5 Discussion:
The case presented highlights a typical scenario of myiasis, a parasitic infestation caused by fly larvae, in a 33-year-old female traveler who was affected in a challenging setting due to the ongoing conflict in Sudan [12 - 16]. The clinical presentation included sharp stinging pain, discharge, redness, and a visible puncture with clear discharge, all indicative of a myiasis infestation [1, 11]. The absence of regional lymphadenopathy, combined with normal vital signs and systemic examinations, along with laboratory tests—including liver and renal function tests—provided a comprehensive picture of the patient’s health status, effectively ruling out other systemic complications.
Myiasis can mimic other conditions such as cutaneous larva migrans, abscesses, cellulitis, spider bites, and pseudomonas infections, making proper identification crucial for effective treatment and complication prevention [1, 17, 18]. In this case, the patient’s symptoms, travel history, and successful larva removal strongly supported a diagnosis of myiasis. While the lesion resembled a typical furuncle characterized by surrounding erythema and serosanguineous exudate, it presented two key distinctions. First, the level of pain was less pronounced than expected based on the surrounding erythema. Second, there was a small punctum evident at the center of the lesion, with some literature noting the occasional presence of a small white protruding body [1, 9 - 11]. Patients with myiasis often report pain, itching, or a crawling sensation [19 - 22]; however, our patient lacked severe pain despite the lesion’s furuncle-like appearance. Lesions commonly manifest on exposed areas, including the head, face, back, abdomen, arms, and hands [1, 11].
The treatment approach, which included wound care, larva removal, and careful dressing changes, successfully facilitated the healing process without recurrence [1, 4 - 11]. The patient was closely monitored during follow-up visits, ensuring a complete recovery.
Myiasis poses significant risks to individuals living in areas affected by war and displacement. The ongoing conflict in Sudan has led to the breakdown of healthcare systems and worsened public sanitation, severely restricting access to clean water and proper hygiene facilities [12 - 17]. This environment fosters the spread of myiasis and other infectious diseases such as dengue, rift valley fever, malaria and mycetoma [23 - 33]. Additionally, the displacement of populations has resulted in overcrowded and unsanitary living conditions, making it easier for flies to deposit their eggs on open wounds or neglected skin, thereby increasing the risk of myiasis infections [34, 35]. The stress and malnutrition associated with war can further compromise immune systems, heightening susceptibility to various infections, including myiasis [35].
Addressing these underlying factors is crucial through adequate healthcare provision, sanitation measures, and ensuring access to essential resources to prevent the emergence and spread of such conditions in conflict-affected regions. The conflict has not only compromised public health infrastructure but has also contributed to an increase in myiasis and other infectious diseases. Comprehensive public health measures are now essential. Key initiatives should include community education about hygiene practices, timely medical intervention for wounds, and enhanced access to healthcare resources. Moreover, establishing effective vector control strategies—such as promoting sanitation and waste management—can help reduce fly populations and, consequently, mitigate the risk of myiasis in affected regions.
In conclusion, while cutaneous myiasis is distressing, it can be effectively managed with appropriate interventions such as larva extraction, wound care, and infection prevention measures. The timely and comprehensive treatment in this case led to the resolution of the infestation, allowing for proper healing of the wound.