Title of Case:

UNEXPECTED TRAVEL COMPANIONS – AN UNUSUAL SOUVENIR FROM GAMBIA

Background:

Myiasis is a rare diagnosis in Germany and is usually only seen after travel to endemic areas. Here we describe a case of myiasis with an initially unclear route of transmission.

Case Presentation Summary:

A previously healthy 14 months-old boy presented to our A&E with five abscess-like skin lesions (image 1). Per parental report, the largest lesion was lanced at home with subsequent removal of five larvae. Suspecting myiasis, he was admitted for treatment of the remaining lesions by covering them with an occlusive transparent film to deprive the larvae of oxygen and encourage them to emerge. However, no additional larvae were retrieved from any of the covered lesions.

Interestingly, the patient’s last reported international travel was 7 months prior to presentation, which is well beyond the typical 6-10 week period between infestation and development of skin manifestations. On further detailed conversation, the patient’s father disclosed that he had travelled to The Gambia a few weeks prior and returned with clothes for his boy as a present. These clothes likely acted as the “travel-vehicle” for the botfly eggs. Upon repeated history taking, trying to overcome the language barrier, the father eventually reported to have lanced all five lesions at home removing one solitary larva from each. The patient was discharged and made a full recovery documented in a follow-up visit 10 days later.

Learning Points/Discussion:

Myiasis in Germany is rare and primarily seen in returning travelers. Infestation without travel to endemic areas can occur indirectly when botfly eggs are transported on clothing to non-endemic areas. Ensuring adequate washing or ironing of clothes imported from endemic areas is key to preventing such transmission events.