[Parasitic dermatoses from abroad]. / Parasitäre Reisedermatosen.

Increased migration, the omnipresent desire to travel, climate change and a globally more mobile population enhance the risk of spreading infectious, tropical pathogens across international borders. In addition to diarrhea and fever, skin diseases present one of the most common reasons for a medical consultation upon return among travelers. These diseases are often caused by parasites. Detailed data on infectious travel diseases is scarce. However, demographic, endemic and travel-related information represent the basic requirements for physicians to choose appropriate diagnostics and adequate treatment for affected patients. This article gives an overview of common parasitic travel dermatoses, their specific diagnostic workup, treatment and preventive measures.

Parasitic skin infections: neglected diseases or just challenging for diagnosis?

PURPOSE OF REVIEW: The aim of the article is to review the most recent evidence concerning parasitic skin infections. RECENT FINDINGS: Parasitic skin infections are increasingly reported worldwide. Special at-risk categories are migrants, returning travelers, and immunocompromised individuals, who are at higher risk to present disseminated disease. The number of reported cases is growing even outside the endemic areas as a consequence of international travels, migration flows, increasing immunocompromised population, climate change, and natural disasters. SUMMARY: Skin parasitoses are neglected infections. Funding assigned to prevent and treat them is limited, even if they affect millions of persons worldwide. Diagnosis could be a challenge for clinicians of high-income countries who are facing an increasing number of such infections related to great epidemiological events.

A case of human Dirofilaria repens infection, causing an asymptomatic subcutaneous nodule.

We present a case of subcutaneous dirofilariasis, a vector-borne zoonotic disease, in a young woman from Austria. The diagnosis was confirmed by ultrasound and histology of the excised subcutaneous nodule. The parasite species was identified as Dirofilaria repens by polymerase chain reaction. We expect to see more cases of human dirofilariasis also due to climate change and associated increase of the spectrum of suitable mosquito vectors.

Exploring Tropical Infections: A Focus on Cutaneous Larva Migrans.

GENERAL PURPOSE: To provide information about infection with cutaneous larva migrans (CLM). TARGET AUDIENCE: This continuing education activity is intended for physicians, physician assistants, NPs, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES: After participating in this educational activity, the participant will:1. Distinguish the clinical features, diagnosis, and management of CLM.2. Explain the epidemiology of CLM. ABSTRACT: Cutaneous larva migrans is a hookworm infection and one of the most common skin diseases of tourists in tropical countries. Most commonly, the infection is transmitted by contact with feces of dogs and cats containing hookworm eggs. This case-based review explores the epidemiology, diagnosis, clinical features, and management of cutaneous larva migrans infection.

Cutaneous larva migrans is a hookworm infection and one of the most common skin diseases of tourists in tropical countries. Most commonly, the infection is transmitted by contact with feces of dogs and cats containing hookworm eggs. This case-based review explores the epidemiology, diagnosis, clinical features, and management of cutaneous larva migrans infection.

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.

Outbreak of Swimmer's Itch in Denmark.

Swimmer's itch, or cercarial dermatitis, is a waterborne non-communicable skin condition caused by schistosome cercariae released by aquatic snails. Cercarial dermatitis appears worldwide, but may be caused by different trematode species. The itchy maculopapular rash develops on exposed areas of the skin and typically resolves within 1-3 weeks. Shedding of infective larvae from snails is temperature dependent, and high temperatures and sunshine increase the risk of encountering the parasite and becoming infected. The unusually warm spring and summer of 2018 led to an increasing number of reports of the condition in Denmark and established a collaboration between the Department of Dermatology and the Faculty of Health and Medical Sciences, Department of Veterinary and Animal Sciences. This study explored the clinical picture of the disease, and demonstrated the occurrence of infected fresh water snail species in selected Danish water bodies. In conclusion, a risk of swimmer's itch in Denmark was confirmed.

Cutaneous schistosomiasis and leishmaniasis coinfection: a case report.

BACKGROUND: The polymorphic clinical presentations of schistosomiasis and leishmaniasis allow their inclusion in the differential diagnoses of several conditions. Although an overlap in distribution of these diseases has been reported in endemic areas, coinfection with cutaneous schistosomiasis and cutaneous leishmaniasis in the same patient is rare. OBJECTIVES: We report an unusual case of concomitant cutaneous schistosomiasis and cutaneous leishmaniasis. Actions for the management and diagnosis were proposed. METHODS: A patient presented with cutaneous lesions on the abdomen and left elbow. The presence of degenerated ova of Schistosoma mansoni in the skin biopsy led to perform a complementary investigation with immunohistochemical techniques, rectal biopsy and abdominal ultrasonography. After the left elbow lesions had failed to improve after several weeks of standard treatment, a new biopsy was performed and led to diagnosis of another infection. RESULTS: The patient lived in an endemic area for two infectious diseases (schistosomiasis and leishmaniasis). Biopsies revealed chronic granulomatous dermatitis. Degenerated S. mansoni eggs were found in the abdominal lesion and in a rectal biopsy specimen. Ultrasonography revealed hepatic involvement. Despite combination treatment with oxamniquine and praziquantel, a cutaneous lesion persisted on the left elbow; a new biopsy revealed amastigote forms of Leishmania. The patient was successfully treated with intramuscular and intralesional meglumine antimoniate. CONCLUSIONS: The presence of a similar granulomatous infiltrate in lesions caused by the two different infectious agents led to a delay in the diagnosis of cutaneous leishmaniasis. This report serves as a warning of the unusual possibility of cutaneous schistosomiasis and leishmaniasis coinfection in an endemic area.

[Dermato-urology: Male genital lesions urologist should know]. / Dermato-urologie : les lésions des organes génitaux externes de l'homme à connaître par l'urologue.

This article aimed to gather male genital dermatoses that may lead to consult a urologist, except pre-neoplastic or neoplastic lesion. METHOD: This review is based on a research on Pubmed and EM-consult database, in English and in French, using the following key terms "male genital dermatoses", "male genital lesions", "balanitis", "balanoposthitis", "dermatoses des organes génitaux externes masculines", "lésions des organes génitaux externes de l'homme", "balanoposthites". RESULTS: It highlights normal morphological aspects, acute balanoposthitis (nonspecific, infectious, allergic, irritative and traumatic), common skin disease localized to male genital and male genital specific dermatoses. CONCLUSION: Any suspicious, fixed, must lead to a skin biopsy.

Phthiriasis palpebrarum presenting as anterior blepharitis.

In humans, Pthirus pubis or crab louse usually infests hair of pubic region. Phthiriasis palpebrarum (infestation of the eyelashes and eyelids) is not as rare as is reported in literature, especially in low socioeconomic communities. It is possible that the disease is being perhaps missed due to its clinical similarity with anterior blepharitis. The nits and adult lice adhering to the eyelashes can easily be overlooked. This study presents five cases of phthiriasis palpebrarum, coming from the same locality and socioeconomic background, presenting with itching, hyperemia of lids, and excoriation of skin. Two patients were misdiagnosed elsewhere. All were successfully treated. The presence of P. pubis reflects the low level of health and hygiene of that stratum of the society. Higher prevalence could be related to rapid urbanization, overcrowding, and extreme poverty. The health-care providers and policymakers should give more merit to this not so uncommon disease having high morbidity.

Bedside diagnostics in dermatology: Parasitic and noninfectious diseases.

In addition to aiding the diagnosis of viral, bacterial, and fungal diseases, mineral oil preparation, Tzanck smear, and other techniques can be used to diagnose parasitic infections, neonatal pustular dermatoses, blistering diseases, Stevens-Johnson syndrome, and a plethora of other benign and malignant conditions, including granulomatous diseases and tumors. In many cases, these techniques are specific, reliable, and easy to perform and interpret. In others, a certain amount of training and expertise are required. In the proper clinical scenario, these tests are rapid, economical, and compare favorably with other diagnostic methods.

Clinical Manifestation of a Patient With Forehead Sparganosis.

Human sparganosis is a parasite infection caused by the larva of a tapeworm of the genus Spirometra. Ocular, central nervous system, auricular, pulmonary, intraosseous, intraperitoneal, and subcutaneous manifestations of this infection in the neck or inguinal region have been described.The authors report the rare occurrence of cutaneous forehead sparganosis of a 19-year-old male who presented with a soft subcutaneous mass in the forehead, along with a related literature review.

Trichoscopic diagnosis of cutaneous Pelodera strongyloides infestation in a dog.

BACKGROUND: Pelodera strongyloides infestation has rarely been reported in dogs. It is a saprophytic free-living nematode, found in moist decaying organic matter, whose L3 larval stages occasionally can invade the skin of dogs and humans. Larvae penetrate the follicular infundibula causing an erythematous and pruritic dermatitis. The disease is usually diagnosed by deep skin scraping or histopathology, with large numbers of parasites readily identified in hair follicles. CASE REPORT: Pelodera strongyloides dermatitis was diagnosed in a six-year-old mixed breed dog presenting with alopecia, erythema and severe pruritus on the ventrum and limbs. The infestation was diagnosed by microscopic examination of plucked hair shafts and confirmed on microscopic examination of skin biopsies collected for histopathology. Only two of 10 deep skin scrapings gave positive findings. The nematode infestation was eradicated following two applications, 2 weeks apart, of a moxidectin/imidacloprid spot-on product. CONCLUSION AND CLINICAL IMPORTANCE: Skin scrapings are considered the diagnostic test of choice for P. strongyloides infestations. In this case, parasites were identified by hair trichograms more readily than by skin scrapings.

A rare case of cutaneous acanthamoebiasis in a renal transplant patient.

A 35-year-old woman receiving immunosuppressionfor renal transplantation presented with a onemonthhistory of tender skin nodules on herbilateral upper extremities. A skin biopsy revealedgranulomatous inflammation in the deep dermisand the subcutaneous fat with foci of necrosis.Within the foci of necrosis were large histiocytoidstructures with prominent nuclei. Periodic acid-Schiffstain revealed a round organism with a thick capsule,consistent with amoebal trophozoites. Testing withthe Center for Disease Control revealed the organismto be Acanthamoeba. Despite antimicrobial therapy,the patient continued to develop subcutaneousnodules that extended to the lower extremities andtrunk and ultimately extended to the bone, causingacanthamoebal osteomyelitis. Throughout thehospital course, the patient remained neurologicallyintact without evidence of central nervousinvolvement. A diagnosis of isolated disseminatedcutaneous acanthamoebiasis secondary to iatrogenicimmunosuppression was made. Historically, mostcases of granulomatous amoebic encephalitisand cutaneous acanthamoebiasis have occurredin patients with HIV/AIDS. However, with the useof newer and more effective immunosuppressiveregimens, both are occurring more frequently inthe setting of iatrogenic immunosuppression. Therare and isolated cutaneous nature of this patient'spresentation makes this case unique.

[Update on cutaneous dirofilariasis]. / La dirofilariose cutanée.

Dirofilariasis is a worldwide zoonotic infection that rarely affects humans and is caused by filarial nematodes of the genus Diroflaria transmitted by mosquitoes. Cutaneous dirofilariasis, due to D. repens, presents as inflammatory lesions that develop into subcutaneous nodules. These clinical symptoms may be consistent with Wells' cellulitis. Diagnosis of dirofilariasis involves demonstration of the presence of the nematode during skin biopsy and identification of the worm through macroscopic, histological and PCR analysis. Surgical resection of the nodule remains the gold standard treatment. The number of cases of human cutaneous dirofilariasis has increased in the recent years and the disease must not be misdiagnosed.

Recognizing common parasitic infestations.

Parasitic infestations commonly are seen in patients in primary care, urgent care, and EDs. These infestations are a common cause of pruritus and may lead to secondary infestations. This article reviews the signs and symptoms of pinworms, lice, bedbug, and scabies infestations, as well as diagnosis and appropriate treatment.

Swamp cancer: a case of human pythiosis and review of the literature.

Pythiosis is an infection caused by the aquatic oomycete Pythium insidiosum. Commonly known as 'swamp cancer' in veterinary pathology, pythiosis is now considered an emerging human disease associated with significant morbidity and mortality. However, because clinical information is limited, many healthcare providers, including dermatologists, are unfamiliar with this diagnosis. To increase awareness of this life-threatening infection, a case of cutaneous pythiosis is presented. We describe a middle-aged man with acute myeloid leukaemia who presented with necrotizing haemorrhagic plaques on his thighs after a weekend of freshwater boating. Histological examination of a biopsy specimen showed invasive fungal hyphae associated with dense perivascular inflammation and vessel damage. Diagnostic testing on tissue culture revealed growth of P. insidiosum. Despite multiple debridements and antifungal therapy, the patient died within 2 weeks of presentation. There are four clinical presentations reported in human pythiosis. Pythium insidiosum infection should be considered in any patient with a suggestive exposure history and fungal elements found on histological examination or in culture. Identification of the organism can be difficult, so polymerase chain reaction and serological assays can be useful in making a diagnosis. To improve clinical outcomes, early combination therapy with antifungals and surgery is needed.

Emerging infectious diseases with cutaneous manifestations: Fungal, helminthic, protozoan and ectoparasitic infections.

Given increased international travel, immigration, changing climate conditions, and the increased incidence of iatrogenic immunosuppression, fungal, protozoan, helminthic, and ectoparasitic infections that were once uncommon are being seeing more frequently in the Western hemisphere. However, the diagnosis and management of these infections is fraught with a lack of consistency because there is a dearth of dermatology literature on the cutaneous manifestations of these infections. In addition, delays in the diagnosis and treatment of these diseases can lead to significant patient morbidity and mortality. We review the epidemiology, cutaneous manifestations, diagnostic modalities, and treatment options for emerging fungal, protozoan, helminthic, and ectoparasitic infections. It should be noted, however, that throughout this review we cite statistics documenting their increased incidence to back-up these infections as emerging, and although some of the diagnoses are clinical, others rely on newer laboratory tests, and the possibility exists that the increased incidence could be caused by better detection methods.

Reflectance confocal microscopy for cutaneous infections and infestations.

Reflectance confocal microscopy (RCM) is a high-resolution emerging imaging technique that allows non-invasive diagnosis of several cutaneous disorders. A systematic review of the literature on the use of RCM for the study of infections and infestations has been performed to evaluate the current use of this technique and its possible future applications in this field. RCM is particularly suitable for the identification of Sarcoptes scabies, Demodex folliculorum, Ixodes, Dermatophytes and Candida species in the clinical practice and for the follow-up after treatment. The cytopathic effect of herpes simplex virus, varicella zoster virus and molluscipoxvirus is also detectable by this imaging technique even in a pre-vesicular stage. In addition, thanks to its non-invasiveness, RCM allows pathophysiological studies.

Tropical Skin Diseases in Children: A Review-Part II.

Tropical skin diseases are infectious conditions influenced by factors such as nutrition, housing, and the environment. Migration patterns have caused these conditions to be seen all around the world, not only in developing countries. Many of these diseases have a different presentation in childhood, which changes the diagnostic approach and management options. In this article, we review some of the most common tropical mycobacterial, protozoan, parasitic, and viral dermatologic conditions in children, including their epidemiologic, clinical, diagnostic, and therapeutic aspects.

The real threat of swimmers' itch in anthropogenic recreational water body of the Polish Lowland.

After numerous reports the local press about the "stinging water" in created on the Dzierzecinka River-Water Valley reservoir and recognizing in bathers the symptoms of swimmers' itch, environmental study on the presence of bird schistosome larvae in snail hosts was conducted. Snails belonging to Lymnaeidae and Planorbidae were collected at two sites: (i) part of anthropogenic reservoir (192 individuals) and (ii) the river part (37 individuals). Higher prevalence of Digenea was observed in snail populations living in Water Valley (29.8 %) compared to Dzierzecinka River (21.3 %). The larvae of bird schistosomes were recorded in both localities in 1.8 % of collected snails. The prevalence of bird schistosomes reached 2.9 % in Planorbarius corneus, 2.8 % in Radix auricularia, and 5.9 % in Radix balthica/labiata. Laboratory tests have shown that at 19 °C the number of bird schistosome cercariae released from snail hosts significantly exceeded the number of cercariae of other identified Digenea species. It is worth underlining that despite the low prevalence of bird schistosomes, the high number of released cercariae was sufficient to create a real threat of swimmers' itch in bathers. As indicated by the example presented, anthropogenic reservoirs create excellent conditions for Digenea species including bird schistosomes. In view of the real risk of people using the waters, tests on presence of the parasites in snail hosts should be included to the standard procedure of security control in bathing places.