儿童皮肤蝇蛆病1例及文献复习

Case Report of Children Cutaneous Myiasis and Review of the Literatures

目的提高对皮肤蝇蛆病的认识。方法选择本院2012年10月收治的1例儿童皮肤蝇蛆病患儿为研究对象(本研究遵循的程序符合本院人体试验委员会制定的伦理学标准,得到该委员会的批准,征得受试对象监护人的知情同意,并与家属签署临床研究知情同意书)。复习1999年1月至2013年8月我国其他医院报道的98例皮肤蝇蛆病,总结本病的流行病学、临床表现和诊治方法。结果本例患儿为6岁,男孩,临床表现为发热、肌肉疼痛、多发性皮下结节、虫体钻出后的皮肤损害、镜下血尿、嗜酸粒细胞增多和左侧少量胸腔积液,在皮肤破损周围诱导出蝇蛆,经鉴定为牛皮蝇,给予口服甲苯达唑片治疗3d出院。出院2周后随访结果显示痊愈。从相关文献检索搜集的98例皮肤蝇蛆病可见,皮肤蝇蛆病发病率仅次于眼蝇蛆病,主要致病蝇种为牛皮蝇和纹皮蝇;好发于畜牧区,主要高发地为四川省西北地区,其次为青海省;以儿童多见。发热、游走性疼痛性皮下结节、嗜酸粒细胞增多和虫体钻出后的皮肤损害是皮肤蝇蛆病的典型表现,可并发心脏、肺、胃肠道和大脑等其他内脏器官病变。不典型患者可被误诊为结核性胸膜炎、丹毒、风湿性关节炎、荨麻疹和腮腺炎等其他疾病。检出蝇蛆是确诊本病的主要依据。皮肤蝇蛆病无特异性治疗,多采用去除蝇蛆和对症治疗。阿苯达唑片、氯喹片或甲硝唑片等驱虫剂用于治疗有内脏器官损害患者。结论皮肤蝇蛆病多见于儿童。对不明原因发热、游走性疼痛性皮下结节、嗜酸粒细胞增多和有虫体钻出的皮肤损害患者,应考虑皮肤蝇蛆病。诊断皮肤蝇蛆病主要依据为检出蝇蛆,该病无特异性治疗方法。

Objective Cutaneous myiasis is skin infestation by the larvae （maggots） of certain fly species. The aim of this study is to acquire more knowledge about cutaneous myiasis. Methods One case of children cutaneous myiasis in this hospital was reported. The study protocol was approved by the Ethical Review Board of Investigation in Human Beings of West China Second University Hospital, Sichuan University. Informed consent was obtained from the parents of this child. 98 cases of cutaneous myiasis reported by other domestic hospitals from January 1999 to August 2013 were reviewed. The epidemiology, clinical manifestation, diagnostic methods and treatment of cutaneous myiasis were analyzed and summarized. Results A six-year-old boy presented with fever, myalgia, multiple painful subcutaneous node, skin lesions, microscopic hematuria, eosinophilia and left pleural effusion. Maggot lured by honey was identified as Hypoderma boris. And this boy was orally treated with mebendazole tablet for three days and fully recovered two weeks later. The domestic document showed that cutaneous myiasis was second only to ocular myiasis and most of the infected were children. Main pathogens of cutaneous myiasis were Hypoderma bovis and Hypoderma lineatum. Cutaneous myiasis mainly distributed at pastoral areas, especially in the northwest of Sichuan province, next in Qinghai province. Typical clinical manifestation included fever, migratory painful hypodermic nodule, eosinophilia and skin lesions. Cutaneous myiasis was complicated by visceral lesions. The organ involved included heart, lung, gut and brain. Atypical cutaneous myiasis was misdiagnosed as other diseases such as tuberculous pleurisy, erysipelas, rheumatoid arthritis, urticaria, and mumps. Diagnosis of cutaneous myiasis was made after finding maggot. Treatment was non- specific and consisted of extraction of larva and symptomatic treatment. Oral helminthicide such as albendazole tablet, chloroquine tablet, or metronidazole tablet was applied when visceral lesions occured. Conclusions Most of the cutaneous myiasis patients are children. Cutaneous myiasis should be considered in patients with fever of undetermined origin, migratory painful hypodermic nodule, eosinophilia or skin lesions drilled by maggot. Diagnosis of cutaneous myiasis is mainly based on finding maggot. Treatment of cutaneous myiasis is non-specific.