Aural myiasis in a neonate in peninsular Malaysia

  • Nazni Wasi Ahmad1Email author,

    Affiliated with

    • Anuar Ismail2,

      Affiliated with

      • John Jeffery3,

        Affiliated with

        • Sa'diyah Ibrahim1,

          Affiliated with

          • Azahari Abdul Hadi1,

            Affiliated with

            • Mohd Noor Ibrahim1,

              Affiliated with

              • Heo Chong Chin4 and

                Affiliated with

                • Lee Han Lim1

                  Affiliated with

                  Parasites & Vectors20092:63

                  DOI: 10.1186/1756-3305-2-63

                  Received: 29 September 2009

                  Accepted: 15 December 2009

                  Published: 15 December 2009

                  Abstract

                  Myiasis is a pathological condition in humans and animals caused by various species of dipterous larvae. Myiasis which occurs in a newborn baby is referred as neonatal myiasis. It is a rare condition and there are only a few reports to date. A case of neonatal aural myiasis in a two day old infant is reported in this paper.

                  Findings

                  The first documented case of human myiasis in Malaysia was by Reid [1] of a male who had an ulcer on his big toe infested with the green bottle, Chrysomya bezziana. A review on all human cases of myiasis in Malaysia up to 1984 were classified according to Zumpt's nomenclature [2, 3]. Only a few cases of myiasis have been reported in Malaysia but this could be due to a lack of documentation. In Malaysia, thus far, only 3 cases of aural myiasis have been described [46]. In this paper we report the fourth case of aural myiasis in a 2 day old infant in Malaysia [7].

                  A two day old male infant from Alor Setar, State of Kedah, was discharged from a private specialist medical centre and brought back home. The child was observed to cry often and the parents subsequently brought him to the hospital for medical examination. It was discovered that the left ear was inflamed. On close examination, the medical officer found moving objects in the ear. The objects were carefully removed using fine forceps and were confirmed to be maggots. No damage to the ear drum was observed. After removing the maggots and administration of appropriate medication, the child was discharged. Four maggots in 70% alcohol were sent to the Medical Entomology Unit, Institute for Medical Research, Kuala Lumpur. The specimens were processed for study and identification according to standard procedures [8]. The specimens were examined under a microscope at 400× magnification.

                  Based on the presence of two respiratory slits each in the posterior spiracles, the 4 maggots were identified as second stage maggot of the fly family Sarcophagidae. An important gross taxonomic feature in this family is the nature of the posterior spiracle which is located within a depression/pit at the posterior end of the maggot (Figure 1). Additionally, the maggots were easily recognized as a species of Sarcophagidae by the following features: (i) by the possession of thin incomplete peritreme with respiratory slits directed away from the opening (Figure 2), and (ii) the cephalopharyngeal armature having split dorsal cornu (Figure 3). Flies of this family are larviparous in habit i.e. laying first stage larvae instead of eggs. The mean body length of these larvae was 3.0 ± 0.1 mm indicating that the minimum age of this larvae at the time of removal was at least 12-23 hours old. No attempt was made to identify the specimens to species level as males are needed for this purpose. The adults of these flies can be considered as facultative myiasis producers which opportunistically infest the wounds or body cavities of the host. Human cases of facultative myiasis caused by members of this family Sarcophagidae (Diptera) have been found throughout the world [2, 911]
                  http://static-content.springer.com/image/art%3A10.1186%2F1756-3305-2-63/MediaObjects/13071_2009_Article_111_Fig1_HTML.jpg
                  Figure 1

                  Posterior spiracle (PS) within a depression/pit of Sarcophagidae.

                  http://static-content.springer.com/image/art%3A10.1186%2F1756-3305-2-63/MediaObjects/13071_2009_Article_111_Fig2_HTML.jpg
                  Figure 2

                  Spiracles of a second stage larvae showing 2 slits and incomplete peritreme directed away from opening.

                  http://static-content.springer.com/image/art%3A10.1186%2F1756-3305-2-63/MediaObjects/13071_2009_Article_111_Fig3_HTML.jpg
                  Figure 3

                  Picture showing cephalopharyngeal armature with split dorsal cornu.

                  Occurrence of infestation may be due to a gravid female being attracted to odour emanating from the ear. The presence of these larvae could also indicate that the neonate probably acquired the infestation while in the hospital prior to being discharged. The first case of auricular myiasis in Malaysia was from a ten year old Indian girl infested with third instar larvae of Chrysomya megacephala [4]. The second case was a 41 year old Malay woman from a lower socio-economic environment. The maggots were third instar larvae of the fly Chrysomya bezziana [5], while in the third case Chrysomya bezziana larvae were also recovered from a 41 year old aborigine male [6]. Aural myiasis in adults infested by Sarcophagidae (Diptera) have been reported in other parts of the world [12, 13]. This is the first report of an infant being infested with a species of Sarcophagidae in Malaysia. Myiasis patients should be treated immediately by removing the maggots from the infested area. Although aural and ocular myiasis can be dangerous, they can be treated effectively in neonates with topical and systemic therapies [14].

                  Declarations

                  Acknowledgements

                  The authors wish to acknowledge the Director General of Health, Malaysia, and the Director, Institute for Medical Research, for permission to publish.

                  Authors’ Affiliations

                  (1)
                  Medical Entomology Unit, Infectious Diseases Research Centre, Institute For Medical Research
                  (2)
                  Kedah State Vector Control Program
                  (3)
                  Department of Parasitology, Faculty of Medicine, Universiti Malaya
                  (4)
                  Faculty of Medicine, Universiti Teknologi MARA

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                  Copyright

                  © Ahmad et al; licensee BioMed Central Ltd. 2009

                  This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://​creativecommons.​org/​licenses/​by/​2.​0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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