A Case of Oral Myiasis Caused by Lucilia sericata (Diptera: Calliphoridae) in Korea
Secondary to the diagnosis of Becker's muscular dystrophy, the patient (37-year-old man) has been bedbound for 30 years. On the evening of 21 October 2011, he complained of dyspnea and chest pain while at his nursing home. His blood pressure dropped to 60/30 mmHg and his mental status became drowsy. He was transferred to the emergency room (ER) of a university hospital, and emergency treatment was performed, including intubation. After spending 8 days in the ER, the patient was moved to an intensive care unit (ICU) in Busan St. Mary's Medical Center by the request of a guardian. The patient had symptoms, including hematochezia, fever, and chills. Laboratory findings included WBC of 5,200/mm3, hemoglobin (Hb) concentration of 12.5g/dl, and C-reactive protein (CRP) of 159.45 mg/L. Chest CT scans revealed bronchiectasis in the left lung field. There were no specific findings on abdominal CT scans. Several hours after transfer to the ICU, 38 maggots were removed during suction of the oral cavity. Two hours later, 5 more maggots were removed from the oral cavity. A fecal occult blood test was positive, and Hb taken on the next day was less than the normal range (11.6 g/dl). Laryngoscopic examination revealed no additional maggots or wounds in the nasal cavity or laryngopharyngeal space. The patient's condition improved and he returned to the nursing home on 26 December 2011.\nFor light microscopic observations, the larvae were preserved in 70% ethanol, and then they were cleared in a 10% aqueous solution of KOH. After clearing, the specimens were mounted on slides using glycerin-jelly medium. Additional maggots were preserved in 2% glutaraldehyde for SEM analysis. After washing 3 times with 2% glutaraldehyde, the specimens were dehydrated through a graded alcohol series (50%, 70%, 80%, 90%, 95%, and absolute alcohol), dried with hexamethyldisilazane, coated with gold (JFC-1100E ion sputtering device), and observed with Electron SEM Philips XL-30S (Philips, London, UK) at a 15-kV accelerating voltage. Species identification was done using the keys described by previous workers [,] and the Natural History Museum (London, UK) website ().\nThe collected maggots were 9-12 mm (mean; 10.3 mm) in length with a beige coloring (). The larvae showed the typical maggot-like body shape. The pseudocephalon had a pair of blunting antennae, each equipped with 2 sensory papillae. A pair of hooks was also located in the buccal cavity (). A pigmented accessory oral sclerite was not observed in the cephalopharyngeal skeleton. The anus had 1 pair of anal papillae surrounded by numerous tiny spines and was located under the posterior spiracular plate in the last segment (). The body surface was covered with many tiny short spines. The body spines were sharp with a single point and arranged in distinct bands around the body showing clearly defined spine bands (). Anterior spiracles showed a fan-like structure with 8 lobes (). The posterior spiracles were not positioned within a cavity (). The shape of the posterior spiracles was approximately round with a surrounding complete peritremal ring with no gap (). The button was present on both spiracles, and 3 slits in each posterior spiracle were straight (). The distances (d1, d2, and d3) of the dorsal papillae (p1), median papillae (p2), and outer papillae (p3) in the 12th segment were similar ().