Laboratory life cycle of Ornithodoros puertoricensis (Ixodida: Argasidae) collected in the Colombian Caribbean.

Three studies on the biology of Ornithodoros puertoricensis are available in the literature, using different hosts and incubation temperatures. In a previous study, we identified O. puertoricensis in the Colombian Caribbean. The aim of the present work was to analyze life cycle data along one generation from these specimens under laboratory conditions. Eggs of O. puertoricensis were collected in between fragments of bahareque material in a rural dwelling in the municipality of Planeta Rica (Córdoba Department, Colombia), and transported to the laboratory. All post-egg stages (i.e., larvae, nymphs, and adults) were incubated at 27 °C and 85% RH and fed on laboratory mice (Mus musculus). Sixteen engorged larvae were obtained to start a laboratory colony. Average feeding period for larvae was 4.6 days (4-5). The first nymphal instar (N1) did not require feeding and the subsequent nymphal stages (N2, N3, and N4) and adults had feeding periods ranging from 55 to 75 min. Average pre-molting period in nymphs was 15 days (10-21). Most of the N3 molted to males and all N4 molted to females. Two gonotrophic cycles were recorded: the first had a preoviposition period of 12 days (7-18) and produced 190 eggs (171-223), the second lasted 6.6 days (6-7) and produced 146 eggs (104-201). The mean life cycle duration (from parental eggs to F1 eggs) was 70.7 days (58.7-82.7) without fasting periods. The collected data agree with previous studies even with differences in hosts and maintenance conditions.

MRSA Femoral Osteomyelitis from Superinfected Scabies Lesions: A Pediatric Case Report.

Scabies is a skin infestation from the Sarcoptes scabiei. It is considered a public health issue causing concern in developing countries and is considered a "neglected tropical disease" by the World Health Organization (WHO). Scabies skin lesions may cause severe itching and can be the portal of entry for opportunistic and pathogenic bacteria, which can cause serious systemic infections. We report the case of a 3-year-old boy with recurrent scabies infections who presented to the emergency department because of a fever and refusal to walk. Blood tests showed neutrophilic leukocytosis and significantly increased C reactive protein (CRP) and procalcitonin. Upon medical examination, his right thigh was extremely painful upon palpation, knee flexion was lost and he was unable to stand, so magnetic resonance imaging (MRI) was performed. MRI showed osteomyelitis of metaphysis and distal diaphysis of the right femur with associated subperiosteal purulent collection and concomitant pyomyositis and fasciitis of the distal right thigh. Blood cultures were positive for methicillin-resistant Staphylococcus aureus (MRSA). The patient received a long course of intravenous antibiotic therapy and his condition slowly improved. Follow-up femur X-ray showed a mixed pattern of erosion and sclerosis at the meta-diaphyseal region and periosteal reaction at the diaphyseal region. This case highlights the importance of early scabies diagnosis even in Western countries where poverty and household overcrowding are uncommon. Early diagnosis, timely initiation of proper treatment and evidence of clinical resolution are important elements to prevent recurrence of infection and serious systemic superinfections even from multi-drug resistant bacteria. Clinical consequences from unrecognized disease or inadequate eradication are preventable.

Presence of two species of the Amblyomma cajennense complex (Acari: Ixodidae) and probable zones of sympatry in northwestern Colombia.

The A. cajennense tick complex has been thought to be the main vector of Rickettsia rickettsii in Central and South America. Studies in Colombia have determined the presence of species A. patinoi and A. mixtum of the A. cajennense complex, but it is unknown which species of this complex exist in northwestern Colombia. Our aim was to identify the species of the A. cajennense complex that are present in northwestern Colombia. We sampled ticks of A. cajennense sensu lato infesting equids. Females identified according to the morphology of their genital pore were selected for genetic confirmation. Specimens from each locality were selected to perform molecular and genetic analysis. Specimens were analyzed from five departments (Antioquia, Bolívar, Córdoba, Magdalena, and Sucre). Morphologically 65 specimens were identified as A. patinoi and 5 as A. mixtum. Molecular analysis allowed to confirm the morphological identification of 27 specimens. In this study A. patinoi was widely distributed in the departments of Antioquia, Bolívar, and Córdoba with allopatric and sympatric distribution in some places. These two species in the region could have unexpected effects on the epidemiology of rickettsiosis.

Case for diagnosis. Erythematous and pruritic papules on forearms.

Gamasoidosis is a poorly known and underdiagnosed mite infestation. It is characterized by the presence of erythematous and flattened papules that are quite pruritic, and can affect any region of the body, with preference for areas of folds. This article reports a case of the disease caused by mites of the species Dermanyssus gallinae. Increasingly, the agents that cause this disease are found in urban environments, increasing the incidence of people affected by the disease. This dermatosis has a self-limiting clinical picture and the treatment is done with the use of topical corticosteroids and oral antihistamines.

Case for diagnosis. Erythematous and pruritic papules on forearms

Abstract Gamasoidosis is a poorly known and underdiagnosed mite infestation. It is characterized by the presence of erythematous and flattened papules that are quite pruritic, and can affect any region of the body, with preference for areas of folds. This article reports a case of the disease caused by mites of the species Dermanyssus gallinae. Increasingly, the agents that cause this disease are found in urban environments, increasing the incidence of people affected by the disease. This dermatosis has a self-limiting clinical picture and the treatment is done with the use of topical corticosteroids and oral antihistamines.

[Scabies in old age]. / Skabies im Alter.

Scabies is a frequent ectoparasitosis the prevalence of which also seems to increase in older patients. Correct and timely diagnosis of scabies in older age is hampered by atypical clinical manifestations, the potential lack of pruritus and a variety of differential diagnoses. Scabies crustosa, a highly contagious subtype due to the presence of innumerable mites, is of particular importance. It predominantly occurs in immunosuppressed patients as well as in mentally or physically disabled persons and is the most important source of scabies outbreaks in residential and nursing homes. This article reviews the diagnosis and treatment of scabies and the strategies for managing outbreaks with special reference to older patients.

Cutaneous myiasis in a traveler returning from Argentina.

Myiasis is a common travel-associated dermatosis. We describe a 52-year-old Italian man who acquired Dermatobia hominis when bitten by a mosquito during a visit to Argentina. He had a painful nodular lesion on the left cheek that had been present for about 3 weeks. The complete removal of the larva is the goal of medical treatment. Prescription of antibiotics to avoid secondary infections is not recommended. For psychological reasons and due to the failure of previous therapies, the lesion was excised. Travelers to endemic areas should be informed of preventive measures to reduce mosquito bites and transmission of the infestation.

Disseminated cutaneous larva migrans in a 7-year-old patient

Introduction: Cutaneous larva migrans is a cutaneous infestation caused by zoonotic nematode larvae commonly due to hookworms such as the Ancylostoma braziliense. Case report: Herein we report a case of a 7-year-old child to the Emergency Department complaining of erythematous papular itching lesions on his right elbow, wrist and knee. He had no previous history of contact with sand or animals. The lesions in his right elbow presented impetiginization. Ivermectin 200mcg/kg/day treatment was initiated and oxacillin associated. On the third day of treatment, the patient was discharged with complete resolution of the lesions. Coclusion: The reported case assumes importance because it is a common and benign disease, but due to an unusual presentation was not diagnosed early. The disseminated form commonly may require hospitalization and prolonged treatment as presented

Introdução: A larva migrans cutânea é uma infestação cutânea causada por larvas de nematoides zoonóticos comumente causadas por ancilostomídeos como o Ancylostoma braziliense. Relato de caso: Aqui, relatamos o caso de uma criança de 7 anos de idade levada ao Departamento de Emergência, queixando-se de lesões eritematosas de prurido no cotovelo, punho e joelho direitos. Negava história prévia de contato com areia ou animais. As lesões no cotovelo direito apresentavam impetiginização. Ivermectina 200mcg/kg/dia foi iniciada e oxacilina associada. No terceiro dia de tratamento, o paciente recebeu alta com resolução completa das lesões. Conclusão: O caso relatado assume importância por ser uma doença comum e benigna, mas devido a uma apresentação incomum não foi diagnosticada precocemente. A forma disseminada comumente pode requerer hospitalização e tratamento.

Oral myiasis in older adult with severe Alzheimer's disease.

AIMS: Myiasis is a disease caused by the invasion of tissues by larvae of flies. The aim of this study was to carry out a review of reported cases of oral and maxillofacial myiasis in older adults and to show a case report of oral myiasis in a 95-year-old frail man with severe Alzheimer's disease from Brazil. METHODS AND RESULTS: Between 1988 and 2017, 35 oral and maxillofacial myiasis cases were reported in older adults in English-language studies from PubMed and Lilacs databases. CONCLUSIONS: Oral and maxillofacial myiasis in older adults showed low incidence and good prognosis of cure, when there were no systemic complications. Weakness, frailty, dementia, oral lesions, labial incompetence, poor oral hygiene, and bad breath were associated with this disease in reported cases. Preferential therapy choices were debridement alone or combined with Ivermectin. In this case report, debridement and Ivermectin prescription was an effective therapy for an older adult with severe Alzheimer's disease.

Acute prurigo simplex in humans caused by pigeon lice

Abstract: Pigeon lice are insects that feed on feathers of these birds; their life cycle includes egg, nymph and adult and they may cause dermatoses in humans. Four persons of the same family, living in an urban area, presented with widespread intensely pruritic erythematous papules. A great number of lice were seen in their house, which moved from a nest of pigeons located on the condenser of the air-conditioning to the dormitory of one of the patients. Even in urban environments, dermatitis caused by parasites of birds is a possibility in cases of acute prurigo simplex. Pigeon lice are possible etiological agents of this kind of skin eruption, although they are often neglected, even by dermatologists.

Tungiasis: Outbreak investigation of a zoonosis during overseas deployment.

BACKGROUND: Tungiasis is an ectoparasitosis caused by the sand flea Tunga penetrans. It is endemic in the under privileged communities of Latin America, the Caribbean and Sub Saharan Africa with geographic and seasonal variations even within endemic areas. We describe investigation of an outbreak of Tungiasis in troops deployed as part of UN peacekeeping force in Central Africa. METHODS: Tungiasis was diagnosed in an unusually large number of cases of severely pruritic boils over feet in soldiers of a UN peacekeeping battalion. An outbreak investigation was carried out and the outbreak was described in time, place and person distribution. A retrospective cohort study was done to ascertain the associated risk factors. RESULTS: A total of 36 cases were identified of which 33 had laboratory confirmation. Of the 36 cases, 10(27.77%) had only Fortaleza Stage II lesions, 22 (61.11%) a combination of Fortaleza Stage II and III lesions and four (11.11%) cases had a combination of Stage, II, III and IV lesions. Secondary bacterial infection was seen in 25 (69.44%) cases. Epidemiological analysis revealed that it was a common source single exposure outbreak traced to a temporary campsite along one of the patrolling routes. CONCLUSION: In a Military setting an integrated approach combining health education and environmental control is required to prevent such outbreaks.

Tungiasis under dermoscopy: in vivo and ex vivo examination of the cutaneous infestation due to Tunga penetrans / Tungíase sob dermatoscopia: exame in vivo e ex vivo da infestação cutânea pela Tunga penetrans

The female flea Tunga penetrans is responsible for a cutaneous parasitosis known as Tungiasis. We report the clinical case of a 12 year-old Caucasian boy who sought treatment in a dermatological private office due to a painful lesion in the plantar area and whose dermoscopic examination, without skin contact, allowed the visualization of parasite's movement inside the skin. The diagnosis of tungiasis is clinical, but it can be aided by in vivo and ex vivo dermoscopic examination of the lesion.

A fêmea da pulga Tunga penetrans é responsável pela dermatose ectoparasitária denominada Tungíase. Relatamos o caso clínico de um adolescente branco de 12 anos de idade, o qual procurou atendimento em consultório dermatológico devido à lesão dolorosa na planta e cujo exame dermatoscópico sem contato com a pele permitiu visualizar o movimento do parasita dentro da pele. O diagnóstico da tungíase é clínico, porém pode ser auxiliado pelo exame dermatoscópico in vivo e ex vivo da lesão.

Gnatophyma: a rare form of rosacea / Gnatofima: uma forma rara de rosácea

Phyma is the last stage of rosacea and is due to chronic inflammation and edema. It can affect nose (rhinophyma), chin (gnatophyma), forehead (metophyma), ears (otophyma) and eyelids (blepharophyma). Rhinophyma is the most frequent location and there are few reports about gnatophyma. We report the case of a female patient, 41 years old, who had an infiltrated, erythematous, edematous plaque around the chin and lower lip for two years. Histopathology showed perivascular lymphocytic infiltrate, hypertrophied follicles and sebaceous glands, dilated vessels and fibrosis. She was treated with oral tetracycline, oral ivermectin and metronidazole cream with a satisfactory response. The clinical, histopathological and therapeutic response correlation confirmed the diagnosis of gnatophyma, a rare variant of phyma.

Fima é o estágio final da rosácea e ocorre devido ao edema e inflamação crônica. Pode acometer nariz (rinofima), mento (gnatofima), fronte (metofima), orelhas (otofima) e pálpebras (blefarofima). Rinofima é a localização mais encontrada e há raros relatos de gnatofima. Relataremos paciente feminina, 41 anos, que apresentava placa infiltrada, eritêmato-edematosa, em todo o mento e lábio inferior há dois anos. Histopatológico com infiltrado linfocitário perianexial e perivascular, folículos e glândulas sebáceas hipertrofiadas, vasos ectasiados e fibrose perianexial. Foi instituído tratamento com tetraciclina via oral, ivermectina via oral e metronidazol creme com resposta satisfatória. Através da correlação clínica, histopatológica e resposta terapêutica confirmou-se o diagnóstico da variante rara de fima, gnatofima.

Gamasoidosis illustrated: from the nest to dermoscopy / Gamasoidose ilustrada: do ninho à dermatoscopia

Gamasoidosis (acariasis, avian-mite dermatitis or bird-mite dermatitis) is a challenging diagnosis that is becoming more common because of the frequent use of window air conditioners in tropical countries. These devices may serve as shelters for nests of urban birds such as pigeons. Dermatologists should become familiar with this infestation to establish the correct diagnosis and treatment.

Gamasoidose (acaríase, infestação por "piolhinho-de-pombo" ou dermatite por ácaros aviários) é um diagnóstico desafiador que está se tornando mais comum devido ao uso frequente de aparelhos de ar-condicionado de janela em países tropicais, que servem de abrigo para ninhos de pássaros urbanos tais como pombos. Dermatologistas devem se familiarizar com esta infestação para fazerem diagnóstico e tratamento adequados.

Tungíase disseminada / Disseminated tungiasis

A tungíase é uma infestação zooantropofílica causada pela Tunga penetrans. É endêmica na América Latina e no Caribe. Ocorre, principalmente, em comunidades carentes e sem saneamento básico e em indivíduos que visitam áreas contaminadas. O local mais comum de penetração do ectoparasita é a região periungueal dos pés. Os autores mostram a ocorrência de uma forma disseminada num habitante da zona rural.

Tungiasis is a zoophilic and anthropophilic infestation caused by Tunga penetrans. It is endemic in Latin America and in the Caribbean. It occurs mainly in impoverished communities that have no access to basic sanitation and in individuals that visit contaminated areas. The most common penetration site of this ectoparasite is the periungueal region of the feet. The authors present its disseminated form occurring in a patient inhabiting a rural area.

Tungiasis en población indígena del departamento de Vaupés: epidemiología, clínica, tratamiento y prevención / Tungiasis in native amerindians in Vaupés province: epidemiology, clinical aspects, treatment, and prevention

Introducción. La tungiasis, o infestación cutánea por la pulga Tunga penetrans, ocurre en comunidades muy pobres.Objetivo. Presentar la entidad en indígenas del Vaupés. Métodos. En primer lugar, se revisó el tema. Luego, se describió el área y la vivienda de los pacientes afectados; se detectaron los animales infestados con la zoonosis. Se iIustró el aspecto clínico y sus complicaciones y, posteriormente, se trataron los pacientes con creolina. Se logró hacer modificaciones en el piso de las malocas de dos comunidades, con humedad y arcilla, y se impartió educación a la comunidad sobre esta parasitosis. Resultados. El 95% de los 33.000 habitantes del Vaupés son indígenas. Algunos moran en viviendas de piso arenoso, seco, con detritos alimenticios y perros con tungiasis. Entre 1996 y 2007 confirmamos 942 casos del parasitismo. De los indígenas estudiados, 3 a 8 de cada 1.000 y 62% de los perros, presentaban tungiasis. Los pies se vieron afectados en 98% de los pacientes. Se presentaron casos graves con más de 20 lesiones, en niños y ancianos. Como complicaciones, se presentaron: infección secundaria, dolor, anoniquia, deformación y amputación de los dedos de los pies e imposibilidad para la marcha. Hubo sepsis mortal en tres pacientes. No se presentaron casos de tétanos. Los baños con creolina y la extracción del parásito fueron curativos, en hombres y animales. La modificación de los pisos redujo a cero la enfermedad en una comunidad. Conclusiones. La enfermedad es intradomiciliaria. El piso de la vivienda y la convivencia con perros infestados son ideales para adquirirla. La creolina, la humectación del piso y el cubrirlo con arcilla controlaron un foco de la enfermedad, actividad que podría generalizarse. Ésta es la primera investigación colombiana sobre la tungiasis, entidad conocida en Colombia desde que afectó a los soldados de Gonzalo Jiménez de Quesada, fundador de Santafé de Bogotá en 1538.

Introduction. Tungiasis, the skin infestation with the flea Tunga penetrans, occurs in poor communities.Objective. To present a study of this condition among native Amerindians from Vaupés (Colombia). Methods. After reviewing this topic, we present a description of the geographic area and the housing of the affected subjects; animal carriers infected with this zoonosis were also detected. We illustrate the clinical aspects and complications. Patients were treated with creolin (liquid cresol). We modified the floor of malocas in two communities using wet clay, and we educated the community on this parasite. Results. About 95% of the 33,000 inhabitants of Vaupés are native Amerindians. Some households have dry sandy floors, where food leftovers attract dogs infested with tungiasis. From 1996 to 2007 we confirmed 942 human cases of this parasitic disease. Among the native communities, 3 to 8 per 1,000 persons and 62% of the dogs have tungiasis. Feet were affected in 98% of the patients. Severe cases, with more than 20 lesions, occurred among children and the elderly. Complications included secondary infections, pain, anonychia (loss of toenails), toe deformities, amputation of toes and walking problems. Three patients died as a result of sepsis originating from toe infections. Topic use of liquid creolin and extraction of the parasite cured the problem in humans and dogs. Floor modifications eradicated the problem in one community. Conclusions. Tungiasis is an intradomiciliary disease. Favorable conditions for infestations include dry sandy floors and infected dogs. Treatment of the floors with creolin and wet clay resulted in control of one focus of the disease; this method could be applied more widely. This is the first known research study on tungiasis in Colombia, a disease that affected the soldiers of the Spanish Conquistador Gonzalo Jiménez de Quesada in the 1500s.

Tungíase disseminada tratada com ivermectina / Generalized tungiasis treated with ivermectin

A tungíase é ectoparasitose causada pela penetração da Tunga penetrans na pele do hospedeiro. A infestação por essa pulga está associada à pobreza e ocorre em comunidades carentes na América do Sul e Central, no Caribe e na África sul-sahariana. No Brasil, é mais prevalente em assentamentos urbanos precários, áreas rurais e comunidades de pescadores em todo o país. O tratamento consiste na retirada dos parasitas e, nos casos com infecção secundária, antibioticoterapia. Até o momento, não há droga no mercado com eficácia clínica satisfatória. Relata-se caso de tungíase disseminada tratada com ivermectina oral.

Tungiasis is an ectoparasitic infection caused by the penetration of the sand flea Tunga penetrans into the skin of the host. Flea infestation is associated with poverty and occurs in resource-poor communities in South and Central America, the Caribbean and Sub-Saharan Africa. In Brazil, it is widespread in urban squatter settlements, villages in the rural hinterland and in traditional fishing communities along the coast. Standard therapy for tungiasis consists of removing the embedded flea with a sterile needle, and using an antibiotic agent in case of secondary infection. At present, there is no drug in the market with satisfactory clinical efficacy. We describe a case of generalized Tunga penetrans infestation that was treated with oral ivermectin.

Aspectos epidemiológicos de la escabiosis infantil en el municipio Cabimas, estado Zulia, Venezuela / Epidemiological aspects of the infantile scabies at Cabimas municipality, Zulia state, Venezuela

Fundamento: La escabiosis es un problema de salud pública en el mundo, particularmente en la edad pediátrica, que explica la alta morbilidad en países desarrollados y subdesarrollados, donde constituyen verdaderas epidemias. Objetivo: Determinar algunos aspectos epidemiológicos de la escabiosis infantil en los niños de 0 a 15 años en el consultorio médico «El lucero¼, estado Zulia de Venezuela. Método: Se realizó un estudio descriptivo, longitudinal y prospectivo, en el consultorio médico de la familia correspondiente al sector «El Lucero¼, en el municipio Cabimas, estado Zulia, Venezuela, durante el período comprendido entre el 30 de junio de 2005 al 30 de junio de 2006. El universo de estudio estuvo constituido por 403 pacientes, con edades comprendidas entre un día de nacido y quince años, que asistieron a la consulta de Medicina General Integral por lesiones de piel. La muestra quedó conformada por 202 pacientes, diagnosticados clínicamente por escabiosis, y que asistieron a dicha consulta en el período antes citado. Como fuente primaria de los datos se utilizó la encuesta confeccionada al efecto por la autora de la investigación, previo consentimiento informado. Resultados: Se encontró predominio del sexo masculino y del grupo de edades de uno a cinco años, la mayor parte de los casos presentaron condiciones socioeconómicas e higiénicas sanitarias de la vivienda entre malas y regulares, las lesiones elementales más frecuentes fueron el eritema, la pápula y las excoriaciones, las localizaciones de predilección fueron el cuero cabelludo, los espacios interdigitales de los dedos de las manos y la planta de los pies, la eczematización constituyó la complicación más común y la dermatitis atópica representó la enfermedad asociada más observada. Conclusiones: Los resultados del estudio muestran la incidencia y prevalencia de enfermedades trasmisibles, particularmente en habitantes de zonas urbanas marginales que no poseen acceso a los servicios de salud.

Background: Scabies is a public health problem in the world, particularly in the pediatric age, that explains the high morbidity in developed and underdeveloped countries, which constitutes true epidemics. Objective: To determine some epidemiological aspects of the infantile scabies in children from 0 to 15 years in the doctor's office «El Lucero¼, Zulia state of Venezuela. Method: A prospective, longitudinal, and descriptive study was carried out, in the family doctor's office pertaining to «El Lucero¼, sector in Cabimas municipality, Zulia state, Venezuela, from June 30, 2005 to June 30, 2006. The universe of study was constituted by 403 patients, with ages between a day of born and fifteen years, that attended in the Integral General Medicine consultation by skin lesions. The sample remained conformed by 202 patients, clinically diagnosed by scabies, and that attended to said consultation in the period before mentioned. As data primary source was utilized the survey made to the effect by the author of the investigation, previous informed consent. Results: Male sex and the age groups from one to five years predominated, most of the cases presented socioeconomic and hygienic-sanitary conditions of the house between bad and regular, the most frequent elementary lesions were the erythema, the papule and the excoriations, the localization of predilection were the scalp, the interdigital spaces of the fingers and the sole of the foot, the eczematization constituted the most common complication and the atopic dermatitis represented the most observed associated disease. Conclusions: The results of the study show the incidence and prevalence of transmissible diseases, particularly in inhabitants of marginal urban zones that do not possess access to the health services.

Miíase oral: etiologia, diagnóstico e tratamento / Oral Myiasis: etiology, diagnosis and treatment

A miíase oral é uma doença causada pela infestação dos tecidos por larvas de moscas. As manifestações clínicas da doença não são específicas e variam de acordo com a região do corpo envolvida. O tratamento consiste na remoção mecânica das larvas, sendo recomendado o uso sistêmico de ivermectina. Este artigo traz uma revisão da literatura a respeito desta doença, enfatizando aspectos relativos à etiologia, diagnóstico e tratamento da miíase oral.

Oral myiasis is a disease caused by the invasion of tissues by larvae of flies. Clinical manifestations of myiasis are not specific and vary according to the involved area of the body. The treatment is the mechanical removal of the maggots and recommendation of the use of systemic ivermectin. This paper makes a review of the literature, emphasizing etiological aspects, diagnosis and treatment of oral myiasis.