First case report of human myiasis with Sarcophaga species in Makkah city in the wound of a diabetic patient
A 40-year-old male diabetic patient visited the outpatient clinic of the diabetic center in Alnoor Specialist Hospital, Makkah, Saudi Arabia, seeking medical advice for a single wound in the back of the shoulder since 1 month. He resided in a rural area near Makkah and was working as a shepherd who was in close contact with goats and sheep. A moving worm was found in his wound. After complete general physical examination, which was normal with normal vital signs with no organomegaly or palpable masses, the worm was eliminated through pressure around the wound with forceps and sent to the parasitological department in the laboratory of Alnoor Specialist Hospital. The wound was cleaned and rinsed with antiseptic solution and covered with a sterile dressing of gauze and nylon mesh. The blood report results for thyroid function test (free thyroxin [FT4] and thyroid-stimulating hormone [TSH]) and lipid profile (cholesterol, triglycerides, high-density lipoprotein [HDL]) were found to be within the normal range. However, fasting blood glucose and HbA1c values were high. The patient was discharged on appropriate counseling and medication to control diabetes as well as wound care.\nSubsequently, the larva was subjected to macroscopic and microscopic examination. Macroscopic examination was done by naked eyes, which revealed that it was the third-stage larva of Sarcophaga species, and was grayish in color, 18–19 mm long and 4 mm in width. The body of the larva was pointed anteriorly and was progressively widened posteriorly. For microscopic examination, the larva was cleared in a solution of 10% potassium hydroxide.[]\nThe anterior and posterior parts of the larva were prepared for whole mount for identification of the anterior and the posterior spiracles. A preserved larva sample was prepared.[]\nThe larva was first washed in distilled water and then cleared in 10% potassium hydroxide (KOH) solution for 26 h. The larva was washed again in distilled water, transferred to 10% acetic acid for 30 min and washed again in distilled water. At this stage, all the internal organs of the maggot were removed and the posterior spiracles were cut transversely. The specimens were then dehydrated in ascending series of ethanol (30%, 50%, 70% and 90%) for 30 min each. The larva was then soaked in absolute alcohol for at least 1 h and then transferred into clove oil. The specimens were mounted onto a glass slide using Canada balsam and left in an incubator for 1–2 days. The slide was examined under a light microscope for taxonomy studies and identification. Light microscopic findings revealed that the larva was sub-cylindrical in cross-sections with the flattened ventral surface and tapering toward the anterior extremity. The posterior end was narrowed with a pit-like depression where the posterior spiracles were located. Body segments were banded with transverse spinous swellings. In this third-stage larva of Sarcophaga species, the posterior spiracles were located near each other and each plat was formed of widely opened peritreme with a very indistinct button. Each plate contained of three elongated slits. The median one was straight, whereas the lateral ones were curved anteriorly [Figures and ].