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Imported New World screw-worm fly myiasis

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In mid-August 2012, Pamela (not her real name), a university lecturer, visited the Amazon rainforest in north-eastern Peru to conduct a mammal survey, watching and recording wildlife, for a week. She also owned a small sheep farm in Victoria. She had no pre-existing comorbidities.

During her stay in Peru she noticed increasing soreness and a slight discharge behind her right ear. While flying back to Australia, Pamela felt that “things” were moving in a hole behind her right ear, where intense pain was felt intermittently.

Upon arrival in Melbourne, she presented to The Travel Doctor clinic, suspecting that she might have contracted myiasis. On examination, there was an open cavity of about 1 cm in diameter behind her right pinna, filled with maggots wriggling in serous fluid (Box, A). The diagnosis of wound (rather than dermal) myiasis was immediately obvious.

Twenty-three live larvae were extracted from the cavity. After the procedure, the pain subsided significantly and the wound healed within 12 days. At the Victorian Infectious Diseases Reference Laboratory, the maggots were identified as larvae of Cochliomyia hominivorax, the New World screw-worm fly (NWSF). All containers used for transport and storage were autoclaved and destroyed as biological waste.

Human cutaneous myiasis is typically furuncular and confined to dermal…