Traumatic scalp myiasis in an elderly from rural Sarawak – A rare presentation due to limited healthcare accessibility – A case report

ABSTRACT Introduction: Traumatic myiasis is a rare presentation in a healthy human being. It is caused by parasitic infestation on a neglected open wound by dipteran larvae, which is also known as maggot. The necrotic tissues and pus serve as a good source of nutrition. We hereby reported a case of severe traumatic scalp myiasis in a 60 years old elderly male from a rural area of Sarawak. Ignorance, poor education level and lack of healthcare accessibility were the key factors causing the rare complication. Case presentation: A 60 years old farmer with no known medical illness and drug allergy sustained an open wound over the scalp during farming. He did not seek proper medical treatment due to logistic issues. The wound was found to be infested with maggots after 2 weeks. There was no evidence of osteomyelitic change or intracranial extension on the Computed Tomography Brain (CTB). He was taken to the operation theatre for wound debridement and washout, whereby nearly 80 maggots were removed. He was also covered with broad-spectrum antibiotics for 2 weeks. He eventually returned home with a well-healed wound. Clinical discussion: Most of the myiasis cases reported in Malaysia were attributed to the infestation of Chrysomya bezziana species. It involves a variety of anatomical sites, such as skin, intestine, urogenital organs, oral cavity, nasopharyngeal cavity and auricular area. However, scalp myiasis is relatively rare in Malaysia. Although scalp myiasis is often benign, it can be lethal and extend intracranially if left untreated. The most effective treatment of scalp myiasis is by removing all living larvae from the infestation site using forceps followed by debridement. Conclusion: Traumatic myiasis is uncommon in a healthy well-being. The predisposing factor, such as a neglected wound, could be predicted when myiasis occurs in an otherwise healthy person. In this case, it is attributed to the lack of accessibility to healthcare services in a rural setting. Highlights