Challenges and Solutions in Managing Umbilical Myiasis With Sepsis in a Newborn

Myiasis is caused by the infestation of fly larvae and occurs more frequently in tropical, rural and low socioeconomic areas. We report a rare case of umbilical myiasis in a neonate, complicated by sepsis caused by Staphylococcus aureus .

The patient, born in a vulnerable family, presented on the fourth day of life with erythema in the umbilical region, accompanied by serous drainage and visible larvae. Immobilization and manual removal of the larvae were attempted 3 times but proved ineffective. On the 10th day of hospitalization, oral ivermectin (200 μg/kg) was administered. Two days after initiating the medication, no larvae were observed, and no adverse events occurred. The delay in initiating treatment, due to insufficient robust evidence of ivermectin's safety in children weighing less than 15 kg, contributed to complications and prolonged hospitalization.

Umbilical myiasis reflects inadequate hygiene conditions and socioeconomic vulnerability. Traditional management in children under 15 kg includes occlusion with Vaseline or similar substances and mechanical removal of the larvae. This report emphasizes the critical need for safety studies on ivermectin's use in children weighing less than 15 kg, considering its potential to significantly improve the management of neglected parasitic diseases.