Umbilical cord myiasis in a preterm neonate: a rare sepsis aetiology uncovered by root cause analysis - case report

Myiasis is the infestation of living human or animal tissue by fly larvae and is most common in wounds, body orifices or necrotic tissue in tropical and subtropical regions where hygiene is poor. Of the various forms of human myiasis, umbilical cord myiasis is exceedingly rare, with most reported cases occurring after the 5th day of life in infants cared for at home. A preterm neonate born at 30 weeks gestation developed umbilical cord myiasis with early-onset sepsis by 36 hours of life in a neonatal intensive care unit. This is one of the earliest and rarest presentations to be reported. Live larvae discovered on a necrotic umbilical cord stump were removed mechanically, and empirical anti-staphylococcal therapy was initiated; subsequent blood cultures confirmed multidrug-resistant Staphylococcus haemolyticus, and the infant recovered with targeted therapy. A structured root-cause analysis was carried out using chart review, staff interviews, and observation of delivery and cord-care practices, while an institutional audit examined maternal hygiene on admission, instrument sterilisation, and family participation in care. These processes identified modifiable gaps, and corrective measures were implemented to reinforce asepsis, educate caregivers, and standardise cord monitoring. This case underscores the importance of root-cause analysis in identifying rare aetiologies of sepsis and in recognising modifiable risks.