Point-of-Care Ultrasound Findings in a Case of Botfly Myiasis Contracted in the United States.

Botfly infiltration is a rare cause of pediatric skin manifestations in the United States, but should be considered in nonhealing wounds even in nontravelers. We describe the case of a healthy 6-y-old female who had never traveled outside of the southeast United States, presenting with a nonhealing skin lesion. The point-of-care ultrasound (POCUS) findings suggested subcutaneous parasitic infiltration. This case demonstrates the role of POCUS in identification of subcutaneous parasitic infiltration, and differentiation from other, more common skin lesions.

COMPUTED TOMOGRAPHY OF CUTANEOUS MYIASIS IN AN ORNATE BOX TURTLE (TERRAPENE ORNATA ORNATA).

A juvenile intact female ornate box turtle (Terrapene ornata ornata) was referred for evaluation of right-sided appendicular swelling that was nonresponsive to antimicrobial therapy. Computed tomography (CT) revealed severe soft tissue swelling of the limbs and neck, with multiple associated tortuous gas-filled sinus tracts extending from the cutaneous surface, which contained oblong soft tissue attenuating structures. These CT findings were most consistent with migrating dipterous larvae. Surgical exploration was performed and six sarcophagid larvae (Superfamily Oestroidea) were extracted. To our knowledge, this is the first case report in veterinary medicine providing antemortem CT imaging features of cutaneous myiasis in a reptile.

Cutaneous myiasis in cats and dogs: Cases, predisposing conditions and risk factors.

Two cases of cutaneous myiasis diagnosed in 2018 in Emilia-Romagna region (northern Italy) were reported. The first one, described in a domestic cat Felis silvestris catus L. (Carnivora: Felidae) and caused by Calliphora vicina Robineau-Desvoidy (Diptera: Calliphoridae), was the first one of this type ever reported in Italy in cats. The second one was described in a domestic dog Canis lupus familiaris L. (Carnivora: Canidae) and caused by Lucilia sericata (Meigen) (Diptera: Calliphoridae) and was unusual because it occurred in absence of lesions. An extensive literature search on cutaneous myiasis in these two domestic animal species was performed in order to draw attention to predisposing conditions and risk factors.

Urogenital myiasis caused by Lucilia sericata (Diptera: Calliphoridae) in a domestic rabbit in Italy.

The report describes a case of urogenital myiasis in a domestic rabbit Oryctolagus cuniculus L. (Lagomorpha: Leporidae) caused by Lucilia sericata (Meigen; Diptera: Calliphoridae) in region Emilia-Romagna (Northern Italy). The case, occurring in June 2018, is the first one involving L. sericata as an agent of myiasis in a domestic rabbit in Italy. Species identification was based on morphological investigations of males through identification keys. The rabbit developed the urogenital myiasis as a consequence of chronic enteritis causing an accumulation of faeces in the perianal and perineal region.

Dermatobia hominis misdiagnosed as abscesses in a traveler returning from Brazil to Denmark.

We present the case of a 62-year-old woman that consulted us for two boil-like lesions on her thighs after returning from a trip to São Paulo, Brazil, where she had swum in a freshwater lake. After consulting three specialist doctors and undergoing two antibiotic treatments, she was diagnosed with furuncular myiasis caused by Dermatobia hominis. The parasites were excised with no complications.

Postoperative Wound Myiasis Caused by Sarcophaga carnaria.

Myiasis is a parasitic infection caused by dipteran larvae settling in living tissue and organs. Infestation is generally found in tropical and rural areas, where interaction with animals is common. It is diagnosed based on the evidence of the existence of dipteran larvae in tissues and organs. When planning the treatment, identifying the type of larvae is as important as identifying the infected organ or system. In this case report, we present the case of a female who had a biliary tract injury caused by laparoscopic cholecystectomy and who developed a postoperative enterocutaneous fistula and myiasis caused by third-stage Sarcophaga sp. larvae at the incision area.

Ultrasound Visualization of Atypical Abscess Ultimately Containing Bot Fly Larva.

BACKGROUND: Because of the rise in community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA), presentations to the emergency department for the evaluation of cutaneous abscesses have risen dramatically over the past 2 decades. Soft tissue point of care ultrasound (POCUS) differentiates abscess from cellulitis, determines the size and shape, and characterizes the contents of the abscess. It has been shown to improve medical decision-making and therefore the emergency management of cutaneous abscesses over physical examination alone. CASE REPORT: We report a case of an unusual nonhealing abscess in an 18-year-old woman with a recent history of foreign travel where soft tissue POCUS identified motion within the abscess pocket. This changed the management of the case, leading to the diagnosis of bot fly myiasis. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Clinicians should entertain a broader differential for an apparent abscess and consider liberal use of soft tissue POCUS in these cases.

Botfly larva masquerading as periorbital cellulitis: identification by point-of-care ultrasonography.

Myiasis, or the infiltration of the botfly larvae, is a relatively frequent problem encountered by travelers to parts of Latin America. This is a novel case report that documents a Dermatobia hominis infestation of the left facial region with secondary periorbital cellulitis diagnosed by point-of-care ultrasonography.

Orbital myiasis complicating squamous cell carcinoma in xeroderma pigmentosum.

Ophthalmomyiasis is a rare infection seen in susceptible individuals. We report a case of orbital myiasis in squamous cell carcinoma (SCC) in a patient of xeroderma pigmentosum. On presentation, reddish brown ulcerated mass with numerous maggots in orbit were seen. Computed tomography scan showed the presence of soft tissue lesion without any bony destruction. Following debridement, emergency exenteration with sacrifice of eyelid skin was performed. The diagnosis of SCC was confirmed on histopathologic evaluation. The maggots belonged to family Calliphoridae and secondary bacterial infection with Klebsiella organism was identified. Management issues included extensive involvement requiring exenteration, non-availability of skin graft, delayed secondary healing and recurrence of pigmented lesions in skin lining of orbit. The skin grafting was avoided as it can harbour the neoplasm.

Identification of subcutaneous myiasis using bedside emergency physician performed ultrasound.

BACKGROUND: Subcutaneous myiasis, a maggot infiltration of human tissue, is common in tropical countries. However, physicians in the United States may be unlikely to consider this etiology of dermatologic abnormalities even when a travel history suggests the diagnosis should be included in the differential. CASE REPORT: We report the case of a patient who returned from Sierra Leone with an infestation of a maggot of Cordylobia anthropophaga (tumbu fly) that was diagnosed and appropriately treated based on ultrasound findings. CONCLUSION: As international travel increases, clinicians should maintain a high level of suspicion for tumbu fly infestation in returned travelers from endemic areas. The increasing use of ultrasound in the Emergency Department for evaluation of skin and soft tissue infections may aid the physician in making the diagnosis of subcutaneous myiasis.