Oral myiasis complicating endotracheal intubation in a diabetic patient: a case report

Myiasis is a rare parasitic disease caused by infestation of dipterous fly larvae into living human or animal tissues. Although nosocomial myiasis has been occasionally reported in critically ill patients, cases of oral myiasis in patients with diabetic ketoacidosis (DKA) coma undergoing tracheal intubation remain rarely reported in South China. Herein, we report a clinical case of a 77-year-old male with type 2 diabetes mellitus who developed oral myiasis after emergency tracheal intubation for DKA coma. Comprehensive therapeutic strategies were implemented, including manual removal of larvae, oral debridement and irrigation, anti-infective therapy, and intensive glycemic control. To the best of our knowledge, this study is the first to focus on the clinical characteristics and high-risk predisposing factors of oral myiasis in intubated patients with DKA complicated by multiple organ dysfunction and septic shock in the hot and humid climate of South China. Combined with a literature review, we clarify key points of oral care interventions for such critically ill patients. This case supplements clinical data on this rare complication in South China and provides novel clinical references for the prevention, early identification, diagnosis, and treatment of oral myiasis in critically ill diabetic patients undergoing tracheal intubation in the emergency intensive care unit (EICU). Our findings emphasize that individualized oral care should be strengthened for high-risk inpatients who are bedridden, undergo invasive procedures, and present with severe metabolic disorders to prevent such rare nosocomial infections.