Cutaneous Myiasis in Traveler Returning from Ethiopia
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LETTERS Cutaneous Myiasis has an opening, through which the She reported that 7 days earlier she larva breaths and discharges its waste had returned from a 1-month trip to in Traveler products. Cutaneous myiasis is usually Ethiopia. During her stay in Ethiopia, Returning from an uncomplicated and self-limiting she had been primarily in rural areas Ethiopia disease. The fl ies have adapted to but did not report contact with sick tropical environments, and spread persons. Her vital signs were normal. To the Editor: Myiasis is an to areas in which this disease is not Physical examination showed infestation of human tissue by the endemic is unlikely. a 2.5-cm2 erythematous area on larval stage of fl ies of the order Diptera. In the emergency department, the lateral aspect of the upper arm There are 3 clinical manifestations of cellulitis or furuncular lesions are (Figure, panel A). There was a myiasis: localized furuncular myiasis common with a broad differential 1-mm central punctum and local typically caused by Dermatobia diagnosis. With the introduction of tenderness. Discharge, streaking, hominis, Cordylobia anthropophaga, bedside ultrasonography in the or proximal adenopathy were Wohlfahrtia vigil, and Cuterebra spp.; emergency department, ultrasono- not present. Other results of the creeping dermal myiasis caused by graphic evaluation of soft tissue examination were noncontributory. Gasterophilus spp. and Hypoderma infections is more accurate than Results of a complete blood count spp.; and wound and body cavity clinical examination in detecting and liver function tests were within myiasis caused by Cochliomyia abscesses (8,9). Ultrasonographic reference ranges. Results of a chest hominivorax, Chrysomya bezziana, examination of soft tissue infections radiographic were normal. and Wohlfahrtia magnifi ca (1). The enables more accurate localization of Bedside ultrasonography was Tumbu fl y (C. anthropophaga) and an associated abscess and the potential performed to assess possible abscess. the human botfl y (D. hominis) are to more specifi cally identify etiology During ultrasonography, the patient the most common vectors for myiasis such as a foreign body (10). We report reported a biting sensation and in Africa and the tropical Western a rare case of cutaneous myiasis increased pain in the area of the Hemisphere, respectively (2). The caused by C. rodhaini larvae in a lesion. Ultrasonographic images genus Cordylobia also contains 2 less traveler returning from tropical Africa. of the lesion showed an area of common species (C. ruandae and The patient was a 26-year-old spontaneous movement just below the C. rodhaini) (3). Infection with C. woman who came to the emergency skin, suggestive of cutaneous myiasis rodhaini (Lund’s fl y) is less common. department at Toronto East General (online Video, wwwnc.cdc.gov/EID/ A review of the literature showed Hospital with a 10-day history of a article/17/12/11-1062-V1.htm). only 7 reports of C. rodhani myiasis painful red lesion on her left upper Treatment for myiasis can be in travelers from countries such as arm. She had fi rst assumed it to be an conservative or surgical. Surgical Australia (3), Italy (4), Canada (5), insect bite, but during the preceding treatment consists of mechanical France (6), and Israel (7). All travelers few days the swelling had greatly removal of the larva. After were infested after travel to eastern increased. She had no constitutional consultation with infectious disease and western regions of central Africa. symptoms other than a persisting specialists, we covered the lesion In humans, the skin lesion starts as mild cough for which she had taken a with standard lubricating jelly and a painful red papule that gradually 5-day course of amoxicillin ≈2 weeks Op Site Flexfi x transparent adhesive enlarges and develops into a furuncle. before coming to the hospital. Her (Smith and Nephew, St. Laurent, Typically, the center of the lesion medical history was noncontributory. Quebec, Canada) to obtain a seal. Figure. A) Lateral aspect of the upper arm of a 26-year-old woman showing cutaneous myiasis and an erythematous lesion 2.5 cm in diameter, Canada. B) Cordylobia rodhaini larva (length ≈1 cm) isolated from the erythematous lesion. Scale bar = 10 mm. C) Characteristic posterior spiracles of a C. rodhaini larva. Scale bar = 3 mm. A color version of this fi gure is available online (wwwnc.cdc.gov/EID/ article/17/12/11-1062-F1.htm). Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 17, No. 12, December 2011 2385 LETTERS Approximately 45 minutes later, a 2. White GB. Flies causing myiasis. In: Brucella suis 1-cm, white–yellow larvae emerged Cook GC, Zumla AJ, editors. Manson’s tropical diseases. London: W.B. Saunders; Infection in Dogs, from the area and was removed intact 1996. p. 1661–3. with the dressing (Figure, panel B). 3. Geary MJ, Hudson BJ, Russell RC, Georgia, USA C. rodhaini was identifi ed by its Hardy A. Exotic myiasis with Lund’s characteristic posterior spiracles and fl y (Cordylobia rodhaini). Med J Aust. To the Editor: Brucellosis is a 1999;171:654–5. the pattern of the larvae (Figure, panel serious, globally distributed zoonotic 4. Pampiglione S, Schiavon S, Candiani G, disease. Humans are susceptible to C). Another occlusive dressing was Fioravanti ML. Clinical and parasitologi- applied before patient discharge. At cal observations on a case of disseminated infection by Brucella suis, B. abortus, follow-up 4 days later, the lesion was furuncular myiasis caused by Cordylobia B. melitensis, and B. canis and can rodhaini in a man in Ethiopia [in Italian]. no longer symptomatic and the patient have lifelong symptoms of undulating Parassitologia. 1991;33:159–67. fever, enlarged lymph nodes, malaise, refused further treatment. 5. Scholten TH, Hicks RJ. Myiasis by Physicians should consider Cordylobia rodhaini contracted in Africa and arthritis (1). In 2009, the United myiasis in patients who have a and diagnosed in Canada. Can J Public States was offi cially classifi ed free of Health. 1973;64:488–9. furuncular lesion after returning B. abortus. All states except Texas are 6. Kremer M, Lenys J, Basset M, Rombourg classifi ed as stage III (free) for swine from tropical countries. Bedside H, Molet B. 2 cases of Cordylobia rho- ultrasonography rapidly confi rmed daini myiasis contracted in Cameroon and brucellosis caused by B. suis (2). the diagnosis of myiasis, enabling diagnosed in Alsace [in French]. Bull Soc Consumption of unpasteurized Pathol Exot Filiales. 1970;63:592–6. immediate and appropriate treatment. dairy products confers the highest risk 7. Tamir J, Haik J, Schwartz E. Myiasis for brucellosis in disease-endemic Travelers should be aware of this with Lund’s fl y (Cordylobia rodhaini) in potential infestation with the less travelers. J Travel Med. 2003;10:293–5. areas (3). However, hunters and common Lund’s fl y and not only avoid doi:10.2310/7060.2003.2732 owners of hunting dogs are at high risk 8. Tayal VS, Hasan N, Norton HJ, To- direct contact with clothes left outside for transmission of brucellosis from maszewski CA. The effect of soft tis- wildlife. Sporadic transmission of B. but also avoid direct contact with sue ultrasound on the management of infested material (5). cellulitis in the emergency department. canis from pet dogs to their owners Acad Emerg Med. 2006;13:384–8. has been reported (4–6). We describe doi:10.1111/j.1553-2712.2006.tb00314.x a recent increase in B. suis detection Acknowledgments 9. Squire BT, Fox JC, Anderson C. AB- in dogs in southern Georgia, USA, and We thank clinical laboratory staff SCESS: applied bedside sonogra- caution the public about the potential and public health departments for expert phy for convenient evaluation of superfi cial soft tissue infections. for transmission to humans in contact assistance. Acad Emerg Med. 2005;12:601–6. with infected dogs and wild hogs. doi:10.1111/j.1553-2712.2005.tb00913.x Smooth Brucella spp. express the Paul Hannam, Krishna Khairnar, 10. Banerjee B, Das RK. Sonographic de- James Downey, Jeff Powis, tection of foreign bodies of the ex- immunodominant O side chain on the Filip Ralevski, tremities. Br J Radiol. 1991;64:107–12. lipopolysaccharide of their surface. doi:10.1259/0007-1285-64-758-107 and Dylan R. Pillai1 Therefore, this side chain forms the Author affi liations: Toronto East General antigenic basis of diagnostic tests, Address for correspondence: Dylan R. Pillai, such as the card test. The B. abortus Hospital, Toronto, Ontario, Canada Division of Microbiology, Department of (P. Hannam, J. Downey, J. Powis); plate antigen (BAPA) test can detect Pathology and Laboratory Medicine, Diagnostic smooth species. Because B. canis Ontario Agency for Health Protection and Scientifi c Centre, Calgary Laboratory and Promotion, Toronto (K. Khairnar, F. does not express the O side chain on Services, Rm C4119, 3535 Research Rd NW, its surface, serologic tests for B. canis Ralevski, D.R. Pillai); and University of Calgary, T2L 2K8, Alberta, Canada; email: Toronto, Toronto (D.R. Pillai) differ from tests for B. abortus, B. [email protected] suis, or B. melitensis (7). Therefore, DOI: http://dx.doi.org/10.3201/eid1712.111062 B. suis–infected dogs are unlikely to have positive results for B. canis tests References and vice versa. 1. Maguire JH, Spielman A. Ectoparasite in- During June 2010–July 2011, a festations and arthropod bites and stings. total of 674 canine serum samples In: Fauci AS, Braunwald E, Isselbacher submitted by veterinarians servicing KJ, Wilson JD, Martin JB, Kasper DL, et al, editors. New York: McGraw Hill; 207 kennels or pet owners in Georgia 1998. p. 2250. were tested by using the BAPA and card agglutination tests. Positive 1 Current affi liation: Calgary Laboratory dogs were not detected until late Services, Calgary, Alberta, Canada.