Myiasis in female external genitalia
A 17-year-old young unmarried female presented with a history of pain and swelling in the genitalia and also complaining of dropping of fly larva from vulva. She lived in the rural area with conditions of poor hygiene, which were compatible with high-risk of disease. Her non-hygienic toilet was outside the house and attracted many flies. Her hygiene was poor and wearing dirty clothes. She was accompanied by her aunt as her mother died in childhood and because of her shy nature, she didn’t report to any one until and unless she started having pain. There was a history of normal regular menstrual cycle prior to the onset of this painful swelling of genitalia. Patient did not use readymade sanitary napkins available in the market during the menstrual periods; instead, she used dirty ragged clothes during menstrual cycles. She used to hang the washed clothes and undergarments on a clothes line outside. There was no history of any trauma, insect bite, and sexual activity. There was no history of pain in the lower abdomen. No history of intake of any immunosuppressive or steroidal therapy. She also denied history of any chronic illness including tuberculosis, chronic urinary tract infection, and diabetes. Physical examination of the patient revealed a normal build (height 5 feet 2 inches, weight 52 kg) with vitals in normal range. General physical examination revealed that the patient was of sound physical and mental health and capable of caring herself. She was studying in 11th standard.\nOn local examination, both labia majora were tender, erythematous and swollen with the multiple discharging sinuses stuffed with crawling maggots of creamy-white color []. Labia minora were normal. Hymen was intact. No significant lymphadenopathy was present. Laboratory investigations revealed hemoglobin-9.8 g%, with a normal total and differential leucocytes count, blood sugar-98 g%, urine complete examination-within normal limits, her serology for HIV (Human immunodeficiency virus) and Syphilis (by Venereal Disease Research Laboratory test) was -Negative. Her urine examination and sonography was negative for pregnancy. She was hospitalized and was given injection ceftriaxone, injection metrogyl, injection gentamycin, tablet serratiopeptidase and tablet cetrizine empirically from the 1st day. Initially, on day 1, about 20 maggots were removed using non-toothed forceps and the wound was cleaned with betadine. On 2nd day, we applied Turpentine oil and more maggots were removed on 2nd and 3rd day. On the 4th day, maggots were completely absent. Lesions healed within a week time, patient was discharged and advised regarding personal hygiene to avoid re-infestation.