Eur Arch Otorhinolaryngol (2008) 265:851–853 DOI 10.1007/s00405-007-0535-2
C A S E RE P O RT
Aural myiasis in a patient with Alzheimer’s disease Pascal Werminghaus · Thomas K. HoVmann · Heinz Mehlhorn · Murat Bas
Received: 14 September 2007 / Accepted: 2 November 2007 / Published online: 21 November 2007 © Springer-Verlag 2007
Abstract Myiasis is a disease caused by Xy larvae feeding on the host’s tissue. We report on a 49-year-old patient suVering from Alzheimer's disease with aural myiasis. Clinical examination revealed sanguineous and smeary otorrhoea on the left side with 16 alive maggots occupying the ear. They were removed from the external auditory canal and classiWed as larvae of the family Sarcophagida. Aural manifestation of myiasis may become dangerous if the petrous bone is aVected. Entomological aspects, clinical characteristics, and treatment of this rare disease are reviewed. Keywords Aural myiasis · Alzheimer’s disease · Unilateral otorrhoea
P. Werminghaus · T. K. HoVmann Department of of Otorhinolaryngology, Heinrich Heine University Düsseldorf, Moorenstrasse 5, Düsseldorf, Germany H. Mehlhorn Institute of Zoomorphology, Cellular Biology and Parasitology, Heinrich Heine University Düsseldorf, Moorenstrasse 5, Düsseldorf, Germany M. Bas Department of Otorhinolaryngology, Technical University of Munich, Munich, Germany M. Bas (&) Hals-, Nasen- und Ohrenklinik, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Strasse 22, 81675 Munich, Germany e-mail:
[email protected]
Introduction A recent report of the German Medical Service has identiWed Welds of poor health care in Germany [10]. According to this survey, old patients and individuals suVering from chronic diseases, in particular dementia, are not cared for adequately. Hence, even in a prosperous country, infections with parasites do occur in neglected patients. Myiasis is named after the Greek term “myia”, meaning “Xy” [11], and describes the infestation by dipterian larvae that feed on dead or living host tissue for a variable period of time, aVecting the skin, body cavities and inner organs. Various forms of myiasis exist, being classiWed from an entomological or clinical point of view. Entomologically, myiasis divides into: (1) obligatory or speciWc myiasis, i.e., the larvae need to feed on the live tissue of a host to develop, (2) facultative or semispeciWc myiasis, i.e., the larvae invade wounds or faeces of a host, and (3) accidental myiasis, i.e., the larvae feed on a host normally not involved in their biological cycle. Clinically, myiasis is classiWed according to the anatomic site aVected, such as cutaneous myiasis, myiasis of external oriWces or internal organs, and invasion of head cavities, e.g., nose and paranasal sinuses, and outer ear. Aural manifestations have been reported in children and mentally retarded adults, giving rise to a variety of clinical symptoms, including otalgia, otorrhoea, perforation of the tympanic membrane, bleeding, pruritus, mechanical noise, and hearing impairment [6, 11, 18]. Severe complications may result from involvement of the skull base.
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Eur Arch Otorhinolaryngol (2008) 265:851–853
Case report A 49-year-old man presented with sanguineous and smeary otorrhoea on the left side. There was no history of trauma or previous ear infection. Otoscopy revealed several alive maggots obstructing the heavily inXamed and swollen external auditory canal (Fig. 1). In addition, the patient suVered from Alzheimer’s disease and tetraplegia, being bedridden since 6 months. For total parenteral nutrition, he had received a percutaneous endoscopic gastrostomy tube. Laboratory Wndings showed increased C-reactive-protein (6.0 mg/dl; reference
