Abstract
W. chitiniclastica is a recently described γ-proteobacterium isolated from larvae of the parasitic fly, Wohlfahrtia magnifica. It has been reported in Europe, Egypt and Asian countries, but is rarely reported in low altitude or suburban areas. W. chitiniclastica bacteremia has only been reported in three clinically relevant human cases worldwide. The two cases of this report will be the first reported in Hawai‘i. The first case was a 69-year-old homeless woman with a history of right hemiparesis secondary to a ruptured cerebral aneurysm. She complained of sacral pain and painful urination for one week and blood test showed leukocytosis associated with pyuria on urinalysis. Physical examination revealed stable vital signs, disheveled appearance and multiple decubitus ulcers in her sacral area with stageIII appearance and profuse pus. She was started on IV ceftriaxone and IV vancomycin to cover both the urinary tract and decubitus ulcer infections. She underwent surgical debridement of her decubitus ulcers where a deep tissue wound culture was obtained during the procedure. The wound culture grew polymicrobial flora, which included W.chitiniclastica, Staphylococcus aureus, Aeromonas spp., Staphylococcus simulans and Bacteroides fragilis. A blood culture grew Anaerobiospirilum succinicproducens and Proteus mirabilis was cultured from the urine She was successfully treated and discharged. The second case was a 72-year-old man with history of stroke and communication disability secondary to deafness. After being unattended for three days, he was found unconscious on his home floor. He appeared hypothermic, hypotensive and bradycardic. Multiple lacerations were seen mainly on his right leg and umbilicus. Notably there were maggots continuously crawling out of his wounds. Blood cultures grew Escherichia coli and W.chitiniclastica. The patient was started on piperacillin/tazobactam, clindamycin and vancomycin, but unfortunately expired as a result of septic shock. Distribution of the vector fly Wohlfahrtia magnifica is expanding, and it is possible that it currently exists in Hawai‘i. This case report is intended to increase the awareness of this specific type of infection related to myiasis in the homeless and hygiene-deficient patient population. Furthermore, this report should also offer treatment options for the infection.