Myiasis in a pregnant woman and an effective, sterile method of surgical extraction

BACKGROUND. Cutaneous myiasis caused by Dermatobia hominis involves the infestation of tissue with dipterous fly larvae and is common in many tropical and subtropical areas. We describe a patient in her sixth month of pregnancy who returned from Belize with myiasis detected in the right popliteal fossa. Multiple surgical techniques have been described in the past outlining various ways to extract the botfly larva. No single standardized technique for surgical extraction of larvae has been adopted. OBJECTIVE. To describe a highly effective, sterile method of extraction used in a pregnant patient with botfly infestation. METHODS. A combination of injection with plain 1% lidocaine, sterile occlusion with polymyxin B sulfate ointment and a cruciform incision was used to extract the larva. RESULTS. The botfly larva was easily and completely extracted without remnants of the larval body being left in the skin. CONCLUSION. The sterile technique we describe allows for quick and easy extraction of the larva without risk of secondary infection or need for antibiotics. This method is especially appropriate for pregnant patients or those with medical conditions precluding a completely competent immune response to potential secondary infection.