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Case Report

Indian Pediatr 2011;48: 321-323

Umbilical Myiasis in Newborn

 

Taraknath Ghosh, Kaustav Nayek, Nilanjan Ghosh and *Mrinal Kanti Ghosh

From the Departments of Pediatrics and *Radiology, Burdwan Medical College & Hospital, Burdwan, West Bengal, India.

Correspondence to: Dr Taraknath Ghosh, Doctors Qtr No 22, block-3, Baburbag, Burdwan Medical College,
Burdwan, WB 713 104.
Email: [email protected] 

Received: October 5, 2009;
Initial review: November 10, 2009;
Accepted: January 4, 2010.

 


Umbilical myiasis is rare in newborns. We are reporting two cases of umbilical myiasis from rural West Bengal (India) that were infected by larval forms of blow fly (Chrysomya megacephala). One of them subsequently developed septicemia while the other one was clinically well.

Keywords: Myiasis, Neonate, Umbilical.


M
yiasis is an animal or human disease caused by the immature stage (maggots) of flies which feed on the host’s necrotic or living tissue[1]. Myiasis may affect humans reared in poor hygienic conditions. It is more common in children less than five years of age and with a rural background [2]. Myiasis in the human neonatal period is a rare occurrence and almost exclusively found in neotropic areas [3].

Case Report

Case 1: A nine-day-old, tribal male baby, born at home out of non consanguineous marriage belonging to a poor socioeconomic status from rural Bengal was admitted with complaints of refusal to suck, and discharge from umbilicus. The baby was born by normal vaginal delivery conducted by a local Dai, cried immediately after birth. Antenatal period was uneventful. Mother had received two doses of tetanus toxoid during pregnancy.

The baby weighed 2.1 kg and was lethargic, with subnormal cry and reflexes. Temperature was slightly elevated. Vitals were stable and anterior fontanel was soft and pulsatile. Abdomen was slightly distended, liver and spleen was just palpable and soft. Foul smelling purulent discharge from umbilicus with periumbilical flaring was noted. On close observation after removal of pus with sterile cotton swab, the tip of some white spindle shaped mobile worm like structures were noted. These on pulling out with forceps proved to be a maggot. Hemogram, urine and CSF analysis were normal. Ultrasound scan of the umbilical area showed another twelve maggots and, as soon as all larvae were out of the epidermis, the cellulites rapidly resolved with no sequelae. Blood culture and culture from the umbilical swab revealed growth of Staphylococcus aureus. The baby was treated with intravenous cefotaxime and netilmycin for 7 days.

Case 2: A six day old female neonate presented with history of something coming out from the umbilical region. This baby was delivered vaginally at our medical college. The intra and post natal events of mother were uneventful and both mother and child were discharged from hospital on next day.

Fig. 1 A few maggots and partially attached gangrenous cord at umbilicus of a newborn.

On examination this neonate weighed 2.8 Kg. Her cry, reflex and activities were satisfactory and all vital parameters were within normal limit. The gangrenous cord was partially attached at umbilicus and movements of some maggots were noted at the umbilicus (Fig 1). In the next 3 hours, 13 maggots bored out of umbilicus following instillation of ether (repellent). Ultrasound examination showed another 6 maggots and they also were removed similarly. Following removal the maggots were preserved in 80% of alcohol and sent to School of Tropical Medicine, Kolkata for microscopic examination and species identification. The maggot was found to be of Chrysomya megacephala. Blood samples were collected from the neonate and all the reports were within normal limits. There was no evidence of sepsis and the infant was discharged from the hospital on the 3rd day under satisfactory physical and clinical condition. 

Discussion

Umbilical myiasis, a type of cutaneous tissue myiasis, is usually produced by larvae of flies which are found in wounds and gangrenous tissue where they act as facultative parasites feeding on necrotic tissue and occasionally healthy tissue. In umbilical myiasis the fly lays eggs on dry skin and the larvae subsequently invade the wound and feed rapaciously on healthy tissue, usually in groups to produce characteristic pocket like injuries. Larvae grow rapidly and reach maturity in 4-8 days [4].

The larvae are removed from the affected site of the host by irrigation, manipulation or surgery [5]. The larvae should be killed in hot water to retain the overall shape as the posterior spiracles are very important for species identification. Identification of the maggot can be crucial in determining pathogenesis and as well as controlling of the disease. Third stage larva is ideal for species identification [5].

Chrysomya megacephala, more commonly known as the Oriental Latrine Fly, is known to breed in human feces, meat and fish. In the rural Indian population, defecating in open air is a common practice. The fly is attracted by feces and lays eggs on them. After landing on feces it lands commonly on human foods and on very rare occasion on open human wounds or on umbilicus of a newborn [6]. These may be the events that lead to umbilical myiasis in the two cases that we have reported.

Acknowledgment: Dr AK Dutta, Associate Professor, Pediatrics, Burdwan Medical College, for his participation in the management of the cases, and Dr Netai Pramank, Assistant Professor, School of Tropical Medicine, Kolkata, for expert comments.

Contributors: All were responsible for patient care and investigation. TG & NG prepared the manuscript. KN organized the management and follow up of the case. MKG was responsible for radiological examination of the babies. All authors read and approved the final manuscript.

Funding: None.

Competing interests: None stated.

References

1. Zumpt F. Myiasis in man and animals in the Old World. 1st edition. London: Butterworths; 1965.

2. Singh I, Gathwala G, Yadav SP, Wig U, Jakhar KK. Myiasis in children: The Indian perspective. Int J Pediatr Otorhinolaryngol. 1993;25:127-31.  

3. Duro EA, Mariluis JC, Mulieri PR. Umbilical myiasis in a human newborn. J Perinatol. 2007;27:250-1.

4. Piangjai S, Siriwattanarungsee S, Sukontason KL, Sukontason K. Morphology and developmental rate of blowflies Chrysomya megacephala and Chrysomya rufifacies in Thailand: application in forensic entomology. Parasitol Res. 2008;102:1207-16.

5. Cook GC, Zumla A. Medical Acarology and Entomology. Manson’s Tropical Disease, 21st edition, Saunders (ELST); 2003. p. 1727-32.

6. Hammack L. Oviposition by screw-worm flies (Diptera: Calliphoridae) on contact with host fluids. J Econ Entomol. 1991;84:185-90.
 

 

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