Document Type : Original Article
Authors
1 MSc in Medical Entomology, Faculty of Medical Sciences, Tarbiat Modares University
2 Assistant Professor of Medical Entomology, Faculty of Medical Sciences, Tarbiat Modares University
3 Professor of Parasitology, Faculty of Medical Sciences, Tarbiat Modares University
Abstract
Background: Cutaneous Leishmaniasis (CL) is an endemic disease in Iran. The pentavalent antimonials as first-line drugs are losing efficacy because of side effects, disease relapse and drug resistance. Application of Lucilia sericata larvae (maggot therapy) to diabetic and refractory wounds approved to be satisfactory for accelerating healing process. In this study, therapeutic effects of L. sericata maggot was evaluated in vivo against leishmanial ulcer using BALB/c mice as animal model.
Methods: Female BALB/c mice were inoculated with promastigotes at the base of tails and kept for 28 days until the emergence of early ulcers. The mice were then underwent 4 treatments as follows: Glucantime alone, Glucantime plus maggots, maggot alone and positive control. The control and treated mice were monitored for a period of 5 weeks during which the wound diameters were measured and recorded on a weekly basis. Data were analyzed using Kolmogorov-Smirnov test and ANOVA T- test.
Results: Statistical analysis showed significant difference (p <0.05) between treated groups in terms of wounds diameters. The Glucantime treated mice had the least sized lesions. The wound sizes of otherwise treated mice were smaller than those of control mice, but with no statistically significant differences. Control mice harbored active and progressing ulcers, while treated mice had shrinking and healing wounds upon maggot therapy.
Conclusion: Maggot therapy accelerated closure and healing process of leishmanial wounds in BALB/c mice and appeared promising as a new combinatorial therapeutics for leishmaniasis. However, further clinical trials are needed to evaluate the efficacy of maggot therapy modalities for leishmanial lesion care.
Keywords
- Kedzierski L, Sakthianandeswaren A, Curtis JM, Andrews PC, Junk PC, Kedzierska K. Leishmaniasis: current treatment and prospects for new drugs and vaccines. Curr Med Chem 2009; 16(5):599-614.
- Desjeux P. Leishmaniasis. Public health aspects and control. Clin Dermatol 1996; 14(5):417-23.
- Natera S, Machuca C, Padrón-Nieves M, Romero A, Díaz E, Ponte-Sucre A. Leishmania spp.: proficiency of drug-resistant parasites. Int J Antimicrob Agents 2007; 29(6):637-42.
- Kobets T, Grekov I, Lipoldova M. Leishmaniasis: prevention, parasite detection and treatment Curr Med Chem 2012; 19(10):1443-74.
- Sun X, Jiang K, Chen J, Wu L, Lu H, Wang A, Wang J. A systematic review of maggot debridement therapy for chronically infected wounds and ulcers. Int J Infect Dis 2014; 25:32-7.
- Van der Plas MJ, van der Does AM, Baldry M, Dogterom-Ballering HC, van Gulpen C, van Dissel JT, et al. Maggot excretions/secretions inhibit multiple neutrophil pro-inflammatory responses. Microbes Infect 2007; 9(4):507-14.
- Beasley WD, Hirst G. Making a meal of MRSA-the role of biosurgery in hospital-acquired infection. J Hosp Infect 2004; 56(1):6-9.
- Robinson W, Norwood VH. The rôle of surgical maggots in the disinfection of osteomyelitis and other infected wounds. The Journal of Bone & Joint Surgery 1933; 15(2):409-12.
- Peck GW, Kirkup BC. Biocompatibility of antimicrobials to maggot debridement therapy: medical maggots Lucilia sericata (Diptera: Calliphoridae) exhibit tolerance to clinical maximum doses of antimicrobials. J Med Entomol 2012; 49(5):1137-43.
- Fleischmann W, Grassberger M, Sherman R. Maggot Therapy: A Handbook of Maggot-Assisted Wound Healing. USA: Thieme; 2004.
- Wolff H, Hansson C. Rearing larvae of Lucilia sericata for chronic ulcer treatment--an improved method. Acta Derm Venereol 2005; 85(2):126-31.
- Sherman RA, Hall MJ, Thomas S. Medicinal maggots: an ancient remedy for some contemporary afflictions. Annu Rev Entomol 2000; 45:55-81.
- Pechter EA, Sherman RA. Maggot therapy: the surgical metamorphosis. Plast Reconstr Surg 1983; 72(4):567-70.
- Kholoud A, Mohamed A, Azza MH. Parasitological, Bacteriological and Clinical Study of Wound Myiasis with a Trial of Maggot Therapy in Intractable Wounds. Egyptian Journal of Medical Microbiology 2009; 18(4):77-88.
- Ben Salah A, Ben Messaoud N, Guedri E, Zaatour A, Ben Alaya N, Bettaieb J, et al. Topical paromomycin with or without gentamicin for cutaneous leishmaniasis. N Engl J Med 2013; 368(6):524-32.
- Makwali JA, Wanjala FM, Kaburi JC, Ingonga J, Byrum WW, Anjili CO. Combination and monotherapy of Leishmania major infection in BALB/c mice using plant extracts and herbicides. J Vector Borne Dis 2012; 49(3):123-30.
- Pearson RD, Sousa AQ. Clinical spectrum of Leishmaniasis. Clin Infect Dis1996; 22(1):1-13.
- Croft SL, Seifert K, Yardley V. Current scenario of drug development for leishmaniasis. Indian J Med Res 2006; 123(3):399-410.
- Berman JD. Human leishmaniasis: clinical, diagnostic, and chemotherapeutic developments in the last 10 years. Clin Infect Dis 1997; 24(4):684-703.
- Brodskyn C, de Oliveira CI, Barral A, Barral-Netto M. Vaccines in leishmaniasis: advances in the last five years. Expert Rev Vaccines 2003; 2(5):705-17.
- Alnaimat SM, Wainwright M, Aladaileh SH. An initial in vitro investigation into the potential therapeutic use of Lucilia sericata maggot to control superficial fungal infections. Jordan Journal of Biological Sciences 2013; 6(2):137-42.
- Bexfield A, Bond AE, Morgan C, Wagstaff J, Newton RP, Ratcliffe NA, et al. Amino acid derivatives from Lucilia sericata excretions/secretions may contribute to the beneficial effects of maggot therapy via increased angiogenesis. Br J Dermatol 2010; 162(3):554-62.
- Wollina U, Liebold K, Schmidt WD, Hartmann M, Fassler D. Biosurgery supports granulation and debridement in chronic wounds--clinical data and remittance spectroscopy measurement. Int J Dermatol 2002;41(10):635-9.
- Wang XY, Li XR, Gao L, Wang JN. Could microbe stimulated maggots become a targeted natural antibiotics family? Med Hypotheses 2014; 83(1):60-1.
- Sanei-Dehkordi A, Khamesipour A, Akbarzadeh K, Akhavan AA, Mir Amin Mohammadi A, Mohammadi Y, et al. Anti Leishmania activity of Lucilia sericata and Calliphora vicina maggots in laboratory models. Exp Parasitol 2016; 170:59-65.
- Arrivillaga J, Rodríguez J, Oviedo M. Evaluación preliminar en un modelo animal de la terapia con larvas de Lucilia sericata para el tratamiento de la leishmaniasis cutánea. Biomédica 2008; 28(2):305-10.
- Polat E, Cakan H, Aslan M, Sirekbasan S, Kutlubay Z, Ipek T, et al. Detection of anti-leishmanial effect of the Lucilia sericata larval secretions in vitro and in vivo on Leishmania tropica: first work. Exp Parasitol 2012; 132(2):129-34.
- Polat E, Kutlubay Z. Meglümin antimoniat tedavisine dirençli dört kutanöz leishmaniosis olgusu. Turkiye Parazitol Derg 2014; 38:177-80.
- Choudhary V, Choudhary M, Pandey S, Chauhan VD, Hasnani JJ. Maggot debridement therapy as primary tool to treat chronic wound of animals. Vet World 2016; 9(4):403-9.
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