This is a seven-year-old female patient who was taken by her attendant (padre) to the emergency department by presenting a clinical picture of two weeks of evolution, approximately characterized by the appearance of a spontaneous fever in the occipital region.
The father reported that the child was treated at home for two days with amoxicillin and showed improvement of fever.
The patient had a history of mild intermittent asthma and underwent umbilical hernia repair two years earlier.
The father commented that the child had the complete vaccination scheme, without showing the immunization record.
As psychosocial antecedents, the patient was in primary school, lived with five people and slept in a hammock with her three brothers.
The father and sister slept in the same room.
The house had all basic services (water, sewage, electricity and gas), roof slope and cement floor.
The father commented that his children's mother died a year earlier and he was taking care of them.
On physical examination, the patient was conscious, oriented, hydrated and afflicted 1.21, with a heart rate of 120 beats per minute, respiratory rate of 18 per minute and temperature of 37.5 °C 21 kg.
Upon inspection, a normocephala was found, with a painful swelling of 15 cm in diameter in the parieto-occipital region and multiple orifices through which abundant larvae and purulent secretion emerged.
Pruritus ulceration due to pedis was found.
The rest of the physical examination was within normal limits.
Diagnosis of cutaneous myiasis was made by: 1) cutaneous myiasis forum; 2) pedal abuse capitis; 3) suspicion of child maltreatment with poor personal hygiene (abandonment) (11), and 4) eutrophic school children.
It was decided to hospitalize the patient and start antibiotic therapy with clindamycin (30 mg/kg per day), gentamicin (6 mg/kg per day) and concomitant medication with oral medication (200 μg/aminophen per dose).
The lesion area was shaved and covered with dressings.
Daily cures, simple skull x-ray and evaluation by plastic surgery and by the Colombian Institute of Family Welfare were ordered.
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Paraclinical tests reported leukocytes, 16,600/mm3; lymphocytes, 2,200/mm3; neutrophils, 13,800/mm3; hemoglobin, 9.8 mg/dl and erythrocyte sedimentation rate, 26000/hour.
Simple skull radiographs showed no bone involvement.
The plastic surgery service decided to continue the same therapeutic management and schedule for surgical lavage and debridement.
During the first cures, after surgical debridement, dead larvae were extracted.
The patient complained of pain during the procedure.
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Antibiotic therapy was continued and the patient went to the operating room for debridement and surgical lavage.
The patient tolerated the procedure without complications.
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The girl was admitted to the hospital wards, where she had a favorable evolution, with decreased edema, erythema and heat in the lesion and the circumscribed area.
In his postsurgical stay, he did not present larvae only seropositivity in the wound.
It was decided to discharge the patient on the fourth day of hospital stay, with dicloxacillin (60 mg/kg daily) and oral irritation (200 μg/kg) in a single dose.
Suspected child abuse due to abandonment and neglect, psychological follow-up was requested in the Primary Care Unit and referral to the Colombian Institute of Family Welfare.
During their hospital stay, larvae were collected directly from the injured area and preserved in 70% alcohol.
The entomological study was based on taxonomic keys (9).
Based on the characteristics found, it was concluded that the larvae belonged to the C. abortivorax species in stage two, with approximately six days of hatching.
