For maggot therapy, how are maggots disinfected? I'd imagine there's a limited scope of measurements that can be taken to sterilize the maggots - i.e. we don't want to sterilize them and kill them too.
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4$\begingroup$ Speculation : Maybe they are grown in laboratory settings, preventing them from any microbe infection...Something like germ free mice. $\endgroup$– biogirlCommented May 25, 2014 at 9:23
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$\begingroup$ Of course, but what about the first generation? They have to have come from the wild. $\endgroup$– DissenterCommented May 25, 2014 at 15:20
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1$\begingroup$ They are grown in the same way that "clean" mice that don't have any gut flora are grown - originally they came from the wild, were cleaned, then kept in specific conditions after that. The first couple generations may be iffy, but dirt isn't inheritable... $\endgroup$– MattDMoCommented May 26, 2014 at 3:30
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2$\begingroup$ How is gut flora taken care of? I thought gut flora was necessary for digestion. $\endgroup$– DissenterCommented May 26, 2014 at 3:35
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2 Answers
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History
Ambroise Paré is credited with being the first to note his observations on Maggot Debridement Therapy (MDT) in the 1500 though it is a technology that has been used for centuries (reference). It wasn't until the 1920's that therapeutic experimentation with maggots was instigated by William Baer, a clinical professor in orthopaedic surgery at the Johns Hopkins University in Baltimore, Maryland, whose unorthodox methods were successful in the treatment of osteomyelitis and pyogenic wounds. He is also considered the father of modern MDT since he was the first to devise a way to sterilize maggots (reference).
Procedure
In addition to removing necrotic tissue from the wound (a procedure known as debridement) maggots have also been proven to disinfect wounds, promote healing, and inhibit a pesky substance known as biofilm from forming on the wound bed. Maggots are nature’s cleansers, showing up to remove dead tissue and promote healing (reference).
Currently Lucilia sericata, or the greenbottle blowfly larvae is preferred for MDT because
Firstly, larvae have been shown to debride wounds with extremely low probability of myiasis upon clinical application. Larval secretions have been shown to help in tissue regeneration. L. sericata have also been shown to lower bacteremia levels in patients infected with MRSA (reference).
Sterilizing maggots
In early applications, sterilizing the larvae was a major problem. Doctors had to first bathe the eggs in bleach and then soak them in mercuric chloride or formaldehyde. The bandages, gaudy and cumbersome for the patients, were held in place with either surgical tape or Unna’s paste—made of zinc oxide, gelatin, glycerine, and water. Other problems that doctors faced included the maggots escaping during the application process and the leakage of toxic waste secreted by the maggots into the wound, which led to infections such as tetanus. Today, commercial and research laboratories produce sterile larvae. And instead of the bulky gauze bandage, a form-fitting cast with a nylon net to corral the larvae is placed over the wound. An absorbent pad put on top of the netting soaks up the larvae’s toxic waste products. The number of larvae used has also changed. Early prescriptions ranged from 5–6 maggots for a fingertip injury to 500–600 for a more serious wound. Today, the scientific standard of 10 larvae/cm2 is used (reference).
William Baer proposed a method to produce sterilized maggots and it is understood that sterilization has to start from the egg stage in itself (reference). The sterilization solution that he proposed was.
Stock Solution of bichloride of mercury, strength one in 1,000 parts. Stock Solution of fifty per cent. ethyl alcohol. Take equal volume of each Solution, mix, and add one-half of one per cent. chemically pure hydrochloric acid. The final Solution will contain bichloride of mercury, strength one in 2,000 parts, twenty-five per cent. alcohol, and one-half of one per cent. hydrochloric acid.
He did not sterilize the maggots as such but took care to feed it sterile food. His work can be read here. Another solution used for sterilization was 5 per cent solution of formalin plus 1 per cent sodium hydroxide (reference). Sterilization of maggot larvae in itself was found to be hard with some success being reported (reference). Current maggot sterilization techniques include.
UV Sterilization
Rapid washer sterilization
Egg to maggot sterilization (reference)
There is no first generation that has been detailed as such. Mostly sterilization starts from the egg stage. As far as bacteria in the gut is concerned, if sterilization is carried out well, it has been found that there is a significant decrease in any harmful bacteria present (reference). Most details of sterilizing maggot larvae is given in this paper. Consider reading this paper as well.
answered May 31, 2014 at 5:31
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$\begingroup$ Medical maggots are FDA approved. Their use for wound debridement of bullet wounds was recommended in the US Army Special Forces Medic handbook back in the 80's. I assume it is still there. $\endgroup$– BeoCommented Nov 6, 2015 at 16:37
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1$\begingroup$ How could sterilized maggots cause tetanus? Or was it case with un-sterilized maggots? $\endgroup$– abukajCommented Apr 8, 2018 at 14:41
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1$\begingroup$ @abukaj That is in the case of un-sterilized maggots $\endgroup$ Commented Apr 8, 2018 at 14:44
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There is an interesting and authoritative paper on rearing of larvae of blue bottle flies for debridement purposes, cited below.
Essentially the eggs are disinfected (rinsed) using .25 % chloramine solution (NH2Cl), then the larvae are hatched and reared in aseptic conditions and fed sterilized food. There are some additional controls after initial disinfection (eggs are placed in agar and the resulting growth is compared to non-disinfected eggs). The procedure is detailed on page 127-128.
Whether the eggs are perfectly germ-free may be somewhat moot. Historically this was done without disinfecting the eggs (or anything else). Secondary infections were probably not uncommon but the advantages of the technique far outweighed the disadvantages until the advent of antibiotics. Apparently these things are great at debridement of wounds (but shouldn't be used too close to organs or blood vessels).
See Wolff and Hansson, Rearing Larvae of Lucilia sericata for Chronic Ulcer Treatment--An Improved Method, Acta Derm. Venereol. (2005) 85: 126-131.
