maggot therapy

[Guest guest]

I thought this would be interesting in the light of recent discussion.

However--this is one specific

maggot. There are also maggots that invade healthy tissue, as other articles on

the subject tell.

H.J.

http://www.mfa.gov.il/mfa/go.asp?MFAH0dre0

A Fly in the Ointment

'Keep the wound clean!' reads every

first-aid manual. It's a crucial directive

that

we're taught from our first scraped knee

onward – which makes a therapy now

being developed in Israel all the more

shocking to our ears. What therapy?

Sealing hundreds of live maggots into

wounds that don't heal.

by Elliman

The man who breeds and seals in the maggots

is Greek-born Kosta Mumcuoglu, a

parasitologist and senior research associate

at

the Hadassah-Hebrew University School of

Medicine in Jerusalem. He began looking into

maggot therapy three years ago, when two

people came to him independently for help.

" One was a man of 75, a diabetic who'd already

had a leg amputated because of infection, " he

says. " He'd developed a severe infection in

his

other leg, and was in danger of losing that

one,

as well. 'You must help me!' he pleaded. 'I'd

rather die than let them amputate again.' The

other was a physician responsible for elderly

patients with circulation problems in their

extremities due to diabetes or pressure ulcers

that even the strongest antibiotics failed to

heal.

'Even surgery is ineffective,' he told me. 'It

can't

remove every last shred of infected tissue,

and

as long as infected or decaying tissue

remains,

the wound can't heal and usually worsens. The

end of this path is invariably amputation.' "

These cries for help ringing in his ears, Dr.

Mumcuoglu began reading all he could about

maggot therapy, something he'd heard of but

never seen. " Maggot therapy – the use of fly

larvae to clean wounds – was practiced until

the

late 1940s, when the advent of antibiotics and

improved surgical cleansing of wounds

relegated it to the past, " he says. " Before

then,

however, it had been an effective medical

tool.

The chief physician of Napoleon's armies and

an American Civil War medical officer both

noted that soldiers whose wounds were infested

with maggots had a better outcome than those

who did not, as the fly larvae destroyed dead

tissue without harming living matter. As

recently

as the 1930s and 1940s, maggot therapy was

used in over 300 hospitals in the United

States

alone. "

The first priority in reviving maggot therapy

was

choosing the right maggot – a type which feeds

on the decaying or necrotic flesh that

prevents

healing, but leaves healthy tissue alone.

Another

was preparing aseptic maggots, so as not to

bring additional infection into an already

festering wound.

Once he'd chosen his insect, Dr. Mumcuoglu

took a handful of rotting liver and went

outside. " I

was instantly besieged by all kinds of flies, "

he

said, " but it was the metallic green

two-winged

bottlefly that I was after. I picked out a few

and

took them inside to start a new colony. The

flies

cooperated, and each laid 200 to 300 eggs. "

Within days, the eggs hatched into tiny

maggots, which Dr. Mumcuoglu grew in a

medium for 48 hours until they reached the

size

he needed. Then he sterilized them in a weak

concentration of formaldehyde – making them

aseptic – packed them up and headed for his

patient – the 75-year-old diabetic. " When I

saw

his wound, I didn't believe my eyes, " he said.

" I

couldn't believe that in this age of modern

medicine such a terrible thing is still

possible.

The man's foot was swollen, purple and

reeking,

steadily leaking thick yellow pus, literally

rotting

on his body. " With the number of maggots

carefully calculated, proportionate to the

size

and depth of the wound, Dr. Mumcuoglu slipped

in a thousand of them, and glued a

mesh-dressing on top to keep the maggots in

place.

Two days later, he went back to the patient.

" Despite all I'd read, it was hard to credit

what I

saw, " he recalls. " The maggots had worked like

tiny microsurgeons, eating away decaying

tissue with the utmost precision. I replaced

them

with fresh maggots. Within a few days, the

different shifts of maggots had removed every

possible source of infection. " Due to the life

cycle of the maggots, they must be replaced

every few days. When the therapy is over, they

are simply removed.

The man's leg was saved – and shortly

afterward, Dr. Mumcuoglu treated the patient's

identical twin (also diabetic and one-legged)

and saved his leg, as well. To date, he has

used

maggot therapy to treat 60 wounds in 45

patients, and healed them all.

Every year, some 1,000 Israelis have legs

amputated, 84 percent of them because of

diabetes. In the US, the annual number of leg

amputations is 80,000. Amputation, points out

Dr. Mumcuoglu, is a very costly procedure,

economically and in terms of pain and

suffering.

Including a prosthesis to replace the severed

limb, each leg amputation runs to around

$70,000. The cost of healing a wound with

maggot therapy: about $260.

Back in the laboratory, Dr. Mumcuoglu has been

taking a closer look at these

maggot-microsurgeons. With fellow

parasitologists and microbiologists, he has

found that maggots contribute to wound-healing

in more ways than by removing dead and

infected tissue. " Maggots excrete three

different

substances, all of which help tissue heal, " he

explains. " One is a kind of antibiotic: the

maggot's food is decaying tissue which

contains deadly bacteria, so it has evolved

highly effective natural antibiotics to

protect itself

against them. We've tested these

maggot-produced antibiotics on several kinds

of bacteria resistant to the usual

antibiotics, and

found that they work very efficiently. " The

research team has learned that along with the

antibiotics, the maggot excretes salts, which

change the pH in the wound, making it less

acidic and more neutral. Wounds heal better in

a neutral pH environment. And third, it

excretes

a substance which seems to kickstart the

healing process, along with providing a boost

to

the patient's immune system.

The lowly maggot seems set to make a glorious

comeback into healing. At an international

conference held in Jerusalem last May, it took

pride of place with leech and bee venom

treatments, as over 70 scientists from 11

countries discussed therapies which use living

animals to treat disease. As far as Dr.

Mumcuoglu is concerned, this is only at the

beginning. Further down the road, he dreams of

a range of treatments to be researched and

developed at a National Biotherapy Center.