2025machinelearningbasedtext pages 2-5, malekiravasan2020newinsightsinto pages 1-2)

13. Prevention

Primary prevention

cover and regularly inspect wounds; promptly remove necrotic tissue;
maintain personal, oral, household, and livestock hygiene;
use screens, bed nets, protective clothing, and repellents where flies are active;
manage garbage, carrion, manure, and animal wounds;
educate travelers, caregivers, livestock workers, and shepherds;
implement veterinary surveillance and coordinated screwworm control.

Secondary and tertiary prevention

Early recognition and complete extraction prevent deep invasion. Patients with malignant wounds, diabetes, vascular ulcers, immobility, tracheostomy/intubation, or impaired consciousness need scheduled skin, mouth, device-site, and wound examinations. Following treatment, repeat inspection and continued wound coverage reduce retained-larva complications and reinfestation.

Hospitals should use window/door screens, air barriers where feasible, pest surveillance, prompt waste removal, environmental fumigation when an outbreak is confirmed, and meticulous oral care for mechanically ventilated patients. Recent ICU reports document fumigation and window screening as practical outbreak responses. (monney2025myiasisinthe pages 13-15, monney2025myiasisinthe pages 3-5)

There is no human vaccine, chemoprophylaxis program, genetic screening, or validated population screening test.

14. Other species and natural disease

Myiasis is naturally widespread among mammals and birds. Important hosts include sheep, goats, cattle, horses, pigs, camels, dogs, cats, wildlife, and humans. Taxonomic identifiers should be linked at the causative-species level—for example, Oestrus ovis, W. magnifica, L. sericata, C. hominivorax, and C. bezziana—rather than treating “maggot” as one organism.

Recent veterinary data show substantial burden:

In eastern Spain, 3,476 culled sheep/goat heads examined from 2009–2019 yielded 56.3% overall O. ovis prevalence, higher in sheep (61.2%) than goats (43%). Mean intensity was 12.8 larvae/head; temperature was significantly associated with prevalence. The abstract concluded that results showed “the trend increasing in recent years in association with higher mean temperatures.” (garijo‐toledo2023prevalenceofoestrus pages 1-3)
In Mato Grosso, Brazil, 319/697 sheep (45.77%) were infested; 2,412 larvae were recovered, 96.89% identified as O. ovis. Seasonal prevalence ranged from 41% in spring to 56% in summer, but larvae occurred year-round. The authors state: “It is also reported as a zoonosis causing ophthalmomyiasis and nasopharyngeal myiasis.” (silva2024prevalenceandseasonal pages 1-3)
A 2024 Serbian study documented the first reported Western Balkan W. magnifica cases in 80 years. Four sheep had severe hoof, genital, or interdigital disease; two hoof wounds contained 400 and 354 larvae, with deep bleeding foci, horn destruction, inflammation, arthritis, lameness, and poor condition. (simin2024longtimeno pages 1-2, simin2024longtimeno pages 3-5)

Animal disease is both an economic/welfare problem and an exposure reservoir, but ordinary human-to-human or animal-to-human transmission does not occur directly: adult flies mediate infestation. The One Health significance includes shared fly ecology, livestock amplification, climate sensitivity, and fly-associated bacteria such as W. chitiniclastica.

15. Model organisms and research systems

There is no standard genetic knockout, transgenic, zebrafish, organoid, or iPSC model of human myiasis. Natural infestation in sheep, goats, cattle, and other livestock is the most informative comparative system because it reproduces larval colonization, inflammation, pain, tissue destruction, and seasonal ecology. Its limitation is species-specific anatomy and fly–host adaptation.

Experimental models are sparse. A 2026 study—outside the requested 2023–2024 priority window but mechanistically informative—used INFOGEST-like simulated digestive fluids and BALB/c mouse gavage to test Clogmia albipunctata. Gastric exposure reduced egg hatchability from 76.80% to 0% and produced 99.17% larval mortality; mice showed no shedding, mucosal injury, or colonization. The study supports pseudomyiasis or sample contamination as explanations for many purported intestinal cases, but healthy mice do not model hypochlorhydria, dysmotility, altered microbiota, or immunosuppression. (zhan2026clogmiaalbipunctatafails pages 13-15, zhan2026clogmiaalbipunctatafails pages 1-2)

Other useful platforms include fly-rearing systems, larval feeding assays, wound models, microbiome/metagenetic profiling, COI phylogenetics, and insecticide susceptibility studies. These primarily investigate parasite biology, species identification, MDT, veterinary control, and forensic timing rather than inherited human disease.

Evidence appraisal and current research priorities

The strongest current evidence concerns clinical recognition, species morphology/molecular identification, and veterinary epidemiology. Human evidence is weak for comparative drug efficacy, standardized ivermectin regimens, global burden, long-term quality of life, and prognostic biomarkers. A 2025 literature analysis found persistent emphasis on uncommon species, nasal disease, travel, and case reports—an expert signal that the field needs prospective surveillance and standardized reporting rather than additional isolated descriptions. (zhou2025machinelearningbasedtext pages 2-5, zhou2025machinelearningbasedtext pages 1-2)

Priority research needs are: mandatory or sentinel reporting in endemic regions; standardized case definitions separating true myiasis from pseudomyiasis; prospective treatment comparisons; validated protocols for orbital, craniofacial, and malignant-wound disease; genomic surveillance of fly populations; systematic characterization of larval microbiota and bacteremia risk; and integrated veterinary–human–environmental surveillance under a One Health framework.

Key recent sources and publication details

Simin S, et al. Long Time No Hear, Magnificent Wohlfahrtia! Microorganisms. Published 23 January 2024. DOI/URL: https://doi.org/10.3390/microorganisms12020233. The abstract calls W. magnifica “a potentially deadly agent of obligate traumatic myiasis in humans and animals.” (simin2024longtimeno pages 1-2)
Silva VLB, et al. Prevalence and seasonal aspects of parasitism by Oestrus ovis in sheep from Mato Grosso State, Brazil. Brazilian Journal of Veterinary Parasitology. Received 12 December 2023, accepted 11 March 2024. DOI/URL: https://doi.org/10.1590/S1984-29612024020. (silva2024prevalenceandseasonal pages 1-3)
Garijo-Toledo MM, et al. Prevalence of Oestrus ovis in small ruminants from the eastern Iberian Peninsula. Medical and Veterinary Entomology. Published 2023. DOI/URL: https://doi.org/10.1111/mve.12634. (garijo‐toledo2023prevalenceofoestrus pages 1-3)
Monney M, et al. Myiasis in the intensive care unit: report from Switzerland and review of worldwide cases. Swiss Medical Weekly. Published July 2025. DOI/URL: https://doi.org/10.57187/s.3827. This post-2024 review supplies the most current aggregated ICU evidence. (monney2025myiasisinthe pages 1-2, monney2025myiasisinthe pages 2-3)
Zhou Z, et al. Machine learning-based text mining for cutaneous myiasis. Frontiers in Cellular and Infection Microbiology. Published May 2025. DOI/URL: https://doi.org/10.3389/fcimb.2025.1568563. (zhou2025machinelearningbasedtext pages 2-5)
Maleki-Ravasan N, et al. New Insights Into Culturable and Unculturable Bacteria Across the Life History of Medicinal Maggots Lucilia sericata. Frontiers in Microbiology. Published 8 April 2020. DOI/URL: https://doi.org/10.3389/fmicb.2020.00505. (malekiravasan2020newinsightsinto pages 1-2)
Zammarchi L, et al. Human oestriasis acquired in Florence and review on human myiasis in Italy. Parasitology Research. Published May 2014. DOI/URL: https://doi.org/10.1007/s00436-014-3906-9. (zammarchi2014humanoestriasisacquired pages 2-4)
Tuygun N, et al. Furuncular myiasis in a child caused by Wohlfahrtia magnifica associated with eosinophilia. Turkish Journal of Pediatrics. Published 2009;51:279–281. Its abstract states: “Following removal of the larva, the clinical and hematological manifestations returned to normal.” (tuygun2009furuncularmyiasisin pages 1-2)

Database limitation: PMIDs were not exposed in the retrieved full-text metadata, so DOI URLs are supplied rather than risking incorrect PMID assignment. Likewise, exact MONDO, HPO, GO, CL, UBERON, CHEBI, and NCIt numerical identifiers should be resolved against the knowledge base’s pinned ontology releases before production ingestion.

References

(monney2025myiasisinthe pages 1-2): Marine Monney, Jiri Hodecek, Jean-Marc Schwob, N. Buetti, Jacques Schrenzel, and Viviane Donner. Myiasis in the intensive care unit: report from switzerland and review of worldwide cases. Swiss medical weekly, 155:3827, Jul 2025. URL: https://doi.org/10.57187/s.3827, doi:10.57187/s.3827. This article has 1 citations and is from a peer-reviewed journal.
(monney2025myiasisinthe pages 3-5): Marine Monney, Jiri Hodecek, Jean-Marc Schwob, N. Buetti, Jacques Schrenzel, and Viviane Donner. Myiasis in the intensive care unit: report from switzerland and review of worldwide cases. Swiss medical weekly, 155:3827, Jul 2025. URL: https://doi.org/10.57187/s.3827, doi:10.57187/s.3827. This article has 1 citations and is from a peer-reviewed journal.
(tuygun2009furuncularmyiasisin pages 1-2): N Tuygun, A Taylan-Ozkan, and G Tanir. Furuncular myiasis in a child caused by wohlfahrtia magnifica (diptera: sarcophagidae) associated with eosinophilia. Unknown journal, 2009.
(zhou2025machinelearningbasedtext pages 1-2): Zhiyuan Zhou, Chaoran Yu, Danhua Yao, Zhen Wang, Yuhua Huang, Pengfei Wang, Weimin Wang, and Yousheng Li. Machine learning-based text mining for cutaneous myiasis and potential value of an accidental maggot therapy for complicated skin and soft tissue infection with sepsis. Frontiers in Cellular and Infection Microbiology, May 2025. URL: https://doi.org/10.3389/fcimb.2025.1568563, doi:10.3389/fcimb.2025.1568563. This article has 3 citations.
(garijo‐toledo2023prevalenceofoestrus pages 1-3): María Magdalena Garijo‐Toledo, José Sansano‐Maestre, Ana Elena Ahuir‐Baraja, Carlos Martínez‐Carrasco, Francisco Domingo Alonso de Vega, Lola Llobat, and María Rocío Ruiz de Ybáñez‐Carnero. Prevalence of oestrus ovis in small ruminants from the eastern iberian peninsula. a long‐term study. Medical and Veterinary Entomology, 37:330-338, Jan 2023. URL: https://doi.org/10.1111/mve.12634, doi:10.1111/mve.12634. This article has 7 citations and is from a peer-reviewed journal.
(silva2024prevalenceandseasonal pages 1-3): V. L. Silva, D. G. S. Ramos, R. C. Pacheco, Diego Montagner Schenkel, Nilton Pereira Dias Junior, Artur Kanadani Campos, and Fernando H. Furlan. Prevalence and seasonal aspects of parasitism by oestrus ovis (diptera: oestridae) in sheep from mato grosso state, brazil. Revista Brasileira de Parasitologia Veterinária / Brazilian Journal of Veterinary Parasitology, Apr 2024. URL: https://doi.org/10.1590/s1984-29612024020, doi:10.1590/s1984-29612024020. This article has 2 citations.
(monney2025myiasisinthe pages 2-3): Marine Monney, Jiri Hodecek, Jean-Marc Schwob, N. Buetti, Jacques Schrenzel, and Viviane Donner. Myiasis in the intensive care unit: report from switzerland and review of worldwide cases. Swiss medical weekly, 155:3827, Jul 2025. URL: https://doi.org/10.57187/s.3827, doi:10.57187/s.3827. This article has 1 citations and is from a peer-reviewed journal.
(hou2025extensivepalatalnecrosis pages 5-6): Ken Wong Siong Hou, Syamsa Rizal Abdullah, Mohd Rafizul Mohd Yusof, Ahmad Firdaus Mohd Salleh, and Syed Nabil. Extensive palatal necrosis secondary to chrysomya bezziana myiasis: a case report. Archives of Orofacial Sciences, 20:59-68, Jun 2025. URL: https://doi.org/10.21315/aos2025.2001.cr03, doi:10.21315/aos2025.2001.cr03. This article has 0 citations.
(simin2024longtimeno pages 1-2): Stanislav Simin, Snežana Tomanović, Ratko Sukara, Marijana Stefanov, Milan Savović, Bojan Gajić, and Vesna Lalošević. Long time no hear, magnificent wohlfahrtia! morphological and molecular evidence of almost forgotten flesh fly in serbia and western balkans. Microorganisms, 12:233, Jan 2024. URL: https://doi.org/10.3390/microorganisms12020233, doi:10.3390/microorganisms12020233. This article has 2 citations.
(malekiravasan2020newinsightsinto pages 1-2): Naseh Maleki-Ravasan, Nahid Ahmadi, Zahra Soroushzadeh, Abbas Ali Raz, Sedigheh Zakeri, and Navid Dinparast Djadid. New insights into culturable and unculturable bacteria across the life history of medicinal maggots lucilia sericata (meigen) (diptera: calliphoridae). Frontiers in Microbiology, Apr 2020. URL: https://doi.org/10.3389/fmicb.2020.00505, doi:10.3389/fmicb.2020.00505. This article has 46 citations and is from a peer-reviewed journal.
(simin2024longtimeno pages 2-3): Stanislav Simin, Snežana Tomanović, Ratko Sukara, Marijana Stefanov, Milan Savović, Bojan Gajić, and Vesna Lalošević. Long time no hear, magnificent wohlfahrtia! morphological and molecular evidence of almost forgotten flesh fly in serbia and western balkans. Microorganisms, 12:233, Jan 2024. URL: https://doi.org/10.3390/microorganisms12020233, doi:10.3390/microorganisms12020233. This article has 2 citations.
(simin2024longtimeno pages 3-5): Stanislav Simin, Snežana Tomanović, Ratko Sukara, Marijana Stefanov, Milan Savović, Bojan Gajić, and Vesna Lalošević. Long time no hear, magnificent wohlfahrtia! morphological and molecular evidence of almost forgotten flesh fly in serbia and western balkans. Microorganisms, 12:233, Jan 2024. URL: https://doi.org/10.3390/microorganisms12020233, doi:10.3390/microorganisms12020233. This article has 2 citations.
(zhou2025machinelearningbasedtext pages 2-5): Zhiyuan Zhou, Chaoran Yu, Danhua Yao, Zhen Wang, Yuhua Huang, Pengfei Wang, Weimin Wang, and Yousheng Li. Machine learning-based text mining for cutaneous myiasis and potential value of an accidental maggot therapy for complicated skin and soft tissue infection with sepsis. Frontiers in Cellular and Infection Microbiology, May 2025. URL: https://doi.org/10.3389/fcimb.2025.1568563, doi:10.3389/fcimb.2025.1568563. This article has 3 citations.
(monney2025myiasisinthe pages 13-15): Marine Monney, Jiri Hodecek, Jean-Marc Schwob, N. Buetti, Jacques Schrenzel, and Viviane Donner. Myiasis in the intensive care unit: report from switzerland and review of worldwide cases. Swiss medical weekly, 155:3827, Jul 2025. URL: https://doi.org/10.57187/s.3827, doi:10.57187/s.3827. This article has 1 citations and is from a peer-reviewed journal.
(zammarchi2014humanoestriasisacquired pages 2-4): Lorenzo Zammarchi, Andrea Giorni, Simona Gabrielli, Marianne Strohmeyer, Gabriella Cancrini, and Alessandro Bartoloni. Human oestriasis acquired in florence and review on human myiasis in italy. Parasitology Research, 113:2379-2385, May 2014. URL: https://doi.org/10.1007/s00436-014-3906-9, doi:10.1007/s00436-014-3906-9. This article has 40 citations and is from a peer-reviewed journal.
(zhan2026clogmiaalbipunctatafails pages 13-15): Huahan Zhan, Linghong Zhang, Lu Ge, Yanli Chen, Peiyi Zhang, Yumeng Jiao, Xiaocheng Luo, Hui Xia, Qiang Fang, and Zhiyong Tao. Clogmia albipunctata fails to induce true intestinal myiasis: evidence from in vitro and in vivo digestive models. PLOS One, 21(8):e0356742, Aug 2026. URL: https://doi.org/10.1371/journal.pone.0356742, doi:10.1371/journal.pone.0356742. This article has 0 citations and is from a peer-reviewed journal.
(zhan2026clogmiaalbipunctatafails pages 1-2): Huahan Zhan, Linghong Zhang, Lu Ge, Yanli Chen, Peiyi Zhang, Yumeng Jiao, Xiaocheng Luo, Hui Xia, Qiang Fang, and Zhiyong Tao. Clogmia albipunctata fails to induce true intestinal myiasis: evidence from in vitro and in vivo digestive models. PLOS One, 21(8):e0356742, Aug 2026. URL: https://doi.org/10.1371/journal.pone.0356742, doi:10.1371/journal.pone.0356742. This article has 0 citations and is from a peer-reviewed journal.

Artifacts

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Reference Validation

Checked with linkml-reference-validator 0.2.1.

Outcome	Count
References checked	10
Resolved	8
Unresolved (possible confabulation)	2
Unverifiable	0
References weighed for topical relevance	8
On topic	3
Off topic	0

Unresolved references

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DOI:10.1590/S1984-29612024020 (4 mentions) - Identifier did not resolve to a record
DOI:10.1590/s1984-29612024020 (3 mentions) - Identifier did not resolve to a record

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OpenScientist Report

Classifications

Definitions

Subtypes

Discussions and Knowledge Gaps

Pathophysiology

Histopathology

Pathograph

Phenotypes

Medical Actions

Environmental Factors

Diagnosis

Imaging Findings

Progression

Prevalence

Epidemiology

Infectious Agent

Transmission

Differential Diagnoses

Animal Models

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Deep Research

Myiasis: Comprehensive Disease-Characteristics Report

Executive summary

1. Disease information

Definition and classification

Identifiers and synonyms

2. Etiology, risk factors, and protective factors

Causal agents and exposure

Established or plausible risk factors

Protective factors

Genetics and gene–environment interaction

3. Phenotypes

4. Genetic and molecular information

5. Environmental, lifestyle, and infectious-agent information

6. Mechanism and pathophysiology

Causal chain

Molecular profiling

7. Anatomical structures affected

8. Temporal development

9. Inheritance, epidemiology, and population

10. Diagnostics

Clinical and laboratory diagnosis

Species identification

Imaging and pathology

Differential diagnosis

11. Outcome and prognosis

12. Treatment and current applications

Clinical algorithm

Pharmacotherapy and interventions

Important distinction from maggot debridement therapy

13. Prevention

Primary prevention

Secondary and tertiary prevention

14. Other species and natural disease

15. Model organisms and research systems

Evidence appraisal and current research priorities

Key recent sources and publication details

Artifacts

Reference Validation

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