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.