Hospitals in Kenya will start using live larvae to treat some patients after a pilot study on the use of this ancient practice gave promising results.
In a country where many people have to pay for their medicines, the method of healing wounds infected with larvae also promises to reduce medical bills.
«The results were good. Patients who were going to stay here for three months and have surgery on top of using expensive antibiotics were able to leave the hospital in two to three weeks,» said Dr. Christopher Kibiwot, who took part in the pilot at Kenyatta National Hospital.
Larval therapy dates back to the earliest civilizations.
But with the discovery of penicillin and the development of antibiotics in the 20th century, its use declined.
Today, with antibiotic resistance becoming a growing challenge, clinicians are looking for alternatives.
«The worms basically feed on dead tissue, what we call necrotic tissue,» Kibiwot explained.
«In doing so, they compete with the bacteria for food… so the bacteria don’t grow. That’s one way to achieve wound healing without the use of antibiotics.»
To produce the larvae, the Kenya Agricultural Research Institute (KARI) maintains colonies of the green bottle fly.
Phoebe Mukiria, a KARI entomologist who oversaw worm production, said the reason they are so «special» is that they only feed on dead tissue.
«It cleans the wound and the living tissue doesn’t come so you don’t feel any kind of pain,» he said.
In essence, the expert said that the worms surely the dead tissue in liquid that they absorb as food.
They do it by excreting saliva that contains special chemicals that act on the wound, clearly.
«They are called micro-surgeons, since they are able to reach where surgeons are not able to,» he added.
The flies in KARI are kept in cages covered with netting and are fed bran and sugar; sponges soaked in water are also placed inside.
Sated flies are ready to lay their eggs, which they do about three times a week, usually on an animal carcass or some type of developing meat.
Mukiria puts a plate of beef liver into the cage and covers it with a plastic container that has two holes on opposite sides.
After two hours the liver is covered with cream-colored eggs.
The eggs are sterilized in sodium hypochlorite and then incubated for 24 hours, during which time 1 mm long worms are formed.
In the following hours they are washed again and put into envelopes, which resemble tea bags.
These are placed in a cooler ready for delivery to the hospital.
“If they are kept cold they can live for 24 hours so we can transport them to distant hospitals,” Mukiria said.
At Kenyatta National Hospital in the capital Nairobi, Dr. Kibiwot has prepared one of his patients, Hannah Wagio, for therapy as she could not afford antibiotics.
At first, some patients are rather skeptical about the treatment, he says.
«It’s about the fear factor: why are you putting maggots in me while I’m still alive?»
«But after the result is explained to them and they are told that their hospital stay will be reduced, they are willing to try anything.»
Wagio, who has sores on her heels that have left her unable to walk, is willing to give it a try.
He writhes in pain as the doctor cleans his wounds. Part of the skin is turning from the heel surrounded by pus.
Kibiwot then places a small bag of worms on each wound and bandages them.
«I’m being careful not to cover the area with the maggots, as they could suffocate,» he says when he’s done putting on the bandages.
Two days later, it is time to remove the bandages. Wagio seems optimistic.
He says the pain is gone and smiles as the doctor removes the bandages.
The wounds appear clean and dry, and the worm envelopes have swollen.
Kibiwot shows how fat and how large the worms have grown.
Wagio asked for guarantees that all the worms had been removed.
«I was worried that they might eat me later, but they told me not to have any left,» he says.
For patients like Ms. Wagio, the therapy means lower medical bills, a shorter hospital stay, and worries about antibiotic resistance are not an issue.
«I am happy and I will continue with this treatment until I am cured. And when I am cured I hope that other people will also use this therapy,» she says.
The results of the pilot study in Kenya are under evaluation.
But the word has spread across the country, and KARI is receiving calls from patients requesting the low-cost maggot treatment.
Nearly 20 countries around the world are using this therapy, including the US and UK, which recognized it as a medical treatment in 2004.
«It was a very exciting project because it’s new and it’s incredible,» says Mukiria.
«Once we treated the first two or three people, the patients themselves got to request the treatment.»
And the best part, according to the doctor, is that her lab has everything she needs for enough worms throughout the country.