Botfly Infestation Management
Primary Treatment Approach
The definitive treatment for botfly (Dermatobia hominis) infestation is mechanical extraction of the larva from the skin, which can be accomplished safely and effectively using a commercial venom extractor pump in the field or clinical setting. 1
Clinical Recognition
- Botfly myiasis presents as an erythematous papule that enlarges over 4-6 weeks with a central breathing aperture 1, 2
- Patients report feeling movement under the skin and intermittent lancinating (sharp, shooting) pains 1
- The lesion mimics furunculosis or cellulitis but persists despite standard antibiotic treatment 2, 3
- This diagnosis should be considered in any patient presenting 2-6 weeks after travel to Central or South America (particularly Belize) with non-healing "mosquito bite" lesions 1, 4, 3
Extraction Technique
The recommended extraction method involves:
- Apply an occlusive dressing over the lesion for 30 minutes to suffocate the larva and force it closer to the surface 1
- Use a commercial venom extractor pump (such as Sawyer Extractor Pump) applied directly over the lesion 1
- Activate the suction device, which rapidly extracts the larva completely intact 1
- This method is noninvasive, painless, and requires no hospital resources 1
Alternative Extraction Methods
- Standard surgical excision can be performed if venom extraction is unavailable 4
- Multiple native remedies exist but are less reliable than mechanical extraction 4
- The key is complete removal of the intact larva to prevent secondary infection 1
Post-Extraction Management
- The wound typically heals completely without complication after successful larva removal 1
- No antifungal or antiparasitic medications are indicated—this is purely a mechanical problem requiring mechanical solution 1, 2
- Monitor for signs of secondary bacterial infection if the extraction site becomes inflamed
Critical Pitfalls to Avoid
- Do not treat as simple furunculosis or cellulitis with antibiotics alone—the larva must be physically removed 2, 4, 3
- Do not attempt incomplete extraction, as retained larval parts can cause persistent inflammation 1
- Avoid misdiagnosing as a non-healing mosquito bite in travelers—always consider botfly in the appropriate epidemiologic context 3