Villwock Jennifer A, Harris Tucker M
Department of Otolaryngology, State University of New York Upstate Medical University, Syracuse, New York.
J Emerg Med. 2014 Aug;47(2):e37-41. doi: 10.1016/j.jemermed.2014.04.024. Epub 2014 Jun 6.
There is a paucity of literature on wound myiasis of the head and neck originating in the United States. To our knowledge, only three reports during the past 20 years exist in the literature. Even less common is a case of recurrent myiasis, with only one report published from India during the 1970s. There is often a preconceived notion that larvae are noninvasive and "only eat dead tissue." This mentality must be corrected; invasive larvae exist, there are unique myiasis-related infections, and serious complications can occur. We review the literature and describe recent cases of head and neck myiasis treated at our institution in upstate New York.
Four cases, all initially presenting to the emergency department, were identified. Each case was superimposed on cutaneous malignancy and all patients presented with leukocytosis and positive blood or wound cultures. In the case of the recurrent myiasis, initial treatment was external beam radiation therapy for the malignancy, which had the added benefit of eradicating the larvae. Treatment for the other cases was limited to antibiotics and supportive care for medical comorbidities. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Serious complications can develop from head and neck myiasis and, in our experience, an underlying malignancy should be suspected. Proper management is critical and should include, at a minimum, empiric antibiotics, tetanus prophylaxis, biopsy of the surrounding tissue, and reporting to the appropriate health agency. Additional management can include bedside debridement, pharmacologic antiparasitics, and treatment of the underlying disorder.
关于起源于美国的头颈部创伤性蝇蛆病的文献较少。据我们所知，在过去20年的文献中仅有3例报道。复发性蝇蛆病的病例更为罕见，20世纪70年代仅有一篇来自印度的报道。人们常常有一种先入为主的观念，认为幼虫是非侵袭性的，“只吃坏死组织”。这种观念必须纠正；存在侵袭性幼虫，有独特的与蝇蛆病相关的感染，并且可能发生严重并发症。我们回顾了文献并描述了近期在纽约州北部我们机构治疗的头颈部蝇蛆病病例。
共确定了4例病例，所有病例最初均在急诊科就诊。每个病例都叠加在皮肤恶性肿瘤之上，所有患者均出现白细胞增多以及血液或伤口培养阳性。对于复发性蝇蛆病病例，最初的治疗是针对恶性肿瘤的外照射放疗，这还有根除幼虫的额外益处。其他病例的治疗仅限于使用抗生素以及针对合并症的支持性护理。为什么急诊医生应该了解这个情况？：头颈部蝇蛆病可能引发严重并发症，根据我们的经验，应怀疑存在潜在的恶性肿瘤。正确的处理至关重要，至少应包括经验性使用抗生素、破伤风预防、对周围组织进行活检以及向适当的卫生机构报告。额外的处理措施可包括床边清创、使用抗寄生虫药物以及治疗潜在疾病。
