Unusual presentation of myiasis.

Myiasis is a rare condition, produced by the invasion of tissues by maggots, the larvae of flies. This condition may be seen in wounds, eyes, nasal cavities and even intestinal tract and depends basically upon the random or chance infection of these tissues by eggs, of various flies. Recently a 25 years old man presented of vague abdominal pains, hyperacidity and intermittent passage of small worms for the last 3 years. Examination of his stool revealed maggots that were identified as Diptera larvae. Careful eating habits as well as thorough physical examination failed to reveal any clue. He was given clean laboratory containers for his stool examination which showed consistent presence of maggots. There were, however, a few occasions when no maggots were seen in his stools. He was given various treatment regimens like anti helminthics and purges but none seemed to work. Intestinal mylasis is occasionally caused by contamination of food stuff by eggs or larvae of flies such as Musca, Fannia, Chrysomya, Calliphora and other species. These may sometimes survive the passage down the intestinal tract, but the chance of a person perpetually devouring contaminated food for 3 years is minimal. Finally the. defecating habits of the patient were questioned again and it was realised that he would pass the stool on the ground, and then pick it up and place it in the container provided to him for examination. For some reason or the other we failed to recognise this possibility and assumed that he was passing the stool directly in the container when ever asked for a stool examination. After specific instruction, no maggots were found in his stools again and his abdominal symptoms disappeared. In the developing countries where, in addition to poor hygienic conditions, the literacy rate is usually low and the personal habits of individuals may be very bizzare. Therefore, physicians working in such conditions have to be aware of the intricacies involved in dealing with their patients’ personal habits. On most occasions the patients are given symptomatic treatment alone. Unnecessary use of medication can thus be avoided. Psychosomatic aspect of disease manifestations should also be considered as the symptoms in this case were dearly associated with the visual observation of worms in his stool.