GD11 An atypical presentation of cutaneous myiasis of the scalp

Abstract

Myiasis is an ectoparasitic infestation caused by larvae of arthropods in the order Diptera. Cutaneous myiasis is the infection of skin and includes the following types: furuncular, migratory and wound myiasis. Out of all the organisms responsible for this disease, Wohlfahrtia vigil is the most common causative agent in Pakistan, usually seen from June to September, with nearly all patients presenting at a young age. In our case a patient without a history of trauma, skin erosion or animal exposure portrayed a unique presentation. Here, an effort was made to treat a 15-year-old otherwise healthy girl with an unusual presentation of cutaneous myiasis with a multisegmented treatment modality. Follow-up visits were conducted every 3 days for 3 months, at the end of which a 60% decrease in the size of the open wound was seen. Myiasis is a rare but preventable disease, which is very likely to spread in the rural population, the majority of Pakistan. Poor hygiene status, overcrowding and the presence of stray animals provide a breeding ground for the botfly responsible for myiasis. The population needs to be educated regarding good personal and social hygiene, especially in areas where flies are inherent and can cause direct inoculation. However, direct inoculation can be considered a mode of transmission despite good personal hygiene, as in this atypical presentation. Measures should be taken to keep residential areas and farms separate, to dispose of waste away from homes, and to use nets and insecticides while sleeping outside. Educational camps should be set up to spread awareness regarding myiasis, especially cutaneous myiasis of the oral cavity, ear and scalp, which needs to be diagnosed early due to proximity to the brain. Timely removal of larvae and irrigation of the area can prevent detrimental side effects and comorbidities.