Case Report
A Rare Case of Neonatal Aural Myiasis in a 17 days Old Neonate.
Authors
Bhavna B Kamble, Assistant Professor,
Shraddha Jain, Professor,
Meenal Gupta, Third year Resident,
Pragya Singh, First year Resident,
Department of Otorhinolaryngology, Jawarhalal Nehru Institute of Medical Sciences, Sawangi, Meghe, Wardha, Maharashtra, India.
Address for Correspondence
Dr Bhavna B Kamble,
Assistant Professor,
Department of Otorhinolaryngology,
Jawarhalal Institute of Medical Sciences,
AVBRH, Sawangi (Meghe),
Wardha - 442001
Maharashtra, India.
E-mail:
kamblebhavna82@gmail.com
Citation
Kamble BB, Jain S, Gupta M, Singh P. A Rare Case of Neonatal Aural Myiasis in a 17 days Old Neonate. Online J Health Allied Scs.
2015;14(1):4. Available at URL:
http://www.ojhas.org/issue53/2015-1-4.html
Open Access Archives
http://cogprints.org/view/subjects/OJHAS.html
http://openmed.nic.in/view/subjects/ojhas.html
Submitted: Jan 7,
2015; Accepted: Mar 20, 2015; Published: Apr 10, 2015 |
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Introduction:
Myiasis in the neonatal period is rare and there are very few reports of neonatal myiasis.Unhygeinic conditions in a rural setting predisposes to this condition. Many cases have been reported in adults but very few have been reported in neonates and children. This case is more interesting as a single maggot was extruded from the ear of a 17 day neonate and that too in a clean neonate from a rural background.
Case Report:
A 17 day old male baby was brought to the casualty in emergency hours by his parents with history of excessive crying and irritability since one day. He had no other symptoms and was feeding well. His parents gave history of right ear bleed since 2 hours. His weight was 3.48 kg. Immediately a call for paediatrician and ENT Surgeon was sent. A surgical call for inguinal swelling on left side was sent. The inguinal swelling on left side had appeared after the baby had excessively cried according to the mother.
On taking history, baby was a full term normal vaginal delivery in labour room of our hospital with birth weight of 2.6 kg. Baby and mother were discharged on 5th day. Perinatal period was normal and no ICU admission was required. Patient stays in village in kuccha house with a cattle shed at a distance of 50 meters from house. Hygeinic conditions around the surroundings were good.
While waiting in emergency room, father observed crawling of a white coloured maggot of size approxmately 4mmx1mm from right external auditory canal of the baby which was collected and kept in glass bottle. There was no history of trauma, ear picking, ear discharge. Blood and debris was observed which was cleaned by a cotton bud. On enquiry, mother gave history of having cattle shed at a distance of 50 meters from the house.
On otoscopic examination,debris was present and external auditory canal was edematous. 4% lignocaine drops and diluted turpentine oil soaked cotton pledget was kept in external auditory canal but no maggot came out. On otoscopy no crawling movement was seen. Maggot was collected and sent to zoologist and grown into a fly of the Order diptera, family Calliphoridae, genus Calliphora.
Routine investigations were as follows: Hemoglobin 11.8 mg/dl, WBC count 7300/cmm, platelet 2.6 lac, blood sugar 93mg/dl, total bilirubin 4.63 mg/dl, indirect bilirubin 4.02mg/dl, direct bilirubin 0.61mg/dl, SGOT 47IU/L, SGPT 19 IU/L, serum urea 22mg/dl, serum creatinine 0.59 mg/dl.
Baby was started on injection ceftriaxone 50mg /kg/ 12 hourly and injection amikacin 7.5 mg /kg /12 hourly with topical ofloxacin, clotrimazole and 4% lignocaine drops. No further maggot came out. Treatment continued for 7 days with daily cleaning of ear with sterile cotton bud. Tympanic membrane was visualised on day 5th of admission was found to be intact. There was no mastoid tenderness. Ear was completely dry on day 7th and baby had no fever. Baby was discharged on 7th day with no sequelae.
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Fig 1: Photograph of the neonate with maggot in right ear |
Fig 2: Photograph of the single maggot |
Discussion:
Myiasis (from the Greek myia, fly) is the invasion of wounds and body tissues of humans and animals by the larvae of the Diptera or two-winged flies for feeding on the host organs and body fluids.[1-8] Myiasis in the neonatal period is rare and there are very few reports of neonatal myiasis, most commonly from the tropics.[1-6] Most patients belong to the poor socioeconomic strata of society, dwelling in overcrowded premises that are often unsuitable for habitation and in a fly-infested environment. Rural agricultural areas and poor personal hygiene are the other predisposing factors for myiasis.[7]
It is a pathological condition in humans.[4] Humans are accidental or facultative host. It is commonly found in summer months.[9] Causative factors are lack of sanitary measures.[10,11] The fly may also drop its eggs while in flight on the skin, wounds or natural openings. Larvae hatched from the eggs can affect cutaneous tissue, body cavities and body organs.[7] Hypoesthesia or decreased consciousness, paralysis and immobility are the contributing factors that prevent the patient from fending off the fly.[7] In our case, a rural background with presence of cattle shed may be a causative factor. The baby was hygienic and kept clean by mother. The fly that caused infestation in our case was Order Diptera, Family Calliphoridae, genus Calliphora. It was a 4mmx1mm larva in 2nd instar stage.
Children are more commonly affected and more than 50% of children are less than 5 years and belong to rural background.[10] In a study by Singh et al, main symptoms in aural myaisis were passage of worms (81.48%), discharge (44.44%), and pain (44.44%).[10] Most reports reveal instillation of few drops of turpentine oil and manual removal of maggots with forceps along with systemic and local antibiotic instillation.[3,12]
Infestations of the nose and ears are extremely dangerous because the larva may penetrate into the brain, and in these cases the fatality rate is reported as 8%. Myiasis may also be accompanied by inflammatory reactions and secondary bacterial infections, massive destruction and life-threatening consequences.[13] Our case was unique as a single maggot was found unlike from many other reported cases where multiple maggots were found. No other case has been reported in literature where a single maggot was found in a clean neonate.
References:
- Jain S, Audhya A, Madhupriya, Nagpure P S. Aural myiasis in a 1-day-old neonate. Indian J Med Sci [serial online] 2008 [cited 2015 Apr 4];62:164-6. Available from: http://www.indianjmedsci.org/text.asp?2008/62/4/164/40581
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- Bapat SS. Neonatal myasis: Electronic article. Peadiatrics 2000;106:6
- Ahmed NW, Ismail A, Jeffery Jet al. Aural myiasis in a neonate in peninsular Myalsia. Parasites & Vectors 2009;2:63. Available at http://www.parasitesandvectors.com/content/2/1/63
- Clark JM, Weeks WR, Tatton J. Drosophila myiasis mimicking sepsis in a newborn. West J Med. 1982 May;136(5):443-4.
- Koh TH. Neonatal myiasis: a case report and a role of the Internet. J Perinatol 1999;19(7):528-9
- Guli J, Yadav S , Khaowas A.
Mastoid cavity myiasis in a Child: A Case Report. The Internet Journal of Tropical Medicine. 2009;6(2). Available at https://ispub.com/IJTM/6/2/4745
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- Ohkawa T. Biotic foreign in otolaryngology. Pract Otol Kyoto 1979;72:1105-1175
- Singh I, Gathawala G, Yadhav SP, Wig U, Jakhar KK. Myasis in children: The Indian Prespective. Int J Pediatr Otorhinolaryngol. 1993,25:127-31
- Uzun L, Cinar F, Beder LB, Aslan T, Altinas K. Radical mastoidectomy myaisis caused by Wohfahrtia magnifica. J Laryngol Otol 2004;118:54-6
- Adegboye AO, Yakubu AO. Aural myiasis in a 2 week old neonate- A Case report.
Nigerian Medical Practitioner 2007;52(4):94-96
- Çetinkaya M, Özkan H, Köksal N, Coskun SZ, Hacimustafaoğlu M, Girişgin O. Neonatal myiasis: a case report.
The Turkish Journal of Pediatrics. 2008 Nov-Dec;50(6):581-4.
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