D107-21 Tracheostomal Myiasis in a Neurologically Impaired Patient: A Rare Airway Infestation

Myiasis, the infestation of living tissue by fly larvae, is an uncommon clinical condition primarily affecting cutaneous ulcers, nasal cavities, and external auditory canals. Tracheostomal myiasis is an exceedingly rare entity that can lead to potentially fatal airway complications. Here, we present a case of tracheostomal myiasis in a chronically tracheostomized woman, emphasizing the importance of preventive tracheostomy care. A 60-year-old woman with Parkinson’s plus syndrome, progressive supranuclear palsy, and hypertension, tracheostomized for seven months, presented with complaints of foul-smelling tracheostomy secretions and mild bleeding for three days. Local examination revealed multiple live maggots emerging from the tracheostomy stoma, with a small adjacent subcutaneous tract. Mechanical removal of larvae was performed, followed by topical application of turpentine oil to promote extrusion. Throat swab and bronchoalveolar lavage (BAL) cultures grew Pseudomonas aeruginosa, sensitive to Cefoperazone-Sulbactam and Levofloxacin. The patient was managed with intravenous antibiotics, daily povidone-iodine dressing, topical lignocaine, and tracheostomy tube replacement. Bronchoscopy revealed mucoid secretions in both bronchi without intraluminal maggots. Over subsequent days, the wound showed steady healing, and no further larvae were noted. The patient was discharged in a hemodynamically stable condition with advice on daily dressing and strict stoma hygiene. The patient has been under regular follow-up for one year and remains free of recurrence. Tracheostomal myiasis is rare but occurs more frequently in tropical climates, especially among debilitated or bedridden patients with poor tracheostomy care. Flies are attracted by necrotic tissue and foul-smelling discharge, depositing eggs that hatch within hours. Invasion may extend to the trachea or vascular structures, resulting in aspiration pneumonitis or hemorrhage. Early recognition and complete removal of larvae, supported by antimicrobial therapy, are vital for preventing complications. Preventive strategies include patient and caregiver education, environmental cleanliness, use of protective stoma covers, and routine followup. This case highlights the need for increased awareness of tracheostomal myiasis among clinicians managing tracheostomized patients in developing regions. Vigilant wound care, caregiver education, and early intervention can prevent this distressing yet preventable complication. This abstract is funded by: none