Neonatal umbilical myiasis is an unusual occurrence with only a few reported cases in the literature. It is usually found in tropical and subtropical areas [1]. Warm and moist nature of umbilical stump attracts gravid female flies to lay eggs in a neonate kept in an unhygienic environment. The accompanying omphalitis provides the required nutritive support for hatching of eggs and further development into the larval forms [2]. 

Case Report

A nine-day neonate delivered vaginally at term with an uneventful intrapartum and postpartum period, third born to 41-year-old year old female at civil hospital. Child was taken home next day. The umbilical stump fell on 4th day of life. There is history of application of dalda ghee and Jaiphal to the umbilical stump as according to local practice.

On admission she weighed around 3100 g with no congenital anomalies. She was irritable and crying continuously since the night before. She had normal tone and reflexes. There was no history of refusal to feed, posturing or bleeding from any site. Baby was on exclusive breast feeds.

On examination, weight was 3100 g, temperature was 99.6 F, respiratory rate was 38/min, heart rate 118/min, spO2 98 percent on room air and capillary refill time of less than 2 seconds.

The umbilical cord had fallen two days before, peri umbilical region was swollen and greasy having a peculiar malodour. On careful examination maggots were seen crawling out of umbilicus. Multiple whitish worm heads were noted around the umbilical stump (Figure 1).

Abdomen was soft, non-tender. There was no hepatosplenomegaly. Anterior fontanelle was soft and cardiorespiratory examination was within normal limits. Culture of blood, urine, umbilical discharge, sepsis screen, blood sugar, serum electrolytes, urea and creatinine were sent.

Baby was started on intravenous ceftriaxone (100mg/kg/day) and gentamicin (5mg/kg/day). 1 dose of prophylactic tetanus toxoid was also given.

Turpentine oil was applied over the umbilicus and about 47 maggots were removed on the first day and 7 maggots on the second day. The removed maggots were preserved in formalin and sent further for species identification.

Figure 1: Maggots of Chrysomya megacephala Visible around the Umbilical Stump

Figure 2: Third-Stage Chrysomya megacephala Larvae Removed from the Umbilical Region with Complete Resolution after Treatment

Complete blood count showed haemoglobin of 16.2 g/Dl. TLC was 14,300, with 39% neutrophil, 47% lymphocytes, 3% eosinophils and 2% monocytes. C reactive proteins was 6.2, ESR was 30mm/1^st hour. Blood sugar, serum electrolytes, urea and creatinine were within normal limits. None of the cultures showed any growth.

Dead larvae on microscopic examination were identified as third stage larvae of Chrysomya megacephala. USG abdomen scan showed no residual collection or abscess. Periumbilical inflammation resolved after removal of all the maggots. Antibiotics were given till the 5^th day (culture reports were negative) and the baby was discharged on 22^nd day of life (Figure 2).

Myiasis has been classified according to anatomic site of infestation (i.e., aural myiasis, ophthalmomyiasis or cutaneous myiasis) or on the basis of clinical syndrome (furuncular cutaneous myiasis, migratory cutaneous myiasis, or wound myiasis.) [3]. 

Umbilical myiasis is a type of cutaneous myiasis usually produced by larva of dipterous flies. These lay eggs on dry skin and subsequently larvae invade the wound where they grow rapidly and mature in 4-8 days [4].

Chrysomya megacephala, also known as oriental latrine fly or blow fly, breeds on human faeces and lands commonly on foods, wounds and rarely newborn umbilicus [5].

Myiasis of umbilicus in neonate is rare disease with few reported cases in literature [6-9]. Treatment is removal of larvae and control of local and systemic infection. Use of several substances like turpentine oil, mineral oil, ether, phenol or iodoform have been advocated. Their application irritates the maggots causing asphyxia and forcing them to come out of their hiding. Subsequently these can be removed by irrigation, manipulation or surgery of affected site.

Surgery is usually indicated for removing dead or decayed larvae to prevent secondary infection of affected site or sepsis.

1. Obasa T.O. and F.O. Sowunmi. “Myasis Occurring in a Neonate.” 2012. https://doi.org/10.408/pr.2012.e34.

2. Singh A.K. et al. “Neonatal Umbilical Myiasis.” Indian Dermatology Online Journal, vol. 6, 2015, pp. 312–313.

3. Mondal M. et al. “Umbilical Myiasis with Sepsis in a Neonate.” Asian Journal of Medical Sciences, vol. 5, 2014, pp. 106–107.

4. Ghosh T. et al. “Umbilical Myiasis in Newborn.” Indian Pediatrics, vol. 48, 2011, pp. 321–323.

5. Gordon P.M. et al. “Cutaneous Myiasis Due to Dermatobia hominis: A Report of Six Cases.” British Journal of Dermatology, vol. 132, 1995, pp. 811–814.

6. Duro E.A. et al. “Umbilical Myiasis in a Human Newborn.” Journal of Perinatology, vol. 27, 2007, pp. 250–251.

7. Patra S. et al. “Umbilical Myiasis Associated with Staphylococcus aureus Sepsis in a Neonate.” Journal of Clinical Neonatology, vol. 1, 2012, pp. 42–43.

8. Ambey R. and A. Singh. “Umbilical Myiasis in a Healthy Newborn.” Paediatrics International and Child Health, vol. 32, 2012, pp. 56–57.

9. Kumar V. and S.M. Gupta. “Umbilical Myiasis in a Neonate.” Paediatrics International and Child Health, vol. 32, 2012, pp. 58–59.