This was an interesting case of pulmonary myiasis. It is an especially rare occurring, condition in developed countries. In underdeveloped countries where there is a greater chance of pulmonary myiasis or any other type of myiasis, it is primarily due to the prevalence of unhygienic conditions.
Myiasis is described as an infestation of a live invertebrate host with the fly (dipteran) larvae. These larvae will feed on the living and dead tissue of the host. Most of us refer to these larvae as maggots. The gravid female flies are most often attracted to festering unkept wounds where oviposition will occur. Poor personal hygiene attributed to advanced age, mental illness, and any debilitated condition can predispose and create a favorable condition for fly larvae infestation. This can especially be problematic in persons with poor dentition, and oral/sinus health where the foul odor will most certainly attract the gravid fly. In the case of this patient, he was severely debilitated, had poor dentition and was unconscious. The likely scenario was that a gravid fly somehow entered his room and deposited her eggs in his mouth to where the larvae hatched and moved down the trachea to find their way into the patients lungs. This undoubtedly produced the pulmonary symptoms that he had. In many cases the presentation is that of an eosinophilic pneumonia. These cases are generally serious in nature and proceed to a bacterial pneumonia secondary to the infestation.
The patient expired the next day. His advanced age, and severely, debilitated state placed him at an extreme disadvantage for overcoming the pneumonia complication that followed from the infestation.
This case study illustrates the importance of a consistent program of cleaning in a healthcare facility. Generally healthcare facilities require to maintain at least three types of cleaning to avoid infestations by rodents or arthropods, and minimize bacterial spread. These are routine cleaning, terminal cleaning, and scheduled cleaning. But even most important is the elimination of entry points for arthropods and rodents. With regard to arthropods such as flies, the most important preventative measure to institute a strict policy of not having windows open. But such a policy, instituted in a facility where there is poor control of the internal environment, is doomed to fail. A constant comfortable temperature in a healthcare facility is not just for the purpose of comfort, but is also part of safety prevention for the staff and the patient.
Hope you enjoyed this strange yet interesting case study.