This week's case was generously donated by Brieanna Ray and Dr. Mike Mitchell. The following object was submitted for identification. It was removed from the skin and subcutis of a teenage girl living in the United States with no recent travel. What is the most likely diagnosis?
8 comments:
Botfly?
Looks like botfly larva
Greetings from USUHS. Hmmm maybe Cuterebra fontinella from NE or Pacific NW? I think Kevin Baird had a case when he was a Lieutenant in the USN well before his P vivax work.
Agree with botfly larvae. Looks most like rodent botfly to me. Do we know about exposure to squirrels, rabbits, etc.?
The case history and geographic location points towards the New World screw worm. Thought the details of the posterior are not clear, the general body shape is with rows of spines are consistent. The third picture clearly demonstrates the mandibles and the anterior spiracle. These details favor an identification of Cochliomyia hominovorax larva.
Bot fly pupae (or at least in the act of pupation). We have had human infections of Cuterebra here as well as from nonbot flesh flies. The Cuterebra larvae we see tend to have many more spines then those seen on this weeks specimen. Not willing to go further out on this limb.
Pupa. With Oestrus ovis, I would expect it to be found in nose, ears and eyes rather than the skin. Cuterebra fontinella is associated with lagomorphs, and not common in humans. Without knowing the size or seeing posterior spiracles, hard to say. Based on the rounded body shape this may be a member of Hypodermidae. The only members of this family with any prevalence in North America I can think of is Hypoderma bovis or H lineatum. An association with cattle by patient may be expected.
Great ideas for a followup K. Would like to know where bot was located on patient. Does patient have any association with hosts or their burrows(cattle, sheep, rabbits, rodents, etc.). I would also like to know if the specimen was fixed in formalin which can cause a black coloration.
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