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Thursday, December 5, 2013

Maggots in tracheostomy wound


Myiasis is the fancy Latin name of the yucky condition where fly larvae, or maggots, infest a living animal's tissues. The name of the condition derives from the ancient Greek word myia, meaning "fly". Myiasis varies widely in the forms it takes and its effects on the victims. Such variations depend largely on the fly species and where the larvae are located. Some flies lay eggs in open wounds, other larvae may invade unbroken skin or enter the body through the nose or ears, and still others may be swallowed if the eggs are deposited on the lips or on food. The clinical manifestations of wound infestation myiasis are visible larvae in the wound and secondary infection. Sometimes lesions get bigger due to tissue destruction. Treatment consists of applying a substance that deprives the larvae of oxygen (ether, Vaseline, etc.), so they have to emerge to the surface, and then removing them manually. 

Myiasis is a common disease in developing countries. Predisposing factors include poor hygiene and poverty, but it can happen despite ideal conditions, even in hospital settings. Prevention of this disease is accomplished by proper dressing of wounds, good hygiene, and preventing flies from entering houses, hospitals, and so forth. Ironing destroys eggs that may be left on cloth by female flies. 

Here is a pretty gruesome picture of maggots swarming within a tracheostomy opening in a child's neck. Ugh. Note the redness and swelling of the surrounding tissues.

 Image from: Blejter (2012)


An 8-year-old tracheostomized, gastrostomized boy suffering from cerebral palsy was admitted to the hospital for tracheostomy wound myiasis and inflammation of the surrounding tissues. There were multiple maggots, 5 mm long and 1 mm wide. Ether was applied to the wound, and then all the accessible larvae were removed. Antibiotic therapy was initiated. The procedure had to be repeated three more times to extract all the larvae (at the last procedure, the maggots measured 10 mm by 3 mm). An airway endoscopy was performed and ruled out the presence of larvae in the airway, as well as any damage to the wall of the trachea. The patient recovered uneventfully and was discharged.

This looks like a terrible case of neglect by the child's carers - I wonder if any charges were pressed.


Literature:

Blejter J. (2012) Tracheostomy Wound Myiasis in a Child: Case Report and Review of the Literature. Case Rep Pediatr. 2012: 317862. 

Wikipedia: Myiasis 





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