Case Presentation
A 51-year-old man was brought to the emergency department, by a social
activist, with a chronic wound on the left side of his trunk for 3
months. He was complaining of a moving sensation and dull pain at the
wound site. Further inquiry revealed that the wound was caused by an
insect bite that occurred three months earlier but neglected it. He had
no significant past or family history; however, he was homeless for two
years. On inspection, a 10 × 7 cm size wound with multiple openings was
present in the left trunk above and behind the iliac crest. The wound
was covered with unhealthy tissue and multiple maggots with active
movements were noted (Fig. 1 and video). On palpation, the wound was
tender and the base was indurated. His vital signs and systemic
examination were normal.
Due to the poor visibility, attempts to remove the maggots with forceps
were unsuccessful. Therefore, a piece of gauze soaked in turpentine oil
was used to suffocate the maggots. After 30 minutes, the dead maggots
were removed (approximately 50 in number) and the unhealthy tissue was
debrided under local anesthesia. Further, the wound was cleaned with
povidone-iodine, and hemostasis was achieved with an adrenaline-soaked
gauze because of bleeding from granulation tissue. After that, the
patient was discharged under the care of a social activist with
instructions to take oral antibiotics regularly and a wound dressing at
scheduled intervals.
Myiasis, a rare condition, is an infestation of vertebrates by dipterous
larvae (maggot). Wound myiasis- a form of cutaneous myiasis- is
particularly rarer because it typically requires a large and necrotic
wound to deposit eggs, but even minor scratches can cause complications,
as in this case, which began with an insect bite.1, 2Old age, mental illness, low socioeconomic status, poor hygiene, and
diabetes are other risk factors for maggot infestation in addition to
open wounds.3 Manual removal of the maggots, either
with or without suffocation, is the definitive treatment. However,
depending on the severity of the lesion, many wound myiasis requires
further therapies, such as debriding of necrotic tissue, antiseptic
cleansing, dressing, and systemic antibiotics.1
AUTHOR CONTRIBUTIONS
AS managed the case and collected information. AS and BT prepared,
reviewed and edited the original manuscript. NK, BT, and AS finalized
the manuscript.
ACKNOWLEDGEMENTS
None
CONFLICT OF INTEREST
None
DATA AVAILABILITY STATEMENT
All required data are present on the article itself.
ETHICAL APPROVAL
Only observational data used.
CONSENT
Written informed consent was obtained from the patients to publish this
report in accordance with the journal’s patient consent policy.
References:
1. Francesconi, F. and O. Lupi, Myiasis. Clinical microbiology
reviews, 2012. 25 (1): p. 79-105.
2. Solomon, M., T. Lachish, and E. Schwartz, Cutaneous myiasis.Current infectious disease reports, 2016. 18 (9): p. 1-7.
3. Singh, A. and Z. Singh, Incidence of myiasis among humans—a
review. Parasitology Research, 2015. 114 (9): p. 3183-3199.