Nosocomial infection with a crown

Excerpt

Ten live white translucent larvae measuring 10–15 mm long and 2–3 mm wide were found (Fig. 1a, b) in the dental caries (Fig. 1c) of an unconscious 89-year-old man with a long-term tracheostomy, who had been on a ventilator in the intensive care unit (ICU) for 5 months. Scanning electron microscopy revealed a body covered with dense short spikes and a ring-shaped “crown” larval head (Fig. 1d). The larvae were identified as that of the Lucilia sericata fly, and oral myiasis was diagnosed, which is prevalent in Africa and the tropics, but rare in temperate-zone Asia, and even rarer in a closed, managed ICU. The suspected infection pathway of oral myiasis is that the eggs hatch in the mouth of comatose patients who lack oral protection. The main treatment is mechanical removal of the parasites. To prevent infestation, the spread of flies in summer and autumn should be prevented. After removal, the patient did not relapse.

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