Clinical and systemic management of myiasis in a patient with advanced Alzheimer's disease

William Phillip Pereira Da Silva,Mirela Caroline Silva,Stéfany Barbosa,João Matheus Fonseca E Santos,Bruno Coelho Mendes,Osvaldo Magro Filho,Leonardo Perez Faverani,Anderson Maikon De Souza Santos,Mateus Diego Pavelski

doi:10.33448/rsd-v10i3.13145

William Phillip Pereira Da Silva, Mirela Caroline Silva + Show 7 more

Open Access

https://doi.org/10.33448/rsd-v10i3.13145

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Abstract

The management of patients with neurodegenerative conditions such as Alzheimer's disease presents a challenge in promoting oral health, which is mainly linked to the motor and cognitive limitations that these individuals have, making them susceptible to the development of a series of oral diseases, such as oral myiasis. The presence of larvae in the oral cavity in patients with Alzheimer's disease seems to be related to poor oral hygiene condition, to the long periods that the patient remains immobile and with the mouth ajar, facilitating the deposition of eggs. Therefore, this study aimed to report a clinical experience of a patient with Alzheimer's disease in an advanced stage and with manifestation of oral myiasis on the oral floor, vestibule bottom and inserted gum. The 81-year-old patient was debilitated, bedridden, unable to perform his activities alone, was taken to the emergency room by his caregiver, who reported having noticed the presence of larvae in the oral cavity. The patient was hospitalized and immediately administered Ivermectin, ceftriaxone and clindamycin. On the second day of hospitalization, he presented a systemic worsening due to bronchoaspiration, requiring immediate removal of the larvae under local anesthesia. Only after significant improvement in the general condition, thorough surgery was performed to debridement of the injured areas and remnants of larvae. After hospital discharge with 2-month follow-up, the patient did not have any complications related to his oral health, demonstrating that periodic follow-up to debilitated patients is an important tool for preventing opportunistic manifestations such as oral myiasis.

Highlights

The management and care of oral hygiene in patients with physical, and, or mental limitations, present themselves as a challenge in health promotion
Patients in advanced stages of those diseases are often reported with cases of oral myiasis (Weller & Budson, 2018)(Sengoku, 2020)
A descriptive and qualitative interventional study was carried out (Pereira et al, 2018) case study, which was authorized by the patient and his family using an Informed Consent Term (ICT), prepared with easy to understand language so that they were aware of the destination of the personal information collected, as well as the associated risks and benefits

Summary

Introduction

The management and care of oral hygiene in patients with physical, and, or mental limitations, present themselves as a challenge in health promotion. Myiasis occurs when a fly lays its eggs in injured tissue, in skin or mucosa, which hatch in larvae, which start to act as parasites, feeding on healthy or necrotic tissues, liquid substances, or even the food that the host ingest (Thyssen et al, 2012). With that, they go deeper into the soft tissues, so that in more severe conditions, they can cause injuries even in cartilage and bone tissue (Ribeiro et al, 2012)

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