What’s that crawling in my wound?!

So… a few months ago, I was asked to help take care of a young patient who was admitted with a horrible leg infection. This patient was well over 500 pounds heavy and had a sore on one leg which was unbelievably foul smelling. I made the recommendations for antibiotic therapy and gave the patient general advice about preventing recurrence of such infections. Not surprisingly, the main concern of the patient was the fact that they were told that there were maggots in the wound on arrival at the hospital. The question was, how could that have happened?!

Maggot or larva infestation of wounds, also known as myiasis, is actually a problem that may be seen right here in the United States. I admit that I once believed, and I think many people do believe, that this is a problem of the tropics – the Caribbean, Africa, Asia, etc. But I’ve had a few cases right here in the US. In New York and New Jersey, the cases I saw were usually homeless people, but working in the warm South, the couple cases I have seen this year were regular people except that they were morbidly obese (weighing over 300 pounds) with oozing leg wounds from severe swelling. Because of hygiene issues, there is a strong smell which is exactly what flies like. The flies lay their eggs in the wound. The patient doesn’t bathe or at least not properly because their size prevents them from reaching their legs. The eggs then hatch into larvae which feed on dead tissue in the bed of the wound. (There are other types of myiasis in tropical regions like Africa and Asia where the larvae from a particular type of fly imbeds under the skin forming painful swellings.)

Now, as gross as this all sounds, maggots are sometimes deliberately applied to wounds. In fact this is an ancient treatment from centuries ago before we had antibiotics, but it is still used today in monitored settings. The maggots can be applied to just about any necrotic (rotting) wound such as bed sores and diabetic foot ulcers. These “medicinal” maggots are produced specially in labs so that they are free of contamination with germs. To my knowledge, this is not a popular treatment in the developed world. However, with the extent of antibiotic resistance that we are seeing these days, unless new antibiotics are turned out over the coming years, we may see resurgence of some of these ancient therapies.

For now, most of us would prefer not to have maggots in our wounds. How does one prevent unwanted maggot infestation? Keep any open wounds covered, especially if planning to sit around outside for prolonged periods, and pay attention to the legs and feet when bathing. If unable to reach the legs/feet, get a detachable shower head or a body brush with an extended handle to thoroughly wash potentially affected areas.