Umbilical Myiasis Associated with Staphylococcus Aureus Sepsis in a neonate
An exclusively breast fed, 7-day-old, male baby, born at home out of nonconsanguineous marriage to a primi gravida mother with uneventful perinatal, from a flood-devastated remote village in West Bengal was admitted in our hospital with complaints of poor feeding and umbilical discharge. On physical examination the baby weighed 2.1 kg, temperature was 39°C, respiration were 47 breath/min and the heart rate was 170 beats/min. The anterior fontanel was soft and pulsatile. Abdomen was slightly distended; liver and spleen were palpable just below the costal margin. In addition to foul-smelling purulent discharge from umbilicus, mild omphalitis and cellulitis was noted. On close observation after removal of pus with sterile cotton swab, the tip of some white spindle-shaped mobile worm-like structures were noted []. These on pulling out with forceps proved to be a maggot. Blood, urine and cerebrospinal fluid (CSF) were sent for culture and sensitivity. Investigations revealed growth of Staphylococcus aureus on blood culture and the infant was treated accordingly. Urine and CSF analysis were negative. More than hundred maggots were removed within 24 hours of hospital admission following instillation of ether (repellent). Following removal, the maggots were preserved in ethyl alcohol and sent to Department of Parasitology, School of Tropical Medicine, Kolkata, for species identification. The dead maggots were examined microscopically and were identified as Chrysomya megacephala. Ultrasound scan of the umbilical area did not reveal any collection or abscess. As soon as all larvae were out of the epidermis, the periumbilical cellulitis rapidly resolved without any sequelae. The infant was discharged from the hospital on the 10th day after admission with satisfactory physical and clinical condition.