Furuncular myiasis caused by Wohlfahrtia magnifica in a healthy child: A case report

BackgroundDermatologic conditions are among the most frequent health problems in international travelers, following gastrointestinal and febrile illnesses. Myiasis, defined as infestation of human tissue by dipterous fly larvae, represents a noteworthy dermatologic diagnosis, particularly in travelers returning from tropical regions. Furuncular myiasis is the most recognizable form, presenting with painful nodules containing larvae, and is commonly caused by Dermatobia hominis in Central and South America. Increasing international travel is expected to raise the incidence of such conditions in non-endemic regions.Case report and discussionsWe report the case of a 77-year-old Romanian male, with co-morbidities, who developed cutaneous furuncular myiasis following a 12-day trip to Brazil and Argentina. The patient presented with painful nodular skin lesions on the upper limb approximately one month after returning. Initial treatments with anti-inflammatory agents and antibiotics were ineffective. Subsequent surgical drainage revealed the presence of larvae, confirming the diagnosis. Complete healing occurred within 2–3 weeks. Based on clinical presentation and travel history, Dermatobia hominis was considered the most probable etiologic agent, although molecular confirmation was unavailable. Discussion highlights the epidemiology and classification of myiasis-producing flies, emphasizing the geographic distribution of Dermatobia hominis and Cochliomyia hominivorax. Furuncular myiasis is often misdiagnosed as cellulitis or abscess due to nonspecific symptoms. Key diagnostic clues include persistent nodules with central punctum, serous discharge, and recent travel to endemic areas. Ultrasound can aid in identifying larvae, while laboratory confirmation enhances epidemiological surveillance. Management typically involves mechanical or surgical larval extraction, wound care, and monitoring for secondary infection. Preventive measures include insect repellents, protective clothing, and use of insecticide-treated nets. This case underscores the need for heightened clinical awareness in non-endemic countries, where travel-related parasitic infections are increasingly encountered. Pre-travel medical consultations are crucial for providing vaccinations, preventive advice, and education on insect protection. While our patient experienced a favorable outcome, delayed diagnosis and lack of preventive measures may increase morbidity.ConclusionWith the rising popularity of travel to tropical areas, clinicians should consider cutaneous myiasis in travelers with persistent nodular skin lesions. Prompt recognition and extraction of larvae remain the cornerstone of effective treatment.

We present the case of a 12-year-old boy with furuncular myiasis living in an area with continental climate. The boy was admitted to our clinic with a wound on his nape, which started as a little acne and progressed to a large wound in which pus flowed continuously. He complained of itching and was treated with penicillin, clarithromycin, terbinafine, and ibuprofen in the last 2 months, with no big success. Otherwise, the patient was healthy, and his hygienic conditions were within normal standards. The dermatologic examination revealed an off-white ulcer measuring approximately 1x2 cm in the occipital region with regular contours, elevated borders, and purulent flow, while the skin surrounding the ulcer was normal. In the course of the examination, a living larva was removed using a forceps. The ulcer and the surroundings were washed with polyvinylprolidone iodine solution, while fusidic acid pomade was topically applied. The ulcer regressed significantly after 15 days of treatment.

Rationale: Human myiasis is the invasion of tissue or organs by fly larvae. This could be obligatory, facultative, or accidental. Patient concerns: A 4-year-old Saudi boy complained of fever over the past three days with multiple inflamed painful dermal furuncles and worms-like discharge. Diagnosis: Furuncular obligatory myiasis caused by Wohlfahrtia magnifica. Interventions: Maggots were removed for identification. The wounds were cleaned with antiseptic dressings. Topical and oral antibiotics were applied. Outcomes: Seven days later, the wounds completely healed. Lessons: Although several reports correlated human myiasis with old age, low health status, mental retardation, and low socioeconomic status, but the patient in our case was a healthy child from a family with good socioeconomic status, good hygiene, no history of diseases or mental disability, but traveled to a village where the climate is suitable for fly breeding.

Myiasis is a parasitic infection of the skin tissue caused by larvae, which are commonly known as maggots, that is typically observed in the tropical and subtropical areas of Africa and the Americas. Cutaneous myiasis is the most prevalent form of myiasis and is categorized as furuncular, creeping (migratory), or wound (traumatic) myiasis based on its clinical presentation. Few cases of cutaneous myiasis have been observed in Saudi Arabia, and most of these have been observed in southern Saudi Arabia. We present the case of a 14-year-old female patient in Makkah, Saudi Arabia, who developed several itchy, painful, and oozing skin lesions after spending one month in a rural area of Jizan. The patient exhibited multiple raised erythematous boil-like lesions with a central punctum, and a foreign body protruded from one of the lesions. The foreign body was manually removed from the lesion using forceps. Furuncular myiasis was diagnosed because the foreign body comprised larvae. Subsequently, manual removal of all larvae was performed by applying pressure and using forceps. A course of oral antibiotics was administered to treat the bacterial infection, which developed as a complication of a preexisting parasitic infection. The patient was discharged after full recovery. Physicians should be aware of such cases because they are relatively rare in Saudi Arabia. To prevent misdiagnoses, careful medical history and examination should be performed.

Myiasis is derived from the Greek word, myia, meaning fly. The term was first introduced by Hope in 1840 and refers to the infestation of live human and vertebrate animals with dipterous (two-winged) larvae (maggots) which, at least for a certain period, feed on the host's dead or living tissue, liquid body-substance, or ingested food. Myiasis is the fourth most common travel-associated skin disease and cutaneous myiasis is the most frequently encountered clinical form. Cutaneous myiasis can be divided into three main clinical manifestations: furuncular, creeping (migratory), and wound (traumatic) myiasis. The flies that produce a furuncular myiasis include Dermatobia hominis, Cordylobia anthropophaga, Wohlfahrtia vigil, and the Cuterebra species. Gasterophilus and Hypoderma are two flies that produce a creeping myiasis. Flies that cause wound myiasis include screwworm flies such as Cochliomyia hominivorax and Chrysomya bezziana, and Wohlfahrtia magnifica. This article reviews current literature, provides general descriptions, and discusses life cycles of each species. It also gives treatment techniques and descriptions of each type of illness that results from interaction/infestation.

Myiasis is an infestation of the body of a mammal by fly larva that grows inside and feeds on the tissue of the host. It is endemic to sub-Saharan Africa, southeast Mexico, South America, and Central America. It can occur in any age group and has no sex predilection. It is mostly seen among the rural population with many cases unreported and undiagnosed. We report two otherwise healthy Nigerian siblings with furuncular myiasis, who were initially diagnosed with furunculosis and received antibiotics from various hospitals without improvement. The larvae were removed with forceps after application of petroleum jelly and had full healing of all lesions on follow-up. Furuncular myiasis should be considered a differential diagnosis of furunculosis that is not responding to antibiotics, especially in travellers to endemic areas.

Purpose: To report a case of severe mpox in a newly diagnosed HIV patient concerning for Immune Reconstitution Inflammatory Syndrome (IRIS) and/or tecovirimat resistance and to describe the management approach in the setting of refractory disease. Case: 49-year-old man presented with 2 weeks of perianal lesions. He tested positive for mpox PCR in the emergency room and was discharged home with quarantine instructions. Three weeks later, the patient returned with disseminated firm, nodular lesions in the face, neck, scalp, mouth, chest, back, legs, arms, and rectum, with worsening pain and purulent drainage from the rectum. The patient reported being on 3 days of tecovirimat treatment, which was prescribed by the Florida department of health (DOH). During this admission, he was found to be HIV positive. A pelvic CT scan revealed a 2.5 cm perirectal abscess. Treatment with tecovirimat was continued for 14 days, along with an empiric course of antibiotics for treatment of possible superimposed bacterial infection upon discharge. He was seen in the outpatient clinic and initiated antiretroviral therapy (ART) with TAF/emtricitabine/bictegravir. Two weeks after starting ART, the patient was readmitted for worsening mpox rash and rectal pain. Urine PCR also returned positive for chlamydia, for which the patient was prescribed doxycycline. He was discharged on a second course of tecovirimat and antibiotic therapy. Ten days later, the patient was readmitted for the second time due to worsening symptoms and blockage of the nasal airway from progressing lesions. At this point, there were concerns for tecovirimat resistance, and after discussion with CDC, tecovirimat was reinitiated for the third time, with the addition of Cidofovir and Vaccinia, and showed an improvement in his symptoms. He received three doses of cidofovir and two doses of Vaccinia, and the patient was then discharged to complete 30 days of tecovirimat. Outpatient follow-up showed favorable outcomes and near resolution. Conclusion: We reported a challenging case of worsening mpox after Tecovirimat treatment in the setting of new HIV and ART initiation concerning IRIS vs. Tecovirimat resistance. Clinicians should consider the risk of IRIS and weigh the pros and cons of initiating or delaying ART. In patients not responding to first-line treatment with tecovirimat, resistance testing should be performed, and alternative options should be considered. Future research is needed to establish guidance on the role of Cidofovir and Vaccinia immune globulin and the continuation of tecovirimat for refractory mpox.

An Ulcerating Perineal Rash in an 8-month-old Girl.

Furuncular myiasis is a rare disease that affects the skin and is caused by growing maggots of different types of fly species within the arthropod order Diptera. The symptoms of the disease include itching, a sensation of movement, and sometimes fever. The disease predominantly occurs in tropical and subtropical areas. In Saudi Arabia, furuncular myiasis is reported to occur frequently in the Western region. Herein, we present a case of a 10 months-old Saudi girl who came with multiple lesions over her scalp and left hand starting five days following a trip to Al Shafa, southwest of Saudi Arabia. The patient's lesion was red, solid, and increased in size gradually. On examination, a papule with a central punctum was present on the left hand at the dorsal aspect of the first web space. The patient underwent an urgent operation to extract the larvae under general anesthesia. Excision of the furuncular myiasis larvae was done using a punch-biopsy blade with pressurized irrigation of the pocket with normal saline and diluted betadine solution. After two weeks, the patient showed a completely recovered skin infection. Having sufficient clinical awareness is necessary to prevent such disease, diagnose it, and prevent further spreading.

Furuncular myiasis is caused by the genus of botfly Dermatobia hominis. It belongs to the family Cuterebridae and is indigenous to Central andSouth America. to present acase report of the first case of this disease in Slovakia. The term myiasis refers to infestation of the host (animal, man) by botfly larvae. Its larvae burrow under the skin.They feed on the host's living tissues and fluids. MateriAl andmethods: Patient's history analysis, parasitological examination. A58-year-old woman after returning from Central America found in the skin above her m. gluteus mayor 2 indurations, which contained three botfly larvae. Infestation with botfly larvae Dermatobia hominis is for man annoying and from ahealth point of view dangerous. With proper diagnosis, it is possible to remove the larvae safely from furuncles. The authors point to the first case of imported infestation with Furuncular myiasis caused by botfly Dermatobia hominis in man introduced to Slovakia. They note that increasing tourism spread to the countries with the endemic occurrence of Furuncular myiasis will cause its higher prevalence also in Central European countries (Fig. 5, Ref. 45).

Nosocomial myiasis in a patient with diabetes

A Rare Encounter: Locally Acquired Furuncular Myiasis (Botfly) in Ohio.

Disseminated BCG infection is a very rare complication of BCG vaccination. This study presents 11 patients with such complication. The underlying disease in eight of the 11 patients was primary imm...

Cutaneous Myiasis: Diagnosis, Treatment, and Prevention

Myiasis is a parasitic infection caused by dipterous fly larvae that can affect various organs in both human and animals. Cutaneous myiasis is the most common type of myiasis and can be classified into three categories, localized furuncular myiasis, migratory myiasis, and wound myiasis. One of the risk factors for myiasis is seborrheic dermatitis. The definitive treatment for the condition requires complete extraction of larvae, in combination with oral therapy, and localized occlusion to promote hypoxia. This paper reports a case of a 12-year-old girl with furuncular cutaneous myiasis associated with seborrheic dermatitis on the occipital region that showed significant improvements after manual extraction of larvae after local anesthesia injection of 2% lidocaine on the base of the lesion, in combination with oral and topical therapies