DIGITAL INFESTATION WITH THE HUMAN BOT FLY a

tr n V diseases and infestation of vertebrate hosts. The most common form of bot fly infestation in humans involves movement under the skin, particularly when her hands prescribed foreign bo patient ha The foreign body was diagnosed as the larva of the within the subcutaneous tissue, the larva respires and e ground als. y painful. ARTICLE IN PRESSe hand and a normal neurovascular firm, erythematous nodule. The ldiscoloration. The lesion was tender to palpation and there was no fluctuance beneath the mass. We could not express fluid from the pore. She had full motion of all joints of th often has a disquieting sensation of movement and may, occasionally, see part of the larva protruding from the punctum. The punctum usually lies at the centre of a esion is typically 490aspect of the right small finger overlying the proximal phalanx, with an underlying area of induration and dark The pain is typically spasmodic, or intermittent, and may be accompanied by intense itching. The patiento signs of infection. Her local medical officer antibiotics, attempted removal of a presumed dy without success and referred her to us. The d a pin-prick sized pore on the dorso-radial forms the characteristic punctum. The larva g around 8 weeks, then emerges and drops to th to pupate into an adult fly. The skin lesion he The infestation is self-limited but can be verpore and n were submerged in water. She had no drainage from the excretes waste via a tube which passes to the skin and rows forthe eye and is caused by the sheep bot fly, Oestrus ovus (Salomon et al., 1970). Infestation by the human bot fly was first reported in the United States in 1964 and has been reported in many areas of the body, including the scrotum, heel, trunk and arms (Adams and Cooney, 2004; Kay and Higgins, 1964; Rodriguez and Rashid, 2001). We report a case of a bot fly infestation of the hand. CASE REPORT The patient was a 19-year-old student who visited Ecuador and, while in the Amazonian forests, sustained what she presumed to be an insect bite to her little finger. She was symptom-free for 2 weeks following the incident, then developed pain which persisted for 2 weeks and prompted her to seek treatment. She described the pain as spasmodic, but worse with activities such as writing. She also noted persistence of the original pin-point wound. Occasionally, she feltR. D. LAWSO