Severe Oral Myiasis in an Elderly Man with Epilepsy Caused by the New World Screwworm (Cochliomyia hominivorax) in Subtropical Ecuador.

Abstract

Oral myiasis is a rare medical condition in which soft tissues of the oral cavity are invaded by the larvae (maggots) of several flies. We report a fatal case in a 75-year-old man from a subtropical rural region of Ecuador who presented to a public health center with respiratory distress, peripheral cyanosis, dyspnea, and a Glasgow Coma Scale score of 9 of 15. The oral cavity emitted a fetid odor and contained bloody secretions with extensive larval invasion affecting the gingiva, lower lip, tongue, and soft palate. More than 300 larvae were manually extracted and morphologically identified as third-instar Cochliomyia hominivorax. The patient had a known history of epilepsy managed with carbamazepine (400 mg/day). Despite supportive management, including oxygen therapy and fluid resuscitation, the patient died approximately 8 hours after admission. The rapid deterioration was probably owing to airway compromise caused by larval migration toward the oropharynx. This case underscores the importance of prompt diagnosis and aggressive management of oral myiasis in vulnerable elderly individuals.