|Year : 2018 | Volume
| Issue : 2 | Page : 167-169
Furuncular myiasis in a 6-year-old boy
Manoj Kumar Sharma, Sumit Kumar Yadav, Ramesh Kumar, Suresh Jain
Department of Dermatology, Venereology, Leprology, Government Medical College, Kota, Rajasthan, India
|Date of Web Publication||26-Mar-2018|
Department of Dermatology, Venereology, Leprology, Government Medical College, Kota - 324 005, Rajasthan
Source of Support: None, Conflict of Interest: None
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
| Introduction|| |
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. 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.
Herein, we report a case of cutaneous myiasis over scalp in a 6-year-old child caused by Musca domestica larvae.
| Case Report|| |
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.
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.
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|| |
The first description of myiasis was by Hope in 1840. 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. Flies causing myiasis can be categorized, based on relationship with their hosts [Table 1].,,
|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  [Table 2].
|Table 2: The classification of myiasis was given by Bishopp's, James' and Zumpt's|
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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. Clinical variants have been described, such as vesicular, bullous, pustular, erosive, ecchymotic, and ulcerative lesions.
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. 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.,
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|| |
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.
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Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3]
[Table 1], [Table 2]