Imported and locally acquired human myiasis in Canada: a report of two cases

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Figure 1:
(A) Myiasis caused by Cuterebra species in an otherwise healthy 45-year-old woman. Note the periocular erythema, punctum (arrow) and serosanguinous drainage. (B) An intact, live larva was extruded manually from the periocular lesion.
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Figure 2:
Myiasis caused by Dermatobia hominis in a 33-year-old man. Three domiciles were noted on the patient’s anterior chest wall after he returned from Belize.
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Figure 3:
Travel-acquired myiasis caused by Dermatobia hominis in a 33-year-old man. Individual domiciles were visible on the patient’s anterior chest (A–C), with erythema and visible puncta. Intact larvae post extraction measured 2.77 mm (D), 3.87 mm (E), 5.67 mm (F), 12.74 mm (H) and 14.25 mm (I). Note the radial spines on the surface of the organisms. (G) A presumed sixth larval nodule, which closed spontaneously. The larval spiracles can be seen through the punctum.

Box 1: Differential diagnosis of nodular lesions in the returning traveller7

Disease	Pathogen	Region	Clinical features
Furuncular myiasis	Dermatobia hominis, Cordylobia spp., Cuterebra spp., Hypoderma spp., Wohlfahrtia spp., others	Global	One or more nodules with central puncta; may have sensation of movement or lancinating pain
Furunculosis	Staphylococcus aureus, Pseudomonas aeruginosa, polymicrobial infection	Global	Cutaneous abscesses that can be associated with adjacent cellulitis
Tungiasis	Tunga penetrans (sand flea)	South and Central America, Africa, India	Small papule with black centre that can become inflamed; typically invades the feet, including the heel and toes
Nodular lymphangitis	Sporothrix schenckii. Mycobacterium spp., Nocardia spp.	Global	Nodular lesions with spread via lymphatics with associated lymphangitis; classically sporotrichoid or lymphocuticular spread
Cutaneous leishmaniasis	Leishmania spp.	South and Central America, Middle East, Saharan Africa, South Central Asia	Typically ulcerative but can present as nodular or verrucous plaques