Wound myiasis

Wound myiasis (also known as traumatic myiasis or surgical wound myiasis) is a parasitic infestation in which fly larvae (maggots) infest open wounds, ulcers, or other skin lesions. It is classified under the broader category of myiasis (infestation of living tissue by dipterous fly larvae). The condition occurs when certain species of flies — including Cochliomyia hominivorax (New World screwworm), Chrysomya bezziana (Old World screwworm), Lucilia sericata, Wohlfahrtia magnifica, and other species — deposit their eggs or larvae in pre-existing wounds, surgical sites, or areas of damaged skin. The larvae feed on necrotic or living tissue, causing progressive tissue destruction, inflammation, pain, and secondary bacterial infection. The condition primarily affects the skin and soft tissues but can extend to deeper structures including muscle, cartilage, and bone if left untreated. Key clinical features include the presence of visible larvae within the wound, a sensation of movement or crawling, pain, foul-smelling discharge, tissue necrosis, and surrounding inflammation. Patients may also experience fever and systemic symptoms if secondary infection develops. Wound myiasis is more common in tropical and subtropical regions and disproportionately affects individuals with poor wound care, impaired mobility, homelessness, neglected elderly patients, and those with chronic debilitating conditions or poor hygiene. Treatment involves mechanical removal of all larvae from the wound, thorough debridement of necrotic tissue, wound irrigation, and appropriate wound care. Topical application of substances such as petroleum jelly, turpentine, or chloroform may be used to suffocate larvae and facilitate their extraction. Systemic antibiotics are administered when secondary bacterial infection is present. Oral ivermectin has been used as an adjunctive treatment in some cases. Prevention focuses on proper wound management, use of protective dressings, insect repellents, and fly control measures. With prompt and appropriate treatment, the prognosis is generally good, though delayed treatment can lead to significant tissue destruction and complications.

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