[Case of pneumonia associated sepsis accompaning pulmonary myiasis]

Abstract

Myiasis; is defined as the infestation of dead or living tissues of humans and animals by the diptera larvae. It is prevalent all over the world, especially in tropical and subtropical countries with low socioeconomic status. Myiasis of humans has been associated with low socioeconomic status, alcoholism, mental or neurological diseases, poor personal hygiene, patients with varicose veins, diabetes, malnutrition, advanced stage cancer, pediculosis, immunosuppression, sexually transmitted disease, gingivitis and other oral cavity lesions. Myiasis is most commonly seen as skin invasion in the human body, but can be observed in many areas such as eye, ear, nose, throat, urogenital, intestinal, cerebral and tracheopulmonary. Tracheo pulmonary myiasis is a very rare condition. This report presents a case of pneumonia-associated sepsis in a patient with a tracheostomy accompanied by third-stage larval Sarcophagidae. A 51-year-old male patient developed hypoxic brain injury after myocardial infarction 10 months ago before his admission to the hospital. Tracheostomy and percutaneous endoscopic gastrostomy were performed. Shortness of breath and fever were present for five days. The patient has been admitted to the emergency service with the reason for the deterioration of the general situation. The patient was unconscious. Purulent secretion in the tracheostomy area and bilateral crepitation rales in the lung bases were detected. Leukocyte level was normal with C reactive protein (CRP) 14 mg/dl. Nodular infiltration was detected bilaterally in the middle and lower zones, more prominently in the right thoracic computerized tomography. Seftriaxon, moxifloxacin and fluid therapy were initiated in the patient who was admitted with pneumonia-related sepsis diagnosis. The tracheostomy cannula has changed. On the fourth day of admission, Sarcophagidae third stage larvae were detected in deep tracheal aspiration. Treatment of piperacillin/tazobactam and teicoplanin was started by discontinuing the current antibiotherapy of the patient who had no clinical response and elevated CRP level, 18 mg/dl. The patient was discharged on the 25th day of hospitalization with improved clinical and laboratory responses. Complete healing was observed in the control performed by the home care unit. Bed-dependent, lack of self-care, and poor tracheostomy hygiene were risk factors for this patient. In this case, fluid therapy and antibiotic treatment for sepsis was given but no treatment for myiasis. Larva has been considered to have prepared a base for pneumonia due to the foreign body effect and secretion accumulation. Untreated injuries, especially those with impaired oxygenation, leave the eggs of adult flies and provide a suitable environment for larval development. Therefore, should be given importance to combat with flies and regular tracheostomy care in bedside and tracheostomized patients.