nasal nosocomial myiasis infection caused by chrysomya bezziana (diptera: calliphoridae) following the septicemia: a case report

a 74 yr old woman from gonabad, southern part of khorasan razavi province of iran was admitted to a hospital of gonabad, because of respiratory distress, exertional dyspnea and fever. close contact with domes­tic animals, history of chronic obstructive pulmonary disease (copd), and completely resolved pulmonary tuberculosis (tb) in remote past, were nota­ble parts of her past medical history. due to clinical, paraclinical and radio­graphic findings and because of recent hospitalization, she was admitted to internal medicine ward with the diagnosis of health care associated pneumo­nia (hcap). despite the application of broad-spectrum antibiotics and ap­propriate supportive care, she had a poor response to the treatment. during the daily visit in intensive care unit (icu), numerous white larvae were de­tected in both nostrils. further investigation of oropharynx and tracheal tube aspiration, showed no more larvae in mentioned parts. an hour later, nasal spontaneous bleeding occurred. otorhinolaryngology consultation was per­formed and led to surgical procedure. in ent examination, there were nu­merous larvae and massive clot formation in both inferior meatuses and distal nasal septum perforation. thirty-seven extracted larvae were transferred to medical entomology lab by vial 70% ethanol and 5 live larvae for rearing. after pre­cise investigation by aid of light microscopy, the larvae were identified as chrysomya bezziana. due to discovered 2 nd larvae stage and duration of hospitalization, this infestation was identified as nasal myiasis.