[Nasal myiasis due to lucilia sp. in intubated patient: about one case in Morocco]
Manal Bouikhif1,2, Yasmine El Kettani1,2, Mohamed Lyagoubi1,2
1Laboratoire central de parasitologie et mycologie, Centre hospitalier universitaire Ibn Sina, Rabat, Maroc.
Introduction:
Myiasis is the infestation of living bodies of animals and humans with fly larvae or maggots. These accidental or obligatory parasites grow in three stages in the host while feeding on his tissues. Myiasis in a hospital area is a rare situation when flies accidentally lay their eggs on patients, mostly in open wounds or cavities. Case presentation. We report a case of a 72-year-old patient admitted to a general surgery department for peritonitis, then to an intensive care unit (ICU) for septic shock where he was intubated. Some maggots were seen moving in his nasal cavity a few days after his admission and were sent to our laboratory for examination. The larvae were identified as the third larval stage of Lucilia sp. They were removed entirely after intense nasal washing. A checking examination of his nasal cavities revealed no evidence of further infestation. After nasal washing, no other larvae were seen but unfortunately, the patient died of septic shock a few days later.
Discussion:
Few cases of nasal myiasis in hospitalized patients were reported. ICU myiasis, extremely rare, is caused by the patient's inability to fend off the flies because of their conscious state, presence of blood or odors caused by infections, and the warm humid environment.
Conclusion:
Myiasis in intensive care unit is a delicate situation that might be underreported. Preventing this infection is directly related to the control of the flies.
Insights
This case highlights rare nasal myiasis in an intensive care unit (ICU) patient. Prompt larval identification and removal are crucial for managing this unusual hospital-acquired infestation.
Area of Science:
- Medical Entomology
- Infectious Diseases
- Critical Care Medicine
Background:
- Myiasis is the infestation of humans and animals by fly larvae.
- Hospital-acquired myiasis is rare, often occurring in patients with open wounds or body cavities.
- Intensive care unit (ICU) environments present unique risks due to patient immobility and potential attractants.
Observation:
- A case of nasal myiasis occurred in a 72-year-old patient admitted to the ICU for septic shock.
- Maggots, identified as third-stage larvae of *Lucilia* sp., were observed in the patient's nasal cavity.
- Larvae were successfully removed via nasal washing, with no further infestation noted.
Findings:
- Nasal myiasis in an ICU setting is an extremely rare occurrence.
- Factors contributing to ICU myiasis include patient's compromised state and environmental conditions.
- Despite successful larval removal, the patient succumbed to septic shock.
Implications:
- This case underscores the importance of vigilance for unusual infections in ICUs.
- Effective fly control measures are essential to prevent hospital-acquired myiasis.
- Underreporting of ICU myiasis may necessitate improved surveillance and prevention strategies.
