Sarna costrosa: revisión sobre aspectos clínicos de una ectoparasitosis desatendida y de presentación infrecuente / Crusty scabies: review of the clinical aspects of a neglected and infrequent ectoparasitosis

En esta revisión de la literatura se describen aspectos epidemiológicos, fisiopatológicos, clínicos y terapéuticos sobre una presentación atípica y grave de escabiosis, la sarna costrosa o noruega. Esta presentación de escabiosis destaca por afectar principalmente a personas con condiciones de inmunodepresión o sociales que las hacen susceptibles de una alta carga parasitaria, además se asocia a un peor pronóstico y a riesgo de complicaciones. Desde el punto de vista terapéutico, sus estrategias difieren del manejo de la escabiosis clásica.(AU)

This literature review describes epidemiological, pathophysiological, clinical and therapeutic aspects of an atypical and severe presentation of scabies, Norwegian or crusty scabies. This presentation of scabies stands out because it mainly affects people with immunosuppressive or social conditions that make them susceptibleto a high parasite load, it is also associated with a worse prognosis and risk of complications. From a therapeutic point of view, their strategies differ from the management of classic scabies.(AU)

Nest-type associated microclimatic conditions as potential drivers of ectoparasite infestations in African penguin nests.

Nest design and characteristics can influence the microclimatic conditions in the nest. Nest-dwelling ectoparasites are sensitive to temperature and moisture and as such the conditions in the nest can influence parasite infestations. The endangered African penguin (Spheniscus demersus) breeds in different nest types and as yet little is known with regard to the microclimate and parasite infestation within these nests. This study characterized the microclimatic conditions in natural open, natural covered (with vegetation) and artificial nests, and assessed the relationship between nest characteristics (type, age, distance from the coast, orientation and entrance opening) and in-nest ectoparasite infestations and the health of African penguins in Stony Point, South Africa. Penguins (50 adults and 192 chicks) and their nests (n = 308) were sampled in 2016 and 2017. Soil temperature was higher in artificial than in natural nests, and soil and nest material moisture was lower in artificial and natural covered nests than natural open. Ectoparasite infestations were higher under warmer and drier conditions, in artificial nests and nests near the coastline. Penguin (adult and chick) body mass and chick body condition were lower in warmer nests and total plasma protein (in adults and checks) was lower in drier nests. Given the potential adverse effects of ectoparasites on host species, it is recommended that conservation agencies implement a monitoring programme to assess the ectoparasite infestation in artificial nests across multiple colonies. This information will facilitate a more holistic penguin conservation management plan that may prevent further detrimental effects on this endangered penguin species.

Norway rat (Rattus norvegicus) ectoparasites in livestock production systems from central Argentina: Influencing factors on parasitism.

Haematophagous ectoparasites are worldwide vectors of many zoonotic bacterial diseases, both emerging and re-emerging, whose incidences are rising. Livestock development alters different environmental characteristics such as the microclimate of a site, changing the availability, density and susceptibility of the hosts to pathogens and vectors, indirectly influencing the spread and persistence of a disease within an ecosystem. The Norway rat (Rattus norvegicus), the most abundant vertebrate pest species found on livestock farms from Argentina, is a reservoir for several important zoonotic bacteria and may harbor ectoparasite species, which act as their vectors. Even though the Norway rat is widely known for its role as an ectoparasite host, the ecological characteristics of their ectoparasite communities and the related factors with parasitism on livestock farms have never been described. In the present study, we describe the ectoparasite community in Norway rats from central Argentina livestock farms, while also depicting the influencing factors on both ectoparasite occurrence and abundance. Ectoparasites were collected from rats captured in 20 sites from Buenos Aires province, between the winter of 2016 and the summer of 2018. A total of 1441 ectoparasite individuals were collected from 159 Norway rat individuals [Total ectoparasite prevalence = 69.2%; Mean ectoparasite specimen abundance (± CI) = 9.06 ±â€¯2.32 ectoparasite individuals per rat; Mean ectoparasite specimen intensity (±CI) = 13.10 ±â€¯3.08 ectoparasite individuals per infested rat found]. Ectoparasite assemblage consisted of four cosmopolitan species, recognized for their sanitary relevance: mites (Laelapidae: Laelaps nuttalli and Laelaps echidninus), lice (Polyplacidae: Polyplax spinulosa) and fleas (Pulicidae: Xenopsylla cheopis). We observed higher Norway rat abundance in sites related to higher ectoparasite occurrence and abundance frequencies on the rats. Additionally, ectoparasites were more abundant on rats in warm seasons and on male individuals, over female rats. Moreover, the geographical location of the studied sites influenced the ectoparasite assemblage structure observed on the rats. This study broadens the knowledge on the role of Norway rats as zoonotic ectoparasites hosts and analyzes the drivers influencing ectoparasite occurrence and abundance on the most populated region of Argentina, which is also the region with the most intensive livestock farming. Therefore, this survey may assist in evaluating potential risks for humans and generate effective sanitary control strategies for ectoparasite-borne infectious diseases.

Delusional infestation: a prototype of psychodermatological disease.

Delusional infestation (DI) is a disorder in which patients express a firm, unwavering belief that they are infested with some type of organism but otherwise have a typical grasp on reality with relatively normal cognitive functioning. Although classified as a somatic delusional disorder, DI requires special consideration due to its complicated clinical presentation, requiring attention to several possible explanations for the symptoms the patients describe. The purpose of the current review is to first summarize the clinical background and features of the diagnosis then explore treatment options. DI is a rare disorder though has reported cases dating back to the 19th century and spanning across the globe. Patients often experience the disorder as secondary to a medical condition, including substance use/withdrawal. However, there have also been many reported cases of primary DI, occurring in the absence of any other psychiatric or medical disorder. Clinically, DI is a diagnosis of exclusion, where the physician must rule out other medical conditions, including genuine dermatological disorders or infestations, or contributions from medications or substances. Patients with the disorder more commonly present to nonpsychiatric healthcare providers, making it essential for all clinicians to be able to identify the disease. Treatment can include either first or second generation antipsychotics, but it is important to proceed tactfully in discourse with the patient, being careful to address patients in a straightforward manner without reinforcing or questioning the delusion and focusing conversation on what can be done for the symptoms. Future research can continue to evaluate pathophysiology underlying primary DI, which historically has been an under-studied topic.

Furuncular myiasis in 2 American travelers returning from Senegal.

Furuncular myiasis caused by Cordylobia anthropophaga larvae is commonly seen in Africa but rarely is diagnosed in travelers returning from the sub-Saharan region. We report 2 cases of furuncular myiasis due to Cordylobia species in adolescent American travelers returning from Senegal.

Sexually transmitted infections in men.

Sexually transmitted infections (STIs) cause tremendous morbidity, great costs, and numerous avoidable deaths in the United States each year. STIs in men can present as discharge, ulcers, papules, infestations, or systemic disease, but most commonly STIs present without any symptoms. Molecular techniques, single-dose antibiotics and antivirals, and patient-administered therapies present opportunities for enhanced diagnosis and treatment. Screening for STIs should be part of all primary care practices, specifically targeting high-risk persons and those diagnosed with another STI.

Nasal leech infestation: report of seven leeches and literature review.

Nasal leech infestation rarely occurs in society today and it is usually reported as an anecdote. In this study, we present seven nasal leeches in six patients from 1984 to 2008. All patients initially presented with epistaxis. Four patients were less than 8 years old and two patients were older than 60 years old. All patients had spent time in rural streams 2 weeks to 2 months before the symptoms occurred. All of the seven leeches were removed smoothly and one leech migrated to the oropharynx during the operation. The length of the leeches ranged from 2 to 12 cm with an average length of 4.6 cm. Attention should be given to nasal leech infestation, especially in children and senior citizens who have visited rural streams and have been exposed to freshwater. One of our patients had two leeches lodged in his nasal cavities. Therefore, it is also important to re-examine both nasal cavities after the removal of one leech.

Imported human tungiasis in Greece.

BACKGROUND: Tungiasis is a parasitic skin disease caused by the sand flea Tunga penetrans. It is widespread in poor urban and rural communities in sub-Saharan Africa, the Caribbean and South America. Imported cases of tungiasis are increasingly being reported due to the increased numbers of travelers visiting the affected areas. CASE REPORT: A 28-year-old woman presented with a lesion on the subungual area of the right fourth toe, covered with a central dark crust. The lesion appeared two weeks after returning from Tanzania. The flea Tunga penetrans was identified by histopathological examination of a biopsy material. This is the first case of tungiasis in Greece. CONCLUSIONS: Tungiasis should be considered in the differential diagnosis of parasitic infections in travelers returning from endemic geographical areas.

Imported tungiasis in a Finnish journalist: the first case reported from the Nordic countries.

Tungiasis is a parasitic infection widely spread in tropical Africa and in South and Central America. Only a few cases involving travellers have been reported from Europe, and none from the Nordic countries. We report a case of tungiasis in a Finnish journalist returning from Uganda. In this era of increasing intercontinental travel it is important that all physicians are aware of tungiasis.

Tungiasis in the United States: a travel souvenir.

Tungiasis is a cutaneous infestation caused by the burrowing flea, Tunga penetrans. This infection typically results in the development of one or more wart-like fibrous papulonodules. The causative flea is endogenous to Central and South America, sub-Sarahan Africa and portions of India; consequently, tungiasis is rarely reported in North America. However, because of increasing air travel to and from endemic areas due to business and pleasure, it is imperative that this entity remain in the differential diagnosis when evaluating clinically suggestive lesions in a patient who also has a history of recent travel. We report a case of tungiasis in a 24-year-old Caucasian woman who presented with 7-week history of a non-healing, eroded nodule on the medial aspect of her left great toe. Significant history included travel to Tanzania during three months immediately prior to presentation. Following the presumptive clinical diagnosis of tungiasis, surgical removal of the flea and its contents was performed and the base of the lesion was curetted, without complication. The specimen was sent for histopathologic correlation which confirmed the diagnosis.

Imported tungiasis: a report of 19 cases and review of the literature.

Tungiasis is an infestation caused by penetration in the skin of the gravid female of the flea Tunga penetrans. In the period 1991-2006, 19 patients with imported tungiasis were observed at our Institute. All patients were subjected to general and dermatological examination, laboratory tests (including bacteriological examinations) and surgical excision of the lesions with histopathological examination. In all patients tetanus prophylaxis was made. All patients were followed up for at least six weeks. Thirteen patients were males (68.4%) and 6 females (31.6%). The age ranged from 3 to 71 years (average age: 37.8 years). Eleven patients (57.9%) contracted the infestation in Central and South America and 8 (42.1%) in Africa. In 17 patients (89.5%) tungiasis was localized to the feet, in one to the hands and in one to a thigh. In 13 patients (68.4%) the infestation was characterized by a single lesion; in the other 6 patients (31.6%) the lesions were two. In 15 patients (78.9%) tungiasis was characterized by a papular or nodular lesion. Crusted (2 patients), pustular (2 patients) and bullous (1 patient) lesions were also observed; furthermore, one patient presented with a plantar wart-like lesion. In only one patient bacteriological examinations showed the growth of Staphylococcus aureus and Escherichia coli. All patients healed without complications.

Spondylitis in a humpback whale (Megaptera novaeangliae) from the southeast Pacific.

A 7.25 m long male humpback whale (Megaptera novaeangliae) with spondylitis was found beached on August 13, 1994 at Ancon, Ecuador (2 degrees 23' S, 80 degrees 47' W). The condition involved at least 11 vertebrae, 7 lumbar (L4 to L11) and 4 caudal (Ca1 to Ca4). Partial fusion of vertebrae was observed as a result of intervertebral bony proliferation, likely impeding full motion. The relatively young age of this specimen and the severity of the deformities suggest an infectious, rather than degenerative, process. The gross findings are most consistent with some type of spondyloarthritis. Although this condition has previously been identified in a number of cetacean species, the pathogenesis, population impact and ecologic implications have not been fully assessed. This is the third case described for humpback whales and the first for a humpback whale from the SE Pacific.

Unexpected effects of zinc pyrithione and imidacloprid on Japanese medaka fish (Oryzias latipes).

Biological effects of the biocide zinc pyrithione (Zpt), used in anti-dandruff shampoos and antifouling paints and the agricultural insecticide imidacloprid on Japanese medaka fish (Oryzias latipes) were assessed in experimental rice fields. Both chemicals are toxic to medaka, in particular Zpt, which also causes teratogenic effects such as spinal cord deformities in embryos at very low, sublethal concentrations. Rates of malformation in medaka fry from paddies treated twice a week with anti-dandruff shampoo (0.18-0.37 microL/L each time) over a period of 4 months were within the natural background, perhaps due to the quick dissipation rate of this chemical in the environment. Both Zpt and imidacloprid caused stress syndrome in juvenile medaka, with fish from Zpt-shampoo fields having a significantly lower weight to body length ratio than those from control fields. As it often happens with stressed fish, a massive infestation by a Trichodina ectoparasite was observed in medaka from imidacloprid fields. However, despite their high stress levels, fish from the Zpt fields did not suffer such infestation, supposedly because the disinfectant action of this biocide.

Seasonal variation of tungiasis in an endemic community.

Tungiasis (caused by the sand flea Tunga penetrans) is hyperendemic in many resource-poor communities in Brazil. To understand transmission dynamics of this parasitic skin disease in a typical endemic area, a longitudinal study was carried out in a slum in Fortaleza in northeastern Brazil. In a door-to-door survey, the population of a randomly selected area (n = 1,460) was examined on four occasions for the presence of embedded sand fleas. Prevalence rates were 33.6% in March (rainy season), 23.8% in June (end of the rainy season), 54.4% in September (peak of the dry season), and 16.8% in January (begin of the rainy season). Tungiasis was more common in males than in females. The intensity of infestation was correlated with the prevalence. The study shows that prevalence of tungiasis and parasite burden vary significantly during the year with a peak in the dry season. These findings have important consequences for the design of control measures.

Changes in epizoic crustacean infestations during cetacean die-offs: the mass mortality of Mediterranean striped dolphins Stenella coeruleoalba revisited.

In the summer and autumn of 1990, a cetacean morbillivirus caused a massive epizootic mortality of striped dolphins Stenella coeruleoalba in the western Mediterranean. Previous circumstantial evidence suggested that the disease could also have increased host susceptibility to infestations with epizoic crustaceans. In this study we provide strong evidence supporting this hypothesis. We examined striped dolphins stranded along the Mediterranean central coast of Spain from 1981 to 2004 (n = 136), and recorded data on prevalence, intensity of infestation, size and reproductive status of 2 sessile crustacean species specific to cetaceans, the phoront cirriped Xenobalanus globicipitis and the mesoparasitic copepod Pennella balaenopterae. Compared with the pre-epizootic (n = 12) and post-epizootic (n = 62) dolphin samples, the following changes were noted in the dolphins stranded during the epizootic (n = 62): (1) the prevalence of both X. globicipitis and P. balaenopterae increased; (2) the intensity of X. globicipitis and P. balaenopterae infestations did not increase; indeed, it was even slightly lower than in the other periods, as was their degree of aggregation; (3) individuals of both species were smaller, and a higher proportion were non-gravid; (4) the 2 species tended to co-occur in the same dolphins, but their numbers did not co-vary. These patterns strongly suggest that, during the epizootic, there was a short-term increase in the probability of infestation of these 2 species because of the sudden rise in the population of susceptible hosts; the growth of the new recruits was limited by the early death of dolphins. The high susceptibility was likely related to the immunosuppressive effects of viral infection and the abnormally heavy loads of polychlorinated biphenyls found in sick dolphins; the level of inbreeding was also higher in dolphins from the 'epizootic' sample. Epizoic crustaceans could be suitable indicators of health in cetacean populations.

Miasis forunculosa: serie de 5 casos en ind¡genas de la etnia Pemón y revisión de la literatura / Forunculoid myiasis: 5 cases serie in Pem¢n ethnia aborigens and review literature

La infestación por larvas de Dermatobia hominis es frecuente en áreas rurales de Latinoamerica. Hasta la fecha es posible encontrar numerosos reportes de casos en turistas que visitan sus zonas selváticas o montañosas. Sin embargo, es poco lo que se ha escrito sobre la infestación en pobladores habituales de estas regiones. En el presente artículo se reporta una serie de casos en indigenas Pemón de la Gran Sabana venezolana y se hace una extensa revisión de la literatura concerniente a esta enfermedad.

Stowaways with wings: two case reports on high-flying insects.

More people than ever before are traversing continents, either for business purposes or on holiday. Because 3-10 percent of these travelers experience skin, hair, or nail disorders related to these trips there is an increasing likelihood that Western physicians will be expected to treat exotic conditions imported from different countries. Tungiasis and furunculoid myiasis are two typical disorders of intertropical regions. They represent nuisances induced by the presence of arthropod larvae or eggs in the skin. We describe a case of tungiasis, caused by the sand flea Tunga penetrans (TP), and a case of myiasis, caused by Dermatobia hominis (DH), and briefly discuss the epidemiology, biologic life cycles, vectors, reservoirs, and clinical presentations of these parasites.