Efficacy and safety of dimeticones in the treatment of epidermal parasitic skin diseases with special emphasis on tungiasis: an evidence-based critical review

ABSTRACT Epidermal parasitic skin diseases encompass scabies, pediculosis, cutaneous larva migrans, myiasis, and tungiasis. Tungiasis is probably the most neglected of all Neglected Tropical Diseases (NTD). It occurs in South America, the Caribbean and Sub-Saharan Africa and affects marginalized populations where people live in extreme poverty. In endemic communities the prevalence can be up to 30% in general population and 85% in children. Over time, chronic pathology develops characterized by hyperkeratosis, edema around the nail rim, fissures, ulcers, deformation and loss of nails. This leads to a pattern of disabilities, eventually resulting in impairment of mobility.Dimeticones are a family of silicon oils with a potential to kill parasites located on top or inside the epidermis by a physical mode of action. They are considered the treatment of choice for pediculosis capitis and pediculosis pubis. With regard to tungiasis, the so called rear abdominal cone of the parasites has been identified as a target for treatment with dimeticones. NYDA®, a mixture of two dimeticones with different viscosity, is the only dimeticone product for which data on the mode of action, efficacy and safety with regard to tungiasis exists. The product has been shown highly effective against embedded sand fleas, even in very intense infection with more than 500 parasites situated on top of each other. A randomized controlled trial showed that seven days after a targeted application of NYDA® 97% (95% CI 94-99%) of the embedded sand fleas had lost all signs of viability.Comprehensive toxicological investigations on the dimeticones contained in NYDA® showed that there is practically no risk of embryotoxicity, fetotoxicity, teratogenicity, and other toxicity. The safety of dimeticones was also demonstrated in clinical trials with a total of 106 participants with tungiasis, in which not a single adverse event was observed.

Miasis foruncular por Dermatobia Hominis: un diagnóstico emergente en Chile / Foruncular myiasis due to Dermatobia Hominis: a diagnosis emerging in Chile

Las lesiones cutáneas son causa frecuente de consulta en viajeros siendo las picaduras de insectos unas de las más prevalentes. Damos a conocer un caso de paciente que presenta una lesión dolorosa en cuero cabelludo, tras viaje a la selva boliviana, refractario a tratamiento antibiótico empírico y con estudio complementario inconcluyente. Finalmente, se realizó estudio macroscópico de la costra, que determinó que se trataba de una larva de Dermatobia Hominis. Este caso demuestra la importancia de tomar en cuenta estos agentes no presentes en Chile y que son causantes de patologías dermatológicas del viajero.

Cutaneous lesions are frequent cause of consultation in travelers, being insect bites one of the most prevalent. We present a case of a patient with a painful lesion on the scalp, after a trip to the Bolivian jungle, refractory to empirical antibiotic treatment and with an inconclusive complementary study. Finally, macroscopic study of the crust was carried out, which determined that it was a larva of Dermatobia Hominis. This case demonstrates the importance of taking into account these agents not present in Chile and that are the cause of dermatological pathologies of the traveler.

Dermatitis cercarial en bañistas del norte de la Patagonia Argentina / Cercarial dermatitis of bathers in northern Argentine Patagonia

La dermatitis cercarial es una enfermedad cutánea, zoonótica y estival, causada por una larva nadadora de trematodes de la familia Schistosomatidae, llamada cercaria. Esta larva penetra accidentalmente la piel de personas que se encuentran en el agua, generando una reacción alérgica que generalmente no se informa en centros de salud, dificultando el registro de su incidencia. Se han informado casos en todo el mundo, incluyendo a la Argentina, aunque los estudios epidemiológicos se han realizado solamente en el Hemisferio Norte. En este trabajo se estudió la epidemiología de la dermatitis cercarial en tres balnearios patagónicos de los lagos Pellegrini, Mari Menuco y Puelo, donde se realizaron encuestas a visitantes durante los veranos de 2012-2013 y 2013-2014. Se analizaron los factores de riesgo, que fueron agrupados en “características personales”, “uso del recurso” y “medidas de prevención”. En el lago Pellegrini fue la sensibilización de la persona incluida en "características personales" el único factor determinante para la ocurrencia de esta zoonosis, mientras que en el lago Mari Menuco la ocurrencia se asoció con el tiempo y la distancia a la costa y el uso de cremas. En el lago Puelo no se registraron casos durante el período de estudio.

The cercarial dermatitis is a zoonotic, summer, skin-disease, caused by a swimming larva (cercaria) of a schistosomatid trematode. This larva accidentally penetrates the skin of people in the water, causing an allergic reaction, which is not always reported in health centers, so it is difficult to determine its incidence. Cases have been registered worldwide, including Argentina, although the epidemiological studies were performed only in the Northern Hemisphere. In this survey the epidemiology of cercarial dermatitis was studied in three Patagonian lakes watering places, Pellegrini, Mari Menuco, and Puelo, where surveys were conducted during summers of 2012-2013 and 2013-2014. The risk factors were analyzed and grouped in “personal characteristics”, “use of the recreational resource”, and “prevention measures”. At the Pellegrini Lake, the people´s sensitivity included in "personal characteristics" was the only determining factor for the occurrence of this zoonosis, mean while in Mari Menuco Lake, the bathing time and distance from the coast, and the use of lotions would affect the occurrence of swimmer’s itch. In Puelo Lake, no cases were recorded during the study period.

Dermatosis de origen alimentario al regreso de un viaje: gnathostomiasis / Foodborne dermatosis after traveling: gnathostomiasis

Se describe el caso de un paciente de 32 años de edad, residente en Buenos Aires, con manifestaciones dermatológicas compatibles con gnathostomiasis. Había realizado un viaje a Colombia en el mes previo a la aparición de la sintomatología. Allí consumió cebiche (pescado crudo marinado en jugo de limón) en reiteradas oportunidades. El cuadro clínico se presentó como paniculitis eritematosa y migratoria acompañada de eosinofilia sanguínea. Se le realizó biopsia cutánea de una lesión y el diagnóstico anatomopatológico fue "paniculitis eosinofílica". La tríada de paniculitis migratoria, eosinofilia sanguínea y el consumo de pescado crudo durante el viaje a Colombia fue sugestiva de gnathostomiasis por lo que se indicó tratamiento con ivermectina con buena evolución inicial y recaída posterior. Se realizó un nuevo tratamiento con la misma droga con buena evolución y sin recaídas durante tres años de seguimiento. La afección dermatológica es un motivo frecuente de consulta al regreso de un viaje, y representa la tercera causa de morbilidad en viajeros. Es muy importante el reconocimiento de las enfermedades que pueden tener manifestación cutánea, ya que muchas de ellas son potencialmente graves y pueden poner en riesgo la vida del paciente si no son oportunamente diagnosticadas y tratadas.

We describe a case of a 32-year-old man, resident in Buenos Aires, with dermatologic manifestations compatible with gnathostomiasis. The patient had traveled to Colombia in the month prior to the onset of symptoms. There, he repeatedly ate ceviche (raw fish marinated in lemon juice). He presented with an erythematous migratory panniculitis accompanied by eosinophilia. He underwent skin biopsy of a lesion and pathological diagnosis was "eosinophilic panniculitis". The triad of migratory panniculitis, eosinophilia and consume of raw fish during the trip to Colombia was suggestive of gnathostomiasis. Ivermectin treatment started out with good initial response but subsequent relapse. We performed a new treatment with the same drug with good results and no relapses during three years of follow up. The dermatological disease is common upon return from a trip, and is the third leading cause of morbidity in travelers. It is very important to recognize cutaneous manifestations of disease as many of them are potentially serious and may compromise the patient's life if not promptly diagnosed and treated.

Rinosporidiose: manifestação cutânea / Rhinosporidiosis: cutaneous manifestation

A rinosporidiose é uma doença infecciosa zooantropofílica mucocutânea causada pelo Rhinosporidium seeberi. Caracteriza-se por massa polipoide, séssil ou pedunculada, eritematosa, moriforme e friável, principalmente, nas mucosas nasais e oculares. A ocorrência na pele é ocasional, por disseminação a partir da mucosa adjacente, inoculação direta ou generalização via hematogênica. Os autores apresentam o caso clínico de um menino de oito anos de idade, com lesão isolada localizada no epicanto medial do olho direito.

Rhinosporidiosis is an infectious mucocutaneous disease caused by Rhinosporidium seeberi. It is characterized by sessile or pedunculated polyps which are erythematous, moriform and friable and which mainly affect the ocular and nasal mucosa. The occurrence of skin lesions is occasional and due to dissemination from the adjacent mucosa, direct inoculation or hematogenous dissemination. The authors report the clinical case of an eight-year-old boy with an isolated lesion located in the medial epicanthus of the right eye.

Ectopic schistosomiasis: description of five cases involving skin, one ovarian case and one adrenal case / Esquistossomose ectópica: descrição de cinco casos de envolvimento da pele, um do ovário e um da glândula supra-renal

Seven cases of patients with ectopic schistosomiasis from the State of Sergipe, Brazil, are presented (five involving skin, one ovarian and one adrenal). Data were collected from surveying the clinical records and anatomopathological reports in the files of the dermatology and pathology clinics of the University Hospital of the Federal University of Sergipe, from 1995 to 2005. The patients' mean age at diagnosis was 21.1 years. In the dermatological cases, full cures were achieved after treatment with oxamniquine. In the ovarian case, there was an association with embryonic carcinoma: this patient underwent surgery with adjuvant chemotherapy and praziquantel treatment, with satisfactory evolution. The adrenal case was associated with adenoma.

São apresentados sete casos de esquistossomose ectópica (cinco de pele, um de ovário e um de supra-renal) procedentes do Estado de Sergipe, coletados a partir de pesquisa de prontuários e laudos anátomo-patológicos nos arquivos dos Serviços de Dermatologia e de Patologia do Hospital Universitário da Universidade Federal de Sergipe, entre os anos de 1995 e 2005. A média de idade dos pacientes ao diagnóstico foi de 21,1 anos. Nos casos dermatológicos, houve melhora total das lesões após tratamento com oxamniquine. No caso de ovário houve associação com carcinoma embrionário; a paciente foi submetida à cirurgia com quimioterapia adjuvante e praziquantel, evoluindo satisfatoriamente. O caso de supra-renal estava associado a adenoma.

Disseminated cutaneous rhinosporidiomas in an immunocompetent male.

Rhinosporidiosis is a chronic recurrent infective granulomatous disease of man and animals. It is endemic in India and Sri Lanka. Rhinosporidiosis is a chronic disease commonly involving the nose and nasopharynx. Cutaneous lesions, although rare, can occur due to autoinoculation or due to hematogenous spread. However, disseminated cutaneous lesions presenting as tumor-like swellings are rare. We report here a 48-year-old immunocompetent patient who had disseminated painless cutaneous tumor-like swellings over both the upper limbs, abdomen, left buttock and calf since 10 months, gradually increasing in size. On inquiring, the patient gave history of excisions and electrocauterization of subglottic and nasal polyps. Histopathological examination of these lesions was suggestive of rhinosporidiosis. The general and systemic examinations of the patient did not reveal any abnormality.

An investigation on endoparasites of Rana ridibunda complex (s. l.) with dermal parasite (metacercariae) in Dalaman (Turkey).

In this study, endoparasites of the Rana ridibunda specimens collected from Dalaman area, southwestern Turkey were investigated. In the intestine of 17 specimens of R. ridibunda, five different parasites, represented by three species of the trematoda (Diplodiscus sp, Pleurogenoides sp, Plagiorchis sp) and two genera of round worms (Cosmocerca sp; Foleyella sp) were recognized. The trematoda and one of the round worms were found in the rectal region whereas the other round worm species are observed in the abdominal cavity.

Estefanofilariose em humanos: ocorrência e mecanismos de transmissão / Stephanofilariasis in humans: occurrence and transmission mechanisms

Descreve-se aqui o encontro do helminto Stephanofilaria spp., em dermatite nodular ulcerativa em seres humanos, sendo as ulceras pesquisadas de dimensões variadas e com alguns anos de existência. Acredita-se que, a presença desse parasita, que afeta diversas espécies de animais domésticos e silvestres, possa agravar o quadro com as lesões produzidas nos vasos venosos e linfáticos, reduzindo a circulação, retardando a cicatrização. O ciclo deste parasita no ser humano, também é descrito.

This work describes the occurrence of the helminth Stephanofilaria spp in ulcerative nodular dermatitis in humans. The ulcers observed presented a variety of sizes and some years of existence. It is believed that the presence of this parasite, which affects several domestic and wild animal species, may harm human health through lesions produced in venous and lymphatic vessels that reduce blood circulation and retard the healing process. The cycle of this parasite in humans is also described.

Nosocomial submandibular infections with dipterous fly larvae

In September 1998, a case of nosocomial cutaneous myiasis caused by Lucilia sericata (Meigen, 1826) in a 77-year-old male was found. The patient had been receiving partial maxillectomy due to the presence of malignant tumor on premaxilla. This is the first verified case involving Lucilia sericata in Taegu, Korea. In the present paper, the salient morphological features of the third instar larvae involved have been studied.

Lesiones tisulares crônicas en ratones blancos inmunizados e infectados con Trypanosoma cruzi / Chronic tissue lesions in white mice immunized and infected with Trypanosoma cruzi

Mice were immunized with whole membranes of cultured epimastigotes and then inoculated with cultured trypomastigotes. The blood parasite count was lower than in the control. No changes could be detected however, in the length of the prepatent period nor in the extent and duration of the tissue damage observed in the chronic phase of the infection. Damage was evident in the tissues of both immunized and naive animals up to 171 days post inoculum. Blood parasites could be demonstrated neither by direct observation nor by culture, as soon as 117 days after infection. The presence of mast cells a few hours after infection and throughout the study suggests a role of these cells in both the specific and nonspecific components of host response

Esparganosis humana en el Ecuador: informe de un caso en la provincia de Esmeraldas / Human sparganosis in Ecuador: report of a case in the province of Esmeraldas

Se informa el segundo caso de esparganosis humana en Ecuador, en un paciente de sexo masculino, indígena Chachi, procedente de la provincia de Esmeraldas, quien presentó una nodulación localizada en la región escapular izquierda. En su extirpación se demostró la presencia de un céstodo clasificado com Spirometra, no siendo posible determinar la especie

Estado de conocimientos sobre la leishmaniasis tegumentaria americana en Bolivia / Condition of knowledge on the leishmaniasis tegumentary american in Bolivia

La leishmaniasis tegumentar americana en Bolivia, a sido conocida desde la epoca pre-colonial, siendo objeto de estudio por varios investigadores. La informacion conocida nos muestra que es una patologia que basicamente tiene una relacion con grupos humanos sometidos al riesgo de la infeccion por la naturaleza de sus actividades, sin embargo los patrones epidemiologicos varian segun la region estudiada. El area endemica conocida hasta el momento abarca cinco departamentos de los nueve del pais. En relacion a estudios entomologicos como se han capturado varios posibles vectores de la enfermedad. No existe hasta la fecha una metodologia de control que derive de los conocimientos existentes, pues, estos son insuficientes y es necesarios intensificarlos aceleradamente, debido a la extencion de area endemica con la formacion de nuevas ares de colonizacion.