Académique Documents
Professionnel Documents
Culture Documents
ufacturer’s instructions. By use of this extractor, an intact and as it feeds on an animal (a bird or a human [or other mam-
motile maggot (length, 1.5 cm) was rapidly (in !1 s) and easily mal]), and the eggs then hatch, producing larvae that penetrate
extracted. After extrusion of the maggot, the patient had an the skin and reside in the subcutaneous tissue for ∼100 days
uneventful recovery. [1, 7]. After a prolonged stay in the host, the third-stage maggot
Discussion. This case is informative for several reasons. exits via the punctum, falls to the ground, and pupates during
First, with the increase in international travel—in particular, the next 2–3 weeks [5]. After pupation, D. hominis emerges as
travel for adventure and ecotourism—cutaneous myiasis is be- an adult and lives for 8–9 days, during which time it mates
coming a commonly observed skin problem among returning and pastes its eggs to the abdomens of mosquitoes or other
travelers, and it currently accounts for 5%–10% of skin lesions blood-sucking arthropods to complete the life cycle [8]. Be-
seen at our health care center [3]. Second, myiasis is frequently cause D. hominis is a forest-dwelling fly found in Central and
misdiagnosed as a bacterial abscess or furuncle and is subse- South America, individuals who participate in ecotourism and
quently treated with an ineffective course of antibiotics [4]. rural outdoor occupations, such as archeology and mining, in
Serosanguineous discharge from the central punctum and sen- these areas are at risk of developing myiasis. This disease can
sations of movement within the lesion are important clinical be prevented through the use of personal protection measures
clues to the diagnosis. Third, well-described extraction methods to reduce mosquito bites.
that are based on suffocation and application of lateral pressure Although the larvae generally require ∼12 weeks to mature,
take time to perform and may fail. Finally, myiases may be most are removed before that time. An ideal treatment method
complicated by cellulitis that may obscure the underlying di- should allow prompt and complete removal of the maggot to
agnosis and complicate the use of alternative extraction meth- decrease anxiety, inflammatory response, and the risk of abscess
ods, such as surgical excision. formation. Conventional strategies to remove the offending
Lesions of the botfly are often localized to the scalp, face, maggot include surgical excision or suffocation of the maggot
forearms, and legs, which may reflect the unique life cycle of by occlusion of the punctum [1, 3, 4, 6]. Occlusion of the
this organism. The botfly preferentially deposits its eggs on the punctum impairs the ability of the larva to respire and thus
underside of a mosquito [1]. Botfly eggs drop off the mosquito stimulates its migration out of its sinus [3]. Materials that have