Update on parasitic dermatoses

Abstract These are cutaneous diseases caused by insects, worms, protozoa, or coelenterates which may or may not have a parasitic life. In this review the main ethological agents, clinical aspects, laboratory exams, and treatments of these dermatological diseases will be studied.

Skin manifestations of tick bites in humans

Abstract: Ticks are blood-sucking arthropods that attach to human skin through oral devices causing diverse initial cutaneous manifestations, and may also transmit serious infectious diseases. In certain situations, the Health Teams (and especially dermatologists) may face difficulties in identifying the lesions and associating them to the parasites. To assist them in clinical diagnosis, we suggest a classification of the skin manifestations in primary lesions, which occur by the attachment the tick to the host (for toxicity and the anticoagulant substances in the saliva and/or marked inflammation by the penetration and permanence of the mouthparts) and secondary lesions that are manifestations of infections caused by rickettsia, bacteria, protozoa and fungi inoculated by the ticks.

Gnathostomiasis: an emerging infectious disease relevant to all dermatologists

Abstract: Gnathostomiasis is a parasitic infection caused by the third larval stage of nematodes of the genus Gnathostoma. The disease is endemic in some countries around the world. In the American continent, the majority of cases is concentrated in Mexico, Ecuador, and Peru. However, due to increasing traveling either at the intercontinental or intracontinental level, the disease is seen each time more frequently in tourists. Furthermore, countries, such as Brazil, that have never been considered endemic are reporting autochthonous cases. The disease usually presents as a deep-seated or slightly superficial migratory nodule in patients with history of eating raw fish, in the form of ceviche, sushi, or sashimi. Along with the clinical presentation, diagnostic criteria include either blood or tissue eosinophilia. In most instances, these criteria are enough for the attending physician to institute therapy. Chances of finding the parasite are low, unless the biopsy is taken from a very specific area that develops after antiparasitic treatment is started. The potential of other organ involvement with more serious consequences should always be kept in mind.

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.

Cutaneous ectopic schistosomiasis: diagnostic challenge

Abstract Cutaneous schistosomiasis is a rare clinical manifestation of schistosomiasis, an infectious and parasitic disease, caused in Brazil by the trematode Schistosoma mansoni. The lesions are due to the deposition of eggs or, rarely, adult worms, usually involving the genital and groin areas. Extra-genital lesions occur mainly on the torso as papules of zosteriform appearance. The case of a patient with ectopic cutaneous schistosomiasis is reported in this article, due to the rarity of its occurrence and its difficult clinical diagnosis.

Demodicosis: revisión de la literatura / Demodicosis: review of the literature

La demodicosis es una patología cutánea crónica caracterizada por lesiones eritemato-maculares pruriginosas, cuyo agente causal son ácaros foliculares del género Demodex. Presenta un abanico amplio y polimorfo de manifestaciones clínicas, donde la sospecha clínica se presentará frente a una erupción facial crónica persistente o recurrente, resistente a terapia convencional y de distribución asimétrica. El diagnóstico definitivo es difícil, y requiere un cuadro clínico compatible y la presencia de alta densidad de Demodex. El siguiente documento hace una revisión de conceptos con respecto a la patogenia, clínica, diagnóstico y tratamiento de esta entidad.

Demodicosis is a chronic skin condition characterized by itchy erythematous macular lesions whose causal agents are gender follicular Demodex mites. This entity presents a wide and polymorphous range of clinical manifestations, in which clinical suspicion appears in case of persistent or recurrent chronic facial rash, resistant to conventional therapy and with an asymmetric distribution. The definitive diagnosis is hard to reach, and requires a compatible clinical picture and a high density of Demodex. The following document is a review of concepts regarding pathogenesis, symptoms, diagnosis and treatment of this disease.

Ectopic cutaneous schistosomiasis - Case report

Schistosomiasis is best known in its visceral form but it can attack the skin, its ectopic cutaneous manifestation being rare and clinically difficult to diagnose. It is characterized by isolated or coalescent papules, erythematous, pruritic or asymptomatic, with zosteriform distribution, often located on the trunk. The authors report a case of a 28-year-old female patient with lesions on the abdomen, with positive stool results for Schistosoma and absence of active symptoms of visceral disease. The case reveals rare exuberant cutaneous manifestation and the importance of the diagnosis of this entity in patients from endemic regions.

Extensive disseminated cysticercosis.

Cysticercosis, especially neurocysticercosis, is a major public health problem in India. We report an unusual case of disseminated cysticercosis with extensive infi ltration of the skin, central nervous system, skeletal muscles, eye, lung, and heart. A patient with extensive cutaneous cysticercosis must be thoroughly investigated for widespread internal organ involvement.

Ectopic cutaneous schistosomiasis - Case report / Esquistossomose cutanea ectopica - Relato de caso

Schistosomiasis mansoni is a systemic disease caused by a helminth of the schistosoma genus. The disease is generally asymptomatic or gastrointestinal symptoms may predominate. Skin lesions related to the disease are rarely diagnosed, even in endemic areas. The authors report the case of a young girl diagnosed with cutaneous schistosomiasis with involvement of the abdomen, back and scapular region. Schistosoma eggs were found in the lesions by histopathologic exam. There was no evidence of systemic involvement. Schistosomiasis must be included in the list of differential diagnosis of skin damage, especially in endemic areas, due to the potential consequences, in case of late diagnosis and treatment.

A esquistossomose mansônica é uma doença sistêmica causada por um helminto do gênero Schistosoma, geralmente assintomática ou com predomínio de manifestações gastrointestinais. Lesões cutâneas relacionadas à doença são raramente diagnosticadas, mesmo em áreas endêmicas. Relata-se um caso de uma jovem com história de lesões papulosas no abdome, no dorso e na região escapular direita, de distribuição zosteriforme. O exame histopatológico demonstrou a presença de ovos de Schistosoma nessas lesões. Não havia evidências de esquistossomose visceral ativa. Reforça-se a necessidade de que essa doença seja incluída no rol de diagnósticos diferenciais de lesões cutâneas, principalmente em áreas endêmicas, em razão das possíveis consequências em caso de diagnóstico e tratamento tardios.

Ectopic cutaneous Schistosomiasis / Esquistossomose cutanea ectopica

The authors report a case of ectopic cutaneous schistosomiasis in a 35 year-old female who presented clustered reddish macules and papules on the left buttock. The diagnosis was not suspected during clinical evaluation and required visualization of Schistosoma mansoni eggs on sections of tissue.

Os autores relatam um caso de esquistossomose cutânea ectópica em uma paciente de 35 anos que apresentou máculas e pápulas eritematosas agrupadas na nádega esquerda. O diagnostico não foi suspeitado durante a avaliação clínica, tendo sido obtido através da visualização dos ovos no exame histopatológico.

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.

Polymorphic ecthymatoid dermosporidiosis.

We report the case of a young Chhattisgarhi male with polymorphic dermosporidiosis (cutaneous rhinosporidiosis). He had multiple subcutaneous nodules and an ecthymatoid skin lesion along with nasal rhinosporidiosis. The diagnosis was confirmed by demonstration of sporangia with endospores in fine-needle aspiration cytology (FNAC), histopathology, and imprint smear from the skin lesions. Treatment was by surgical excision, electrocoagulation, and dapsone. There was no recurrence. Dermatologists should be aware of the diverse cutaneous manifestations of this primarily nasal disease. This is the second published report of polymorphic dermosporidiosis, and the first one reporting an ecthymatoid lesion.

Disseminated cutaneous rhinosporidiosis.

A 48-year-old male patient presented to Skin and VD outpatient with multiple granulomatous growths of different sizes all over the body, including numerous subcutaneous swellings mimicking lipomas of 2 years duration. Two and half years back he was operated for a polypoidal growth of left nostril with subsequent recurrence. Fine needle aspiration cytology and histopathology of the cutaneous lesion confirmed the diagnosis as rhinosporidiosis. We report this rare case of disseminated cutaneous rhinosporidiosis.

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.

Cutaneous periumbilical purpura in disseminated strongyloidiasis in cancer patients: a pathognomonic feature of potentially lethal disease?

Cutaneous manifestations in disseminated strongyloidiasis are infrequent but should raise the suspicion for its diagnosis. We retrospectively evaluated the charts of six patients with cancer and a proven diagnosis of disseminated strongyloidiasis. All patients had received prophylaxis with albendazole before starting antineoplastic therapy, which included high-dose steroids. They presented with septic shock, acute respiratory failure and characteristic purpuric periumbilical skin lesions. Strongyloides larvae were identified in tracheal aspirates (n=5), gastric aspirates (n=4), lung (n=2) and skin biopsies (n=2). All patients died despite antihelminthic therapy and intensive care support.

Histopathological diagnosis of subcutaneous Dirofilaria repens infection in humans.

The host tissue response in humans, based on a study of biopsies of 14 subcutaneous nodules caused by Dirofilaria repens is described. The response was characterized by accumulation of eosinophilic material or eosinophilic pus adjacent to the parasite with surrounding granulomatous inflammation associated with extensive eosinophil infiltration of the surrounding tissue. Unlike with fungal lesions, fat necrosis was conspicuously absent. Nodules were all less than 3 cm in size. Fifteen percent of the smaller nodules (less than 1 cm) and 30% of the larger nodules required extensive examination of tissue to visualize the parasite. It is concluded that when typical tissue reactions are seen, extended histological processing is indicated for accurate diagnosis of dirofilariasis, by demonstrating the parasite.

Leishmaniasis infantil / Leishmaniasis in the pediatric population

En el periodo comprendido entre septiembre de 1988 y septiembre de 1997, se registraron 164 casos de leishmaniasis en niños menores de 15 años atendidos en el Servicio de Dematologia del Hospital de Clinicas. El sexo masculino fue ligeramente el mas afectado, predominaron las lesiones cutaneas, ulcerosas, unicas y de localizacion cefalica. Se destacan algunos aspectos clinicos poco habituales y la respuesta terapeutica al tratamiento con pentamidina y anfotericina B. El incremento de Leishmaniasis infantil en nuestro medio obliga a tomar medidas de proteccion en area endemicas y a una educacion a la comunidad sobre los riesgos de esta ectoparasitosis, transmitida por la picadura de insectos vectores.

Psicopatologia - Delusional parasitosis a till today not sufficiently know psychiatric syndromre

The most important contribuitions on delusional parasitosis or tactile hallucionosis are by means of the findings in an own sample of 36 patients critically reviewed. Although from a review of the literature, comprising about 500 cases in more than 250 papers, seems to emerge a rather homogeneous picture of the disorder, the views on some clinical data, freqency, age on onset, course, prognosis, nosological classification, underlyng illnesses and pathogenesis are partly different and controversial. It is shown that the syndrome is until today not sufficiently know in psychiatry, above all because the great majority of the patients do not search for psychiatric help. The patients are female more often than male (2.3-1 in the own sample), between 25 and 84 years of age, but in 81 per cent beginning after the age of 50. The onset is in 19 per cent of the own sample, and here exclusively in endogenous psychoses, before the age of 50. As to the nosological classification, the delusional parasitosis develops in the half of the Bonn sample in the course of endogenous, maainly schizophrenic psychoses, in the other half based on organic (cascular) brain diseases. In endogenous psychoses the course is mainly in phases and not chronic or progressing as reported by BERS and CONRAD. The observation of the course speaks for the assumption that qualitatively abnormal bodily sensations, i.e. level-2-cenesthesias, often preceding in long prodomes the proper tactile hallucinosis, are an essential component in the pathogenesis of the syndrome. These sensations are psychopathologically the same bodily experiences that occur in many schizophrenic course and, as dominating symptomatology, in the cenesthetic type of schizophrenia

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