Treating Parasitic Human Botfly by SOPHIA PARSH and BRIDGET PARSH, Edd, MSN, RN, CNS

Infection Prevention

Treating parasitic human botfly BY SOPHIA PARSH AND BRIDGET PARSH, EdD, MSN, RN, CNS

HE PARASITIC HUMAN Patients with botfly infestation can be extracted by applying botfly is associated with often describe feeling movement pressure to the site or using myiasis, the infection of a under the skin as the larva feeds forceps.3,5 fly larva (maggot) in human and grows, but it does not travel in Other removal techniques are T1 tissue. The most common species, the body. Once mature, the larva likely to be more painful because Dermatobia hominis (human botfly), drops to the ground and pupates the larva has spines that anchors it is a large, free-roaming fly resem- in soil. in the wound.2 In a clinical setting, bling a bumblebee found in tropical Signs and symptoms include a local anesthesia can be used to and subtropical areas, particularly hard, raised lesion and localized paralyze the larvae before extract- Central and South America.1,2 erythema, pain, and edema.2,4 Due ing.2,3 If the late stages of growth During one stage of its life cycle, its to the host’s inflammatory response, include ocular involvement or a larvae develop in the subcutaneous the lesion may contain purulent pediatric scalp infection, larvae tissue of a warm-blooded host, most commonly cattle and dogs, Patients traveling to tropical areas where botflies are causing a raised lesion in the skin endemic should be taught how to recognize a botfly skin that becomes hard and sometimes lesion and should seek medical attention if one appears. painful.2 People rarely acquire this parasite in the US, but those who travel to exudate.2 Other signs and symp- need to be surgically removed by a areas where the botfly is endemic toms include night sweats, nausea, healthcare provider in an outpatient are at risk.1 Because myiasis is not pruritus, and symptoms related to or clinic setting. spread from person to person, the the lesion’s location. For example, a Most reported cases are handled only way to contract it is through lesion near the airway can cause by patients themselves, but the exposure to infested flies, ticks, and dysphagia and dyspnea.3,4 extraction may be extremely painful mosquitoes.1 for those who lack medical knowl- Treatment options and edge. In addition, patients may How infestation occurs nursing care succeed in only partially removing To reproduce, female botflies lay Removing the botfly larva is the the larva, leading to a secondary eggs on blood-sucking arthropods only treatment; antibiotics and other infection.5 such as mosquitoes or ticks. The medications are ineffective, although After larva removal, the wound infested arthropods deposit larvae corticosteroids may be prescribed to should be cleaned daily with soap from the eggs when they bite a manage pruritus.2,3 and water to prevent a secondary human or other mammal. A botfly Suffocation of the botfly is the infection.1 Antibiotics may be larva enters the host’s skin through most common, least painful form of considered.2 Wounds typically the bite wound or a hair follicle and removal. The larva can be suffocated heal without scarring in 1 to 2 burrows to subcutaneous tissue.2 It by covering the openings it uses to weeks.2 grows there for 6 to 10 weeks, breathe with an occlusive dressing breathing through two posterior or substance such as petroleum Patient teaching spiracles that lie flush with the jelly.5 Another suffocation method Teach patients traveling to tropical host’s skin. The resulting boil-like includes placing any type of meat on areas where botflies are endemic lesion, or furuncular myiasis, is top of the lesion for 48 hours in how to recognize a botfly skin commonly misidentified as a hopes that the larva will protrude lesion and to seek medical attention methicillin-resistant Staphylococcus into the meat and away from the if one appears. In addition, advise aureus (MRSA) infection and treated human host.3 After 24 to 48 hours, them to take the following preven- inappropriately with antibiotics.3 the larva will begin to emerge and tive steps.1-3 www.Nursing2019.com July l Nursing2019 l 65

• Review and follow the CDC’s recent travel history when assessing 4. Hoenes C, Atiya S, Bidaisee S. Parasitic botfl y Traveler’s Health guidelines for the patients with a suspicious lesion. infection of a child in central Virginia. JAAD Case Rep. 2017;3(4):362-363. intended destination, available at Educating patients to recognize a 5. Smith SM. Treating infestations of the human wwwnc.cdc.gov/travel. botfly lesion will also help speed up botfl y, Dermatobia hominis. Lancet Infect Dis. 2015; • When spending time outside, the treatment process. ■ 15(5):512. cover your skin to limit the area open to bites from flies, mosquitoes, REFERENCES 1. Centers for Disease Control and Prevention. and ticks, and use insect repellent. Parasites – Myiasis. 2013. www.cdc.gov/parasites/ Sophia Parsh is graduating with a BSN from the Sue • myiasis/index.html. and Bill Gross School of Nursing at the University of When indoors, protect yourself California, Irvine in June 2019. Bridget Parsh is a by using window screens and 2. University of Florida Institute of Food and professor at the Sacramento State (Calif.) School of Agricultural Sciences. Featured Creatures. Common Nursing. mosquito nets. name: human bot fl y, torsalo (Central America), moyocuil (México), berne (Brasil), mucha (Colombia), mirunta (Perú), and ura (Argentina, Paraguay, and Recognizing suspicious Uruguay) scientifi c name: Dermatobia hominis lesions (Linnaeus, Jr.) (Insecta: Diptera: Oestridae). 2008. The authors have disclosed no fi nancial relationships http://entnemdept.ufl .edu/creatures/misc/fl ies/ related to this article. Because botfly infection is rare, it human_bot_fl y.htm. is often misidentified as a MRSA 3. Mahal JJ, Sperling JD. Furuncular myiasis from Dermatobia hominus: a case of human infection. To prevent inappropriate botfl y infestation. J Emerg Med. 2012;43(4): or delayed treatment, ask about 618-621. DOI-10.1097/01.NURSE.0000558094.46217.e1

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