Kerion-Associated Myiasis in a Child: A Case of Chrysomya bezziana Infestation

A 10-year-old girl presented with a 10-day history of malodorous, painful scalp lesions. She had been diagnosed with kerion, a fungal scalp infection, 1 month earlier and was prescribed oral griseofulvin. However, her parents chose to use neem paste for a week, a traditional remedy, instead. Clinical examination showed two well-defined ulcers of size 1.9 cm × 1.6 cm and 1.5 cm × 1.3 cm filled with larvae; surrounded crusts were seen on the occipitoparietal region of the scalp. Upon removing the paste, multiple white larvae were observed emerging from two ulcers on her scalp [Figure 1]. An entomologist identified the larvae as Chrysomya bezziana, indicating wound myiasis, a condition where fly larvae infest living tissue [Figure 2]. Treatment included manual removal of the larvae with tweezers after applying turpentine oil, followed by wound irrigation with 1% ivermectin solution. The patient was given a tetanus toxoid injection, oral griseofulvin (15 mg/kg/day), and advised to use 2% ketoconazole shampoo three times a week. Within 4 weeks, her scalp condition showed significant improvement [Figure 3a-c].Figure 1: Numerous creamy white larvae were observed emerging from two kerion lesionsFigure 2: Larvae of Chrysomya bezziana taken from the patientFigure 3: (a-c) Clinical resolution of lesions on day 7, day 14, and day 21 after initiation of treatmentMyiasis is a parasitic infestation by the larvae of various fly species (maggots) that affects live or dead human tissue. Common risk factors include poor personal hygiene, intoxication, tropical climate, low socioeconomic status, and open wounds.[1] The clinical forms of cutaneous myiasis are furuncular, migratory, and wound myiasis. Furuncular myiasis occurs when dipteran larvae penetrate healthy skin, forming an erythematous, furuncle-like nodule containing maggots. The most common causes are Dermatobia hominis and Cordylobia anthropophaga. Migratory myiasis, or creeping myiasis, occurs when dipteran larvae migrate through skin burrows, creating a characteristic migratory lesion. Larvae of the genera Gasterophilus and Hypoderma are the main causes in humans. Wound myiasis occurs when fly larvae infest the open wounds of a mammalian host. This infestation can be caused by either facultative or obligatory parasites. The flies that commonly cause wound myiasis are Cochliomyia hominivorax, Chrysomya bezziana, and Wohlfahrtia magnifica. Common complications include local tissue destruction, deeper invasion into tissues, and secondary infections.[1,2] Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.