Successful Treatment of Cutaneous Leishmaniasis with Topical Paramomycin in a Child After Treatment Failure with Systemic Fluconazole.

It is challenging to find safe, nonscarring and noninvasive treatment of facial cutaneous leishmaniasis (CL) in children. Herein, we report a child with CL from a region endemic for Leishmania tropica, whose lesion persisted after treatment with oral fluconazole but responded to topical paromomycin. Paromomycin should be considered early for treatment of Old World CL and is a well-tolerated and effective mode of therapy for facial lesions.

[Human demodicidosis in Sfax area (Tunisia)]. / La démodécidose humaine dans la région de Sfax (Tunisie).

Demodicidosis is an ectoparasitosis, common to humans and many mammals. It is caused by the proliferation of a mite Demodex sp in the pilosebaceous follicles. Its pathogenic role remains controversial. The aim of our study was to report epidemiological and clinical particularities of cases of demodicidosis diagnosed in our region. Over a period of nine years (January 2000 to December 2008), 427 cases of demodicidosis were diagnosed. 73.2% of cases were blepharitis and 26.8% of cases were facial dermatosis. The mean age was 44 years. Women were slightly more affected (56%) than men. Among 787 chronic blepharitis, 243 cases were due to Demodex sp (30.9%). They were treated with yellow oxide of mercury (Ophtergine® 1%). In the face, this mite has been isolated from erythematous and pruritic papulopustular lesions, and their distribution was as follows: cheeks (22.1%), forehead (13.4%), and nose (11.5%). The diagnosis was confirmed by parasitological examination of scales showing more than 5 Demodex sp/cm(2) and response to treatment with metronidazole (Flagyl®) for three months. Currently, there were a large number of arguments for the incrimination of Demodex sp in pathogenesis of dermatosis and blepharitis. Dermatologists and ophthalmologists must therefore think to this mite. The density of Demodex sp found by parasitological exam is a determining factor in establishing an anti-Demodex treatment whose effectiveness is a further argument for the diagnosis.

Subcutaneous cysticercosis diagnosed by mitochondrial DNA analysis.

BACKGROUND: Cysticercosis is caused by the larval stage of the pork tapeworm, Taenia solium. Central nervous system, eyes, skeletal muscle, and subcutaneous tissue are the most frequent sites of involvement. METHODS: We report a case of subcutaneous larval cestode where no diagnostic histological features such as scolex or bladder wall can be seen on serial sections. Identification of the pathogen was attempted using mitochondrial DNA analysis of the histopathologic specimen. RESULTS: Analysis of PCR-amplified DNA sequences targeting T. solium mitochondrial cox1 gene and cob gene confirmed the diagnosis. CONCLUSIONS: When characteristic morphology is absent in histopathology specimen, mitochondrial DNA diagnosis is a powerful tool for a definitive diagnosis of cysticercosis. The DNA diagnosis using such histopathologic specimens would also be applicable for identification of other parasites as extensive DNA sequence data are currently available.

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.

[Investigation of Demodex sp. using cellophane tape method among university students]. / Universite Ogrencilerinde Selofan-Bant Yöntemi ile Demodex sp. Arastirilmasi.

Demodex sp. is an obligatory ectoparasite of pilosebaceous units in humans. This study was carried out in order to investigate the frequency of Demodex sp. among high school students. For this purpose 75 women and 96 men, making a total of 171 students, were studied. Cellophane-tape preparations taken from their face, especially at the base of the nose, underside of the jaw and the side of the forehead, were examined microscopically. Demodex sp. was found to be positive in five (2.9%) cases.

Onchocercosis mansonella co-infection presenting as a subcutaneous nodule in a child.

A 11-year-old girl presented with a subcutaneous lesion on the forehead, thought to be an implantation dermoid cyst. Microscopic examination revealed an onchocercoma. Microfilariae were found in the blood indicating a co-infection with Mansonella perstans. This case demonstrates the diagnostic difficulties of a parasitic co-infection uncommonly encountered in Europe.

Comparison of Demodex folliculorum density in haemodialysis patients with a control group.

BACKGROUND: Demodex folliculorum (DF) is resident in human pilosebaceous follicles. Mite density is low in healthy skin. Many cases of demodicosis in association with immunosuppression have been reported. Patients undergoing haemodialysis are also immunosuppressed. OBJECTIVE: We aimed to compare the Demodex folliculorum density in haemodialysis patients and healthy subjects. METHODS: Mite density of 87 patients undergoing haemodialysis was compared with that of age- and sex-matched controls. Two samples of standardized skin surface biopsies were taken from each subject from the forehead, cheek and nose. The number of mites counted on the surface area of 1 cm2 was accepted as the density of DF. The length and width of mites were measured by oculometer. RESULTS: DF density was found in 17 (19.54%) of the 87 dialysis patients and in 9 (10.34%) of 87 controls. A mean mite density of 5.11+/-5.65 was found in dialysis patients and of 2.55+/-1.6 in controls. Differences between the two groups in mite density were not statistically significant (P=0.13). There was also no significant difference in mite length between the two groups (P=0.06). There was, however, a significant difference in mite width (P=0.018). CONCLUSION: Despite the presence of sebaceous gland atrophy in haemodialysis patients, the higher density of DF in these patients than controls supports the supposition that this mite can increase immunosuppression.

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.