(565) Unexpected Intruders: A Rare Case of Tracheostomy Myiasis in a Patient With Hypopharyngeal Cancer

Introduction: Myiasis is a parasitic infection caused by Dipterous larvae, well known to veterinarians worldwide but an extremely rare infection in humans of the developed world. Gravid female flies target festering wounds, which create the perfect environment for oviposition. Risk factors for human myiasis include low socioeconomic status, poor hygiene, advanced age, cognitive impairment, neurologic diseases, alcoholism and living in low resource countries.

Description: A 69-year-old American male with a history of hypopharyngeal cancer, post tracheostomy formation, presented with an infestation of maggots in his neck. Physical exam noted erythema, swelling, and malodorous tissue with maggots surrounding the stoma. He reported working outdoors three days prior to the presentation and noted walking through a swarm of gnats. Prior to this, the cannula was adequately maintained at home along with routine outpatient check-ups. Ear-Nose-Throat and Pulmonology services were consulted for evaluation. Bedside bronchoscopy revealed irregular tissue surrounding the stoma opening, with partially fungating appearance and the presence of clotted blood in the airway. There were concerns raised regarding fistula formation due to tissue disruption within the airway. Computed Tomography of the chest and neck showed patchy consolidation within the right middle and lower lobes, likely infectious in nature. The patient was empirically treated with Vancomycin and Ampicillin-Sulbactam and underwent stoma debridement with direct laryngoscopy and bronchoscopy.

Discussion: This case report illustrates the importance of meticulous care and monitoring of tracheostomy sites. While also serving as a critical reminder for physicians to be vigilant of uncommon infections in vulnerable populations, despite being in an environment with low prevalence of insect-associated diseases. Prompt intervention, including debridement and broad-spectrum antibiotics, is essential to avoid complications such as secondary infection, airway stenosis, obstruction or fistula formation. Ivermectin therapy has been mentioned in the literature as an alternative treatment, although there is no clear evidence for its role in improving patient outcomes.