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*Corresponding author: E-mail: raafath2001@yahoo.com; 
 
 
 

Asian Journal of Immunology 
 
3(1): 106-113, 2020; Article no.AJI.56084 
 

 
 

 

 

A Case of Furuncular Myiasis Due to Cordylobia 
anthropophaga in Infant in Makkah, Saudi Arabia 

 
Raafat A. Hassanein1,2*, Amal M. Almatary3,4 and Mohammad O. Alkurbi1 

 
1
Department of Laboratory Medicine, Faculty of Applied Medical Sciences,  

Umm Al-Qura University, Saudi Arabia. 
2
Department of Zoonoses, Faculty of Veterinary Medicine, Assiut University, Assiut, Egypt. 

3
Parasitology Unit, Maternity and Children Hospital, Makkah, Saudi Arabia. 

4
Department of Parasitology, Faculty of Medicine, Assiut University, Egypt.

 

 
Authors’ contributions   

 
This work was carried out in collaboration among all authors. Author RAH designed the study, wrote 

the protocol and wrote the first draft of the manuscript. Authors AMA and MOA managed the analyses 
of the study. Author MOA managed the literature searches. All authors read and approved the final 

manuscript. 
 

Article Information 
 

Editor(s): 
(1) Cynthia Aracely Alvizo Báez, Autonomous University of Nuevo Leon, Mexico. 

Reviewers: 
(1) S. K. Kuria, Walter Sisulu University, South Africa. 

 (2) Papa Kofi Amissah-Reynolds, University of Education, Winneba, Ghana. 
Complete Peer review History: http://www.sdiarticle4.com/review-history/56084 

 
 
 
 

Received 02 February 2020  
Accepted 09 April 2020 
Published 14 April 2020 

 
 

ABSTRACT 
 

The cutaneous myiasis has been rarely reported in Saudi Arabia. We intended to describe here a 
case of furuncular cutaneous myiasis caused by Cordylobia anthropophaga larvae in infant from 
south area in Makkah, Saudi Arabia. A female infant, 17-day-old, had lived with her family in area 
closed to animal houses. Physical examinations showed 2 tender erythematous nodules with small 
central ulceration on the infant back and hand. During investigation, 2 larvae came out from the 
lesion. C. anthropophaga was identified by paired mouth hooks (toothed, spade-like, oral hooks) 
and 2 posterior spiracles, which lack a distinct chitinous rim. Although rarely described in Saudi 
Arabia until now, cutaneous myiasis should be expected in people living nearby such livestock, with 
flies and poor hygienic conditions. 

 

 

Case Study 



 
 
 
 

Hassanein et al.; AJI, 3(1): 106-113, 2020; Article no.AJI.56084 
 

 

 
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Keywords: Cordylobia anthropophagi; cutaneous; myiasis; furuncular myiasis; Saudi Arabia. 
 

1. INTRODUCTION 
 

Myiasis is defined as the infestation of live 
human and vertebrate animals with dipterous 
larvae, which, at least for a certain period, feed 
on the host’s dead or living tissue, liquid body-
substances, or ingested food. It can involve 
cutaneous, enteric, ophthalmic, nasopharyngeal, 
auricular, and urogenital systems by larvae of the 
order of Diptera (true flies). It is widespread in 
tropical and subtropical areas, including Central 
America, South America, and tropical Africa [1,2]. 
In addition, myiasis is continuously recorded 
throughout the world due to travelers returning 
from endemic areas. It has been reported in 
several countries, including France [3] China [4], 
US [5], Japan [6], Saudi Arabia [7,8]. 
 

The cutaneous myiasis is the most frequent and 
impressive form and it can be divided into 3 
types by clinical features and type of larvae: 
furuncular, creeping (migratory) and wound 
(traumatic) myiasis [9]. 
 

Furuncular myiasis is defined as the penetration 
of the larvae inside the healthy skin and 
development of a boil-like nodule. It is more 
common in tropical countries and can be caused 
by Dermatobia hominis, C. anthropophaga, 
Cuterebra sp. and Wohlfahrtia vigil [10,1,11,12, 
13,14]. 
 

Gasterophilus and Hypoderma are two flies that 
produce a creeping myiasis. Flies that cause 
wound myiasis include screwworm flies such 
as Cochliomyia hominivorax and Chrysomya 
bezziana, and Wohlfahrtia magnifica [9]. 
 

The human botfly, Dermatobia hominis 
(Linnaeus, 1781), causes obligatory myiasis and 
this parasite depends on the host to complete its 
life cycle [15]. Humans can be infested through 
direct exposure to environments contaminated 
with eggs of the fly [16]. 
 

In this study, we present the case of furuncular 
myiasis in an infant living with her family nearby 
livestock’s area, with flies and poor hygienic 
conditions south of Makkah, KSA. The larva was 
removed from a boil-like lesion of infant back and 
hand and identified as C. anthropophaga from 
morphology. 
 

2. CASE REPORT 
 

A 17-day-old female infant presented to pediatric 
department at Maternity and Children hospital, 

Makkah, Saudi Arabia on 10 February 2020, with 
1-week history of 5 painful erythematous nodules 
boil-like lesions with a small central punctum 
appeared on her back and developed as an 
abscess on the back and hand (Fig. 1). A third 
instar larva 8×3 mm in size (Fig. 2), yellowish 
color with cylindrical body was removed from two 
of the lesions and identified in the parasitology 
unit, Maternity and Children Hospital. 
 
The larvae were first washed in distilled water 
and then cleared in 10% sodium hydroxide 
(NAOH) solution for 1 h. The larvae were washed 
again in distilled water, transferred to 10% acetic 
acid for 30 min and washed again in distilled 
water. The specimens were then dehydrated in 
ascending series of ethanol (30%, 50%, 70% and 
90%) for 30 min each. The larvae were then 
soaked in absolute alcohol for at least 1 h and 
then transferred into Xylene for one hour. At this 
stage, all the internal organs of the maggot were 
removed and the posterior spiracles were cut 
transversely, also the anterior end cut 
transversely and the medium portion 
longitudinally, then specimens were mounted 
onto a glass slide using DPX and left to dry to the 
next day. The slides were examined under a light 
microscope for taxonomy studies and 
identification [17]. 
 
The morphology of the larvae body was almost 
completely covered by conic small black, 
scattered spines with a brown apex, pointing 
towards the posterior end (Fig. 3). Two copper-
colored posterior spiracles, each bearing 3 
sinuous spiracular slits which lack a distinct 
chitinous rim (Fig. 4). In the anterior end of larva, 
the mouth with a pair of spade-like stout hooks 
with curved and sharp tips without cluster of 
conic denticles and anterior spiracles were 
characteristically observed (Fig. 5). These 
morphological characteristics were consistent 
with those described for C. anthropophaga         
[18]. 
 

Laboratory tests demonstrated high monocytes 
2.54 x 10

3
/Ul, high eosinophils 1.40 x 10

3
/Ul, high 

Mean Corpuscular Haemoglobin 33.1 pg, high 
Bilirubin (5.1 umol/L), high potassium-k (5.7 
mmol/L), high creatinine (41.0 umol/L), high 
calcium (2.8 mmol/L), low SGOT/AST (30) 
indicating renal impairment. 
 

Skin lesions were markedly improved after the 
remove of larvae and 2-week antibiotic 
treatment, and there was no recurrence. 



 
 
 
 

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Fig. 1A. Boil-like lesions caused by Cordylobia anthropophaga on the back of the patient 
 

 
 
Fig. 1B. Boil-like lesions caused by Cordylobia anthropophaga on the abdomen of the patient 

 

 
 

Fig. 1C. Boil-like lesions caused by Cordylobia anthropophaga on the hand of the patient 
 



 
 
 
 

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Fig. 2. Barrel-shaped larvae were about 8 mm in length and 4 mm in width 
 

 
 

Fig. 3. Conic spines on the body with a brown apex, pointing towards the posterior end 
(magnification 20X) 



 
 
 
 

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Fig. 4. Two copper-colored posterior spiracles, each carrying 3 sinuous spiracular slits which 

lack a distinct chitinous rim (magnification 20X) 
 

 
 

Fig. 5. Anterior end of C. anthropophaga showing paired mouth hooks (toothed, spade-like, 
oral hook) protruded ventrally from anterior 2 black mouth-hooks (magnification 20X) 

 

3. DISCUSSION 
 

The definitive study on the Tumbu fly                         
(C. anthropophaga) was carried out in Sierra 
Leone in 1923 [10]. In Africa, furuncular myiasis 
is caused by 3 species of the genus Cordylobia:             
C. anthropophaga (endemic throughout Africa), 
C. rodhaini (parts of Africa with rainforests) and 
C. ruandae (Zaire border and Rwanda), whereas 
D. hominisis common in Central and                    
South America [3]. Among Cordylobia spp.,                         

C. anthropophaga is the dominant causative 
agent compared with the other species [19]. 
 
The larvae can penetrate the unbroken skin of 
the host, who is usually lying on the ground or by 
the contaminated clothes. Interestingly, the host 
usually feels no symptoms at the time of skin 
penetration by larvae. Therefore, most patients 
do not think maggots as a cause of their skin 
problems. Within 1 to 2 weeks, the larvae 
develop into the second and third in stars and the 



 
 
 
 

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111 

 

8×3mm sized mature larvae that can emerge 
from the central pore of the skin lesions [20]. 
 
In this report, morphological characteristics of 
larvae of C. anthropophaga (ex, a pair of spade-
like hooks, anterior spiracles, and posterior 
spiracles) are well observed in Figs. 3, 4 and 5. 
These morphological characteristics were 
consistent with those described for                            
C. anthropophaga [4,13,14,18]. In the posterior 
spiracles, the 3 spiracular openings are slightly 
sinuous slits in C. anthropophaga, whereas 
tortuously sinuous in C. rodhaini.                                
C. anthropophaga has mouth hooks with curved 
and sharp tips, but there is neither cluster of 
conic denticles nor oral grooves. On the other 
hand, C. rodhaini has mouth-hooks with broad 
and rounded tips and cluster of conic denticles 
as typical feature. 
 
Therefore, sufficient knowledge and experience 
for diagnosis is needed to avoid misdiagnosis, 
such as pyoderma, impetigo, staphylococcal 
furunculosis, and cutaneous leishmaniasis [1]. 
 
Early lesions may resemble other reactions due 
to insect bite, but furuncular lesions with an 
intense inflammatory reaction in the surrounding 
tissue rapidly develop [20,21]. 
 
Myiasis has a greater economic impact as an 
infestation of animals than of humans; there are 
no species of Diptera which are restricted to 
humans for their development but there are 
many that have a very restricted host range on 
animals [22,23]. 
 
The infestation for our case may be occurs 
through a fly itself where the infant family lived 
near animal houses such as sheep, horses and 
cattle in south area in Makkah (Malikan area), 
Saudi Arabia. This case report again highlights 
this disease should be expected in people living 
nearby such livestock, with flies and poor 
hygienic conditions. These people should be 
taught hygienic practices and methods to control 
fly population. 
 
The “tumbu fly”, C. anthropophaga, is an agent of 
obligatory cutaneous (furuncular) myiasis, widely 
distributed in the sub-Saharan region [24], 
although at least one autochthonous case has 
been recently reported in Saudi Arabia [25]. This 
species, with rodents as natural hosts, has 
secondarily adapted to other wild and domestic 
animals and to humans [26]. 
 

Myiasis is more common in summer and spring 
seasons of tropical countries [27]. Our case 
occurs in February where the end of winter and 
atmospheric temperature in Makkah area is 
slightly high especially at daytime like spring 
temperature.  
 

The goal of treatment is removal of the larva and 
prevention of the secondary infection. Occlusion, 
larvicides such as ivermectin, or manual 
squeezing can be used to remove the larva. 
Occlusion deprives the larva of oxygen and 
either kills the larva or induces it to move upward 
in search of air [1]. Manually squeezing out the 
larva is therapeutic option in all forms of 
furuncular myiasis. Sometimes, surgical removal 
is needed for removing the larvae or their 
fragments [28]. 
 

4. CONCLUSION 
 

In conclusion, we report a case of furuncular 
cutaneous myiasis on the back and hand in an 
infant by C. anthropophaga, living nearby such 
livestock, with flies and poor hygienic conditions, 
which has been rarely described in Saudi Arabia. 
Considering the increasing close association with 
animal houses, physicians should be more 
concerned about clinical manifestations of 
cutaneous myiasis and morphologic 
characteristics of dipterous larvae. 
 

CONSENT 
 
As per international standard informed and 
written parental consent has been collected and 
preserved by the authors. 
  

ETHICAL APPROVAL 
  
As per international standard written ethical 
permission has been collected and preserved by 
the author(s). 
 

ACKNOWLEDGEMENT 
 
The authors would like to express sincere 
appreciation to staff members and technicians of 
the Maternity and Children Hospital, Makkah, 
Saudi Arabia for their assistance in 
parasitological identification and data collection. 

 
COMPETING INTERESTS 
 
Authors have declared that no competing 
interests exist. 
 



 
 
 
 

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