Sunday, May 11, 2008

Mango Fly / Putzi Fly / Tumbu Fly - a Practical approach to dealing with the little buggers..

Mango Fly

Technical Blurb:

Mango flies, or myiatic flies, are also known Putzi Fly or Tumbu Fly all depending on which side of the Ruvuma you reside on. They are a member of the blow fly family (Cordylobia Anthropophaga) and the flies in this family are often metallic in appearance and between 10 to 12 mm in length - aka “Blue Bottles “ or “Bog Flies”. The condition is known as cutaneous myiasis.

Dogs & rodents are usually the hosts, but humans often become accidental hosts.

Infestation in Humans:

My 8 month old son was one such accidental host and I spent ages reading up on the web about Mango fly and was so disappointed with all that I could find that I decided to write this blog in the hope that it would prove useful to other people.

The relevant websites fine for really big people but I couldn’t pronounce, let alone spell half of what was written about the condition, or more importantly how to treat and prevent it. Medical facilities in Arusha are at the best down right awful and was not going to subject my son to “Tank ya Maji or Mohammed’s” queues and thus turned to the T.U.R.D’s (The Usa River Dames - women far wiser, and greyer, than I and am eternally grateful to Cathie, Aideen & Lizzie for their support, squeezing techniques and knowledge of all applicable drugs (unfortunately the legal ones..)

I hope this proves useful but as I’m not a qualified medical person if you are at all worried best you get down to the Doctors…

Recognizing the Mango Fly:

At first the ‘bite’ looks like a normal mozzi, or flea bite, and then slowly develops, over the next 2 – 3 days in what will become a small (2 – 3mm) very itchy, and sore, infected boil like spot. The main distinguishing factor is that there is always a ‘hole’ in the middle, which basically the maggot breathes through. There is quite often a clear fluid that oozes out of the hole.

After 2 days there is a very definite black spot in the middle, but you can see that the black spot is subcutaneous and does look a little like a sunken black head - unlike an infected tick bite which has a large jet black centre which looks more like a scab than a spot.

How do we get infected?

The main way humans get infected is when the fly lays eggs on damp clothes lying on the ground, or even whilst on the washing line. Judging by the number of bites on Tavari’s legs one can also get them from sitting directly on the lawn. Bra straps, knicker lines and jean belt areas seem to be the fav places as they stay damper longer than other parts of clothes. One website talked about the flies being attracted to shady soil that has often been contaminated by urine or feces so all families with dogs & cats need to be extra cautious. Dogs & puppies are quite often infected in their paws and tummies thus again giving weight to the fact that the eggs are laid in damp grass.

Eggs hatch after 1 – 3 days, and depending on which site you were reading can survive anywhere from 48 hours to 15 days waiting for a suitable host and can once in contact with skin can take as little as 25 seconds to burrow in. Thankfully, eggs are never deposited directly on the skin of the host.

How to remove the maggots:

The main thing that I learnt during this whole dreadful experience is you have to have patience. You can do far more damage by trying to forcibly remove the maggots before they are good and ready to come out. If you suspect that your child has Mango fly instruct your nannies that under no circumstances must they try and remove the offending little creatures themselves. Over enthusiastic nannies have done more damage, both physically and emotionally, by trying to squeeze the maggots out too early and I have heard some pretty horrific stories. However, interesting enough neither of my two nannies had ever come across the condition, but I rather suspect that they are always thought to be just boils or “Jipu” as they are called in Tanzania.

They are usually ‘ready’ at about 3 - 4 days after you notice the red bites, but I was still removing them some 5 days later and these ones proved to be by far the easiest and way less traumatic for the baby then the earlier ones. These were huge by now and were over 10mm long – the majority of the 2 -3 day old ones were in the region of about 5 – 6 mm long and in hindsight I should have waited until day 4 to have dealt with them. However, after saying that I certainly do not recommend waiting 5 days before beginning the extractions - apart from the trauma of knowing there are live maggots in your baby the itching will drive him mad. Lashings of a good antihistamine cream after bath and before bed is a must and again in the middle of the night.

First thing is you have to figure out is the orientation of the maggot to know from which direction to apply pressure from. The easiest were the straight up and down ones, but sometime they were laying at an angle. Then clean the entire area with a good antiseptic wash (I was given a surgical scrub liquid soap that worked a treat) but surgical spirit, alcohol or an iodine solution will be fine too. Apply a thick cap of Vaseline jelly (about 3 mm thick) covering the whole boil but making sure that it covers the breathing hole. Wait a good minute or two until you see definite ‘movement’. This is the maggot trying frantically to find some air, and you will see the Vaseline moving (a good head torch is a handy thing to have at this moment) – you should also see at least a good millimeter at the maggot coming out of the hole. Holding two small bits of either cotton wool, or toilet paper (you need this as the Vaseline makes the whole area very slippery and if you remove the Vaseline to see what’s happening the maggot shoots back down into his hole!). Apply downward pressure about half a centimeter either side from the boil then bring your thumbs together trying to get under the maggot and push it up and out - just like a juicy blackhead - I kept mine in a shot glass of Vodka to show interested guests. If you see no movement then the maggot is definitely not ready so wait another day and try again.

If after a good squeeze, or two, and the maggot doesn’t come out… STOP. It’s not ready and all you will do is either squash it in side - killing it, or will bruise the child or will plain just hurt the child unnecessarily. Chatting to a Doctor in Nairobi he said that if the maggot dies inside it will actually just be absorbed by the body – but you need to apply a good antiseptic cream and keep the whole area clean to minimize infection.

After a successful extraction clean the whole area again and apply Grabacin antibiotic dusting powder directly into the hole, following this up later with a good antiseptic cream. Be extra careful of applying cream to ones on the face as you do not want the baby rubbing this into his eyes. I also had my baby on a course of Augmentin antibiotics to combat infection. What was surprising is how quickly they cleared up and healed after extraction showing that the little buggers do keep clean houses..

Sometimes the clear fluid that oozes out of the hole would develop a ‘scab’ of sorts over the top of the ‘boil’ – but never actually blocking the breathing hole. This I found could inhibit a speedy extraction so I got hot salty water (as hot as possible) and dipped in cotton wool and then laid it over the ‘boil’ for a minute or two which would just soften up the whole area. I also found that the maggots really didn’t like this heat and were more than happy to vacate their burrows. Whilst working on the ones on the baby’s back I laid him down in a nice hot bath for about 10 minutes (with his back totally underwater) and found these ones popped out very easily – but they too were very ‘ready’ and were about 3 days old.
Twice a day I washed the baby in the surgical wash to keep his whole body as clean as possible. The clear fluid that oozes out of the whole does include maggot poo so best keep everything sparkling clean...

They are surprisingly hard to get out and this in part is to do with the fact that the back half of the maggot is covered in rings of fine black hairs that work a bit like a bottle brush in that it’s easy to push in but a bugger to pull out.

How to prevent being an “Accidental Host”:

- Iron all you clothes, especially underpants & bras, all baby clothes including sheets and pillow cases.
- Use a tumble drier in the rainy season as a this really will kill all the eggs.
- Make sure your clothes line is in direct sunlight at all times.
- Keep the grass very short under the clothes line.
- Fence in the clothes line so that the area around cannot be contaminated by cat & dogs.
A new update to this is that I found that Tee Tree Oil works very well at killing very new fresh mango flys. Apply directly into the new red bite mark about 3 - 4 times a day for a couple of days and bingo they die! Marvelous, well chuffed with this discovery.