Becky Gladis

Disclosures

Dermatology Nursing. 2003;15(5) 

History: A 66-year-old Caucasian male presented with a chief complaint of a nonhealing bump on his left forearm for the past several weeks. He returned to the United States recently after traveling in Central America for 2 months. He recalls being bitten on the arm by a bug or fly while there. After returning home this nodule developed. Despite being treated by his family physician with a 10-day course of oral antibiotics, it has become increasingly warm and tender.

Description of Lesion: Upon examination, a 2-cm erythematous nodule was present on the left forearm. Easily visible on the nodule was a central punctum where serosanguinous fluid was draining (see Figure 1). When examined with a magnifying lens, a slight movement was noted within the opening and also occasional bubbling. The patient denied any constitutional symptoms of fever, chills, nausea, vomiting, diarrhea, or general malaise.

Initial appearance

Location: Myiasis usually occurs on the skin, but it can be seen in the nose, sinuses, auditory canal, and the digestive and urinary tracts.

Hallmark of the Disease: In the United States, myiasis is primarily seen in people who have recently traveled to Central or South America or Africa. Some patients can recall a stinging bug bite while others have no recollection of a specific bite. Patients present with a chief complaint of an enlarging, inflamed nodule that has begun to drain serous fluid.

Treatment: The area was anesthetized with 1% lidocaine with epinephrine. After sterile prep and drape, an incision was made and the larva was identified and removed (see Figures 2 & 3). The wound was irrigated with copious amounts of saline followed by primary closure. A prescription was given for Cipro® 500 mg po q 12 h × 10 days. Suture removal was scheduled in 14 days.

Intraoperative extraction

Larva following extraction

Normal Course: Numerous species of flies inflict painful bites on the skin but only occasionally does one leave behind a larva. Myiasis is defined as the invasion of live tissue by a fly larva. Once left on the skin, the larva burrows its way into the subcutaneous tissues where it can feed and grow until a fly emerges or the larva is mechanically removed. As the larva grows, a red papule approximately 2 to 4 centimeters in diameter develops on the skin where serous fluid drains. This closely resembles a cyst or furuncle. As the larva matures, the head will rise to the central opening approximately every minute for air. This motion can be detected if carefully observed. The larva can be forced out by direct pressure around the area or by occluding the air supply with a thick layer of petrolatum. Surgical excision is often the method of treatment because it is an immediate remedy. Patients should always be treated with antibiotics and the wound should be thoroughly irrigated.

Nursing Measures: The most vital step for a nurse is to obtain a thorough and pertinent history. An important clue in this diagnosis was that the patient had recently traveled outside of the United States and could recall a bug bite. Next, the nurse should obtain vital signs and assess other symptoms, followed by a list of all current medications and allergies.

Patient Education: Patients should be educated to the course of illness. Special care should be taken to emphasize that this is not a matter of personal hygiene, and that this is not a contagious or communicable condition. Patients must complete a full course of antibiotics as prescribed. Following surgical extraction, teaching should include the following: wound care and bandaging techniques, measures to alleviate discomfort, signs and symptoms of infection, any activity restrictions, and date for suture removal. Any followup appointments are variable in each case.

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