Cutaneous myiasis in an infant with cerebral palsy.

Sir,

A neglected, 1-year-old infant with cerebral palsy developed a furunculoid lesion on the scalp. Clinical examination led to the diagnosis of cutaneous myiasis due to Dermatobium hominis (human botfly). Furuncular myiasis is most commonly caused by infestation with D. hominis.[1] There is only a single report describing two infants with cerebral palsy manifesting oral myiais,[2] while another report illustrated similar manifestation in an adult.[3] The present report illustrates cutaneous myiasis in an infant with cerebral palsy.

The case patient (Age: 1 year, Gender: Female, Weight on birth: 4 kg) had furunculoid lesions over her scalp for 10 days as reported by her mother, who resided with the infant in a slum area in Delhi, India. The child was not given bath in the last 1 month. The consulting physician prescribed framycetin cream for application on the lesions, which did not provide any relief. Further examination revealed inflammatory nodules occupying the whole vertex of the scalp with central discharging pores [Figure 1], which exuded serosanguineous discharge. There was associated lymphadenopathy of the left preauricular region as well and the child ran fever because of the same. Rest of the mucocutaneous examination was normal. Complete blood counts revealed eosinophilia. Bacterial cultures of the wound discharge revealed Staphylococcus aureus. An X-ray of the skull and CT scan of the head ruled out any bony invasion. An occlusive dressing soaked in liquid paraffin was stuffed in the cavities of the lesions, and 24 hours later larvae were extracted from the same, which was identified to be D. hominis [Figure 2]. For this, amoxicillin-clavulanate was prescribed for oral administration. The lesions had largely regressed over 10 days, but without scarring. The parents were advised to maintain personal hygiene and take anti-fly measures.

Figure 1

Inflammatory nodule over the scalp with central discharging pore

Figure 2

Larval stage of Dermatobium hominis

Furunculoid, migratory, and wound myiasis are the clinical forms of cutaneous myiasis. D. hominis (tropical bot) and Cordylobia (tumbu fly) are the common causative organisms of cutaneous myiasis.[1] Cutaneous myiasis is a clinical diagnosis based on the characteristic morphology and identification of maggots. Furthermore, if the area bearing the lesions is submerged in water, it may form bubbles. Dermatoscopy and skin ultrasound have recently been used as supplements.[1] There have been occasional reports of cutaneous myiasis in the pediatric age group, including reports of 2 children with cerebral palsy, who got afflicted with oral myiasis.[2] Both these children had incompetent lips, anterior open bite, and very poor oral hygiene. Both patients had denuded areas of hard palate anteriorly. However, in the present case, the scalp was affected by furuncular myiasis because of poor hygiene and health neglect. Therefore, it is imperative to ensure adequate hygiene and sanitation and to maintain a high index of suspicion of myiasis with such clinical presentations in patients with cerebral palsy and similar diseases with debility. Treatment of cutaneous myiasis is largely physical as the larvae can be removed by surgical debridement. The usual recommended therapy is blocking the passages where the maggots reside by using petroleum jelly or oil of turpentine. Topical permethrin and ivermectin are the other treatment options.[1] Fatal cerebral myiasis following invasion of the fontanels is a dreaded complication in infants.[4] Cellulitis, abscess formation, tetanus, and osteomyelitis are the other complications.