Human urinary myiasis due to larvae of Clogmia (Telmatoscopus) albipunctata Williston (Diptera: Psychodidae) first report in Egypt.

tissue of living human with dipterous larvae”1. Parasitologically myiasis could be classified as obligatory, facultative or accidental. Clinically myiasis may be classified according to part of the body tissue invaded. Cutaneous myiasis is the commonest type. Body cavity myiasis; nasopharyngeal, ocular, aural and the gastrointestinal tract urogenital system are less common. Urethral myiasis is exceptionally rare, even in sites usually protected by clothes, inaccessible for the flies1–2. A large number of fly species may cause urinary myiasis. Larvae of Fannia scalaris3 is the most frequent cause of urinary myiasis. Other fly genera Musca, Sarcophaga, Lucilia, Wohlfahrtia or Calliphora were also associated with cases of urinary myiasis4. Few cases of urinary myiasis were caused by Eristalis5,6, Psychoda7 and Megaselia8 flies. Cases of urinary myiasis were caused by larvae of Clogmia albipunctata worldwide9 but had never been reported before in our region. Urinary myiasis may occur whilst human urinate in unsanitary toilets or at night in warm weather whilst peoples (usually females) sleeping without covering. Urogenital discharges, or soiled or un-bathed pubic area may attract fly oviposition around the external genitalia and urethral orifices, then hatched larvae may enter the bladder and pass through urethra and produce symptoms of cystitis and/or urethritis that may include dysuria, haematuria, urethral discharge, and abdominal pain3,10. Urogenital myiasis usually occurs in human with poor personal hygiene, poor general condition, with low mobility and ulcerating lesions. Urinary myiasis may be associated with underline urinary tract pathology6 or surgical intervention7,10. The pathogenicity results from inflammation and toxin secreted by the larvae which prevents healing, progressive and continuous necrosis of bladder wall may occur associated with larval growth and invasion11. We report on the first case of human urinary myiasis caused by Clogmia albipunctata in Egypt and the second case worldwide. Case report The patient presented with repeated passage of numerous living dark-colored larvae in urine, 7–12 larvae were voided intermittently over two months. She was complaining of dysuria, fever and itching in the periurethral and genital regions. No history of travelling outside Egypt in the past or the present time. Complete urine analysis and stool examination using direct and concentrated smear was done. Plain X-ray and pelviabdominal ultrasound were also done. Larvae from two different fresh urine samples were identified morphologically as larvae of Clogmia albipunctata (Diptera: Psychodidae). Repeated passages of different larval stages in this case confirmed our diagnosis of true urinary myiasis. Voided urine with larvae and urine in between passages of larvae was normal on microscopical examination. Stool examinations and imaging were normal. Urine analysis and culture was free, plain X-ray and pelviabdominal ultrasound revealed no abnormalities. A written consent was obtained from the patient.