TO THE EDITOR: A 64-year-old woman ...

TO THE EDITOR: A 64-year-old woman not absented to our Urgent Care center for evaluation of an itchy lesion in succession her right medial lower leg which had lasted for 15 days. She reported having an insect bite forward this area of her leg while in El Salvador. Physical examination revealed a 2-cm violaceous nodule with "pinpoint "central opening and serosanguineous discharge. She was treated for an infected insect bite with cephalexin, 500 mg three times daily. After three days, she showed no improvement. This examination revealed a tiny dark intention protruding from the central punctum With careful lateral influence and traction, a 2-cm -long botfly (Dermatobia hominis) larva was removed

The botfly is base in the forests of Mexico, Central America, and southern America. The gravid female flap usually captures a mosquito and sticks a packet of harasss into its abdomen. When the carrier insect sustains on a warm-blooded animal, the harrys hatch and the larva penetrates the skin. It give food tos on host tissue and maintains a breathing pore in the skin. (1) The larva then goe by means of the second and third stages of maturation. A third-stage larva measures 2 to 3 cm and has riots of spines around its abdomen. (2) Between 27 and 128 days, the third-stage larva exits between the walls of the entrance wound and pupates in the soil for another 27 to 78 days. At that time, an adult hover emerges and lives two to 19 days without feeding. The entire life round of years lasts three to four month (3)

parts with botfly myiasis have a history of travel and an insect bite, and symptoms include itching or pain, and/or a feeling of emotion in the skin. The typical lesion is a subcutaneous nodule with central pore and serosanguineous discharge. This lesion may be mistaken for an infected insect bite, boil, or inflamed epidermal inclusion cyst

Attempts to suffocate and force extrusion of the larva with paraffin oil, mineral oil jelly, bacon, chewing gum, beeswax, or polymyxin B ointment have been made with variable succes tame traction reinforced with lateral squeezing also may be effective, as with our patient. any physicians have used local lidocaine, chloroform, or a venom extractor. (4) Physicians must be careful not to leave behind parts of larva. Surgery al gentles complete removal of larva and debridement of the cavity. Secondary infection is rare because of the bacteriostatic nature of the intestinal secretions of the larva. Using protective clothing and insect repellings should help prevent this and similar infections. (5)

NAEEM SAJJAD, MD

GREGORY BIEDERMAN, MD

East Boston Neighborhood Health Center

10 Gove St

East Boston, MA 02152

REFERENCES

(1) Bravo F Sanchez MR of the present day and reemerging cutaneous infectious diseases in Latin America and other geographic areas. Dermatol Clin 2003;21:655-68

(2) Sampson CE MaGuire J Eriksson E Botfly myiasis: case report and brief review. Ann Plast Surg 2001;46:150-2

(3) Powers NR Yorgensen ML Rumm PD Souffront W Myiasis in humans: an overview and a report of brace cases in the Republic of Panama.Mil M 1996;161:495-7

(4) Boggild AK, Keystone J Kain KC Furuncular myiasis: a simple and rapid process for extraction of intact Dermatobia hominis larvae. Clin Infect Dis 2002;35:336-8

(5) Robert L Yelton J Imported furuncular myiasis in Germany. Mil M 2002;167:990-3

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