Three cases of cutaneous myiasis caused by Cordylobia rodhaini

Cordylobia sp. is a fly belonging to the Calliphoridae family. Three species of Cordylobia are known: C. anthropophaga, C. rodhaini and C. ruandae. The C. rodhaini Gedoelst 1909 lives in Sub-Saharan Africa, especially in rain forest areas. Usual hosts are rodents and antelopes. Humans are accidentally infested. Myiasis caused by C. rodhaini has been very rarely reported in the literature. We present three cases of C. rodhaini myiasis acquired in Ethiopia and Uganda.


Introduction
Cordylobia sp. is a fly belonging to the Calliphoridae family.Three species of Cordylobia are known: C. anthropophaga, C. rodhaini and C. ruandae.C. rodhaini Gedoelst 1909 was first described by Gedoelst in 1905.It was initially named "Lund's fly", after the surname of Captain Lund, who is considered the first patient affected by myiasis due to C. rodhaini: in fact, a larva was extracted from his arm in Congo [1].C. rodhaini lives in Sub-Saharan Africa, especially in rain forest areas.Usual hosts are rodents such as Cricetomys gambianus, the "gambian rat" or "northern giant pouched rat" and small antelopes (Cephalophus dorsalis, the "bay duiker" and Cephalophus grimmi) [1].Humans are accidentally infested.
We present three cases of C. rodhaini myiasis acquired in Ethiopia (one patient) and Uganda (two patients).All patients were treated at the Department of Pathophysiology and Transplantation, University of Milan, Italy.

Case Reports
We observed three Caucasian patients, a man and two women, aged 59, 58 and 52 years, respectively.
Locations of the lesions were on the right leg for the first patient; on the abdomen, pubis, scrotum and left thigh, for the second patient; in the left shoulder for the third patient.Two patients presented with a lesion each, and a patient with five lesions.Two patients had nodular-ulcerative lesions and one a furuncular lesion (Figure 1-2).Patients' characteristics are reported in Table 1.In all patients a single third stage larva of C. rodhaini was extracted (Figure 3).Diagnosis of third stage larva of C. rodhaini was based on the typical random distribution of tiny hooks on the surface of the larva.

Discussion
The life of the adult of C. rodhaini is approximately one month [1].The female lays approximately 500 eggs in dry soil; however, eggs may be laid also on clothing.The eggs hatch 2-4 days later.On contact with the skin of a suitable host, the larvae penetrate.Twelve-15 days later, the larvae develop into second and third stage, during the latter the larvae can reach the length of 1.5 cm.Mature larvae may emerge from the skin spontaneously [6].
All published cases of myiasis due to C. rodhaini are related to travellers who visited sub-Saharan Africa: Cameroon [2,4], Kenya [3], Ethiopia [1,6,9] and Ghana [8].At first, an inflammatory papule appears; it enlarges becoming a nodule with a central opening, from which a serous fluid oozes.The typical clinical appearance is the same as a nodular-ulcerative lesion or a furuncle, this is where the term "furuncular myiasis" [8] comes from.The myiasis is accompanied by pain [8,9] or burning sensation [1].The number of the lesions is extremely variable: from one to 15 lesions can be observed on patients.Even a patient with 150 lesions located on the scalp, forehead, neck, chest, limbs, back, pubis, genitalia and buttocks has been reported [1,6].Systemic symptoms are very rare, although can be sometimes severe, such as fever [1,6] as well as cervical, axillary, trochlear and inguinal lymphadenopathy [6].Laboratory abnormalities such as neutrophilic leucocytosis are rare [1,6].
As previously mentioned, mature larvae may emerge from the skin spontaneously [6], for this reason often no treatment is necessary.In order to force the larvae to emerge some authors applied petrolatum [7,8].In our patients, the leakage of the larvae was obtained by means of a gentle manual pressure at the edge of the lesions.A hyperpigmentation may persist on the skin of the affected area for several months [6].