|Year : 2017 | Volume
| Issue : 2 | Page : 121-123
Neonatal umbilical myiasis
Mritunjay Kumar, Kanchan Chand Thakur, Rohit Chib, Girish Gupta
Department of Paediatrics, SGRR Institute of Medical and Health Sciences, Dehradun, Uttarakhand, India
|Date of Web Publication||13-Apr-2017|
Department of Paediatrics, SGRR Institute of Medical and Health Sciences, Dehradun - 248 001, Uttarakhand
Source of Support: None, Conflict of Interest: None
Myiasis is an infection of live mammalian tissue by the larvae of dipterous flies and commonly found in the tropical and subtropical area. It usually infects domestic and wild animals, but rarely affects humans as well. Neonatal umbilical myiasis is an unusual occurrence with only a few reported cases in the literature. We report a case of an 8-day-old neonate from a rural area who presented with umbilical myiasis caused by larval form of Chrysomya megacephala.
Keywords: Chrysomya, myiasis, neonate, umbilical
|How to cite this article:|
Kumar M, Thakur KC, Chib R, Gupta G. Neonatal umbilical myiasis. J Clin Neonatol 2017;6:121-3
| Introduction|| |
Myiasis is a rare form of infestation caused by larvae of the dipterous fly. It is mainly observed in tropical and subtropical regions where basic sanitation is lacking. Although umbilical myiasis is well recognized in animals, infestation of human umbilical cord is a rare occurrence and almost exclusively found in neotropic areas. Warm and moist nature of umbilical stump attracts gravid female flies to lay eggs if a neonate is kept in an unhygienic environment. The accompanying omphalitis provides the required nutritive support for hatching of eggs and further development into the larval form.
| Case Report|| |
An 8-day-old neonate, delivered vaginally at term with an uneventful intrapartum and postpartum period, was brought to the Neonatal Intensive Care Unit with complaints of worms coming out of umbilical stump for 2 days. The neonate was delivered at a local quack's clinic with a history of cord being cut and tied in an unhygienic condition. There was no history of any specific application over the umbilical cord. The neonate was on exclusive breast feeds since birth, and no prelacteals were given. There was history of previous sibling death at 1 h of birth. Repeated inquiries directed toward possible etiologies for early neonatal death were not good enough to reach the diagnosis. It was mainly due to the poor educational status of the parents and delivery at a local quack's clinic during previous pregnancy. At admission, the neonate was active, alert and had normal tone and reflexes. There was no history of refusal to feed, fever, lethargy, excessive cry, abnormal body movements or posturing, and bleeding from any site. On examination, weight was 3000 g, temperature 98.7°F, respiratory rate 38/min, heart rate 130/min, SpO2 100% on room air, and capillary refill time 2 s. There was poor umbilical hygiene associated with foul-smelling dark brownish discharge and periumbilical cellulitis. Multiple whitish mobile worms were noted coming out from the umbilical stump following antiseptic cleaning of the stump [Figure 1]. The abdomen was soft, nontender, and there was no hepatosplenomegaly. Anterior fontanelle was soft, and cardiorespiratory examination was unremarkable. Cultures of blood, urine, and umbilical pus were obtained. Sepsis screen, blood sugar, serum electrolytes, blood urea, and serum creatinine levels were sent as well. The neonate was started on intravenous ampicillin (100 mg/kg/day) and gentamicin (5 mg/kg/day). As the mother was not sure of her tetanus immunization status, 1 dose of prophylactic tetanus toxoid was administered to the neonate at admission. Ether was applied over the umbilicus, and more than 50 maggots were removed. Retrieved maggots were preserved in formalin and later sent to microbiology department for species identification. Complete blood count showed a hematocrit of 53%, and hemoglobin was 17.7 g/dl. Total leukocyte count was 15,880/mm 3 with a differential count of 9% band forms, 40% neutrophils, 46% lymphocytes, 3% eosinophils, and 2% monocytes. C-reactive protein (immunoturbidimetry method) was 6.17 mg/L (normal range 0–6 mg/L), and microerythrocyte sedimentation rate was found to be 8 mm/1st h. Blood sugar, serum Na/K/Ca, blood urea, and serum creatinine values were within normal limits. Sepsis screen was negative, and none of the cultures showed any growth. The dead larvae were examined microscopically after being cleaned in saline solution. They were identified as third-stage instar larva of Chrysomya megacephala. Ultrasound scan of the abdomen showed no residual worms, collection, or abscess. Periumbilical cellulitis resolved completely following removal of all the maggots [Figure 2]. Antibiotics were stopped once confirmed culture reports were available, and the neonate was discharged in a satisfactory condition.
| Discussion|| |
Myiasis has been classified according to the anatomic site of infestation (i.e., aural myiasis, ophthalmomyiasis, or cutaneous myiasis) or on the basis of the clinical syndrome (i.e., furuncular cutaneous myiasis, migratory cutaneous myiasis, or wound myiasis). Umbilical myiasis, a type of cutaneous tissue myiasis, is usually produced by larvae of dipterous flies which are found in wounds and gangrenous tissue where they act as facultative parasites. The flies lay eggs on dry skin, and the larvae subsequently invade the wound where they grow rapidly and reach maturity in 4–8 days. The role of natural mummification of fetal tissue during umbilical separation as a risk factor for myiasis is not very clear. Identification of species of maggots is extremely crucial in understanding pathogenesis and determining control measures for myiasis. Third-stage larva has been found to be ideal for species identification.C. megacephala commonly known as the oriental latrine fly or blow fly, breeds on human feces. They land commonly on foods, open wounds, or rarely newborn umbilicus. It creates a port of entry for skin flora which may be the pathogenesis for Staphylococcus sepsis. Therefore, antibiotic coverage against Staphylococcus aureus is crucial to manage omphalitis associated with neonatal sepsis. Effective management of myiasis consists of removal of the larvae, cleaning of the wound, and use of local antiseptics and systemic antibiotics to control any possible associated infection. When there are multiple larvae, adjuvant measures such as treating the area with ether or other solvents have been advocated in literature. These solvents irritate the maggots causing larval asphyxia and forcing them to come out of their hiding place. Local application of several substances such as turpentine oil, mineral oil, ether, chloroform, ethyl chloride, mercuric chloride, phenol, olive oil, or iodoform results in complete removal of all larvae. Subsequently, they can be removed from the affected site by irrigation, manipulation, or surgery. Surgery is usually unnecessary while the larvae are alive but indicated for the removal of dead or decayed larvae from the affected site to prevent secondary infection or sepsis.
| Conclusion|| |
Umbilical myiasis is a depiction of poor hygienic condition and improper health education in the community. The prevention of human myiasis requires adequate personal hygiene, screening to protect against flies, good wound care, and the prevention of myiasis in domestic animals. Health-care facilities need to be improved in remote areas of developing countries where institutional deliveries and good perinatal care are still theoretical.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Beeregowda YC, Kiran B, Gowda NY. Neonatal umbilical myiasis with sepsis. Indian J Pediatr 2010;77:1443-5.
Singh AK, Nag SS, Mitra P, Roy A. Neonatal umbilical myiasis. Indian Dermatol Online J 2015;6:312-3.
] [Full text]
Mondal M, Biswas T, Banerji N, Bose S, Biswas B, Mandal PK. Umblical myiasis with sepsis in a neonate. Asian J Med Sci 2014;5:106-7.
Ghosh T, Nayek K, Ghosh N, Ghosh MK. Umbilical myiasis in newborn. Indian Pediatr 2011;48:321-3.
Zupan J, Garner P, Omari AA. Topical umbilical cord care at birth. Cochrane Database Syst Rev 2004;3:CD001057.
Cook GC, Zumla A. Medical acarology and entomology. Manson's Tropical Disease. 21st
ed. Philadelphia: Saunders (ELST); 2003. p. 1727-32.
Gordon PM, Hepburn NC, Williams AE, Bunney MH. Cutaneous myiasis due to Dermatobia hominis
: A report of six cases. Br J Dermatol 1995;132:811-4.
Kumar SL, Manuel S, John TV, Sivan MP. Extensive gingival myiasis – Diagnosis, treatment, and prevention. J Oral Maxillofac Pathol 2011;15:340-3.
[Figure 1], [Figure 2]