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Discussion in 'General Issues and Discussion Forum' started by JaY, Nov 30, 2011.

  1. JaY

    JaY Active Member

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    A 46 year old male patient presented to my practice concerned about a corn underneath the lateral-planatar aspect of his right hallux. On debriding, the tissue felt spongy and was very unlike normal hyperkeratosis. A tiny sac eventually "popped" out, leaving a clean small ulcer. When I popped this sac, tiny rod-shaped cream-coloured eggs were expelled. No systemic symptoms were expereinced. Patient is well.

    He had been in Mozambique approximately 3-4 months ago and was walking barefoot in the sand and on the sea rocks.

    Any ideas of what type of parasitic infection this may have been transmitted by a certain fly/insect?

    This is the first case that I have seen like this...I am flawed. :bash:
  2. blinda

    blinda MVP

    Lekker ;)

    Got any pics?

  3. Maddog

    Maddog Member

    ?? Guinea worm eggs.
  4. twirly

    twirly Well-Known Member

    Hi Jay,

    Did you keep a sample of the 'eggs'? May be worth tracking down someone in an entomology dept. locally. Just a thought....


  5. Nellermoe

    Nellermoe Member

    What you describe sounds something like the larva of what's called a Bot Fly. These are seen in cattle in the mid west of the U.S. Not known to infect humans. But then, anything is possible in Africa I would suppose.
    Someone mentioned sending it to an entemologist. That would be enlightening!
    Keep us posted, this is most interesting.

    Mark Nellermoe
  6. blinda

    blinda MVP

    Could well be. Botflies are not opposed to infecting humans. My eldest, Christopher, brought home a couple of uninvited guests from his field trip to Belize a few years ago. Couple of weeks later he was sitting on the sofa, picking at his mozzy bites when he said, "this bite won`t heal, can you take a look?" I looked. I saw a small hole. Then a white `thing` popped up and back down again. The GP was fascinated, but wouldn`t touch it. After 3 hours in A&E they found someone who was prepared to anaesthetize the area and remove our friends. He was gutted that he wasn`t allowed to keep them.

  7. Nellermoe

    Nellermoe Member

    Oh, Dear!! First person I've heard of who actually was infested! If it was realy a cattle bot fly larvae, he would have been less enthusiastic. Those I've seen are larger than a grown man's thumb.
    Not really cute and cuddly. But then boys are boys!
  8. Catfoot

    Catfoot Well-Known Member

  9. maxants33

    maxants33 Active Member


    This is an interesting and relevant paper - I read another paper a while ago about a similar case with an almost identical history to your pt's, and Im sure it turned out to be some kind of sand flea, cant find the paper Im thinking of though.
  10. JaY

    JaY Active Member

    It turned out to be a pregnant sand flea in his foot!

    After copulation, the female sand flea attaches itself head-first to the next host that comes its way (usually cows, but also humans!). It's head burrows into the dermis as the belly gets bigger and bigger with her eggs... There is a tiny hole on this belly that allows the eggs to be spewed out into the environment (during which the female actually dies but does not detach from its host). The dead female will usually fall off with time, but should actually be removed and the little ulcer left behind should be dressed appropriately.

    I will never miss this diagnosis again!
  11. davidh

    davidh Podiatry Arena Veteran

    You may forget JaY, unless you see the condition more than once every few years.

    I removed a chigger from someone's foot about thirty years ago. It sounds about the same. Chigger or Jigger - I forget!:D

    Sea-urchin spines - now they are a relatively common presentation in the UK. Probably where you are too. They present as black dots, usually on the heel. Each dot is the top of a broken spine which has to be removed. It can be done easily and painlessly with a no 11 blade......

    Interesting thread.......:good:
  12. JaY

    JaY Active Member

    Yeah that's right - it's a Jigger :drinks

    Never seen sea urchin spines before...but I'm sure I will sooner or later with me living in a coastal city.

    The other day I had to remove caterpillar hairs (ranging from 1 to 2 mm) from underneath a patient's toe area. He had quickly shoved his boots on (without socks) to take out the trash. The next thing he just became incredibly itcy and when he took his foot out of the boot he could see these tiny little hairs sticking out of his skin. Unfortunately he only saw me 1 week after the incident, so these hairs were no longer sticky out, but rather embedded nice and deep into his skin...Shame he had close to 50 tiny holes (some larger than others) after I had finished up with him.

    I love my job!

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