“This is what we call the Justice Tree,” says Victor, my guide for the Amazon Basin trek, as he points to a harmless looking tree.
He explains that in this area of Peru, if a person commits a crime he will be bound to the Justice Tree and left overnight. By daybreak, only a skeleton will remain. All the flesh would be devoured.
“But what, you ask, would eat a man?” Victor says with a magician’s flourish. He taps the tree bark with his machete. Thousands of fire ants cover the bark, prepared to fight and devour. “This is why tomorrow, when we trek through the jungle of Monkey Island, you must cover all of your skin. You don’t want to get bit by a fire ant or mosquito or something else.”
I have no desire to find out what ‘something else’ means. The next morning I am careful to leave no flesh exposed. I look like the bundled up kid from A Christmas Story, despite the fact it is 95 degrees Fahrenheit (35 C), sunny and humid. I have no desire to be a snack for an insect.
Victor brandishes a machete and hacks a way for us through the brush. He points out tarantulas, which are as large as my hand, and monkeys swoop down from the ceiling of trees and allow us to hand feed them bananas. In the evening, our group returns to the lodge, which consists of quaint screened-in wooden cabins offering two beds, two hammocks, a rocking chair and a shower. The cabins are not equipped with electricity, which, although annoying at first, is probably good, as I’m sure in the night that creepy crawly insects populate the cabin floor. Some things are just better left unseen.
I know that aside from my roommate, there were indeed, other creatures living in the room. One night, I wake sitting upright in bed scratching my ankle with such ferocity as to remove skin. Mercifully, I falll back to sleep and in the morning examine the red welt on the inside of my left ankle.
I look closely at the bump. At first I think it is a spider bite. I once had a spider bite and the bump was visible and hardened in the same manner. The only difference was at the summit of the bump, only one opening was visible, while usually with a spider bite there are two small incisions. As I layer up for the day’s hike, I make a mental note to watch the bite to make sure an infection does not set in.
For the next several days the bite itches periodically, but the redness remains in a localized area. I fly back home to New Jersey and begin treating the wound by drowning it in hydrogen peroxide and rubbing alcohol. By this time, I have irritated it so badly that it resembles a small volcano. The red bump is a half-inch (1.2 cm) in height and in the center of the wound there is an opening. I affectionately refer to the bump as my second left ankle. I keep waiting for the opening to scab up and heal. For the next several days, I pour peroxide directly into the hole and cover it with a bandage.
Several boxes of BAND-AIDs later, the opening in my flesh is still not closing. So, I do the next logical step: I ignore it. Perhaps by constantly flooding the cut with peroxide, I am not allowing the chance for it to heal and dry up on its own. Yes, ignoring the wound seems to be the next best course.
Four weeks after being bitten in the Amazon, the wound is still not better. I finally decide to go to a doctor. He prescribes a topical antibiotic and an oral antibiotic. The pills are so large, it is possible to throw them in spiral fashion, like a football. Since I dislike taking pills, I decide to only use the topical antibiotic.
I eagerly fill the prescription and go home to do battle with my flesh wound. I slather on the ointment and spackle up the hole in my leg. I notice after a minute of filling the hole up with the cream, it blows out the cream like a valve. I think: “Hmmm. It looks like my second ankle is breathing.” I push some more cream into the hole and firmly secure it with a bandage.
I follow this regimen for several days. I notice my second ankle is no longer as red, but it is still very hard and the hole is as big as ever. Also, every two hours I experience a stabbing sensation, as if someone is taking a needle and shoving it directly into the hole in my leg. I discover that draining the wound, like squeezing a giant pimple with my thumbs, helps alleviate the pain.
Now I have a new step to my regimen. About four times a day I drain my volcano, then spackle it shut with the cream. I wait for the stabbing sensation to return and then repeat the procedure.
One day at work, exactly six weeks since the time of the original bite, I have had enough. I am doing computer work when the acute stabbing feeling returns. I go to an empty room, prop my leg on a table and vow to finally drain this wound for good. I grab a ream of paper towels and go to work. The more I press, the more transparent orange-yellow liquid oozes. I mop up the exudate with a paper towel. I change the position of my thumbs and press on the wound from different angles. More liquid pours from the hole. I press harder. Tears well in my eyes. I am really hurting myself.
As I continue pressing, I can see a white substance surface at the hole. Perhaps this is pus and I can simply squeeze the pus capsule out. Now I have a goal. I attack my leg with a vengeance. I press on it again and see the white thing surface once more. I resolutely give my wound the mother of all squeezes, and suddenly a half inch (1.2 cm) long white thing that looks like a piece of uncooked spaghetti shoots out from my wound.
I grab the thing; still thinking it is a large column of pus between my thumb and forefinger. It stands firm and erect and is still anchored in the wound. It is not squishy. It is hard and it is wiggling and it is trying to get back into my leg!
“Oh my god!” I shout to no one. “It’s not pus! It’s a worm!” I am hyperventilating, holding half a maggot that has been living in me for six weeks. If I let the worm go, it will retreat back into my leg. If I pull on it, the worm will rip in half. The larva is not letting go of my ankle. I feel my stomach do a back flip and I begin to gag. “Get a hold of yourself!” I command. “Focus! Get the worm out of your leg, NOW!”
I continue to hold the worm between my thumb and index finger to prevent it from retreating back into my leg. Using my other hand, I dig my fingernails into the skin around the hole. I give the worm a good pull. It snaps in half. I put that half on the paper towel and pop the other half from my ankle. I seal the worm in a baggie as proof of what I have just endured. I hysterically tell a few colleagues about my struggle and rush to the doctor clutching my baggie full of worm.
In the doctor’s office, I sit upon the upholstered, paper-covered patient table. The doctor enters and calmly asks what brings me here today. I proudly hold up my baggie and exclaim, “I just popped this out of my leg!” This is the first time I have seen a doctor visibly pale.
He brings in another doctor to help him as he admits this is the strangest thing he has had to deal with. I ask him to imagine how I felt.
The three of us pour over a volume of “Clinical Dermatology,” and discover the parasite I played host to for six weeks wasDermatobia hominis, better known as the Human Botfly. My understanding of what happened is that the botfly landed on me while I was sleeping, bit me and quickly deposited an egg in my skin. The egg hatched and the larva grew and fed and tunneled about in my ankle happy to be living in a warm nutrient-filled home. I guess the worm did not know it would be journeying to New Jersey.
The inflamed cyst on my leg is properly called a warble, not a mini-volcano. The maggot is called a bot. While living in the warble, the larva needs to poke its head out and surface for air once a minute. This explained why the layer of cream I used to cover the hole continued to flap open.
There are three ways to remove a botfly larva from the skin. The first is by manual pressure, squeezing the wound like a pimple. The second is by flushing out the maggot by injecting a solution of lidocaine hydrochloride. The third is the Bacon method. I thought this procedure was named after a doctor distantly related to the actor Kevin Bacon, but it is aptly named, as the procedure requires the patient to place a fatty piece of bacon atop the hole of the wound. Within three hours, the maggot chooses to eat bacon rather than human flesh. Needless to say, I am relieved not to have to go food shopping for my larva.
My life has been changed forever by this experience. The mere fact I gave birth to an entity through a hole in my ankle has rendered me minor celebrity status. Many people curiously want to know who is the father. My friends have yet to organize a baby shower on my behalf, but certainly, bacon would be an appropriate gift.
If You Go
National Center for Infectious Diseases — Travelers Health