Myiasis Workup

  • Author: Eleni Grammatikopoulou, MD; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: Apr 21, 2011
 

Laboratory Studies

CBC count may show leukocytosis and eosinophilia.

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Imaging Studies

MRI has been used in a number of cases of cerebral myiasis; breast myiasis; and facial, orbital, and furuncular myiasis. Ultrasonography can also be very useful in establishing the diagnosis and in determining the size of the larvae. CT scan has also been suggested.[11]

In one study, Doppler ultrasonography (DUSG) was performed using a high-resolution (10-MHz) soft-tissue transducer. Using the standard mode, hypoechogenic masses underneath the skin were first located, and then DUSG was used, which demonstrated circulation of fluid within the parasite as well as the number of parasites, their size, and their situation within the lesion. This is especially useful when lesions are still small and look like insect bites. Secretion and pain are minimal or absent, and the punctum is almost always absent. In these cases, high-resolution DUSG proved to be 100% effective in diagnosis.[12]

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Procedures

Biopsies are not necessary, but if performed, histopathologic findings include an ulcerated epidermis with an inflammatory infiltrate of neutrophils, lymphocytes, giant cells, mast cells, plasma cells, and eosinophils that occur in stages. The larvae can be seen in cross-section.[1, 12]

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Contributor Information and Disclosures
Author

Eleni Grammatikopoulou, MD  Visiting Physician, University of Virginia School of Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Barbara B Wilson, MD  Edward P Cawley Associate Professor, Department of Dermatology, University of Virginia School of Medicine

Barbara B Wilson, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Medical Society of Virginia, and Sigma Xi

Disclosure: Nothing to disclose.

Specialty Editor Board

Robert L Norris, MD  Professor, Department of Surgery; Chief, Division of Emergency Medicine, Stanford University Medical Center

Robert L Norris, MD is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, California Medical Association, International Society of Toxinology, Society for Academic Emergency Medicine, and Wilderness Medical Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD 

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

References

  1. Bolognia JL, Jorizzo JL, Rapini R. Cutaneous myiasis. In: Dermatology. Vol 1. 2nd ed. Mosby Elsevier; 2008:1300-01.

  2. Burns T, Breathnach S, Cox N, Griffiths C. Diseases caused by arthropods and other noxious animals. In: Rook's Textbook of Dermatology. Vol 2. 7th ed. Malden, MA: Blackwell Publishing; 2004:33.8 - 11.

  3. Auerbach PS. Arthropod envenomation and parasitism. In: Wilderness Medicine. 5th ed. Philadelphia, PA: Mosby Elsevier; 2007:969-974.

  4. Mandell GL, Bennett JE, Dolin R. Infectious diseases and their etiologic agents. In: Principles and Practice of Infectious Diseases. Vol 2. 5th ed. Philadelphia, PA: Churchill Livingstone; 2000:2976-2979.

  5. Cestari TF, Pessato S, Ramos-e-Silva M. Tungiasis and myiasis. Clin Dermatol. Mar-Apr 2007;25(2):158-64. [Medline].

  6. Masoodi M, Hosseini K. External ophthalmomyiasis caused by sheepbotfly (Oestrus Ovis) larva: a report of 8 cases. Arch Iran Med. 2004;7:136-139.

  7. Aydin E, Uysal S, Akkuzu B, et al. Nasal myiasis by fruit fly larvae: a case report. Eur Arch Otorhinolaryngol. Dec 2006;263(12):1142-3. [Medline].

  8. Sharma H, Dayal D, Agrawal SP. Nasal myiasis: review of 10 years experience. J Laryngol Otol. May 1989;103(5):489-91. [Medline].

  9. Terterov S, Taghva A, MacDougall M, Giannotta S. Posttraumatic human cerebral myiasis. World Neurosurg. May 2010;73(5):557-9. [Medline].

  10. Garvin KW, Singh V. Case report: cutaneous myiasis caused by Dermatobia hominis, the human botfly. Travel Med Infect Dis. May 2007;5(3):199-201. [Medline].

  11. Ofordeme KG, Papa L, Brennan DF. Botfly myiasis: a case report. CJEM. Sep 2007;9(5):380-2. [Medline].

  12. Quintanilla-Cedillo MR, Leon-Urena H, Contreras-Ruiz J, Arenas R. The value of Doppler ultrasound in diagnosis in 25 cases of furunculoid myiasis. Int J Dermatol. Jan 2005;44(1):34-7. [Medline].

  13. Lebwohl MG, Heymann WR, Berth-Jones J, Coulson I. Myiasis. In: Treatment of Skin Diseases. Comprehensive Therapeutic Strategies. 2nd ed. Elesevier-Mosby; 2006:420-421.

  14. Osorio J, Moncada L, Molano A, et al. Role of ivermectin in the treatment of severe orbital myiasis due to Cochliomyia hominivorax. Clin Infect Dis. Sep 15 2006;43(6):e57-9. [Medline].

  15. Costa DC, Pierre-Filho Pde T, Medina FM, Mota RG, Carrera CR. Use of oral ivermectin in a patient with destructive rhino-orbital myiasis. Eye. Sep 2005;19(9):1018-20. [Medline].

  16. Clyti E, Nacher M, Merrien L, et al. Myiasis owing to Dermatobia hominis in a HIV-infected subject: Treatment by topical ivermectin. Int J Dermatol. Jan 2007;46(1):52-4. [Medline].

 
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Mature larva of the Dermatobia hominis fly; rows of hooks apparent on its tapered body. Image courtesy of Kenneth E Greer.
Boil-like lesion on toe of a patient with botfly myiasis; the central punctum is apparent. Image courtesy of Kenneth E Greer.
Boil-like lesions on a patient with botfly myiasis; the central punctum is apparent. Image courtesy of Kenneth E Greer.
Suffocation technique. Placement of a beef strip over the central punctum to coax larvae to exit. Image courtesy of Kenneth E Greer.
 
 
 
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