Inflammatory papules on the back of a traveling businessman. Tumbu fly myiasis

An exotic abscess within the United Kingdom from The Gambia: a case report

“…To the best of our knowledge, less than ten larvae are usually extracted in an infected patient. However, up to 64 maggots were retrieved from a white soldier based in West Africa and 94 from a child in Ghana [ 14 , 18 ].…”

“…A few cases were reported where patients had fever [ 10 , 19 , 20 , 21 ]. This was the case when there were multiple infestations and subsequently there was an increase in systemic inflammatory markers, eosinophils, and immunoglobulin E level [ 2 , 10 , 19 , 18 ]. Sometimes, the pain and itch could not be borne, which led to extreme agitation, insomnia, and distress in the patient [ 6 , 14 , 18 ].…”

“…This was the case when there were multiple infestations and subsequently there was an increase in systemic inflammatory markers, eosinophils, and immunoglobulin E level [ 2 , 10 , 19 , 18 ]. Sometimes, the pain and itch could not be borne, which led to extreme agitation, insomnia, and distress in the patient [ 6 , 14 , 18 ]. As a result, some patients were diagnosed as having delusional parasitosis due to the sensation of movement or crawling under the skin [ 2 , 14 ].…”

“…Clinical laboratory results are usually normal except in severe multiple infestations, then mild eosinophilia is usually reported. No biopsy is required for diagnosis [ 2 , 10 , 16 , 18 ]. However, knowledge of skin lesion and a good travel history with particular emphasis on specific location, timing, and risk behavior, and physical examination would lead to a correct diagnosis and simple treatment as outlined below.…”

“…During this time, the larvae may fail to wriggle out and die of hypoxia [ 2 ]. Consequently, surgical incision and drainage may be necessary when asphyxiation technique fails or to extract the dead or decaying larvae [ 10 , 14 , 18 ]. It is crucial to avoid rupturing a larva during extraction because a remnant may cause an intense granulomatous inflammation and complicate the wound [ 7 , 16 ].…”