Postoperative cerebral myiasis: A rare cause of wound dehiscence in developing countries

Cerebral Myiasis, An Unexpected Intraoperative Finding - A Case Report and Systematic Review

Postoperative complications, exemplified by surgical site infections, are commonplace in the realm of daily surgical interventions. Conversely, certain infectious entities, such as cerebral myiasis (CM), are distinctly rare. This report elucidates the clinical presentation of a 74-year-old female afflicted with a CSF fistula, within the context of a preceding surgical microvascular decompression employing a suboccipital craniotomy approach. Notably, the course of evaluation and treatment unveiled an intraoperative manifestation of severe CM. This case report underscores the critical significance of prompt identification, precise diagnostic elucidation, and comprehensive multidisciplinary management to optimize patient outcomes in instances of CM. Furthermore, a systematic literature review on CM supplements this report, contributing to the understanding of this infrequent complication.

Cerebral Myiasis Secondary to Burr Hole Evacuation: A Rare Illustrative Case Report

Myiasis (maggot infestation) is a condition in which fly maggots feed off and develop in the tissues of living organisms. Most common in tropical and subtropical regions, human myiasis, is prevalent among individuals in close association of domestic animals and those inhabiting the unhygienic conditions. We, hereby, describe a rare case of cerebral myiasis (17th in the world, 3rd in India) that presented to our institution in Eastern India secondary in the operated site of craniotomy and burr hole few years back. Cerebral myiases are exceedingly rare conditions, especially in high-income countries with only 17 previously published cases with the reported mortality as high as 6 out of 7 cases dying of the disease. We additionally also present a compiled review of previous case literatures to highlight the comparative clinical, epidemiological features and outcome of such cases. Although rare, brain myiasis should be a differential diagnosis of surgical wound dehiscence in developing countries where conditions do exist in this country that permit myiasis. This differential diagnosis should be remembered, particularly when the classic signs of inflammation are not present.

Typical intracranial myiasis in Nigerian red river hogs (Potamochoerus porcus) caused by an unknown bot fly (Diptera: Oestridae)

We report an unknown taxon of bot fly (Diptera: Oestridae: Oestrinae) in red river hogs (Potamochoerus porcus Linnaeus, 1758) in Cross River State, Nigeria. From direct observation and interviews with local hunters, we document that, remarkably, the parasite typically occurs within the intracranial supra-meningeal space - i.e., between the inner wall of the skull and the brain - but without causing visible inflammation or clinical signs. The parasite is most similar (up to 87.9%) to Rhinoestrus usbekistanicus based on cytochrome oxidase subunit 1 DNA sequencing but is sufficiently divergent phylogenetically to represent a new or previously un-sequenced taxon. Morphologically, the parasite shares some, but not all, features with R. nivarleti. Local cultural belief systems attribute aspects of red river hog behavior (e.g. intelligence, elusiveness) to the parasite, suggesting a prolonged presence in the red river hog population. The parasite's unusual anatomic location may be aberrant, or it may be a protective adaptation to life in red river hogs, which forage vigorously with their snouts.

A Severe Case of Brain Myiasis: Treatment Rationale and Review of Literature

Cerebral myiasis is a rare condition caused by a parasitic infestation of fly larvae feeding on the host's necrotic or living tissue. Only 16 cases of cerebral myiasis have been published. We presented the case of a 72-year-old man with a neglected infestation of an extensive ulcerative cancer of the scalp. A large cranial lesion, with exposed brain and dura mater and severe Sarcophaga carnaria maggot infestation, was evident. We gently removed the maggots and covered the defect with thick gauze and sodium hypochlorite solution dressing. We additionally present a review of the literature to highlight shared features and suggestions for care management. In all cases, there was an absence of fatal meningitis and encephalitis, which is surprising given the open skull erosion with prolonged cortical exposure and points to the protective effects of larvae wound infestation.

Perioperative challenges in managing a patient with COVID-19 undergoing debridement for massive scalp myiasis

A young man presented to our centre needing an urgent debridement of his postcraniotomy wound due to massive myiasis during the COVID-19 pandemic in October 2020. Prior to the surgery, his nasopharyngeal swab real-time PCR test result was unknown. One day later, it returned as SARS-CoV-2 positive. All healthcare workers who were involved in the patient management avoided cross infection as they wore appropriate personal protective equipment. This article depicts the importance of adequate preparations when handling potentially infectious patients and the perioperative issues associated with it.