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.

13 comments:

Taps said...

Well done Maggot Man MD, great job. Something else to consider - our daughter also became an "accidental host" at age 3 after wetting her bed at night and we put the mattress out to dry on the grass, I understand Urine is very appealing to the flies, so extra care must be taken in this fairly common occurence with young kids, if the plastic sheet is missed....... What about the use of lavender and/or teatree oils in the bath? Taps

http://reluctantmemsahib.wordpress.com said...

What a simply marvellous and brilliantly eloquent piece on a beastie that so many feel obliged to wreathe in cloaks of mystery and too big words so that – as you say – none us common-or-garden mums can comprehend how to even begin to tackle the blasted thing.

You are not, as I am sure you gathered, alone. Do not fear, as I did when I first encountered wriggling little nasty on the edge of eldest offspring’s bath (similar age then to yours, he had spent several nights howling and I was at a loss to fathom the cause of his distress) that you have been dispatched to Social Siberia and forever cast as pariah and bad mother. Afraid I would be dismissed as one of the Great Unwashed (raising whole team of Unwashed who’d never be asked to a single birthday party) I tried to persuade people who spied – and commented upon – rising ‘boils’ on my babies’ peachy skins that they were just that: boils. Then back home I’d be frantically (pre-internet days) trying to grasp this subcutaneous invasion, poking, prodding, picking, squeezing, generally making everybody unhappy and finally (with a modicum of understanding beneath my own itching waistline) urging the ayah to please, please iron the inside of children’s jeans, shorts, underpants. Who irons their frickin knickers? I used to sneer, get a life! I used to think. Until, of course, I encountered putzi where one does not, really does not, want to.

So outed as a putzi host, along with my children, their guinea pigs and the dogs, we began to iron everything (except the guinea pigs and the dogs, obviously).

Needlessly it would appear, considering where I live now.

You can’t get a pedicure here, you are hard pressed, really hard pressed, to buy a bottle of Shiraz and you don’t even get putzi fly. Too dry I am told; they’d desiccate before getting down to it. Or us. My own theory as to their absence? Outpost’s geography such that even the mango fly aren’t tempted to come this far out.

One must be mindful of small mercies I suppose?

In any event, very well done.

nuttycow said...

Ever since having seen a mango worm being extracted I've refused to eat mangos. *shudder*

Good work though.

making ripples said...

My two year old was infected last week. The folks here in Moshi told us he had a boil from eating bad oil. I read on the internet that if you wait a period of time after taking your clothes off the line that the eggs die and you don't have to iron. I have 4 kids and don't feel like ironing 42 outfits a week!

Snaz! said...

Nice blog entry - congrats!
The longer you wait the easier it is. Once they make a small lump on the skin then you can just squeeze them out with your fingers one by one. A little antiseptic afterwards and you're all done! Have taken hundreds out of the dogs and some out of us and the neighbours too!
Ironing everything well is the cure, and you'll ever get them again :)

Fiona Leonard said...

Thanks for this detailed post. Am lying on the bed reading it while my husband picks a maggot out of my back. Is all very glamorous! It's useful to have all your info though to know how to approach it.

Steve said...

Thanks for the info! After just pulling something out of my 3 year olds scalp and having a Night of the Body Snatchers fear, glad to know we just have to wait another 24 hours for the one on her leg and things should be good. Thanks again!

labelmail said...

I would like to add a method which worked a treat when my son (6) had about 30 tiny maggots in a row on his bottom.
take a empty big bottle, fill it with boiling water, let it stand until the bottle is thoroughly hot.
Then empty it and immediately put the opening over the maggot spot.
Leave it there whilst the bottle is cooling down. The temperature difference produces enough suction to pull the maggot out.
It doesn't hurt and works also well as soon as you can see the breathing hole.

Jocelyn Frey said...

Thanks for this detailed post! My 15 month old has 76 mango worms in her right now... I just about had a heart attack. It's been rough trying to get them out, I can only do so many at a time as it's not a pleasant process. But thanks for some great tips that I will use to get the other 50 out... Ugh

greeneyedgirl said...

Has there been a lot of dogs or cats getting these here in the U.S.?

Esmé Harris said...

Thanks for an informative post! I would like to know, however, how to sanitise dog bedding, especially matrasses, since this is not so easily washed, ironed or tumbledried. Can one spray it with a strong saline or vinegar solution?

Wiets Botes said...

Thank you SO much for the information that you shared on this blog. We visited Hoedspruit, Limpopo, South Africa over the long weekend. We returned home and noticed these "mosquito" bites on my 5 year old son. Not 1 or 2 but 7 of them. The bites became bad and the doctor diagnosed it as tick bites. These turned out to be mango fly larva's!

I did a quick search and found your blog. The advice about taking a hot bath worked and we managed to remove them, not without a scene of course.

Thank you so much for sharing your knowledge and experience with everyone! You will be rewarded!

Gigi Wing-Davies said...

Hello from Zimbabwe. Not sure you'll get this as doesn't seem an active site but I just want to say how glad I was to find this last night, as, Horror of Horrors, what I thought to be a large boil on my 9 year old's arm, turned out to be a maggot/putsi fly. Couldnt' find anything useful on the internet until this posting. I used vaseline and then when the revolting creature stuck its head out a few mm (it was actually quite a big one) I pulled it off with tweezers, very very gently so as not to break it. Instant pain relief for my poor girl. Now discovering some very suspicous spots on me and I am certain I know my fate! My daughter is of course delighted that her mother will now properly understand how horrible it was for her (so painful!). she was literally dancing around singing with glee 'I've got a maggoty mother, I've got a maggoty mother' ha ha!