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Parasitic Maggot Under Scalp

54:25 recording · AUTO · 4 speakers

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Brief overview

A traveler back from Brazil had three scalp furuncles caused by human botfly larvae, Dermatobia hominis.

  1. Three lesions point to the botflyDermatobia leaves only a few lesions because each needs an infected mosquito to land, unlike screwworm's hundreds of eggs in one wound.
  2. Geography and exposed skin narrow the diagnosisThe botfly is a Western hemisphere parasite and its lesions sit on exposed parts such as the scalp, where mosquitoes bite.
  3. Manual extraction beats scalpels and antibioticsEyal pushes the larva out by hand rather than cutting, and says the tunnels are rather sterile so prophylactic antibiotics are unnecessary.
Executive Summary AI
  • Eyal Leshem presents a 43-year-old woman who returned to Israel in May 2025 from a two-week dance class on a farm two hours west of Rio de Janeiro, feeling pricking and movement under her scalp with three non-healing furuncles that emitted serous discharge.3:19
  • A non-surgical office procedure recovered the object and confirmed the diagnosis, and the listeners are asked what the parasite and the procedure were.4:59
  • Eyal confirms Dermatobia hominis and lists the matching features: the Western hemisphere distribution from Latin America up to Mexico, only three lesions rather than hundreds, lesions on exposed skin where mosquitoes bite, and the distinctive morphology of the extracted larvae.30:23
  • He never uses anesthesia, a scalpel or instruments, because puncturing the larva leaves parts behind, and instead pushes the larva out by hand; in about a hundred myiasis travelers over roughly ten years, about ten cases a year, only one ended with an infected skin lesion, so he uses no prophylactic antibiotics.32:59
  • The new case is a man in his 40s who grew up in Haiti, on Eliquis for a prior DVT and with diet-controlled diabetes, whose brain MRI showed a 3 by 2.8 by 2.9 enhancing mass read as typical for glioblastoma, but whose biopsy returned necrosis, inflammation and rare microorganisms.46:34
Key Quote
“I love that saying, successful systems attract parasites.”
— Vincent Racaniello1:23
Key Quote
“Do you know what I find really interesting with the eggs on the mosquito?”
— Christina Naula37:48
Key Quote
“So you were right, it is indeed Dermatobia hominis.”
— Eyal Leshem32:16