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Furuncular myiasis — Clinical Guidelines

Overview

Furuncular myiasis is a parasitic infestation of the skin caused by the larvae of various fly species, commonly affecting travelers returning from endemic tropical regions 1 4. It presents as localized, painful nodules with a central punctum.

Diagnosis

Clinical Presentation: Inflammatory nodule with a central punctum 1.

Travel History: Recent travel to endemic areas (e.g., South America, Africa) 1 4.

Physical Examination: Identification of larva or its exuviae within the nodule 1.

Entomological Identification: Species-specific identification (e.g., Dermatobia hominis, Cordylobia anthropophaga) 1.

Management

First-Line Treatment: Manual extraction of the larva under local anesthesia 1.

Adjunctive Treatments: Topical treatments (e.g., occlusive dressings) may be considered but are not essential 1.

Avoid: Doppler ultrasound and other invasive imaging unless necessary for complex cases 1.

Special Populations

Pediatrics: Manual extraction remains effective and safe; no specific modifications noted 1.

Comorbidities: No specific adjustments to treatment based on comorbidities mentioned; standard manual extraction applies 1.

Key Recommendations

Manual Extraction: Primary treatment for furuncular myiasis, ensuring complete removal of the larva 1 (Evidence: Strong).

Outpatient Management: Most cases can be managed effectively in outpatient settings without hospital referral 1 (Evidence: Moderate).

Avoid Unnecessary Imaging: Doppler ultrasound and other invasive imaging techniques are not routinely required 1 (Evidence: Expert opinion).

References

1 Blaizot R, Vanhecke C, Le Gall P, Duvignaud A, Receveur MC, Malvy D. Furuncular myiasis for the Western dermatologist: treatment in outpatient consultation. International journal of dermatology 2018. link 2 Bosmia AN, Zimmermann TM, Griessenauer CJ, Shane Tubbs R, Rosenthal EL. Nasal Myiasis in Hinduism and Contemporary Otorhinolaryngology. Journal of religion and health 2017. link 3 Jervis-Bardy J, Fitzpatrick N, Masood A, Crossland G, Patel H. Myiasis of the ear: a review with entomological aspects for the otolaryngologist. The Annals of otology, rhinology, and laryngology 2015. link 4 Kitching J. Tropical myiasis: an unwanted holiday souvenir. Journal of accident & emergency medicine 1997. link 5 Deroo H, Jongbloet L, Aelbrecht M, Van Hecke E, Naeyaert JM. Human cutaneous parasitosis: two cases of furuncular and creeping myiasis. Dermatologica 1990. link 6 Miller KB, Hribar LJ, Sanders LJ. Human myiasis caused by Phormia regina in Pennsylvania. Journal of the American Podiatric Medical Association 1990. link

Furuncular myiasis