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| CASE REPORT |
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| Ahead of print publication |
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Cutaneous myiasis (Cordylobia Anthropophaga): An interesting case report of a patient returning back from Central Africa
Ravishekar N Hiremath1, Anuj Bhatnagar2, Chetan C Patil2, Renu Kandpal3, Sunmeet Sandhu2, Audukoori Sreenivas1
1 Department of Community Medicine, AFMS, New Delhi, India
2 Department of Dermatology, Command Hospital Air Force, Bangalore, India
3 Department of Dermatology, AFMS, New Delhi, India
| Date of Submission | 14-Aug-2021 |
| Date of Decision | 10-Oct-2021 |
| Date of Acceptance | 17-Oct-2021 |
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Correspondence Address:
Chetan C Patil,
Department of Dermatology, Command Hospital Air Force, Bangalore
India
 Source of Support: None, Conflict of Interest: None DOI: 10.4103/mjdrdypu.mjdrdypu_675_21
Myiasis is a disease caused by the larvae of Diptera flies infesting living tissue. The most common type of myiasis is cutaneous involvement. Imported infections are becoming more common as a result of international travel to tropical regions. After a 3 month stay in Congo, a 29-year-old developed furuncular myiasis on returning to India.
Keywords: Cordylobia anthropophaga, cutaneous, myiasis
How to cite this URL:
Hiremath RN, Bhatnagar A, Patil CC, Kandpal R, Sandhu S, Sreenivas A. Cutaneous myiasis (Cordylobia Anthropophaga): An interesting case report of a patient returning back from Central Africa. Med J DY Patil Vidyapeeth [Epub ahead of print] [cited 2023 Mar 20]. Available from: https://www.mjdrdypv.org/preprintarticle.asp?id=339186 |
| Introductory | |  |
Myiasis is a fly larvae infection of the skin or other organs that lasts for a few days. The larvae form boil-like sores on the skin. Patients frequently describe creeping feelings and agony. Following the larvae's maturation, they experience spontaneous exiting and healing. A case study of a traveler returning from the Central African Republic is shown here. He has no history of insect bites. The sores occurred on skin that had not been exposed to the sun. The larvae were morphologically characterized to determine the particular diagnosis, which revealed Cordylobia anthropophaga, the most common form of myiasis in Africa. Here, we report a case of cutaneous myiasis.
| Case Report | | |
The individual was well built with no known comorbidities and was apparently normal till he developed multiple erythematous papulonodular lesions over his left inguinal area. Subsequently, similar lesions appeared over his trunk and left lower limb. Over the next 4 days, the lesions increased in size and were associated with pain and redness. The patient had a travel history. He returned from Congo 9 days ago (Central), where he stayed for about 3 months and was asymptomatic during this period.
With these symptoms, the patient reported to OPD. Initially, a differential diagnosis of multiple furunculosis was kept. On exertion of pressure over the lesions to express pus, live single maggots of varying sizes were extruded and were seen in each lesion. Maggots were proportional in size to the cutaneous lesion. The largest lesion was present over the left inguinal area. No other constitutional symptoms are present.
Multiple polysized tenders, erosive ulcerative plaque lesions with minimal tenderness [Figure 1] over erythematous base were found in the right abdominothoracic region, left inguinal, left upper thigh, associated with oozing, and on pressure expressed live maggots. Largest sized larva measured 15 mm and was pearly white with light brown marginal streaks showing unidirectional movement [Figure 2]. One maggot was present per lesion. | Figure 1: Multiple polysized tender, erosive-ulcerative plaque lesions over erythematous base over different parts of body
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The individual was treated by incision drainage and oral antibiotics. The patient was followed up for 3 months. The lesions healed with normal skin.
| Discussion | | |
The live maggots were identified as larvae of Cordylobia anthropophaga and could survive for only 1 day when taken out of the body.
Cordylobia spp. anthropophaga (the mango fly, tumbu fly, tumba fly, putzi fly, or skin maggot fly) is a species of blow fly common in East and Central Africa. It is a parasite of large mammals (including humans) during its larval stage.[1] A mango fly has been endemic in the subtropics of Africa for more than 135 years and is a common cause of myiasis in humans in the region.[2]
This condition is not found in our subcontinent. Its specific epithet, anthropophaga, derives from the Greek word anthropophagos, “human eater.” The larvae of the tumbu fly, C. anthropophaga, were first described in Senegal in 1862.[3]
Life cycle
Female tumbu flies deposit 100–300 eggs in sandy soil, often contaminated with animal feces. The hatched larvae can remain viable in the soil for 9–15 days until they need to find a host for development.[4] If a larva finds a host, it will penetrate the skin and take 8–12 days to develop through three larval stages before it reaches the prepupal stage. It will then leave the host, drop to the ground, bury itself, and pupate. It then becomes an adult fly able to reproduce and begin the cycle all over again.
In humans, it rarely causes severe problems but successful penetrations cause furuncular myiasis, which typically appears on the backs of the arms or around the waist, lower back, or buttocks. At first, the host may experience only intermittent, slight itching, but pain develops and increases in frequency and intensity as the lesions develop into a furuncle. The furuncle's aperture opens, permitting fluids containing blood and waste products of the maggot to drain.
Transmission
Female mango flies lay their eggs in soil contaminated with feces or urine or on damp clothing or bed linens. Damp clothing hanging to dry makes for a perfect spot. The larvae hatch in 2–3 days and attach to unbroken skin and penetrate the skin, producing swelling. If the larvae hatch in the soil, any disturbance of the soil causes them to wriggle to the surface to penetrate the skin of the host.
Many animals are hosts to C. anthropophaga. The dog is the most common domestic host and several species of wild rats are the preferred field hosts. Domestic fowl are dead-end hosts, meaning that the larvae cannot develop when they enter the tissue of a fowl. Humans are accidental hosts.[2]
Cutaneous myiasis caused by the tumbu fly should be suspected when a patient who has just spent time in Africa presents with ulcers or boil-like sores. Definitive diagnosis is only possible when the larvae are found. They should be removed and allowed to develop into adult flies for identification purposes.
Treatment modalities consist of occlusion, manual removal, and larvicidal.
Occlusion with petrolatum, animal fat, beeswax, paraffin, hair gel, or mineral oil can be used. The occlusive substance is placed over the pore area of the furuncle for 24 h. Due to asphyxia, the larva migrates to the skin surface and can be removed manually.
Larvicidal such as ivermectin, mineral oil, ethanol spray, and turpentine can also be used.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient (s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Acknowledgment
We are deeply indebted to the patient and his relatives for being exceptionally cooperative in all the diagnostic procedures and the repeated examination.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Wangia M, Glenn C, Mitchell C, Fisher S. Florid Cordylobia anthropophaga furuncular myiasis from travel in Nigeria. J Dermatol 2012;39:1099-100.  |
| 2. | Adisa CA, Mbanaso A. 'Furuncular myiasis of the breast caused by the larvae of the Tumbu fly ( Cordylobia anthropophaga)'. BMC Surg 2004;4:5. |
| 3. | Ko JY, Lee IY, Park BJ, Shin JM, Ryu JS. A case of cutaneous myiasis caused by Cordylobia anthropophaga larvae in a Korean traveler returning from central Africa. Korean J Parasitol 2018;56:199-203. |
| 4. | Ockenhouse CF, Samlaska CP, Benson PM, Roberts LW, Eliasson A, Malane S, et al. Cutaneous myiasis caused by the African tumbu fly ( Cordylobia anthropophaga). Arch Dermatol 1990;126:199-202. |
[Figure 1], [Figure 2]
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