A 30 yrs male with scalp wound filled with maggots was successfully treated by picking up the maggots followed by dressing with turpentine oil and oral Ivermectine. But history revealed that he is having recurrent attacks of scalp wound with maggots almost every rainy seasons. Why wounds and maggots re-occur?
Recurrent maggot infestation suggests incomplete removal of all organisms. This could be due to indolent subclinical "cavitary myiasis" (burrowing through subcutaneous tunnels) which is particularly difficult to eradicate with standard treatment modalities, or alternatively, due to persistence of conditions that predispose to recurrent re-infection during the rainy seasons when such infections frequently occur. Predisposing conditions include poor scalp/skin hygiene, frequent exposure (e.g. soil), or other factors less likely in this case (e.g., malignancy). Suggest the comprehensive recent review in Clinal Microbiology Reviews (Jan 2012) by Francesconi and Lupi at:
http://cmr.asm.org/content/25/1/79.full
I agree with the response of tunneling and supra-contamination. I had a similar patient some years ago. The gentleman was 98 and had recurrent maggots in leg wounds due to venous insufficiency.
His living environment was the first thing we looked to in order to identify etiology. Our findings were that he had food sitting that was uncovered. He also had screens missing, but had his windows open as well.
ALso, the area of his town was flooded by a rainy season here in the Midwest US. The maggot infestation was re-activated by that event.
To terminally remove the maggots, we had to move him out of his home to a care center. (for his safety on a number of levels). The treatment we inistituted was to use ether to the areas of wounding to his legs. Topical treatment alone has limited success.
Is this patient using some type of hair treatment that is attracting the flies/maggots?
Seems like a simple question...but one never knows for sure.
Another question... those tunnels/tracts look well defined and appear to be epithialized done into the tract. Have you considered perhaps a secondary infestation?
Maggots don't typically respond to Ivermectin (in my experience)
I came across a posting by a physician who works with a maggot lab. Contacting him may be an avenue to explore given his experience with the therapeutic aspect of maggot therapy.
I have attached the information that I came across.
I want to clarify the comment on using ether. That treatment was targeting the maggots..not the venous disease. The venous disease was managed according to standards of management at the time.
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