Furuncular cutaneous myiasis after travel in South America: case report and epidemiologic, diagnostic and management considerations.

Abstract

Background: Dermatologic conditions are among the most frequent health problems in international travelers, following gastrointestinal and febrile illnesses. Myiasis, defined as infestation of human tissue by dipterous fly larvae, represents a noteworthy dermatologic diagnosis, particularly in travelers returning from tropical regions. Furuncular myiasis is the most recognizable form, presenting with painful nodules containing larvae, and is commonly caused by Dermatobia hominis in Central and South America. Increasing international travel is expected to raise the incidence of such conditions in non-endemic regions.

Case report and discussions: We report the case of a 77-year-old Romanian male, with co-morbidities, who developed cutaneous furuncular myiasis following a 12-day trip to Brazil and Argentina. The patient presented with painful nodular skin lesions on the upper limb approximately one month after returning. Initial treatments with anti-inflammatory agents and antibiotics were ineffective. Subsequent surgical drainage revealed the presence of larvae, confirming the diagnosis. Complete healing occurred within 2-3 weeks. Based on clinical presentation and travel history, Dermatobia hominis was considered the most probable etiologic agent, although molecular confirmation was unavailable. Discussion highlights the epidemiology and classification of myiasis-producing flies, emphasizing the geographic distribution of Dermatobia hominis and Cochliomyia hominivorax. Furuncular myiasis is often misdiagnosed as cellulitis or abscess due to nonspecific symptoms. Key diagnostic clues include persistent nodules with central punctum, serous discharge, and recent travel to endemic areas. Ultrasound can aid in identifying larvae, while laboratory confirmation enhances epidemiological surveillance. Management typically involves mechanical or surgical larval extraction, wound care, and monitoring for secondary infection. Preventive measures include insect repellents, protective clothing, and use of insecticide-treated nets. This case underscores the need for heightened clinical awareness in non-endemic countries, where travel-related parasitic infections are increasingly encountered. Pre-travel medical consultations are crucial for providing vaccinations, preventive advice, and education on insect protection. While our patient experienced a favorable outcome, delayed diagnosis and lack of preventive measures may increase morbidity.

Conclusion: With the rising popularity of travel to tropical areas, clinicians should consider cutaneous myiasis in travelers with persistent nodular skin lesions. Prompt recognition and extraction of larvae remain the cornerstone of effective treatment.