Multispecies blow fly myiasis combined with hypothermia in a man assumed to be dead

Abstract

We describe the case of a man who was found with severe hypothermia and advanced myiasis involving five species of blow flies, which eventually led to a transtibial amputation of the man's right leg. A case of such a heavy and species-rich infestation with fly larvae in an urban environment is extraordinary and has, to our knowledge, never been described so far. Best practice in cases such as this one demands accurate species identification not only to ensure appropriate treatment and pest management but also, from a forensic point of view, to explore the possibility of third-party responsibility. The cooperation between physicians and forensic entomologists is highlighted.

It is all about the insects: a retrospective on 20 years of forensic entomology highlights the importance of insects in legal investigations

“…L. sericata is not only one of the first colonizers of carrion, but can also cause severe cases of myiasis, i.e. the infestation of living people by fly larvae [35,36]. In these cases, there is often neglect, both self-inflicted and by third parties.…”

Human myiasis in Sub-Saharan Africa: A systematic review

“…For molecular identification, larvae cannot be killed in hot water. Instead, larvae could be stored in 70%-95% ethanol for a short period or samples can be frozen to -20°C or -80°C for long-term preservation [ 9 , 23 , 44 ].…”

“…Dehecq and colleauges [ 34 ] manually extracted two larvae from a 9-month-old boy and the lesions healed shortly after extraction [ 23 , 66 ]. There was 45.3% of the reviewed literature which used manual extraction to successfully remove larvae [ 9 , 17 , 30 , 33 , 36 , 37 ]. None of these cases reported larval fragmentation during the extraction process.…”

“…Facultative myiasis on the other hand is caused by free-living fly species (feeding on decaying organic matter and can opportunistically infest living tissues), their larvae do not require a living host to complete their life cycle. While accidental myiasis is a condition in which the larval stages of dipteran flies are accidentally ingested through contaminated food or water [ 8 , 9 ]. Additionally, human myiasis can further be classified into primary and secondary myiasis.…”