Ignatzschineria indica bacteremia in a fatal case of accidental wound myiasis.

Ignatzschineria indica is a rare Gram-negative bacterium increasingly recognized as a potential human pathogen associated with wound myiasis and severe bloodstream infections. Here we report a fatal case of I. indica bacteremia in a 63-year-old woman admitted to the intensive care unit with septic shock. The patient had arterial hypertension and liver cirrhosis and was found after prolonged immobilization in severely neglected conditions. Clinical examination revealed extensive pressure ulcers complicated by maggot infestation and a left pertrochanteric femoral fracture. Blood cultures became positive for Gram-negative rods, with the isolate identified by mass spectrometry as I. indica. Antimicrobial susceptibility tests using gradient diffusion demonstrated susceptibility to all tested antibiotics (cefotaxime, cefepime, meropenem, piperacillin/tazobactam, ciprofloxacin, trimethoprim-sulfamethoxazole and gentamicin). However, despite intensive care management, broad-spectrum antimicrobial therapy, and surgical wound debridement, the patient developed progressive multiorgan failure and died from refractory septic shock. Subsequently, the presence of I. indica in the blood culture was confirmed by whole-genome sequencing, showing a 98.8% average nucleotide identity with the reference genome. This case highlights the pathogenic potential of I. indica in patients with neglected myiasis-associated wounds. The rarity lies particularly in the fact that despite all modern available care (including necrectomy, debridement, and treatment with suitable antibiotics), the patient died within three days of admission. This is unique in Central Europe, where no report on lethal infection with I. indica has been reported so far. Hence, this paper can serve as a valuable piece of knowledge on the treatment of maggot-infested wounds, particularly where I. indica infections are concerned.