He had sores and boils all over his skin and he told me he spent hours every night pulling half inch black larvae out of his painful eruptions.
He was not delusional. He was not on drugs. I had never seen anything like it before. He had already talked to a doctor who gave him his diagnosis: Bot fly infestation. He had also been told there is no real treatment for this.
The only bots I knew of were computer bots that spread viruses.
Bot flies are usually found in Central America, but my patient hadn’t been south of New Hampshire.
The typical treatment, we both learned through computer searches, begins with covering lesions with occlusive topicals. This helps suffocate the larvae, who breathe through small skin openings on their victim’s body. The next, painful, step is removing them, dead or alive, one by one.
When the lesions are infected, antibiotics like clindamycin can be necessary. We used several rounds of it.
As the weeks went by, my patient became run down and frustrated. The wait to see an infectious disease specialist would be another month, he found out, and even longer for a dermatologist. But my reading in The Lancet and elsewhere suggested they really would not have anything more to offer.
My patient one day told me he decided to get healthy. He stopped drinking soda and eating junk food. He began eating more fresh vegetables. He started running and lifting weights.
Two weeks later he had almost no new lesions but the ones he had were inflamed. He asked if I had heard that metronidazole can help get rid of bot flies. I had not, but searching for “metronidazole bot fly” I did see a 2009 case report supporting its use.
I sent in a prescription and one week later my patient said:
“I think I’m cured. And I feel great.”
A Country Doctor Writes: 
You are the specialist. The referrals you sought were to partialists.
Saw my first bot fly in Honduras. Never here in the US. I wonder if a half hour in a hot tub might suffocate the larva.
And change the tub water afterward lol
Morgellon’s. I had a patient I “cured” with hydroxyzine. I’ve seen plenty of cattle bot fly larvae decades ago that were the size of your thumb.
Wow, so you never figured out why or how the patient got it? Great job though listening to your patient and being available, the real practice of medicine!
Are you sure it wasn’t Morgellon’s disease cured by getting on a healthy lifestyle and taking care of himself? Did you see the larvae? That might cinch it.
This was a patient without a PCP I only see for MAT (Suboxone treatment) via telemedicine. He and his partner had seen doctors on site and the partner had even been hospitalized with sepsis related to this.
My sister lives in Central America. 2 of her children were bitten by bot flies several years back. One, hatched in his scalp, and he would drop to the ground and scream in pain, as it made it’s way across nerves. He was bitten in 2 or 3 places, as was his sibling. The standard treatment at the time,by local lay people as well as physicians, was to cover the area with a banana peel to starve the larvae of oxygen. When the larvae surfaced for air, they would get a glass soda bottle, heat it (if I remember correctly), and turn it upside down on the skin to create suction. Giving it a hard “pop” on the bottom of the bottle, the worm would pop out. Interesting stuff!