Cutaneous myiasis: Think beyond furunculosis

Atypical neonatal cutaneous myiasis: A diagnostic challenge mimicking pustular rash in a resource-limited setting

Key Clinical Message

Neonatal cutaneous myiasis is a rare disease in newborns. Although it is unlikely, the level of suspicion for this condition should be high, especially in tropical regions. Treatment may deviate from the standard approach when necessary, and chemical debridement can be considered, particularly for smaller lesions. Ultimately, clinical judgment plays a key role in decision-making.

Abstract

Myiasis is the infestation of the skin of a mammal by larvae or maggots. The skin is the most affected organ. However, it can also affect other organs of the body. Gasterophilus and Hypoderma are two flies that produce creeping myiasis, a type of cutaneous myiasis our patient had. The infestation is common in Sub-Saharan Africa and most especially among rural dwellers. We report on a case of a 7-day-old term neonate who reported to St. Mary's Hospital Lacor, a Private-not-for-Profit hospital situated in the Northern region of Uganda, who was admitted as a case of neonatal sepsis with a focus on the skin initially, however, while on the ward was eventually diagnosed with Cutaneous Myiasis. The management plan included chemical debridement with Hydrogen peroxide, IV antibiotics, and other supportive therapies, and the neonate was ultimately discharged home after 9 days in the NICU. This case report aims to inform healthcare workers of the importance of heightening the index of suspicion of myiasis for neonates who present with sudden-onset rash that can resemble pustules and be mistaken for a pustular rash. Additionally, chemical debridement, in this case, underscores the importance of an innovative approach to managing cutaneous myiasis in resource-limited settings. Mass education and awareness programs focusing on proper hygiene practices, safe handling of newborns, and early recognition of symptoms can help mitigate the risk of myiasis.

Human myiasis in Sub-Saharan Africa: A systematic review

BACKGROUND

Human myiasis is a parasitic dipteran fly infestation that infects humans and vertebrates worldwide. However, the disease is endemic in Sub-Saharan Africa and Latin America. In Sub-Saharan Africa, it is under-reported and therefore its prevalence is unknown. This systematic review aims to elucidate the prevalence of human myiasis, factors that influence the infection, and myiasis-causing fly species in SSA. The review also dwelled on the common myiasis types and treatment methods of human myiasis.

METHODS

Here, we collect cases of human myiasis in Sub-Saharan Africa based on literature retrieved from PubMed, Google Scholar and Science Direct from 1959 to 2022. A total of 75 articles and 157 cases were included in the study. The recommendations of PRISMA 2020 were used for the realization of this systematic review.

RESULTS

In total, 157 cases of human myiasis in SSA were reviewed. Eleven fly species (Cordylobia anthropophaga, Cordylobia rodhaini, Dermatobia hominis, Lucilia cuprina, Lucilia sericata, Oestrus ovis, Sarcophaga spp., Sarcophaga nodosa, Chrysomya megacephala, Chrysomya chloropyga and Clogmia albipuntum) were found to cause human myiasis in SSA. Cordylobia anthropophaga was the most prevalent myiasis-causing species of the reported cases (n = 104, 66.2%). More than half of the reported cases were from travelers returning from SSA (n = 122, 77.7%). Cutaneous myiasis was the most common clinical presentation of the disease (n = 86, 54.7%). Females were more infected (n = 78, 49.6%) than males, and there was a higher infestation in adults than young children.

CONCLUSION

The findings of this study reveals that international travelers to Sub-Saharan Africa were mostly infested therefore, we recommend that both international travelers and natives of SSA be enlightened by public health officers about the disease and its risk factors at entry points in SSA and the community level respectively. Clinicians in Sub-Saharan Africa often misdiagnose the disease and most of them lack the expertise to properly identify larvae, so we recommend the extensive use of molecular identification methods instead.

Cordylobia anthropophaga Myiasis Mimicking Hyperproliferative Skin Disorder in Traveler Returning from Sub-Saharan Africa

Myiasis is one of the most common skin diseases found in travelers returning from tropical and subtropical regions, where humans living in or visiting the African continent are most commonly infested by C. anthropophaga during the rainy season in regions with a warm climate. Here, we present a case of furuncular myiasis caused by C. anthropophaga in a Serbian patient returning from temporary work in Kenya, where the initial histology of skin lesion mimicked hyperproliferative skin disorder.

A RARE FINDING OF DISTAL PENILE FURUNCULAR MYIASIS IN A CHILD OF A NIGERIAN HEALTH CARE WORKER

Introduction

Myiasis is the infestation of tissues of humans and other living vertebrates with the larva of flies, and it can affect any part of the body. Cutaneous myiasis is the commonest form of presentation. Furuncular myiasis which is a sub-type of cutaneous myiasis typifies the presentation in this index patient. It is commonly caused by Cordylobia anthropophaga in Sub-Saharan African countries including Nigeria. It commonly occurs among rural dwellers, as well as people of low socio-economic and poor educational status.

Case presentation

We present a case of balanitis from distal penile myiasis in a 3 year 8-month-old male child of a health worker in a tertiary hospital in Nigeria.

Conclusion

It is believed that with adequate knowledge, measures such as good hygiene and proper drying and ironing of underwear are helpful.

Human myiasis cases originating and reported in africa for the last two decades (1998-2018): A review

The article reviews literature on myiasis in Africa and cases that originated in Africa over the last two decades (1998-2018). The relevant literature was obtained by using several databases (Science-Direct, JSTOR, Google Scholar, Ebscohost and PubMed). We searched for the following words or their combination myiasis, maggots, fly species responsible for myiasis found in Africa, and the different types of myiasis. References in several articles provided links to other relevant works. Only papers written in English were reviewed. In total, we reviewed 51 articles which covered a total of 849 myiasis cases. The review encompasses geographical distribution of the disease, dipteran species responsible, predisposing factors, sex of the patient, type of myiasis and treatment. Myiasis is found in most parts of the African continent, however only 18 articles reported myiasis cases in Africa during the period under review. The rest of the articles report cases from the rest of the world but acquired by travellers when visiting Africa. Cordylobia anthropophaga (Blanchard) was responsible for 93.28% of all the reported cases in this review. The low number of articles on human myiasis reported in Africa may be due to underreporting by physicians or most cases are not diagnosed. Therefore, the actual prevalence of myiasis in Africa is currently unknown.