Abstract
In November 2010, a healthy 27-year-old active duty US marine presented to the Battalion Landing Team 3/8 Battalion Aid Station located, at the time, on a beach in the East African nation of Djibouti. His chief complaint was of a foreign body sensation in the right eye, reporting that a bug had flown into the eye 8 hours prior. He denied further symptoms. Physical exam revealed multiple 1 to 2 mm larvae moving vigorously on the conjunctiva of the affected eye, confirming the diagnosis of ocular myiasis. The patient's eye and its maggots were anesthetized with 0.5% tetracaine ophthalmic drops, and a total of 15 maggots were collected manually using cotton-tipped applicators. Antibacterial prophylaxis was given with topical moxifloxacin drops and erythromycin ointment. Slit lamp and fluorescein exams were normal after the procedure. Treatment was stopped after 3 days and the patient had no complications.
In March 2011, the entomology team at Camp Leatherneck, Afghanistan, examined the specimens and determined they were most likely the lively, hook-mouthed maggots of the viviparous sheep nasal bot, a fly endemic to most of the Middle East and northern Africa. The presentation was similar to several others described in the literature, though no baseline incidence or other cases have been reported from Djibouti. The environment for the field exercise was a secluded beachfront inhabited sparsely by migrant goat herders with an estimated livestock-to-human ratio of 20:1. The rapid insertion of a 300-man reinforced US Marine Corps rifle company likely changed the behavior of the herds and tenders, but also drastically altered the balance of hosts available to the average gravid bot. The result was a counterintuitive but foreseeable urban microcosm formed in an otherwise desolate rural area. In such a situation, clinicians may reasonably expect the risk for human infestation by zoonotic parasites to well exceed the local baseline risk.
The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, or the US Government.