Oral myiasis caused by Musca domestica larvae in a child

Abstract

Myiasis or infestation of living tissues by Diptera (two winged) fly larvae is primarily a problem of cattle and livestock in tropics. Human infestation is rare, occurs accidentally in persons at extremes of age, who are debilitated or not able to ensure basic hygiene and wound cleanliness. Necrotic tissue in wounds of whatever origin provides ideal substrate for the developing larvae. Depending upon the anatomic sites affected it presents clinically as cutaneous myiasis, myiasis of external orifices (oral, nasal, ocular, aural, anal, genital), and myiasis of internal organs (intestinal, urinary). Cutaneous myiasis is perhaps the most commonly reported entity. Species causing skin, subcutaneous and mucosal myiasis include Gastrophilus intestinalis (horse botfly), Hypoderma bovis (cattle botfly), and Dermatobia homonis (human botfly). Musca domestica, the common house fly, is a rare cause of myiasis despite its presence in abundance. This paper describes oral myiasis in a 16-year-old girl of hypotonic cerebral palsy. She had episodic fever, fetid breath, erythematous, tender and ulcerated swelling over anterior palate from which pus and maggots were coming out. She had lip incompetence and bad orodental hygiene. Radiologic and laboratory investigations revealed no abnormality. The maggots were removed manually and she was treated with orodental hygiene sessions, wound care, antibiotics and nutritional supplements. The larval specimens were identified as early instar of M. domestica. Prevention of human myiasis is important and involves control of fly population, general cleanliness, basic sanitation and health education with a special emphasis on oral health care in patients with special needs.