Journal of Preventive Medicine

Introduction
Insects and arthropods are important from two aspects of agriculture and health due to their direct and indirect damage to humans and their properties. In terms of health, the importance is due to causing annoyance, biting, and emergence and transmission of disease to humans. One of the diseases caused by flies is myiasis, which is caused by the invasion of their eggs and larvae into the living or dead organs and tissues of the host. This disease usually occurs in domestic animals and less frequently in humans. Due to the life cycle and the need for favorable environmental conditions of flies and mosquitoes, myiasis is more widespread in tropical and temperate regions and its spread is global.
Due to causing a lot of economic damage in the animal husbandry industry, especially through the impact on the reduction of livestock products and livestock weight due to the proximity of humans to livestock in rural areas, this disease has increased in developed and developing countries, including Iran. The purpose of this review study is to investigate the prevalence of human myiasis and its epidemiological aspects in Iran between 2013 and 2020.
Methods
This is a review study. A search was conducted on related studies in Google Scholar, Scopus, Scimago, PubMed, IranMedex, Magiran, MagIran databases using the MeSH keywords. All articles reporting cases of human myiasis between 2013 and 2020 in Iran were included in the study. Information related to the type of myiasis, species causing the disease, patient’s age, occupation, place of residence (urban/rural areas), and gender; reason for referral, treatment method, and number of larvae removed from the patient’s body were extracted and recorded by a researcher-made checklist. Data analysis, using descriptive statistics (frequency, percentage, and mean) and statistical tests, was done in SPSS v. 26 software.
Results
Twenty-six cases of human myiasis were reported in Iran from 2013 to September 2020; the most cases were seen in 2015 (n=5, 26.9%). Most of patients were at the age group >60 years (n=10, 38.5%); 50% of patients were male and 50% were female; 88.5% lived in the city and 11.5% lived in the village. Oral myiasis (n=6, 23.1%), followed by ocular myiasis and intestinal myiasis (n=5, 19.2%) were the most common types of myiasis. The species of Megaselia scalaris, Sarchophaga Fertoni, oestrus ovis, Lucilia sericata, Chrysomia bezziana, Eristalis tenax, Lucilia illustris, Calliphora vicina, Sarchophaga argyrostoma, and two unidentified species from the Psychoda sp. and Sarcophaga sp. were reported to cause the disease. Lucilia illustris with 7 cases (26.9%), Chrysomia bezziana with 5 cases (19.2%) and family Calliphordae with 18 cases (69.2 %) were the most common species and family (Table 1).


The cases were from 12 provinces including Hormozgan, Tehran, Yazd, Khorasan Razavi, Mazandaran, Zanjan, Kurdistan, Tabriz, Isfahan, Khuzestan, Kermanshah, and Hamedan. Tehran and Tabriz provinces had the most patients each with 5 cases (19.2%). Sixty percent of patients had referred to medical centers due to sudden abdominal pain or observation of larvae in stool (40%). The mean number of larvae removed from patients was 21.5±5.4.
Discussion
Changes in climate conditions in recent decades have caused changes in the fauna of flies. An increase in temperature causes an increase in the growth rate of flies, a faster completion of their life cycle and, as a result, an increase in their generations. In this situation, the wounds on the human body can create more olfactory cues for myiasis-causing flies. The occurrence of myiasis among humans can be related to the increase in the population of flies, improper health conditions, and the presence of domestic animals in the vicinity of human settlements. In addition, the low awareness of the people has important role in the occurrence of this disease because the general public has little knowledge about this disease and the related factors.
The results of this study provide useful information about the prevalence of myiasis factors in Iran. Raising awareness of this disease in Iran can lead to the definition of new interventions and preparation of appropriate programs for disease control and treatment. Adopting the correct prevention and control strategies as well as personal protection strategies against the disease agents can help reduce the disease prevalence in humans and animals and the costs incurred by it in various fields of health. The results of this study can be useful for health centers, veterinary departments, medical centers, and the general public.

Ethical Considerations
Compliance with ethical guidelines
This research was carried out  with project number 99s24 and ethical code IR.AJUMS.REC.1399.278 

Funding
This research was carried out with the financial support of Jundishapur University of Medical Sciences, Ahvaz. 

Authors' contributions
Collection of articles, data extraction: Abolfazl Jokar; Guiding the implementation of the project, compiling and submitting the article: Mena Sharififard; Guidance on extracting articles and analyzing data, drawing a map: one's global inspiration.

Conflicts of interest
The authors declared no conflict of interest.

Acknowledgements
The authors thank the student research committee of Jundishapur University of Medical Sciences, Ahvaz.
 

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