OBJECTIVE--To evaluate a simple, noninvasive method for removing fly larvae from patients with furuncular myiasis. DESIGN--Case series. SETTING--Ambulatory office of a tertiary care center. PATIENTS--Three patients who presented with Dermatobia hominis infestation. INTERVENTION--The patients with D hominis infestation were treated with the application of bacon fat over the larval apertures. MAIN OUTCOME MEASURE--Removal of intact larvae. RESULTS--Within 3 hours of the application of bacon, the larvae had migrated sufficiently far out of the skin to be removed with tweezers. Ten larvae were removed with this method. There were no treatment failures or complications. CONCLUSIONS--Furuncular myiasis will be seen more frequently in temperate areas as individuals travel to endemic areas. We describe the clinical characteristics of myiasis and a simple method of treatment that permits rapid diagnosis and cure.

Human infection with botfly larvae (Cuterebra species) are reported, and 54 cases are reviewed. Biologic, epidemiologic, clinical, histopathologic, and diagnostic features of North American cuterebrid myiasis are described. A cuterebrid maggot generally causes a single furuncular nodule. Most cases occur in children in the northeastern United States or the Pacific Northwest; however, exceptions are common. Most lesions of North American cuterebrid myiasis are caused by second or third instar Cuterebra maggots that appear in late August, September, and October. First instar maggots are unusual and occur in the vitreous humor or in the upper respiratory tract of patients in late spring and early summer.

We describe two patients with cutaneous myiasis caused by Dermatobia hominis. Three larvae were removed successfully by a simple technique that involved the injection of each larva with 2 mL of lidocaine, making surgical extraction by incision and exploration unnecessary.

Ophthalmomyiasis, infestation of the eye by dipterous fly larvae, may result in sequelae ranging from minor irritation to blindness, disfigurement, and death. Infestation with Cochliomyia hominivorax, a medically significant and economically important species, exemplifies the mechanisms by which larvae can cause tissue damage. Although clinical history may be suggestive of ophthalmomyiasis, the definitive diagnosis requires direct observation of larvae. Treatment of ophthalmomyiasis involves removal or destruction of the larvae, if alive, and appropriate management of any sequelae. Preventive measures may not always be successful.

Cutaneous myiasis is the infestation of tissue by the larvae of flies. There are many causes and they are geographically dependent. The clinical presentation is variable depending on the cause and the body part(s) affected, which can include skin, nasal, ocular, oral, aural, gastrointestinal, and genitourinary tracts. Treatment is complete removal of the larvae from the affected site. The ultimate goal is prevention. We briefly review a case report and then review definition, causes, clinical presentation, differential diagnosis, treatment, and prevention. Cutaneous myiasis reiterates the basics of clinical medicine, which require one to obtain a thorough history, including travel, potential risk exposure, and occupation, and to perform a complete physical examination of a patient with any suspicious lesion.

External ophthalmomyiasis occurred in a 16-year-old white girl who was infected on Catalina Island, an endemic area for the sheep bot fly. With the patient under topical anesthesia, we isolated the larva, Estrus ovis, removed it with jewelers' forceps, and examined it with light and scanning electron microscopy. The patient responded well to a treatment regimen of corticosteroids and antibiotics.

From a study carried out in 22 townships of the Etnean area, by interviewing 112 shepherds, it was confirmed that 90 of them (80.3%), once or more in their lives, had contracted myiasis by Oestrus ovis L., habitual agent of estriasis in sheep. The most frequent sites of involvement were the pharynx (77 times), often extending to the larynx, the conjunctiva (56), followed by the nose (32) and rarely the ear (1). Multiple simultaneous sites involvement was also frequent affecting 54.4% of the shepherds. The chief symptom was pain, sometimes accompanied by fever and malaise. The shepherds go rarely to see a doctor (only 7 out of 90), the greater part preferring traditional remedies. It is curious to note that myiasis associated with Oe. ovis was already observed more than 150 years ago by a Sicilian physician, G. A. Galvagni, who had pointed out the high incidence of the myiasis in shepherds in the area. The persistence of human myiasis in the Etnean area appears to be related to the fact that in this region the conditions of sheep farming and the lifestyle of shepherds have not changed so much since then.

An unusual form of larval infestation from South America is presented which, in view of increasing tourism to South america's tropical areas, may present to any accident and emergency department. Infestation with Dermatobia hominis is reviewed in terms of clinical recognition and life cycle. Techniques of removal are described.

A 29-year-old man with a furuncle-like lesion brought in a maggot on the next day after his first visit to our clinic. He said it moved out from the eruption spontaneously. He had previously visited Parana and Sao Paulo in Brazil before he noticed the symptom. The maggot was confirmed to be a third instar larva of Dermatobia hominis. Japanese cases of cutaneous myiasis are reviewed.