Maggots are useful in treating infected or necrotic wounds
BMJ 1999; 318 doi: https://doi.org/10.1136/bmj.318.7186.807 (Published 20 March 1999) Cite this as: BMJ 1999;318:807
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With reference to the editorial by Wise et al which discusses
antibiotic resistant bacteria,(1) Thomas et al describe the use of
Lucilia sericata larvae as a technique to improve infected or necrotic
wound healing.(2) Other such "biosurgical" techniques are in fact
widespread as traditional health practices in developing countries.
Across Southern India anecdotes abound of the use of fish to aid in
the healing of skin wounds. Macropodus cupanus, the Indian Paradise Fish,
has been identified as an organism drawn to infected, infested or necrotic
wounds.(3) By nibbling at the infected flesh, wounds are reported to heal
quicker. The practice is particularly widespread for treating scabies
infestations in children’s limbs.
Whilst not positively advocating such practices in the absence of
quality evidence of their efficacy, they do serve to broaden one’s
perspective in the global fight against anti-microbial resistance as an
alternative approach to drug therapy.
(1) Wise R, Hart T, Cars O, Streulens M, Helmuth R, Huovinen P, et
al. Antimicrobial resistance. BMJ 1998; 317: 609-610. (5 September.)
(2) Thomas S, Andrews A, Jones M, Church J. Maggots are useful in
treating infected or necrotic wounds. BMJ 1999; 318: 807-808. (20 March.)
(3) Padmanabham K, Reader in Fish Biology, University of Kerala,
Trivandrum, South India. Personal Communication.
Competing interests: No competing interests
Editor- In their interesting reply to the editorial of Wise et al 1,
Thomas et al 2 illustrate another option in the treatment of infected and
necrotic wounds namely larval treatment or biosurgery. We highlight a
further application of the term biosurgery and of larvae (maggots) in
medical practice.
We in our centre are developing a suitable animal spinal model, both
for biomechanical studies of the human spine and for testing of implants.
There is difficulty in procuring human cadaveric spine and there are
restriction imposed by the ministry of agriculture, fisheries and food on
the usage of calf and sheep spine for experimental work, with the advent
of bovine spongiform encephalopathy (BSE). 3 There is potential risk of
transmission of bovine spongiform encephalopathy (BSE) to humans in the
form of New Variant Cruetzfield Jakob (CJD) disease.
To validate the animal model it is necessary to carry out exhaustive
morphometric measurements of the animal spine in order to compare it to
the humans. It is imperative to clear the spine by proper surgical
dissection before making measurements to ensure accuracy. 4 Surgical
dissection is tedious and time consuming, as well as has the potential
risk of sharps injury. Some other authors have combined surgical
dissection with boiling of the specimen to make the procedure easier 5,
which we feel is equally as bad.
We placed fresh deer spine specimen, which till date have no reported
cases of being carriers of prion disease, in a maggot farm for a period of
48 to 72 hours. During this period the "biosurgeons" (maggots) cleared the
specimen of all the soft tissues sparing the major ligaments, the joint
capsule, intervertebral disc and the bone. Prior to taking the
measurements, the maggots were removed by washing, under plain tap water
and the remainder removed by the immersing the specimen in bleach.
Currently the preparation of anatomical specimen is carried out by
sharp dissection. We suggest the use of maggots as an alternative. This
particular use of maggots adds another limb to the term of "biosurgery"
with respect to the use of maggots in medical practice.
Naresh Kumar Senior spinal fellow
Mushtaque Ishaque Spinal fellow
Sandeep Kukreti Research fellow
Prof. RC Mulholland Prof. spine surgery
Department of Spinal Surgery,
Queen's Medical Centre,
NOTTINGHAM. NG7 2UH
REFERENCES:
1. Wise R, Hart T, Cars O, Streulens M, Helmuth R, Huovinen P et al.
Antimicrobial resistance. BMJ 1998: 317; 609-10. ( 5 September)
2. Thomas S, Church J. Maggots are useful in treating infected or
necrotic wounds. BMJ 1999; 318: 807-808. (20, March)
3. Ministry of agriculture, fisheries, and food. London, June 1998.
Bovine spongiform encephalopathy in Great Britain. A progress report.
4. Wilke HJ, Kettler A, Wegner KH, Claes LE. Anatomy of the sheep
spine and its comparison to the human spine. Anat. Rec. 1997; 247(4): 542-
55.
5. Panjabi MM, Takata K, Goel V, Federico D, Oxland T, Duranceau J,
Krag M. Thoracic human vertebrae; quantitative three-dimensional anatomy.
Spine 1991; 16(8): 888-901.
Competing interests: No competing interests
The larva of the greenbottle fly, Lucilia sericata, has removed the
fear many would have had about maggots. During my tenure as a medical
office with the Leprosy Mission in South Asia I had occasion to treat
several patients who had plantar ulcers any myiasis, the maggots being
usually from the Musca domestica or the Tabanus. If the larvae of the
Lucilia species can modify the wound pH and also ingest and destroy the
bacteria as a normal feeding pattern, so would the other maggots. Diabetic
ulcers are an excellent medium for most maggots (and bacteria as well).
The Lucilia sericata has also been implicated in myiasis in a skin
tumor in an 87-year old lady (2). This larve is considered to be the most
common causal agent of tissue, cavity, ocular and urogenital human myiasis
in Central Europe (2). But larva therapy has been recommended in cases of
intractable gangrene and osteomyelitis when treatment with antibiotics and
surgical debridement has failed (3).
Social acceptability of larva therapy could hamper its advocacy.
Centuries ago, at the outskirts of ancient Jerusalem was an area marked
as "Gehenna", where the worm did not die and the fire was not quenched.
Based on Jewish beliefs myiasis has been considered to be synonymous with
a living death - a gradual decay of the body while the patient is still
alive. Gehenna symbolised the land of those who were cursed. This concept
of myiasis is still prevalent in many parts of the world.
If the Lucilia larva can even take care of methicillin-resistant
Staph. aureus, we are perhaps returning to the law of signatures, with
nature itself providing a cure for human illnesses. Sterile larvae? an
apparent misnomer, specially when its role as a pathogen in cattle has
been well documented. But in the war of ethe worlds it may the maggot the
preserves mankind from pathogenic microbes - so long as the larva does not
metamorphose and the greenbottle does not fly off.
If one green bottle should accidentally fall, there'll be no green
bottles hanging on the wall.
References:
1. Thomas S, A Andrews, M Jones, J Church. Maggots are useful in
treating infected or necrotic wounds. BMJ 1999; 318: 807
2. Minar J & A Valkoum. Myiasis in a skin tumor. Epidemiol.
Mikribiol. Immunol. 1998; 47 (1): 32-34 (Medline)
3. Mumcuoglu KY, M Lipo, I Ioffe-Uspensky, et al. Maggot therapy for
gangrene and osteomyelitis. Harefuah 1997; 132 (5): 322-325 (Medline)
Competing interests: No competing interests
Re: Fish as well as maggots can aid the healing of wounds
Hello,
A French TV series yesterday (10/8/2006) showed the Welsh surgeon
(perhaps
now retired) who is/was using maggot therapy. I immediately thought of a
Lady
who was suffering of scalp psoriasis and went to Turkey (to a place I
could find)
where, near a spring, fishes ate her squamae. As a consequence of that
short
cure, she completely recovered from her psoriasis.
Have you heard of maggot therapy experiments applied on scalp psoriasis ?
Who would be abble to conduct such an experiment today ?
Thank you
Competing interests:
None declared
Competing interests: No competing interests