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LETTERS TO THE EDITOR |
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| Year : 2023 | Volume
: 28
| Issue : 1 | Page : 86-87 |
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Newborn umbilical cord stump myiasis: Report of an earliest presentation
Shyam Bihari Sharma1, Rahul Gupta2
1 Department of General Surgery, K.D. Medical College Hospital and Research Center, Mathura, Uttar Pradesh, India
2 Department of Paediatric Surgery, SMS Medical College, Jaipur, Rajasthan, India
| Date of Submission | 03-Sep-2022 |
| Date of Decision | 21-Sep-2022 |
| Date of Acceptance | 08-Oct-2022 |
| Date of Web Publication | 10-Jan-2023 |
Correspondence Address:
Rahul Gupta
Associate Professor, Department of Paediatric Surgery, SMS Medical College, Jaipur, Rajasthan
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/jiaps.jiaps_125_22
How to cite this article:
Sharma SB, Gupta R. Newborn umbilical cord stump myiasis: Report of an earliest presentation. J Indian Assoc Pediatr Surg 2023;28:86-7 |
How to cite this URL:
Sharma SB, Gupta R. Newborn umbilical cord stump myiasis: Report of an earliest presentation. J Indian Assoc Pediatr Surg [serial online] 2023 [cited 2023 Feb 8];28:86-7. Available from: https://www.jiaps.com/text.asp?2023/28/1/86/367381 |
Dear Sir,
Umbilical myiasis is purported to be due to a paucity of the umbilicus/umbilical cord stump care.[1] It is a rare entity in a newborn.[1],[2] Here, we present the earliest presentation of an umbilical cord stump myiasis in a 2-day-old male newborn admitted to the neonatal intensive care unit (NICU).
A 2-day-old male newborn, weighing 2400 g, delivered full term by cesarean section was admitted to NICU. The Apgar score was 10, and the baby was breastfed within 4 h of birth. He presented with worms coming out from the umbilical cord stump. There was no sign suggestive of systemic infection. There was no history of redness or pus discharge from the cord stump. On clinical evaluation, the baby was stable. Local examination revealed an umbilical clamp in situ. On the umbilical cord stump, two-dozen white-colored worms were seen coming out from the umbilical cord stump and umbilical clamp [Figure 1]. A provisional diagnosis of umbilical cord stump myiasis was made. Radiological evaluation of the newborn was unremarkable. The septic screen was negative. Turpentine oil was gradually instilled over the umbilical cord stump, and visible worms were removed manually. The patient's wound was cleaned and dressed with turpentine oil for 1 day. The patient was optimized. On the next day, the umbilical cord stump was excised under anesthesia. The umbilicus was free from the worms; the wound was dressed with povidone-iodine till its epithelialization. The worms were sent to a public health expert who identified them as larvae of Chrysomya megacephala. The outcome was favorable, and there was no sequel on follow-up at 1 month [Figure 1]. | Figure 1: Clinical photograph shows umbilical cord stump myiasis along with larvae around the umbilical clamp in the newborn (a); postoperative photograph after treatment with turpentine oil and excision of the umbilical cord stump (b)
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Myiasis is a parasitic infestation of tissue(s) by larvae (maggots) of several fly species to complete, partial, or total development of their evolutive cycle. It usually occurs in animals. Myiasis is classified based on the anatomical site of infestation.[3],[4]
Umbilical myiasis is a rare entity in neonates, with only a few cases reported in the literature, especially from the third world.[2],[3] Only one similar case presenting as early as the 2nd day of life has been reported in the literature.[5] Barolia et al. summarized all the neonates with umbilical myiasis.[1] The age ranged from 2 to 20 days, with most cases presenting on the 7th day and beyond the 1st week of life.[1]
Umbilical myiasis in neonates occurs in underprivileged and low socioeconomic settings. The authors observed that the presence of wet umbilical cord stump, especially the presence of glycosaminoglycans in Wharton's jelly (nutrient-dense area), draws flies to lay eggs and also favors the growth of the maggots. It is seen with unhygienic cord practices associated with the ghee application on the umbilical cord and locally prevalent local myths about cord care. Therefore, IEC about dry cord care must be promoted.[1],[5]
The condition should be timely treated as it can lead to complications such as omphalitis and septicemia. Management of the disease consists of excising the umbilical cord, cleaning the local area with antiseptics, killing the larvae by suffocating and repelling them using either turpentine oil, ether, or camphorated petroleum jelly, and then subsequent removal and treatment of the associated local or systemic infection.[1],[2]
In all cases with myiasis, maggots should be submitted to the laboratory in alcohol or formaldehyde, and at least one maggot should be submitted alive to facilitate species identification (as in our case). Mandatory reporting of myiasis helps in an epidemiological study.[3] Finally, educating the community regarding the umbilical cord and good hygiene is the job of the treating clinician.
Declaration of patient consent
The authors certify that they have obtained appropriate consent from parents. In the form, the legal guardian has given his consent for images and other clinical information to be reported in the journal. The guardian understands that names and initials will not be published and due efforts will be made to conceal patient identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
 References | |  |
| 1. | Barolia DK, Singh AP, Tanger R, Gupta AK. Umbilical myiasis in a human neonate – Treated with turpentine oil. J NTR Univ Health Sci 2020;9:143-5.  [Full text] |
| 2. | Barot K, Vala H, Bankapur A. A case of umbilical myiasis in a neonate AJPR 2021;5:9-12. |
| 3. | Predy G, Angus M, Honish L, E Burnett C, Stagg A. Myiasis in an urban setting: A case report. Can J Infect Dis 2004;15:51-2. |
| 4. | Gupta R, Singh I, Sharma SB, Patel J. White discharge per vaginum: Can it be vaginal myiasis?” Indian Obstet Gynaecol 2014;4:30-2. |
| 5. | Dey PK, Bhattacharya T, Pal SN, Das S, Pal S. Umbilical myiasis in a newborn: A case report. J Coll Med Sci Nepal 2012;8:458. |
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