Machine learning-based text mining for cutaneous myiasis and potential value of an accidental maggot therapy for complicated skin and soft tissue infection with sepsis

Abstract

Background: Cutaneous myiasis, one of the most frequently diagnosed myiasis types, is defined as skin or soft tissue on a living host infested by dipterous larvae (maggots). However, bibliometric analysis of this disease remains sparse. Machine learning techniques and updated publications provide an opportunity for such an investigation.

Materials and methods: All the studies were retrieved from PubMed and were processed using R software in the bibliometric analysis and latent Dirichlet allocation (LDA) topic modeling. Furthermore, the clinical management of two diabetes patients with serious soft tissue infection-associated sepsis was analyzed.

Results: A total of 211 results were retrieved and 50 topics relevant to cutaneous myiasis were determined by the LDA algorithm. The topics of uncommon fly species, nasal infestation, and physician discussion of cutaneous myiasis were consistently common over the last 20 years. Case report remains one of the key features in myiasis. Four major clusters were identified, i.e., case report related, disease type and development, travel in the tropics, and skin disease. To further delve into clinical practice, the clinical features of two patients with soft tissue infection-related sepsis were demonstrated, and a distinct beneficial role of myiasis was found. The levels of white blood cell, blood glucose, and C-reactive protein in the case with cutaneous myiasis were more stable than the other case without cutaneous myiasis but with sepsis shock.

Conclusion: Maggot debridement therapy may be a promising treatment and beneficial for soft tissue infection-related sepsis. The model analysis of maggot therapy and its clinical advantages shows increasing research value and possible application in future clinical practice.

Keywords: bibliometric; cutaneous myiasis; diabetes; latent Dirichlet allocation; soft tissue infection.

Figure 1

MeSH (Medical Subject Headings) relating to myiasis studies retrieved from the Pubmed (https://www.ncbi.nlm.nih.gov/pubmed/). The top 20 keywords are displayed from 2001 to 2021. Dark blue indicates a low number of publications and light blue indicates a high number of publications. .

Figure 2

Distribution values of latent Dirichlet allocation (LDA) for 50 topics from 2001 to 2021. The topics of uncommon infestation species, nasal infection, and physician discussion of cutaneous myiasis were consistently intensively studied during the last 20 years. The topics of case report, subtypes, and causes were found in 2021. Red indicates a high value and white indicates a low value.

Figure 3

Latent Dirichlet allocation (LDA) research topic cluster network. Four clusters were determined, including case report-related (pink), disease type and development (green), tropic travel and skin disease (blue), and others (black).

Figure 4

Two patients with cutaneous wounds and long-term diabetes were presented in this article. (A) A 70 year-old woman presented with a massive decubitus ulcer infested with maggots and necrotizing soft tissues at the lumbosacral area; (B) a 51 year-old man presented with a massive wound infection in neck and back area.

Figure 5

Comparison of clinical variables between the patient with maggots and the patient without maggots. (A) White blood cell count (WBC, 10×9/L); (B) blood potassium (K, mmol/L); (C) C-reactive protein (CRP, mg/L); (D) blood glucose (GLU, mmol/L); (E) blood neutrophils percentage (NEUT, %); (F) blood lactate (LAC, mmol/L); (G) CO2 blood test (Total_CO2, mmol/L); (H) Bicarbonate (HCO3, mmol/L); red dash line indicated normal value threshold.

Figure 6

Schematic model of maggot therapy for diabetic wounds with mechanisms, depicting distinct clinical outcomes with or without maggot presentation.