Posttraumatic human cerebral myiasis

Only eight cases of cerebral myiasis in humans have been reported worldwide and only one in the United States. Presented here is a case of cerebral myiasis in the setting of head trauma in suburban Los Angeles.

The article includes chart review and description of a clinical case presentation.

A 42-year-old HIV-positive man was found in a ditch after 2 weeks, the victim of apparent assault. He had multiple facial fractures along with open depressed bifrontal sinus fractures with necrotic bone, eroded dura, exposed cortex, and extensive maggot infestation of the left frontal lobe. The patient was taken urgently to the operating room, where the maggots where evacuated by irrigation and suction. Debridement of necrotic bone, dura, and brain was performed, the frontal sinuses were exenterated, and skull defects plated with titanium mesh. Intraoperative cultures revealed a polymicrobial meningitis/encephalitis, which was treated postoperatively with antibiotics. The patient's neurologic exam stabilized and the patient was transferred to a rehabilitation facility for further care, ultimately achieving functionality and holding a job.

This is the first published case of cerebral myiasis secondary to trauma, and to our knowledge, the first documented long-term survivor of extensive cerebral myiasis. Wide debridement to normal brain followed by 6 weeks of broad-spectrum antibiotic treatment is effective in managing this condition. A well-functioning outcome can be expected with prompt recognition and treatment of the disease. Larval infestation may have a protective effect against bacterial infection and may allow for greater tolerance of treatment delay.