NUSANTARA BIOSCIENCE ISSN: 2087-3948 Vol. 12, No. 2, pp. 143-147 E-ISSN: 2087-3956 November 2020 DOI: 10.13057/nusbiosci/n120209 Human myiasis survey in Ilam Province, Southwest of Iran MORTEZA AKBARI1, JAVAD RAFINEJAD1, AHMAD-ALI HANAFI-BOJD1, ALI ASHRAF AIVAZI2, AKBAR BIGLARIAN3, SORAYA SHEIKHI1, ZAHRA SHAVALI1, KAMRAN AKBARZADEH1,♥ 1Department of Medical Entomology & Vector Control, School of Public Health and National Institute of Health Research, Tehran University of Medical Sciences. Tehran, Iran. ♥email: [email protected], [email protected] 2Department of Public Health, School of Health, Ilam University of Medical Sciences. Ilam, Iran 3Department of Biostatistics, University of Social Welfare and Rehabilitation Sciences. Tehran, Iran Manuscript received: 5 October 2020. Revision accepted: 19 October 2020. Abstract. Akbari M, Rafinejad J, Hanafi-Bojd AA, Aivazi AA, Biglarian A, Sheikhi S, Shavali Z, Akbarzadeh K. 2020. Human myiasis survey in Ilam Province, Southwest of Iran. Nusantara Bioscience 12: 143-147. Myiasis is the infestation of live human and vertebrate animals with dipterous larvae, which at least for a period. Ilam Province of Iran is one of the most important animal husbandry areas, especially nomadic, in Iran. The objective of this study was to identify the prevalence of myiasis in shepherds in Ilam Province. A cross- sectional study was conducted among the shepherds in Ilam Province, western Iran. Out of the 11 counties in Ilam Province, 6 were randomly chosen from three different climates for this study. A questionnaire was used by a trained interviewer to obtain the information from subjects. The disease has been seen in spring, summer, and autumn seasons. About 94.1% of people have been infested at least once. Pharyngeal myiasis had the highest prevalence with 58.3%. Itchy, painful throat, sneeze, cough, and headache were common symptoms. About 85.1% of people described the symptoms of the disease as severe and very severe. About 75.4% stated that the duration of the disease was more than 5 days. According to the results of the study, it was found that the prevalence of myiasis among shepherds in the Ilam Province is high and it is necessary to take appropriate measures to control the disease and increase health literacy. Keywords: Flies, Iran, myiasis, surveys INTRODUCTION accidental forms (Ward 2008). Species of the fly are involved, and most vertebrate animals are susceptible to Non-biting flies may be medically important because of this disease. Although humans can suffer from myiasis, it is direct damage to the human or animal by attacking with the much more common in livestock and wildlife, and flies, larval stage (more commonly known as maggots). Myiasis especially in the obligatory form. The first report of is defined as the infestation of tissues and organs of living myiasis in Iran, an ophthalmomyiasis in a woman in or dead human and vertebrate, for a period due to the Tehran, was reported in1976 by Minar (Minar 1976) and dipterous larvae invasion, feed on the host's dead or living up to 2017, about 81 cases of human myiasis have been tissue, liquid body substances, or ingested food (Ramana reported (Hazratian et al. 2020). 2012). It can lead to severe injury, secondary infection, Human and animal myiasis is not defined in Iranian prolonged pain, tissue, and fluid loss, reduced fitness, and health and veterinary reporting systems (Alizadeh et al. even death, especially if sensitive organs such as the nose, 2014). Therefore the epidemiology of this disease in some eyes, and ears are attacked by larvae (Ramana 2012). parts of Iran is unclear but according to previous studies, Myiasis has been defined by Zumpt and has been the prevalence of the disease among shepherds and cattle reported in various world regions (Smith 1973). It remains breeders has been reported as very high (Salimi et al. a neglected disease (Otranto and Stevens 2002), and in the 2010). Losses in livestock due to myiasis have been vast majority of cases a self-limiting infection with substantial. There have been $800 million in losses minimal complications (McGraw and Turiansky 2008). annually to cattlemen from the southern USA from Florida The disease is more prevalent in areas where many people to California (Eldridge and Edman 2012). Although such are engaged in animal husbandry. Myiasis is a common an estimate has not been reported in Iran, the great medical and veterinary problem in many tropic areas economic damage caused by myiasis among domestic (Baskaran et al. 2007). Myiasis is considered an animals and disease in humans is apprehended posing to be occupational disease among people who live near the a major threat to the livestock industry and the health livestock and affects mainly persons in rural areas such as system in Iran (Shoorijeh et al. 2011). More than 6,400 km2 butchers, shepherds, and farmers (Masoudi and Hosseini of the Ilam Province, about 31% of its territory, is covered 2004). with scattered to dense forests. Due to its geographical In the entomological method, myiasis classifies location, natural conditions, and the diversity of its according to the type of host-parasite relationship. In this habitats, Ilam Province is one of the most important animal way, myiasis is divided into facultative, obligatory, and husbandry areas, especially nomadic, in Iran. Based on the 144 NUSANTARA BIOSCIENCE 12 (2): 143-147, November 2020 statistics, more than 50% of the province's employment The rest of the province is experiencing something between depends on livestock and animal husbandry. Although it these two climates. seems the myiasis disease has been highly prevalent in humans and animals in Ilam Province, to our best Study procedure knowledge, it has not been studied yet. Thus, the objective A cross-sectional study was conducted among the of this study was to identify the prevalence of myiasis in shepherds in Ilam Province from April to June 2020. Out of shepherds in Ilam Province. Current data on this disease the 11 counties in Ilam Province, 6 were randomly selected can be helpful in the prevention, diagnosis, cure, and from three different climates for this study as follows: Ilam surveillance of health programs. and Eyvan in the northern part, Abdanan and Darreh Shahr in the central part, and Dehloran and Mehran in the southern part of the province. The interview tool was a MATERIALS AND METHODS questionnaire. To determine the reliability of the questions in each domain, the validity of the questionnaire was The study area examined using Cronbach's alpha index. For Cronbach's Ilam Province is located in the western part of Iran, alpha, questions were considered reliable if values of 0.7 between 32º03´ and 34º02´ North longitude and 45º40´ and and above 0.7 were found. 48º03´ East latitude. It has an area of 20,150 km2 and sharing 425 km of border with Iraq, and also bordering on Statistical analysis the provinces of Kermanshah, Lorestan, and Khuzestan. The sample size (n) = Z1−α/2 pq/d2 =268 was The province consists of 11 counties and its capital is Ilam calculated where p=0.775 (4), q=0.225, d=0.05 at 95% city (Fig 1). Due to various factors such as altitude, confidence and 5% level of significance. A researcher- proximity to the Arabian Desert, the plains of Khuzestan, made questionnaire on human myiasis was used by a and Iraq, the climate of the province is so diverse: Northern trained interviewer to obtain information from subjects. mountainous areas such as Ilam and Eyvan have temperate The data were analyzed using SPSS version 22 software. climates, cold winters and mild summers with an annual rainfall of about 600 mm. While the southern and Species identification southwestern plains such as Mehran and Dehloran have a The identification of flies was performed using valid very hot climate with an annual rainfall of about 200 mm. and identification keys (Smith 1989). Figure 1. The geographical location of Ilam Province, southwest of Iran AKBAR et al. – Human myiasis survey in Ilam Province, Iran 145 RESULTS AND DISCUSSION prevalence of myiasis in this province is very high, and during the activity season of myiasis-causing flies, a high The present study was conducted among 290 shepherds percentage of shepherds suffered from this disease. The in the selected county of Ilam Province in the west of Iran. result of the present study also showed that the prevalence In each household, one person responded to the of this disease is very high among shepherds and 94.1% of questionnaire. Out of them, 49% was the head of the participants had the disease at least once. In a family, 23.4% the spouse, and 28.6% the children. 61% of questionnaire-based study conducted in Fars province participants were male and 39% were female. cleared that more than 88% of the participants were The results showed that the myiasis has been seen in infected at least one time with myiasis (Akbarzadeh et al. spring, summer, and autumn seasons. It was most prevalent 2012). in summer with 63.4% of self-declaration. About 93.8% of Based on the statements of the participants in the study people were breeding sheep, and 72.4% reported their about the behavior of flies, it seems that the predominant family members’ infestation history. About 94.1% of cause of the disease in this area is Oestrus ovis. Some of people have been infected at least once and 11% have the cattle herders caught the attacking flies, which were O. experienced it more than 10 times (Table 1). About 43.8% ovis. Infection by the larvae of O. ovis was reported in believed that they got the disease while grazing, 22.1% got other parts of Iran and is a well-known zoonosis.