Nondisseminated rhinosporidiosis with multisite involvement in the head and neck.

Rhinosporidiosis is a communicable disease prevalent in tropical countries that affects one or more mucocutaneous sites such as the nasal cavity, pharynx, skin, bronchus, genitals, and bone, in isolation or together. We report a case of multicentric rhinosporidiosis involving the nasal cavity, oropharynx, larynx, and cheek skin without disseminated disease outside the head and neck. Although the appearance of mucocutaneous lesions in our patient was similar to that of papilloma or neoplasm, the distinct clinicopathologic characteristics of the rhinosporidiosis guided us in managing the case successfully. In our own experience with 11 patients with rhinosporidiosis on whom we operated over the past 5 years, the nasal cavity and pharynx were the most commonly involved sites in the head and neck. Surgical excision of all lesions along with cauterization of the base and long-term dapsone therapy is the current standard of care for multicentric rhinosporidiosis.

Dermatoscopic signs in cutaneous leishmaniasis

Abstract: Dermoscopy is a non-invasive technique widely used to aid in the characterization and diagnosis of pigmented skin lesions. Recently, it has also been employed for the evaluation of non-pigmented skin tumours, and inflammatory and infectious cutaneous diseases. Although the diagnosis of cutaneous leishmaniasis is confirmed by the demonstration of amastigotes in infected skin or by the growth of promastigotes in culture medium, dermoscopy could be useful as a further diagnostic test. We report a patient with a nodular lesion located on the right cheek for almost two years. The lesion was clinically suggestive of cutaneous leishmaniasis. Dermoscopy showed yellow tears, erythema and vascular structures. The diagnosis was confirmed by the demonstration of amastigotes in a skin scraping sample.

The effect of skin moisture, pH, and temperature on the density of Demodex folliculorum and Demodex brevis (Acari: Demodicidae) in students and staff of the Erzincan University, Turkey.

BACKGROUND: The aim of this study was to determine the prevalence and density of Demodex folliculorum and Demodex brevis in students and staff of the Erzincan University, Turkey, and to define the influence of age, gender, educational level, and hygiene as well as skin moisture, pH, and temperature on the presence of Demodex mites. METHODS: Healthy people without apparent facial dermatoses from nine faculties and five vocational schools of the university were included in the study. The measurements for moisture, pH, and temperature were conducted in the cheek region, while samples for mite presence were taken from the same region using the standard superficial skin biopsy technique. RESULTS: A total of 538 healthy people, 385 students and 153 university staff, were included in the study. Demodex mites were detected in 50.1% of the students (mean 7.1/cm2 ) and in 69.3% of the university staff (mean 13.1/cm2 ). There were statistical differences between the groups of people who were cleaning their face one, two, three, or more times daily and between those who were using and not using personal towels. There was a borderline significant difference between the different age groups and people with different education levels. The density of mites was higher in those with a skin moisture of less than 50%, with a pH of 5-6.5 and temperature of 24-28 °C, however the differences between the groups with different skin moisture, skin pH, and skin temperature were not statistically significant. CONCLUSION: Demodex mites are very prevalent in healthy individuals of both sexes, and this should be taken into consideration when epidemiological and clinical studies are conducted with patients having different dermatological ailments.

Dermatoscopic signs in cutaneous leishmaniasis.

Dermoscopy is a non-invasive technique widely used to aid in the characterization and diagnosis of pigmented skin lesions. Recently, it has also been employed for the evaluation of non-pigmented skin tumours, and inflammatory and infectious cutaneous diseases. Although the diagnosis of cutaneous leishmaniasis is confirmed by the demonstration of amastigotes in infected skin or by the growth of promastigotes in culture medium, dermoscopy could be useful as a further diagnostic test. We report a patient with a nodular lesion located on the right cheek for almost two years. The lesion was clinically suggestive of cutaneous leishmaniasis. Dermoscopy showed yellow tears, erythema and vascular structures. The diagnosis was confirmed by the demonstration of amastigotes in a skin scraping sample.

Centrofacial Balamuthiasis: case report of a rare cutaneous amebic infection.

Free-living amebae are ubiquitous in our environment, but rarely cause cutaneous infection. Balamuthia mandrillaris has a predilection for infecting skin of the central face. Infection may be restricted to the skin or associated with life-threatening central nervous system (CNS) involvement. We report a case of a 91-year-old woman, who presented with a non-healing red plaque over her right cheek. Several punch biopsies exhibited non-specific granulomatous inflammation without demonstrable fungi or mycobacteria in histochemical stains. She was treated empirically for granulomatous rosacea, but the lesion continued to progress. A larger incisional biopsy was performed in which amebae were observed in hematoxylin-eosin stained sections. These were retrospectively apparent in the prior punch biopsy specimens. Immunohistochemistry and polymerase chain reaction studies identified the organisms as Balamuthia mandrillaris. Cutaneous infection by B. mandrillaris is a rare condition that is sometimes complicated by life-threatening CNS involvement and which often evades timely diagnosis due to its rarity and nonspecific clinical manifestations. Moreover, these amebae are easily overlooked in histopathologic sections because of their small number and their resemblance to histiocytes. Dermatopathologists should be familiar with the histopathologic appearance of these organisms and include balamuthiasis and other amebic infections in the differential diagnosis of granulomatous dermatitis.

Demodex Mite, Rosacea and Skin Melanoma; Coincidence or Association?

OBJECTIVE: To examine the possible associations between Demodex folliculorum and a number of skin diseases. METHODS: Standardized skin surface biopsy samples were obtained from the cheeks of 144 patients with histopathologically proven basal cell carcinoma (BCC, n = 27), squamous cell carcinoma (SCC, n = 28), melanoma (n = 23), discoid lupus erythematosus (DLE, n = 32), and rosacea (n = 34). Thirty-four sex- and age-matched healthy volunteers served as controls. Mite density (per cm2) and infestation (density ≥ 5) were compared between the controls and patients. RESULTS: Mite infestation rates (%) did not differ significantly between the controls (20.6) and patients with BCC (22.2, p = 0.88), SCC (17.9, p = 0.79), melanoma (4.3, p = 0.08), and DLE (21.9, p = 0.90). Compared with the controls, the mite infestation rate was significantly higher in patients with rosacea (47.1, p = 0.02, odds ratio: 3.43, 95% confidence interval: 1.18-9.99). The mean mite density did not differ significantly between the controls (4.11 ± 2.17) and patients with BCC (5.34 ± 2.35, p = 0.75), SCC (3.57 ± 2.01, p = 0.38), and DLE (3.56 ± 1.34, p = 0.83), whereas it was significantly higher in patients with rosacea (8.78 ± 3.58, p = 0.02) and lower in patients with melanoma (1.89 ± 0.69, p = 0.02). CONCLUSIONS: D. folliculorum may be associated with rosacea and melanoma but not with BCC, SCC, or DLE.

Actinomycosis of the cheek.

INTRODUCTION: Actinomycosis is an uncommon chronic granulomatous infection first described by Bollinger in 1 877.The infection is caused by actinomyces species and it is characterized by slow contiguous spread and suppurative inflammation, formation of multiple abscesses and sinus tracts with possible drainage of "sulfur granules". CASE OUTLINE: We report an unusual case of actinomycosis of the cheek that occurred 6 years after buccal odontogenic abscess. A 56-year-old male was referred to the Department of Oral Surgery because of a painless swelling of the left cheek, which initiated three weeks prior to the referral. The diagnosis of actinomycosis was confirmed by histopathologic examination. In accordance with the diagnosis oral penicillin was prescribed for four months with complete resolution. CONCLUSION: This case of actinomycosis is presented as a rarity. For proper diagnosis, careful examination and a high degree of clinical suspicion are necessary.

Masseter muscle cysticercosis: a common disease with uncommon presentation.

Cysticercosis in humans is caused by Taenia solium larvae infestation. Oral cysticercosis is a rare condition and is challenging to diagnose. We present a case of masseter cysticercosis in a young woman who presented with painful recurrent cheek swelling. Diagnosis confirmed it after neuroimaging and histopathological examination of the excised lesion from masseter muscle.

The prevalence of Demodex folliculorum on the scrotum and male perineal skin.

Demodex folliculorum (D. folliculorum) is a human ectoparasite that resides in the pilosebasceous skin unit. Common sites of predilection are the skin of cheeks, forehead, nose, nasolabial fold and eyelids. Genital D. folliculorum inoculation case reports are extremely rare and depend on investigation of skin lesions. There is no study of genital skin without lesions, and, as far as we know, there is no literature on D. folliculorum prevalence in male genital skin. We examined D. folliculorum prevalence on the healthy scrotum and male perineum. One hundred males were examined for D. folliculorum on facial and genital skin. Samples were taken from cheek, forehead, scrotum and perineum by standard skin surface biopsy (SSSB) or hair epilation. The mean age was 53.5+/-13.0 (24-70) years. Eight percent of males had D. folliculorum on their facial skin. Mean Demodex density (Dd) of men with D. folliculorum positivity was 5.1+/- 2.9/ cm (2)(2-9/cm(2)). Diagnostic results of both sampling methods were similar. No D. folliculorum was demonstrated on genital skin.

Investigating demodex in forensic autopsy cases.

Demodex is an ectoparasite living in the skin as a nonpathogen or a pathogen. It is also known that demodex acts as a vector of pathogenic microorganisms. In this study, we have investigated the rate of occurrence and vitality of demodex in forensic autopsies that have a high risk of contamination by infected organisms. The study, which was cross-sectional, conducted on 100 autopsy cases: 77 of the bodies were male and 23 female. The average age was 41. The samples were taken from the forehead, nose, cheeks, eyelashes and the temporal areas using the standardized skin surface biopsy and hair epilation techniques that were modified for this study. The data obtained were assessed statistically. Demodex was determined in 10% of all the cases. The cases revealed that demodex increased in old age and was more frequently seen in people with fair complexion. It was most frequently found in the forehead and the cheek. The longest postmortem interval in the positive cases was 55 h. The relationship between the postmortem interval and the presence of demodex was not statistically significant. Considering the fact that demodex, which is transmitted from human to human through skin contact, acts as a vector of pathogenic organisms and can stay alive in dead bodies for a long time, we think that the personnel performing autopsies without taking the necessary precautions are under risk.

Is demodex really non-pathogenic?

Although usually considered a non-pathogenic parasite in parasitological textbooks, Demodex folliculorum has been implicated as a causative agent for some dermatological conditions, such as rosacea-like eruptions and some types of blepharitis. Several anecdotal reports have demonstrated unequivocal tissue damage directly related to the presence of the parasite. However, this seems to be exceedingly rare, in contrast with the marked prevalence of this infestation. We have had the opportunity to observe one of such cases. A 38-year-old woman presented with rosacea-like papular lesions in her right cheek. Histopathological examination revealed granulomatous dermal inflammation with a well-preserved mite phagocytized by a multinucleated giant cell. This finding may be taken as an evidence for the pathogenicity of the parasite, inasmuch as it does not explain how such a common parasite is able to produce such a rare disease.

Is Demodex really non-pathogenic?

Although usually considered a non-pathogenic parasite in parasitological textbooks, Demodex folliculorum has been implicated as a causative agent for some dermatological conditions, such as rosacea-like eruptions and some types of blepharitis. Several anecdotal reports have demonstrated unequivocal tissue damage directly related to the presence of the parasite. However, this seems to be exceedingly rare, in contrast with the marked prevalence of this infestation. We have had the opportunity to observe one of such cases. A 38-year-old woman presented with rosacea-like papular lesions in her right cheek. Histopathological examination revealed granulomatous dermal inflammation with a well-preserved mite phagocytized by a multinucleated giant cell. This finding may be taken as an evidence for the pathogenicity of the parasite, inasmuch as it does not explain how such a common parasite is able to produce such a rare disease.

Maxillofacial hydatid cysts.

We report 2 cases of hydatid cysts occurring in the submandibular gland and buccal submucosa, respectively. Our first case occurred in the submandibular salivary gland of a 20-year-old woman and the second involved the buccal submucosa of a 6-year-old boy. Both diagnoses were made after the excision of the lesions. Both patients were evaluated after surgery, and both were followed up, but no other organs were involved.

Extraintestinal development of Caryospora simplex (Apicomplexa: Eimeriidae) in experimentally infected mice, Mus musculus.

Developmental stages of Caryospora simplex were found in connective tissue of the cheek, tongue, and nose of Swiss-Webster and C57 BL/6 mice (Mus musculus) from 8 through 70 days after oral inoculation with 50,000 or 250,000 oocysts, or 60,000 free sporocysts of the same species obtained from an Ottoman viper, Vipera xanthina xanthina. The earliest developmental stages were seen on day 8 post-inoculation (PI) and consisted of two types of meronts and gamonts (undifferentiated sexual stages). Gamonts, microgametocytes, macrogametes, and unsporulated oocysts were found on days 10 and 12 PI. Fully sporulated, thin-walled oocysts containing eight sporozoites surrounded by a thin sporocyst membrane were first seen 12 days PI. Monozoic cysts (caryocysts) were first seen 12 days PI and appeared fully viable throughout the duration of the study, 70 days PI. Four mice injected intra-peritoneally with 150,000 free sporozoites and killed 12 days PI contained unsporulated and sporulated oocysts in connective tissues of the cheek, tongue, and nose, suggesting that sporozoites may be carried to the site of infection via the lymphatic/circulatory system. Four cotton rats, Sigmodon hispidus, inoculated orally with 250,000 oocysts all had unsporulated and sporulated oocysts of C. simplex in connective tissue of the cheek, tongue, and nose when killed on day 12 PI, indicating extraintestinal development in the secondary host is not species specific. This is the first report of a heteroxenous coccidium with both asexual and sexual development in the primary (predator) and secondary (prey) hosts.