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 Table of Contents  
CASE REPORT
Year : 2018  |  Volume : 19  |  Issue : 2  |  Page : 167-169

Furuncular myiasis in a 6-year-old boy


Department of Dermatology, Venereology, Leprology, Government Medical College, Kota, Rajasthan, India

Date of Web Publication26-Mar-2018

Correspondence Address:
Suresh Jain
Department of Dermatology, Venereology, Leprology, Government Medical College, Kota - 324 005, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijpd.IJPD_122_16

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  Abstract 


Myiasis is caused by the invasion of tissues or organs of humans or animals by dipterous larvae. A 6-year-old boy presented with 1-month history of scalp ulcer that has initially started as a painful, itchy swelling in the vertex region. Cutaneous examination revealed live maggots in the ulcerous wound. Clinicians should be more alert to the possibility of myiasis in patients with furuncloid or boil-like lesions. Herein, we report this case because of its rarity.

Keywords: Furuncular myiasis, maggots, mineral oil


How to cite this article:
Sharma MK, Yadav SK, Kumar R, Jain S. Furuncular myiasis in a 6-year-old boy. Indian J Paediatr Dermatol 2018;19:167-9

How to cite this URL:
Sharma MK, Yadav SK, Kumar R, Jain S. Furuncular myiasis in a 6-year-old boy. Indian J Paediatr Dermatol [serial online] 2018 [cited 2020 Sep 22];19:167-9. Available from: http://www.ijpd.in/text.asp?2018/19/2/167/216941




  Introduction Top


Myiasis is defined by Zumpt as “the infestation of live human and vertebrate animals with dipterous larvae, which, at least for a certain period, feed on the host's dead or living tissue, liquid body-substances, or ingested food.[1] Human myiasis is a rare clinical condition, but more frequently seen in tropical and subtropical areas. Hot, humid climate with inadequate sanitary conditions favors the development of this condition. Dermatitis, psychiatric illnesses, leprosy, and diabetes are some contributory factors.[2]

Herein, we report a case of cutaneous myiasis over scalp in a 6-year-old child caused by Musca domestica larvae.


  Case Report Top


A 6-year-old boy was referred by the Pediatric Department to our Outpatient Department of Dermatology with complaints of painful, pus-filled lesion with crawling sensation over vertex region of scalp, associated with fever. The patient gave history that lesion initially started as painful itchy swelling. He lived in village with his other six family members in small house with poor hygienic conditions. The family also had livestock nearby their house. He was earlier diagnosed as furuncle of scalp.

On examination, he had a single erythematous crusted purulent lesion of approximately 2–3 cm over vertex region of scalp [Figure 1]. The rest of cutaneous examination did not reveal any other abnormality except bilateral cervical lymphadenopathy. The crust was removed by saline-soaked gauze, revealed a pus-filled, foul-smelling ulcer. We could see the movement on base of ulcer. We suspected case of cutaneous myiasis. After few minutes of application of mineral oil, maggots could be seen squirming. Maggots were removed with the help of forceps [Figure 2]. Other systemic examination was unremarkable.
Figure 1: Ulcerative wound over scalp

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Figure 2: Removal of maggots with forceps

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The surgical debridement was done. A large number of larvae were extracted [Figure 3]. Dressing with paraffin followed by povidone iodine was done. The patient was treated with antibiotics and analgesics.
Figure 3: Maggot

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Laboratory investigations revealed hemoglobin 11 g/dl and total leukocytes count 17 × 109/L with raised neutrophils. X-ray skull did not show any abnormality.


  Discussion Top


The first description of myiasis was by Hope in 1840.[3] Myiasis occurs as a result of the raid on tissues and organs of humans or animals by dipterous larvae. These larvae have ability to to infect skin, dead tissues, and natural cavities of living persons.[4] Flies causing myiasis can be categorized, based on relationship with their hosts [Table 1].[5],[6],[7]
Table 1: Flies causing myiasis can be categorized, based on the relationship with their hosts

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Myiasis is the fourth most common travel-associated skin disease and can be divided according to the body's tissues vulnerable. The most common type as well as the most frequently encountered clinical form is cutaneous myiasis while body cavity myiasis, nasopharyngeal, ocular, aural, gastrointestinal, and urogenital are less common [8] [Table 2].
Table 2: The classification of myiasis was given by Bishopp's, James' and Zumpt's[9]

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Furuncular myiasis occurs after the penetration of the dipteran larva into healthy skin, where an erythematous, furuncle-like nodule develops with one or more maggots within it. Most common causative agents for furuncular myiasis are Dermatobia hominis and Cordylobia anthropophaga. The typical furuncular lesion is a papule or nodule with a central punctum that exudes serosanguinous or purulent fluid. Pruritus, pain, and movement sensation are the most common symptoms and usually happen suddenly at night.[10] Clinical variants have been described, such as vesicular, bullous, pustular, erosive, ecchymotic, and ulcerative lesions.[11]

Migratory (creeping) myiasis dipteran maggot starts to migrate, aimlessly, through burrows in the skin, producing the migratory pattern of the lesions. Symptoms depended on the deepness of the tunnel and the migration speed. Larvae of the genera Gasterophilus (horse bot fly) and Hypoderma (cattle bot fly) cause almost all cases of creeping myiasis in humans. Humans are accidental hosts of these agents, and these agents are unable to complete their life cycle within human skin.

Wound myiasis occurs when fly larvae infest open wounds. This kind of infestation may be the result of facultative or obligatory parasites.

The larvae of the house fly, M. domestica, are saprophagus, being found in dung and decaying refuse. Infestation is believed to be self-promoting; egg-laying female flies are particularly attracted to the odor of an existing myiasis, resulting in expansion of the lesion. Most Sarcophagidae species that cause myiasis deposit their eggs or larvae onto the host at some predisposing site, such as wounding, necrosis, or bacterial contamination.[12] Advanced age, poor social conditions, poor personal hygiene, poor general condition, mental retardation, immobilization, diabetes mellitus, alcoholism, vascular occlusive disease, ulcerating lesions, bacterial infection of wounds and infected dermatitis, travel to endemic areas, and contact with livestock are predisposing factors for cutaneous myiasis.[8],[13]

Herein, we present a case of furuncular myiasis which is an uncommon condition emphasize that we should be aware of the condition during examination of furuncloid or boil-like lesions.


  Conclusion Top


A correct diagnosis will help alleviate the anxiety of the patient and helps prevent complications. Prevention and control of myiasis should include strategic planning that recommends basic cleaning and sanitary education programs for the community. Personal initiative terms of reducing predisposing factors are also extremely important in the prevention of this parasite.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Zumpt F. Myiasis in Man and Animals in the Old World. London, UK: Butterworth & Co.; 1965. p. 1-107.  Back to cited text no. 1
    
2.
Bayindir T, Cicek MT, Atambay M, Kizilay A. Cutaneous myiasis in a malignant wound of the head and neck region. J Craniofac Surg 2012;23:e19-20.  Back to cited text no. 2
[PUBMED]    
3.
Hope FW. On insects and their larvae occasionally found in the human body. Trans R Soc Entomol1840;2:256-71.  Back to cited text no. 3
    
4.
Francesconi F, Lupi O. Myiasis. Clin Microbiol Rev 2012;25:79-105.  Back to cited text no. 4
[PUBMED]    
5.
Hall MJ, Smith KG. Diptera causing myiasis in man. In: Lane RP, Crosskey RW, editors. Medical Insects and Arachnids. London: Chapman and Hall; 1993. p. 429-69.  Back to cited text no. 5
    
6.
James MT. The Flies that Cause Myiasis in Man. United States Department of Agriculture Miscellaneous Publication No. 631. United States Department of Agriculture; 1947.  Back to cited text no. 6
    
7.
Hall M, Wall R. Myiasis of humans and domestic animals. Adv Parasitol 1995;35:257-334.  Back to cited text no. 7
[PUBMED]    
8.
Kokcam I, Saki CE. A case of cutaneous myiasis caused by Wohlfahrtia magnifica. J Dermatol 2005;32:459-63.  Back to cited text no. 8
[PUBMED]    
9.
James MT. The Flies that Cause Myiasis in Man. U.S. Department of Agriculture Miscellaneous Publication No. 631. Washington, DC: USDA; 1947. p. 1-175.  Back to cited text no. 9
    
10.
Royce LA, Rossignol PA, Kubitz ML, Burton FR. Recovery of a second instar Gasterophilus larva in a human infant: A case report. Am J Trop Med Hyg 1999;60:403-4.  Back to cited text no. 10
[PUBMED]    
11.
Sherman RA. Wound myiasis in urban and suburban United States. Arch Intern Med 2000;160:2004-14.  Back to cited text no. 11
[PUBMED]    
12.
Ruiz-Martinez I, Soler-Cruz MD, Benitez-Rodriguez R, Perez-Jimenez JM, Diaz-Lopez M. Postembryonic development of Wohlfahrtia magnifica (Schiner, 1862) (Diptera: Sarcophagidae). J Parasitol 1989;75:531-9.  Back to cited text no. 12
[PUBMED]    
13.
Failoc-Rojas VE, Silva-Díaz H. Review of Cases and a patient report of myiasis with tracheostomy, Peru. Emerg Infect Dis 2016;22:563-5.  Back to cited text no. 13
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1], [Table 2]



 

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