Woman sneezes out maggots after fly larvae got trapped in her deviated septum

He underwent surgery to remove the mucus chewers, from which 10 larvae in different stages and one pupa were recovered. Genetic testing and DNA sequencing confirmed they were sheep flies, as did visual inspection of two third-instar larvae and the puparium.

Third instar Oestrus ovis larva and puparium recovered from the sinuses of a 58-year-old female patient, Greece. A) The third instar was yellowish, with rows of spines on the ventral surface. B) The posterior peritremes were circular with a central button. C) The broken puparium was black and wrinkled and contained remains of the pupa.

nasal novelty

Not only had the experts never found a pupa in a human snout before, but they also thought development to that stage was “biologically implausible.”

“The sinus environment does not meet the temperature and humidity requirements for pupation, and host secretions, immune responses, and resident microbiota create a hostile environment for pupal development,” wrote the experts, led by Ilias Kioulos, a medical entomologist at the Agricultural University of Athens.

Still, in this poor woman’s nose, the pests persisted. Kioulos and his colleagues speculate that two factors favored the woman’s suppurative fly infection: a large initial dose of larvae and her severely deviated septum.

“From a purely anatomical perspective, we hypothesize that the combination of high larval numbers and septal deviation prevented normal exit from the nasal passages, allowing progression to the (third larval stage) and, in one case, pupation,” they wrote. In other words, there were so many worms in his twisted nasal passage that they created a bottleneck in getting out, allowing some to stay longer than usual. The other, equally disturbing possibility is that the flies are adapting to the use of human noses throughout their life cycle.

Experts point out that, in a way, the woman was lucky. In animals, third stage larvae cannot pupate when they become trapped in the sinuses. Instead, they dry out, liquefy, or calcify, which can lead to secondary bacterial infections.

From here, Kioulos and his colleagues warn that doctors should be aware of the potential for human cases of sheep fly infections, which are widely distributed around the world.