Myiase nasale à Lucilia sp. chez un patient intubé : à propos d’un cas au Maroc

Résumé

Introduction. Les myiases sont des infections parasitaires accidentelles ou obligatoires des animaux et de l’homme par les larves de mouches ou asticots. Les myiases en milieu hospitalier restent exceptionnelles.

Observation. Un patient de 72 ans a été admis au service de réanimation pour la prise en charge d’un choc septique compliquant une péritonite secondaire. Le patient a été intubé. Quelques jours après, des larves mobiles de couleur blanche ont été découvertes dans les cavités nasales du patient et ont été adressées au laboratoire de parasitologie pour identification. L’étude microscopique des larves a permis de diagnostiquer une myiase à Lucilia sp.

Discussion/Conclusion. Les myiases des unités de soins intensifs restent exceptionnelles et touchent préférablement les patients intubés ou présentant des lésions infectées ou nécrosées. Le traitement est l’extirpation en totalité des larves. La prévention de cette infection repose sur tous les moyens physiques et chimiques permettant d’éliminer les mouches dans le milieu hospitalier.

Nasal myiasis due to Lucilia sp. in intubated patient: about one case in Morocco

Introduction. Myiasis is the infestation of living bodies of animals and humans with fly larvae or maggots. These accidental or obligatory parasites grow in three stages in the host while feeding on his tissues. Myiasis in a hospital area is a rare situation when flies accidentally lay their eggs on patients, mostly in open wounds or cavities.

Case presentation. We report a case of a 72-year-old patient admitted to a general surgery department for peritonitis, then to an intensive care unit (ICU) for septic shock where he was intubated. Some maggots were seen moving in his nasal cavity a few days after his admission and were sent to our laboratory for examination. The larvae were identified as the third larval stage of Lucilia sp. They were removed entirely after intense nasal washing. A checking examination of his nasal cavities revealed no evidence of further infestation. After nasal washing, no other larvae were seen but unfortunately, the patient died of septic shock a few days later.

Discussion. Few cases of nasal myiasis in hospitalized patients were reported. ICU myiasis, extremely rare, is caused by the patient’s inability to fend off the flies because of their conscious state, presence of blood or odors caused by infections, and the warm humid environment.

Conclusion. Myiasis in intensive care unit is a delicate situation that might be underreported. Preventing this infection is directly related to the control of the flies.