Download Biotherapy in none healing wound in diabetic patient Dr.Seyed Ali

Biotherapy in none healing wound in diabetic patient
Dr.Seyed Ali Asghar Sefidgar,Dr.M.Mirzaei Hamzde sharfifi
Babol Medical University Mycology department,
Introduction
In 2007, 246million people aged 20 - 79 years were diagnosed with diabetes mellitus – a global
epidemic affecting 6% of the adult population.
25% of these develop foot problems...that are 61.5 million diabetic feet!
And, worryingly, the prevalence of diabetes mellitus is expected to reach 333 million by 2025.
“That’s a lot! How many of these get foot ulcers?”
Developed countries: 15% of people with diabetes get ulcers at least once in their lifetime
Developing countries: the prevalence is even higher at 20%.
“...and does amputation use vary from place to place?”  Yes! See below;
Incidence of minor and major amputations per 1000 people with diabetes
Source: International Diabetes Federation and The international Working Group on
Diabetes joint publication 2005.
Incidence per 1000
Population
Year
Mauritania
680
Hospital-oriented
1998-2002
Tanzania
400
Hospital-oriented
2002
Croatia
6.8
Hospital-oriented
2002
UK
2.6
Regional
1998
The Netherlands
3.6
Nationwide
1991-2000
In recent wound healing problems increased for antibiotic resistanc of causal agent bacteria
such as Methicillin resistant Staphyloccocus Aureus (MRSA) and group A and B Streptococci, ),
Pseudomonas aeruginosa, Vancomycin resistant enteroccocus (VRE), and Candida albicans. and so
on in nosocomial infection and other condition we require new source for treatment of this
acquired non healing wound. Biotherapy is a alternative aid for increased wound healing in
patines with nonhealing wound. The popularity of Biotherapy is growing in the United States and
around the world. Biotherapy is the medical use of live organisms. Such as:
Leach thrapy :Hirudo medicinalis (medicinal leech). The leeches in action on the body of a patient
with haematoma.
Leeches suck
blood as part of
a therapy
Leech Therapy
For Acne and
other skin
wound
Ichthyotherapy :As Alternative Treatment for Patients with Psoriasis
Fecal Bacteriotherapy:, Fecal Transplant, and the Microbiome
fecal transplant
enema
Fecal
Transplant
Therapy
Fecal
Bacteriotherapy,
Fecal Transplant,
and the
Microbiome
Bee Venom Therapy: is also sometimes referred to as Bee Sting Therapy.
Bee Venom
Therapy is also
sometimes
referred to as
Bee Sting
Therapy.
(BVT)
powerful
properties of
bee
venom (BV)
in treatment
of various
diseases such
as RA
Snake Venom Therapy: Using snake venom for treatment of various diseases .Snake venom toxins
contributed significantly to the treatment of many medical conditions.
Venomous Snakes:
Envenoming,
Therapy
Maggothrapy: Maggot – Larva of the fly. Maggots from the green blowfly are used for medical
purposes.
Electron
microscopic
image of a
Lucilia
(Phaenicia)
sericata larve
The foot of
diabetic
patient
showing
extensive
tissue necrosis
Maggot debridement therapy, (MDT)
Chronic bacterial colonization or infection of ulcer is one of the major factors interfering proper
wound healing, especially in diabetic foot ulcers. The maggot therapy has been used for
debridement of necrotic tissues, however, never been studied for potential antimicrobial
properties
Maggots clean up wounds beautifully, a fact known for centuries, especially to military surgeons,
who found that battle wounds accidentally infested with maggots healed quickly without
becoming infected. According to Dr. Ronald Sherman (University of California, Irvine, CA, USA),
maggot therapy was introduced into civilian medicine in the USA in the 1930s but fell out of favor
with the introduction of antibiotics. But maggots are now making a comeback, especially in the
treatment of chronic wounds infected with antibiotic-resistant bacteria.
Recently, Dr. Sherman presented the preliminary results of his prospective trial of conventional
wound care followed by maggot therapy at a Wound Healing Society symposium in Toronto,
Canada. 43 maggot-treated wounds were derided faster and more completely than they had been
during conventional treatment.
Live maggots were clinically suggested to kill or inhibit the growth of a range of pathogenic
bacteria, especially Methicillin resistant Staphylococcus aurous (MRSA) and group A and B
Streptococci. They show clinical activity against Pseudomonas species, although no formal
prospective experimental study was arranged in the past. The clinical findings are consistent with
the observations that maggots can combat infections in a variety of wound types, including those
In fact the treatment of wounds infected with MRSA is infected with antibiotic-resistant strains.
likely to become a major indication for the use of maggot therapy in the future. The presence of
large amounts of necrotic tissue in wounds can prevent topical antibacterials, such as mupirocin,
from reaching the site of infection. Maggots were used to clean wounds from battles to prevent
infection. Without the aid of maggots wounds would become infected and many people had limbs
amputated because of small wounds that could not be healed. Maggot Debridement Therapy
(MDT) The use of maggots in the removal of necrotic tissue. Maggots are used in wounds that are
non receptive to antibiotics and are deemed as non-healing wounds. Maggots from the Green
Blowfly are used, because they are a species that only eat necrotic tissue. Maggot is the larva of
Lucilia (Phaenicia) sericata after sterilization of fly egg by suitable chemical material or UV beam
in a special wave length .After surgeon debridment and cleaning wound by sterile normal saline
put 7- 10 larva per cm3 and after 2-4 days remove larva and put another Seri of new larva to heal
wound. Some healing materials in larval activity are: allantoin, urea, phenylacetic acid,
phenylacetaldehyde, calcium carbonate,NH4OH , proteolytic enzymes and many others .
The Benefits of MDT
Before MDT
After MDT
MDT: a wound after 4 treatments
1
2
4
Some References:
1: Jarvis A. Maggot therapy.Lancet. 2000 Dec 9; 356(9246):2016.
•
2. Wayman J, Nirojogi V, Walker A, Sowinski A, Walker MA... The cost effectiveness of
larval therapy in venous ulcers. J Tissue Viability. 2000 Jul; 10(3):91-4. Erratum in: J Tissue
Viability 2001Jan; 11(1):51.
•
3: Bonn D. Maggot therapy: an alternative for wound infection. Lancet. 2000 Sep
30;356(9236):1174.
•
. 4. Dissemond J, Koppermann M, Esser S, Schultewolter T, Goos M, Wagner SN
Treatment of methicillin-resistant Staphylococcus aureus (MRSA) as part of biosurgical
Hautarzt 2002 Sep;53(9):608-1 management of a chronic leg ulcer.
•
5-B., K. Maggots as healers: the increasing use of maggot debridement therapy. University
of Washington, Zoology, 2000.
•
6-Church, J.C.T. The traditional use of maggots in wound healing, and the development of
larva therapy (biosurgery) in modern medicine. J. Alt. Compl. Med. Vol 2 Iss 4, 525, 1996.
•
7-McGovern, Celeste. Brave new world. Report/Newsmagazine, Vol. 28, Issue 10, 60, 2001.
•
8-Namias, N., Varela, et al. Biodebridement: A case report of maggot therapy for limb
salvage after fourth-degree burns. J. Burn Care Rehab, Vol 21, 254, 2000.
•
9-Reames, M.K, Christensen, C., and Luce, E.A. The use of maggots in wound debridement.
Annual Plastic Surgery, Vol 21, Iss 4, 388, 1988.
•
10-Sherman, R.A. et al. Maggot debridement therapy in outpatients. Archives of Physical
Medicine and Rehabilitation, Vol 82, 1226, 2001.
•
11-Shinkman, Ron. Worms and squirms. Modern Healthcare, Vol 30, Iss 43, 54, 2000.
•