Myiasis in a Neglected Elderly: Urgent Action Needed in South America

BACKGROUND: Myiasis is an infestation by fly larvae. Some species exclusively affect humans, contaminating wounds, mucous membranes, and other tissues. It is a disease with marked socioeconomic connotations. CASE PRESENTATION: The current case involves a 95-year-old woman, an inhabitant of the Andean region of Ecuador with a history of resection of basal cell carcinoma in the left zygomatic region and a diagnosis of chronic leukemia. The surgical wound was secondarily infested with Cochliomyia hominivorax fly larvae and the patient was readmitted to the hospital to treat this complication. A marked clinical improvement was observed after surgical debridement, removal of larvae and administration of ivermectin and antibiotics. CONCLUSION: The determinants of this infestation were advanced age, neglect, and destitution in a patient with an open wound on the face after resection of a basal cell carcinoma. This case illustrates the appalling reality of the marginalized and excluded population of South America. Also of concern is the expansion of myiasis-producing fly populations to areas outside their natural humid and warm habitat. South American governments are called upon to act jointly and effectively against this ominous disease.