Tungiasis, a rare case of plantar inflammatory disease, a review of travelers skin lesions for emergency providers.

Parasitic infections while common in underdeveloped nations are rarely seen in developed urban centers. We report a case of a thirty-three-year-old male with no past medical history who presented to the emergency department with a chief complaint of "eggs coming out of my foot" after returning home from Brazil. Based on clinical presentation, travel history, and appearance of the lesion, diagnosis was most consistent with tungiasis infection which was confirmed by the pathology examination. It is important to make the appropriate diagnosis when skin lesions are found in returning travelers and emergency providers should take broad differential diagnosis into consideration.

A case of cutaneous larva migrans presenting in a pregnant patient.

Cutaneous larva migrans (CLM) is a pruritic dermatitis caused by migration of animal hookworm larvae into the skin. We present a case of CLM in a 31-year-old pregnant woman. The treatment of CLM relies on antihelminthic agents, such as thiabendazole, albendazole, and ivermectin. This case was interesting in that the standard treatment options previously mentioned were contraindicated owing to the patient's pregnancy. Cryotherapy with liquid nitrogen resulted in complete resolution of her lesion and symptoms.

Establishment of Tunga trimamillata (Siphonaptera: Tungidae) in Brazil.

Tunga trimamillata is a species of sand flea occurring in Ecuador and Peru parasitizing cattle, goat, sheep, swine, and man. This is the first report of this species in Brazil, having been found on the hooves of cows in Barretos, São Paulo State, and Felixlândia, Minas Gerais State, and previously misidentified as Tunga penetrans. A previous report concerning Hydrochoerus hydrochaeris from Rio Novo, Minas Gerais State, may also be attributed to that species of sand flea, a possible the primary host. Given the large geographical distribution of T. trimamillata, the vast cattle population in Brazil, and the high number of individuals subject to the risk of tungiasis, the number of cases attributed to this sand flea will most likely increase over time.

Foot-pad dermatitis and experimentally induced coccidiosis in young turkeys fed a diet without anticoccidia.

Foot-pad dermatitis (FPD) is a widespread challenge to turkey production. This study aimed at evaluating the effects of using floor heating and exposure to litter with critical moisture content (35%) under experimental infection with Eimeria. adenoeides on the severity of FPD in turkeys. Two trials were done; in each trial, 4 groups of 2-wk-old female turkeys were reared over 4 wk. At the start of the experiment (d 14), each bird had normal foot pads. All birds were fed ad libitum on identical pelleted diets without any anticoccidial additive. The first 2 groups were kept on dry wood shavings with or without floor heating; the other 2 groups were housed on wet wood shavings of 35% moisture with or without floor heating. Two birds in each of the 4 groups were experimentally infected with E. adenoeides via crop intubation (~50,000 oocysts/bird). Foot pads were assessed weekly for external scoring and at d 42 of life for histopathological scoring. The number of oocysts eliminated via excreta was determined. In both trials, using floor heating resulted in significantly decreased FPD scores (2.06 ± 0.735; 1.47 ± 0.734, trials 1 and 2, respectively) compared with groups housed without floor heating (3.88 ± 0.812; 2.73 ± 1.25, trials 1 and 2, respectively). Birds continuously exposed to wet litter (35% moisture) showed significantly increased FPD scores (3.41 ± 1.23; 2.69 ± 1.34, trials 1 and 2, respectively) compared with the group not exposed to wet litter (2.53 ± 1.00; 1.53 ± 0.683, trials 1 and 2, respectively). The coccidial infection in both trials resulted in markedly lowered DM contents of excreta (14.8 and 15.1%, trials 1 and 2, respectively) and litter (58.0 and 57.6%, trials 1 and 2, respectively) in the groups exposed to wet litter without using floor heating. In both trials, using floor heating resulted in the highest mean DM content of litter (85.1 and 85.0%, trials 1 and 2, respectively) and the highest BW (2,693 and 2,559 g, trials 1 and 2, respectively). The results suggest that induced diarrhea caused by coccidial infection led to poor litter quality, and hence, increased the severity of FPD, which can be overcome by using floor heating.

Claw histopathology and parasitic load in natural cases of canine leishmaniosis associated with Leishmania infantum.

Histological lesions and the presence of Leishmania spp. amastigotes in claw tissues were investigated in 40 dogs with leishmaniosis, with (16/40--group A) or without (24/40--group B) generalized onychogryphosis. Following euthanasia, the entire third phalanx with intact claw was amputated, formalin fixed, decalcified in a formic acid solution, embedded in paraffin, sectioned longitudinally and stained with haematoxylin and eosin, and acid orcein-Giemsa. Nested polymerase chain reaction (PCR) was used for the detection of Leishmania amastigotes. Lichenoid mononuclear infiltration (all dogs in group A, 21 of 24 dogs in group B), basal keratinocyte vacuolation (nine of 16 dogs in group A, 15 of 24 dogs in group B) and dermoepidermal clefting (13 of 16 dogs in group A, 18 of 24 dogs in group B) were the most prominent histopathological findings. There was no difference in the frequency and severity of these lesions between the two groups. Leishmania amastigotes could not be visualized in the dermis of any of the H&E sections, but their presence was demonstrated by nested PCR in three of 16 dogs in group A and two of 24 dogs in group B. However, the frequency of positive nested PCRs was not significantly different between the two groups. In conclusion, claw histopathology in symptomatic dogs with leishmaniosis, either with or without onychogryphosis is mainly characterized by mononuclear lichenoid dermatitis with or without interface dermatitis and dermoepidermal clefting, and is not accompanied by substantial local parasitism.

Validation of the Dermatology Life Quality Index among patients with podoconiosis in southern Ethiopia.

BACKGROUND: Podoconiosis is a geochemical elephantiasis common among subsistence farmers in Ethiopia. It is completely preventable but, untreated, leads to considerable physical disability, social stigma and economic disadvantage. Quality of life has to date not been assessed among patients with podoconiosis. OBJECTIVES: We aimed to assess the feasibility, internal consistency and concurrent validity of an Amharic translation of the Cardiff Dermatology Life Quality Index (DLQI) among patients with podoconiosis in southern Ethiopia. METHODS: We performed a comparative cross-sectional study among 74 new patients and 74 patients treated for at least 3 months at outreach clinics of the Mossy Foot Treatment and Prevention Association, a nongovernment organization providing services for more than 30,000 patients annually in southern Ethiopia. RESULTS: The DLQI was quick and simple to use, taking on average 4 min to administer. It distinguished successfully between new and treated patients (median scores 13 vs. 3, P < 0.001). The inter-item correlation averaged 0.44, and Cronbach's alpha was 0.90, indicating high internal consistency. The mean DLQI score for all patients was 8.42, and the highest score was for item 2 (feeling self-conscious). The item with the highest score among new patients was item 1 (pain), while that among treated patients was item 4 (clothes choice). CONCLUSIONS: The Amharic DLQI appears feasible, reliable and valid among patients with podoconiosis in southern Ethiopia. The DLQI will play an important role in assessing the physical and social interventions available locally and in guiding the roll-out of these interventions to much larger groups of patients throughout Ethiopia.

Learning more about scaly leg and tassel foot.

Georgina Mills explains how members of the public have contributed to investigations of leg lesions in garden finches.

Tunga penetrans in Giant anteater (Myrmecophaga tridactyla) from Argentina.

Tunga penetrans (Siphonaptera, Tungidae) is a flea that infests humans and a variety of domestic and wild animals. Burrowing of the female flea under the skin causes tungiasis, a disease that manifests in skin lesions that if untreated, can progress to severe complications. In this paper, we report the first case of T. penetrans in a wild giant anteater (Myrmecophaga tridactyla) from Argentina. We describe the lesions and discuss the potential role of the giant anteater as a host or reservoir for this flea.

Tungiasis: a poorly-known diagnosis in Europe. Two paradigmatic cases from Portugal.

Tungiasis is a cutaneous parasitosis caused by infestation of the skin by gravid fleas of the genus Tunga, mainly Tunga penetrans. This flea is very common in tropical and subtropical regions of the globe, but not in Europe. The infestation is acquired by walking barefoot or lying in places where the flea is present, usually beaches or sandy soils. We report two unrelated cases of imported tungiasis in Portugal that presented to our clinic in the same week. We draw attention to one of the most common dermatological diseases in travelers returning from tropical countries, the diagnosis of which is primarily clinical but nonetheless is largely unfamiliar to clinicians attending those patients.

A plant-based repellent protects against Tunga penetrans infestation and sand flea disease.

Tungiasis is a parasitic skin disease prevalent in impoverished populations in the tropics and associated with considerable morbidity. Treatment options are limited and prophylaxis has never been attempted. We assessed the effectiveness of a plant-based repellent to prevent infestation with Tunga penetrans and sand flea disease in an urban squatter settlement in Fortaleza, Northeast Brazil. Two cohorts were formed. One cohort started with the intervention while another served as control. The plant-based repellent Zanzarin was applied twice daily on the skin of the feet. After 4 weeks and a wash-out-phase of another 2 weeks, cross-over was performed. Study members were examined twice per week for the presence of newly embedded sand fleas. The number of viable and dead sand fleas and the total number of sand flea lesions were determined. Sentinel rats were used to assess local transmission dynamics. Outcome measures were the number of newly embedded sand fleas per individual per day, number of sand flea lesions per individual according to the stage, as well as type and degree of clinical pathology. Zanzarin applied twice daily on the feet reduced the number of newly embedded fleas by 92% (interquartile range 81-100%), the total number of lesions by 87% (81-98%) and reversed tungiasis-associated clinical pathology almost completely. In conclusion, in a setting in which tungiasis is an important health threat, the daily application of a plant-based repellent prevented the infestation with T. penetrans and sand flea disease.

[Cutaneous larva migrans syndrome on a malformed foot (a case report)]. / Syndrome de larva migrans cutanée sur pied malformé (à propos d'un cas).

Cutaneous larva migrans syndrome is a subcutaneous dermatitis caused by hookworms' larvae, originating from animals in parasitic impasse in humans. Transcutaneous infestation is favored by contact with contaminated soil. We report the case of a 15-month-old child, native of Guinea - Bissau, suffering from cutaneous larva migrans syndrome on a malformed foot. This malformation in the form of a syndactyly, associated with a tumefaction of the foot cause a delay in the standing position. Besides, the fact that the child never wears shoes because of the sick foot is another factor contributing to the patient's infestation by the larvae of the nematode.

Tunga penetrans. A case report and review of the literature.

Tungiasis is an infection caused by infestation of Tunga Penetrans into the epidermis. Although, at the moment, presentation of this condition seems rare in Europe and Northern America, tungiasis is highly endemic in other parts of the world. We describe a case of Tunga Penetrans infection in the foot of a 22-year old Dutch female returning from Kenya, and present a review of the literature. Now that intercontinental travel is increasing, physicians in other parts of the world will be expected to recognize and treat this exotic infection. Knowledge of human tungiasis is mandatory in order to recognize the symptoms, achieve correct diagnosis and ensure adequate medical treatment to our patients.

Papillomatous pastern dermatitis with spirochetes and Pelodera strongyloides in a Tennessee Walking Horse.

Papillomatous digital dermatitis is a common disease in cattle. The pastern dermatitis observed in a horse shared many of the gross characteristics of papillomatous digital dermatitis in cattle. Lesions included a mixture of proliferative and erosive changes, with a verrucose appearance in some areas. Microscopic similarities included pseudoepitheliomatous and papillomatous epidermal hyperplasia with hyperkeratosis, spongiosis of the epidermis, and intraepidermal spirochetes. The horse was also concurrently infected with Pelodera strongyloides. Papillomatous digital dermatitis in cattle is associated with poor husbandry practices. The environment of the affected horse was heavily contaminated with urine, manure, and other organic debris. Verrucous pododermatitis of horses may be the same as or similar to bovine papillomatous digital dermatitis, and these conditions have similar etiologies.

The role of Hyalomma ticks in foot infestations and temporary lameness of sheep in a semi-arid region of South Africa.

An outbreak of lameness amongst Merino lambs, associated with the presence of Hyalomma ticks, was investigated on a farm in the south-western Free State, South Africa. The purpose was to follow the progress of the condition and to determine the extent of involvement of the two Hyalomma species which occur in the region. The flock of experimental sheep (n = 460) ranged free in natural veld under extensive farming conditions. During September and October 1993, adult ewes and lambs in this flock were examined at weekly intervals to determine tick identity, abundance and attachment-site preferences on lame and unaffected animals. Lameness occurred only among lambs, of which 68 were affected during the 8-week period. Hyalomma ticks tended to aggregate and mean numbers of ticks/aggregation were significantly higher on lame lambs (mean = 11.3) than on either the unaffected lambs (mean = 6.9) or the ewes (mean = 7.1). Most tick aggregations (72.4%) on the lame lambs occurred on the lower legs and feet, 34 out of 55 of these on the fetlocks or interdigital clefts. Hyalomma truncatum dominated (> 97%) on all animals examined. Only 15.8% of the Hyalomma marginatum rufipes recovered from the lame animals were attached to the legs. At two other localities at which H. marginatum rufipes was more abundant, or even dominant, few ticks attached to the lower legs or feet. Those that did were mostly H. truncatum (> 90%). Both H. marginatum rufipes and H. truncatum may attach to the same ventral and anogenital body regions, but H. truncatum has a tendency to attach also to the feet and lower legs. Although attachment of one or a few ticks in the axillar region or upper legs may cause lameness in sheep, the attachment of ticks to the interdigital clefts and fetlocks almost always causes lameness. The latter condition is more likely to occur in regions where H. truncatum dominates.

Case report: an unusual cutaneous myiasis of the foot.

A case of rare cutaneous myiasis, which has not heretofore been described in the foot, is presented. The unusual life cycle is described in order to understand the clinical presentation. The treatment options are discussed and recommendations are made to avoid treatment pitfalls.