Myiasis of the tracheostomy wound: case report

"Myiasis" is a parasitic infestation of live human or vertebrate animal tissues or cavities caused by dipterous larvae (maggots) which feed on the host's dead or living tissue, liquid body substances or ingested food. They are extremely rare in Western countries, especially in E.N.T. practice, and to the best of our knowledge, only two cases of myiasis in a tracheostomy wound have been reported in the English literature. The case is reported, probably the first, of percutaneous tracheotomy myiasis. It was caused by infestation with larvae of Lucilia Caesar. The patient had undergone Griggs percutaneous tracheostomy 3 years earlier and was in a persistent vegetative state on account of a pontomesencephalic haemorrhage but maintained spontaneous breathing. The condition was treated by applying ether to the tracheotomy wound, which caused spontaneous exit of approximately 30 larvae, easily removed with forceps. The laboratory microbiologist observed and photographed macroscopic and microscopic characters of the larvae, of primary importance for species diagnosis. Predisposing factors could be: 1. smaller dimension of percutaneous tracheostomy in comparison to surgical tracheostomy; 2. vegetative state of patient; 3. poor hygiene of outer and inner tube; 4. bad smell of wound, which attracts flies; 5. living in a rural area. Although this is not a lethal disorder, knowledge of the disease is necessary from the preventive, diagnostic and curative standpoint. It is important to proceed with identification of the larvae, distinguishing them from other types of myiasis involving different therapeutic implications. Ecology, classification, and treatment of myiasis are reviewed.