Cutaneous Myiasis Due to Botfly Larvae

A 2-year-old girl presented with what appeared to be a superinfected insect sting on the left thigh. Approximately 4 weeks earlier while vacationing in Italy, a “sting” had been noticed for the first time, which became progressively larger and more nodular despite local and antibiotic therapy as well as being lanced twice; there was also painless itching without signs of systemic inflammation. After detecting a “foreign body” on ultrasound (Figure a), we removed a 1.5-cm long botfly larva (Dermatobia hominis) during wound exploration (Figure b). A detailed history-taking revealed that the child had been in Colombia 1 week prior to the occurrence of the purported “sting.” The botfly, which was originally endemic to Central and South America, and the related myiasis, also referred to as fly maggot disease, are now indigenous to Europe due to climate change. Egg transmission takes place indirectly via other insects or objects. Typical symptoms include itching, movement beneath the skin, sharp stabbing pain, and a small opening for the larvae to breathe located in nodular redness of the skin; occlusion of the opening with a waterproof plaster or petroleum jelly can be attempted in order to make the larvae emerge. Dead larvae can cause severe inflammatory reactions. Rare secondary infections require antibiotic therapy.

Figure.

Translated from the original German by Christine Rye.

Cite this as: Schüpbach F, Lavagno C, Heinz P: Cutaneous myiasis due to botfly larvae.