Skip to main content

Main menu

  • Home
  • Content
    • Current
    • Ahead of print
    • Archive
  • Info for
    • Authors
    • Reviewers
  • About Us
    • About the Ochsner Journal
    • Editorial Board
  • More
    • Alerts
    • Feedback
  • Other Publications
    • Ochsner Journal Blog

User menu

  • My alerts
  • Log in

Search

  • Advanced search
Ochsner Journal
  • Other Publications
    • Ochsner Journal Blog
  • My alerts
  • Log in
Ochsner Journal

Advanced Search

  • Home
  • Content
    • Current
    • Ahead of print
    • Archive
  • Info for
    • Authors
    • Reviewers
  • About Us
    • About the Ochsner Journal
    • Editorial Board
  • More
    • Alerts
    • Feedback
Case ReportCASE REPORTS AND CLINICAL OBSERVATIONS
Open Access

Cutaneous Myiasis in Rural Haiti

Amanda Theppote, Yvens Laborde, Leise Knoepp, Shontell Thomas and Obinna N. Nnedu
Ochsner Journal September 2020, 20 (3) 331-333; DOI: https://doi.org/10.31486/toj.19.0073
Amanda Theppote
1Department of Internal Medicine, Ochsner Clinic Foundation, New Orleans, LA
2The University of Queensland Faculty of Medicine, Ochsner Clinical School, New Orleans, LA
MD
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Yvens Laborde
2The University of Queensland Faculty of Medicine, Ochsner Clinical School, New Orleans, LA
3Medical Director, Global Health Education, Medical Director, Public Health, Ochsner Clinic Foundation, New Orleans, LA
MD
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Leise Knoepp
2The University of Queensland Faculty of Medicine, Ochsner Clinical School, New Orleans, LA
4Department of Obstetrics and Gynecology, Ochsner Clinic Foundation, New Orleans, LA
MD
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Shontell Thomas
2The University of Queensland Faculty of Medicine, Ochsner Clinical School, New Orleans, LA
4Department of Obstetrics and Gynecology, Ochsner Clinic Foundation, New Orleans, LA
MD, MSPH
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Obinna N. Nnedu
2The University of Queensland Faculty of Medicine, Ochsner Clinical School, New Orleans, LA
5Department of Infectious Diseases, Ochsner Clinic Foundation, New Orleans, LA
MD, MPH
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • For correspondence: onnedu@ochsner.org
  • Article
  • Figures & Data
  • References
  • Info & Metrics
  • PDF
Loading

Abstract

Background: Myiasis is a disease caused by the infestation of human tissue by the larval stage of various flies. It has been identified in sub-Saharan Africa and in tropical parts of the Americas. Cases have also been identified among travelers returning to the United States. Infestations may involve any part of the body, including the scalp, and open wounds may become infected with these larvae. The primary cause of wound myiasis in the western hemisphere is Cochliomyia hominivorax.

Case Report: We present a case of wound myiasis in an adult Haitian male with a persistent wound for 2 years. To our knowledge, only 1 other report of wound myiasis in Haiti caused by C hominivorax has been published.

Conclusion: Wound myiasis can occur in many tropical regions of the world, including Haiti. Because of the prevalence of global travel, clinicians should be familiar with the condition's diagnosis and management.

Keywords:
  • Myiasis
  • screw worm infection

INTRODUCTION

Myiasis is the infestation of vertebrate animals and humans with dipterous larvae that feed on the host's living or dead tissue.1 The method of invasion into tissue differs, depending on the species of fly.2,3 Cutaneous myiasis may manifest clinically in 3 ways: furuncular, migratory, or wound type. Furuncular myiasis is the most common presentation and occurs when 1 or more larvae infest the skin and cause a furuncle.3 Migratory or creeping dermal myiasis typically starts with a papule that progresses to a pruritic, serpentine lesion as the larvae burrow through the skin.4 Wound myiasis occurs when fly larvae are directly inoculated into or in the vicinity of a wound. To our knowledge, only 1 other report has been published of myiasis caused by Cochliomyia hominivorax in 2 patients in Haiti.5 We describe another case of myiasis in a Haitian male whose preexisting skin lesion was secondarily infested with C hominivorax larvae.

CASE REPORT

A 26-year-old male presented to a rural clinic in northern Haiti with a 2-year history of a nodular wound on the back of his head. He denied trauma or memory of an insect bite to the area. He was unsure how the wound started. The wound was initially painless, but the patient noted that the nodule had slowly grown larger and had become painful. He denied constitutional symptoms and relevant medical history. His human immunodeficiency virus status was unknown; testing was not available at the clinic at the time of his presentation. He worked outdoors on a farm and had not sought medical care prior to presenting to the clinic.

Initial examination revealed a 3 × 2 × 1-cm nodule in the occipital area of the head. Purulent fluid was draining from the sinus tracts within the nodule. The examination was also notable for cervical and postauricular lymphadenopathy.

In clinic, the nodule was irrigated with sterile saline and chlorhexidine. The sinus tracts were opened, and the nodule was debrided. Following debridement, hemostasis was achieved, and the patient's wound was dressed. He was started on trimethoprim-sulfamethoxazole (TMP-SMX) 160-800 mg and discharged with instructions to follow up the next day for dressing change. On the following day, the patient's wound still exuded a fair amount of drainage, so it was reopened and again debrided, the wound was dressed, and amoxicillin-clavulanic acid 875-125 mg was added to the patient's antibiotic regimen.

The patient presented to the clinic on the third day with complaints of feeling a crawling sensation at the back of his head. When the dressings were removed, larvae were visualized within the tracts of the wound (Figure 1). With the patient in the prone position on the examination table, the sinus tracts were expanded with forceps. The larvae were visualized with the assistance of a flashlight and extracted with tweezers. In total, 12 larvae were removed (Figure 2). His wound was cleansed with chlorhexidine and dressed. He was instructed to complete an additional 10-day course of TMP-SMX and amoxicillin-clavulanic acid. He followed up approximately 1 year later to the clinic, and the wound had healed completely.

Figure 1.
  • Download figure
  • Open in new tab
  • Download powerpoint
Figure 1.

Multiple larvae were present within the patient's wound.

Figure 2.
  • Download figure
  • Open in new tab
  • Download powerpoint
Figure 2.

Twelve larvae were extracted from the patient's wound.

DISCUSSION

Wound myiasis is commonly caused by C hominivorax in South and Central America, including Haiti.1,5 C hominivorax, also known as the New World screwworm (NWS), is an obligatory wound parasite that lays eggs in or on the edges of wounds. The female deposits multiple eggs at once.1,2 After a short incubation period of nearly 24 hours, the eggs hatch and feed upon live tissue for 4 to 8 days.1 During the maturation process, the larvae burrow or screw deep into tissue and create the deep pocket-like lesions characteristic of NWS that cause significant local pain.2,6 C hominivorax can be identified by the dark pigmentation on their dorsal tracheal trunks.6 Predisposing factors for wound myiasis include poor hygiene, poor social conditions, and open wounds.1 International travel has become a risk factor as well. The number of tourists who crossed international boundaries increased from 537 million in 1995 to 1.135 billion in 2014.7 Myiasis is 1 of the 5 most common travel-related skin infections, accounting for 3.5% to 9% of all travel-related skin infections.8,9

There are 3 primary ways to manage myiasis. The first treatment modality is to expose the larvae to toxic substances. Topical or oral ivermectin is toxic to the larvae and may lead to death. The drawback to this approach is that the death of larvae within tissues may provoke a brisk localized inflammatory response. The second treatment modality is to create localized hypoxia by using petroleum jelly or paraffin to cover the sinus tracts. The larvae emerge from the sinus tracts for oxygen, allowing for ease of removal. The third and most common way to manage these wounds is mechanical or surgical removal of the larvae.

CONCLUSION

Myiasis is a tropical disease associated with poor living conditions in developing countries and may also be seen in international travelers. Knowledge of the diagnosis and management of myiasis is not only important for clinicians working in endemic areas but also for those working in nonendemic areas because of widespread international travel.

This article meets the Accreditation Council for Graduate Medical Education and the American Board of Medical Specialties Maintenance of Certification competencies for Patient Care and Medical Knowledge.

ACKNOWLEDGMENTS

The authors have no financial or proprietary interest in the subject matter of this article.

  • ©2020 by the author(s); Creative Commons Attribution License (CC BY)

©2020 by the author(s); licensee Ochsner Journal, Ochsner Clinic Foundation, New Orleans, LA. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (creativecommons.org/licenses/by/4.0/legalcode) that permits unrestricted use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.

REFERENCES

  1. 1.↵
    1. McGraw T,
    2. Turiansky GW
    . Cutaneous myiasis. J Am Acad Dermatol. 2008 Jun;58(6):907-926. doi: 10.1016/j.jaad.2008.03.014.
    OpenUrlCrossRefPubMed
  2. 2.↵
    1. Francesconi F,
    2. Lupi O
    . Myiasis. Clin Microbiol Rev. 2012 Jan;25(1):79-105. doi: 10.1128/CMR.00010-11.
    OpenUrlAbstract/FREE Full Text
  3. 3.↵
    1. Radwan HM
    . Myiasis. Trop Med Surg. 2015 Oct 12;3(4):1-3. doi: 10.4172/2329-9088.1000197.
    OpenUrlCrossRef
  4. 4.↵
    1. Safdar N,
    2. Young DK,
    3. Andes D
    . Autochthonous furuncular myiasis in the United States: case report and literature review. Clin Infect Dis. 2003 Apr 1;36(7):e73-80. doi: 10.1086/368183.
    OpenUrlCrossRefPubMed
  5. 5.↵
    1. Lindsay R,
    2. Stancil J,
    3. Ray JM
    . Myiasis of facial wounds by Cochliomyia hominivorax sustained in a natural disaster in Haiti. Otolaryngol Head Neck Surg. 2010 Oct;143(4):595-596. doi: 10.1016/j.otohns.2010.04.273.
    OpenUrlCrossRefPubMed
  6. 6.↵
    1. Hall MJR
    . Screwworm flies as agent of wound myiasis. World Anim Rev. 1991. www.fao.org/3/U4220T/u4220T07.htm. Accessed July 29, 2020.
  7. 7.↵
    Annual Report 2014. United Nations World Tourism Organization. www.e-unwto.org/doi/pdf/10.18111/9789284416905. Published 2015. Accessed July 29, 2020.
  8. 8.↵
    1. Hochedez P,
    2. Caumes E
    . Common skin infections in travelers. J Travel Med. 2008 Jul-Aug;15(4):252-262. doi: 10.1111/j.1708-8305.2008.00206.x.
    OpenUrlCrossRefPubMed
  9. 9.↵
    1. Caumes E,
    2. Carrière J,
    3. Guermonprez G,
    4. Bricaire F,
    5. Danis M,
    6. Gentilini M
    . Dermatoses associated with travel to tropical countries: a prospective study of the diagnosis and management of 269 patients presenting to a tropical disease unit. Clin Infect Dis. 1995 Mar;20(3):542-548. doi: 10.1093/clinids/20.3.542.
    OpenUrlCrossRefPubMed
PreviousNext
Back to top

In this issue

Ochsner Journal: 20 (3)
Ochsner Journal
Vol. 20, Issue 3
Sep 2020
  • Table of Contents
  • Table of Contents (PDF)
  • About the Cover
  • Index by author
  • Advertising (PDF)
  • Back Matter (PDF)
  • Ed Board (PDF)
  • Front Matter (PDF)
Print
Download PDF
Email Article

Thank you for your interest in spreading the word on Ochsner Journal.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Cutaneous Myiasis in Rural Haiti
(Your Name) has sent you a message from Ochsner Journal
(Your Name) thought you would like to see the Ochsner Journal web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Cutaneous Myiasis in Rural Haiti
Amanda Theppote, Yvens Laborde, Leise Knoepp, Shontell Thomas, Obinna N. Nnedu
Ochsner Journal Sep 2020, 20 (3) 331-333; DOI: 10.31486/toj.19.0073

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Share
Cutaneous Myiasis in Rural Haiti
Amanda Theppote, Yvens Laborde, Leise Knoepp, Shontell Thomas, Obinna N. Nnedu
Ochsner Journal Sep 2020, 20 (3) 331-333; DOI: 10.31486/toj.19.0073
del.icio.us logo Twitter logo Facebook logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Abstract
    • INTRODUCTION
    • CASE REPORT
    • DISCUSSION
    • CONCLUSION
    • ACKNOWLEDGMENTS
    • REFERENCES
  • Figures & Data
  • References
  • Info & Metrics
  • PDF

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

  • Idiopathic Arginine Vasopressin Deficiency With Mild and Reversible Hypercalcemia
  • Management of Spontaneous Renal Arteriovenous Fistula in Pregnancy
  • Cerebellar Ataxia With Neuropathy and Bilateral Vestibular Areflexia Syndrome Coexisting With JAK2-Positive Polycythemia Vera and Myelofibrosis
Show more CASE REPORTS AND CLINICAL OBSERVATIONS

Similar Articles

Keywords

  • Myiasis
  • screw worm infection

Ochsner Journal Blog

Current Post

Be Careful Where You Publish -- Part 2

Our Content

  • Home
  • Current Issue
  • Ahead of Print
  • Archive
  • Featured Contributors
  • Ochsner Journal Blog
  • Archive at PubMed Central

Information & Forms

  • Instructions for Authors
  • Instructions for Reviewers
  • Submission Checklist
  • FAQ
  • License for Publishing-Author Attestation
  • Patient Consent Form
  • Submit a Manuscript

Services & Contacts

  • Permissions
  • Sign up for our electronic table of contents
  • Feedback Form
  • Contact Us

About Us

  • Editorial Board
  • About the Ochsner Journal
  • Ochsner Health
  • University of Queensland-Ochsner Clinical School
  • Alliance of Independent Academic Medical Centers

© 2025 Ochsner Clinic Foundation

Powered by HighWire