This Bengaluru woman complained of headaches; doctors found a living botfly larva in her scalp

She returned from South America with swelling, headaches, and was left horrified when she discovered a botfly larva had burrowed into her head.

ByChetana Belagere

Published Dec 13, 2023 | 9:00 AMUpdatedDec 13, 2023 | 9:27 AM

The botfly larva that was removed from the woman's scalp. (Supplied)

For 26-year-old wildlife conservationist Neelima (name changed), who works with an NGO in Bengaluru, it began with excruciating pain in her scalp. Little did she know that she was hosting a living and growing botfly larva.

After enduring a week of excruciating pain and a peculiar crawling sensation on her scalp, she approached the doctors at a city hospital, only to discover the presence of the larva.

Doctors at Trilife Hospital in Bengaluru performed a meticulous surgery, under local anaesthesia, making a careful incision in the scalp and extracting the live larva.

Emphasising the uniqueness of the case, Dr Raghavendra Kaladagi, Consultant Plastic Surgeon at Trilife Hospital, told South First, “This is a rare case. In India, botfly infestations are not commonly seen and could easily be misdiagnosed due to their symptom resemblance to common skin conditions, like furuncles.”

The procedure was successful, with the patient experiencing no complications post-surgery.

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What is the case about?

Explaining the case, Dr Kaladagi, who operated on Neelima, told South First that she came in with swelling in one area of the scalp, which was giving her terrible pain for over a week. The area was swollen and was getting bigger and bigger each day. She even felt a crawling sensation in her scalp.

Botfly larva. (Wikimedia Commons)

Botfly larva. (Wikimedia Commons)

On careful examination and listening to the patient’s travel history, doctors diagnosed her with myiasis — infection with a fly larva — and advised immediate surgical intervention.

The doctors explained that this case highlights the importance of early detection and removal of botfly larvae, as a failure to do so can lead to severe tissue destruction, with the larvae potentially developing into adult botflies.

“To spread awareness, medical professionals are advised to maintain a high index of suspicion, especially when dealing with patients who have recently traveled to South America and who present with painful skin boils,” explained Dr Kaladagi.

“In light of this rare occurrence, adoption of preventive measures is recommended for those travelling to regions where botflies are prevalent. This includes the use of caps or hats, clothing that covers the entire body, and insect repellents when visiting the Amazon rainforests or engaging in ecotourism in Central and South America,” added Dr Neema Sandra Dias, Consultant Dermatologist at Trilife Hospital, while interacting with the media.

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How does a botfly larva enter the human body?

South First spoke to Dr Sudhir Kumar, Neurologist at Apollo Hospitals in Hyderabad, who explained the process in simple terms. He also stressed that this is an extremely rare case in India. However, with people travelling in and out to many countries, this kind of incident may be found in other countries as well.

Botfly. (Wikimedia Commons)

Botfly. (Wikimedia Commons)

The botfly is a large, beautifully-coloured fly found mostly in Central and South America. It lives for only a few days as an adult. During that time, the female will mate and deposit her eggs on skin-piercing insects like mosquitoes.

“They typically find their way into human hosts through an intermediary — the mosquito. When the mosquito bites a human, it transfers the eggs of the botfly through that hole in the skin. The warmth of the skin triggers the hatching of these eggs and the larvae then burrow into the skin,” explained Dr Sudhir.

The most common place for this larva to enter the body is through the legs and scalp as they are the most exposed parts of the body, he added.

Dr Sudhir Kumar explained that inside the human, the larvae can feed and grow until they leave the host to pupate on the ground. It can even grow up to 3.2 cm long.

“The whole cycle — from the laying of eggs by the botfly on the mosquito, to the transfer of these eggs onto human skin, and their subsequent development into larvae — is a complex and rare phenomenon,” the doctor said.

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Symptoms of botfly larva in humans

Symptoms of botfly larva infestation include pain, swelling, and a sensation of movement under the skin.

Click to enlarge.

Click to enlarge.

However, these signs can easily be mistaken for more common conditions, like sebaceous cysts.

Dr Sudhir Kumar noted that, in most cases, patients seek medical help for what appears to be an ordinary skin infection. Only upon surgical intervention and pathological examination does the true nature of these cases come to light.

The removal of a botfly larva is a straightforward procedure, usually performed under local anesthesia.

“The procedure involved making an incision in the scalp skin to extract the live larva, followed by careful suturing,” explained Dr Kaladagi.

Travelling to such countries? Be prepared!

Dr Sudhir Kumar stressed that though even in regions where botflies are endemic, cases involving humans are sporadic.

When travelling to countries where botflies are seen, individuals should use insect repellent, wear protective clothing that covers the skin, and avoid mosquito bites to prevent infestations.

Also, they must ensure to report to the hospital if they feel any odd symptoms after visiting such countries, explained the doctors.