[Scabies-clinical resistance to permethrin therapy : Case reports and a critical discussion of current treatment recommendations]. / Skabies ­ klinische Therapieresistenz auf Permethrin : Fallbeschreibungen und eine kritische Auseinandersetzung mit den aktuellen Therapieempfehlungen.

Scabies is a contagious disease with increasing frequency. This is confirmed by data from insurance companies as well as increased search queries on Google. There is a controversial discussion in the scientific literature whether the mite has become resistant to standard therapy with permethrin. One case report and a group of cases (N = 12) from a mother-child facility are described in the following demonstrating decreased effectiveness of permethrin therapy. Dermatoscopy can be helpful in diagnosis and in assessing effectiveness of therapy. Dermatoscopic criteria are shown and therapeutic concepts are critically discussed.

Update on parasitic dermatoses.

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.

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.

Lagoquilascaríase humana: um diagnóstico a ser lembrado diante de tumoração de cabeça e pescoço: relato de caso / Human lagochilascariasis: a differential diagnosis to be remembered as it is related to head and neck tumor: a case report

A lagoquilascaríase é uma zoonose incomum decorrente do parasitismo por Lagochilascaris minor. Na Região Amazônica, o primeiro caso foi descrito em 1978, em um paciente do sexo masculino, e caracterizou-se pelo aparecimento de tumoração em região de cabeça e pescoço. O objetivo deste estudo foi relatar um caso de lagoquilascaríase. Paciente do sexo feminino, 18 anos, procedente de Itaituba, área de garimpo, em Belém (PA). Relatava surgimento de nodulação cervical durante gestação, com eliminação de vermes pelo ouvido e por escarro. Foi encaminhada, em 1987, à Fundação Centro de Controle de Oncologia do Estado do Amazonas, onde biópsia evidenciou resultado de processo inflamatório granulomatoso de especificidade não estabelecida. Evoluiu 1 ano depois com massa tumoral em face lateral cervical esquerda, região submandibular e retroauricular, associada à perda ponderal, queda do estado geral e intensa astenia. Apresentava cicatriz cirúrgica prévia, eliminando secreção cremosa, purulenta e inodora. Foi instituído tratamento com tiabendazol e levamisol, com remissão da lesão e parada da eliminação de vermes por escarro e ouvido esquerdo. A lagoquilascaríase humana é uma zoonose causada por L. minor, que cursa com massa cervical e deve ser listada como diagnóstico diferencial das tumorações da cabeça e pescoço.(AU)

Lagochilascariasis is an uncommon parasitic zoonosis caused by Lagochilascaris minor. In the Amazon region, the first case was described in 1978 in a male patient, and it was characterized by the appearance of tumors in the head and neck. The aim of this study was to report a case of lagochilascariasis. An 18-yearold female patient from the city of Itaituba, a mining area in Belém do Pará, reported the emergence of cervical nodulation during pregnancy with elimination of worms in the sputum and from the ears. In 1987 she was sent to the Foundation Oncology Control Center of the state of Amazonas, where biopsy results showed a nonspecific granulomatous inflammation. A year later, it progressed to a tumor mass on the left lateral cervical aspect, in the submandibular and retroauricular region, which was associated with weight loss, poor general condition, and severe asthenia. She had a previous surgical scar that discharged a creamy, purulent and odorless secretion. Treatment was initiated with thiabendazole and levamisole, with remission of the lesion and interruption of the elimination of worms in the sputum and from the left ear. Human lagochilascariasis is an infection caused by L. minor that leads to cervical mass, and should be listed as a differential diagnosis of head and neck tumors.(AU)

Disseminated tungiasis

Abstract: The authors report an unusual case of disseminated tungiasis in a 52-year-old patient living in the city of Campo Grande, state of Mato Grosso do Sul, who had crusted-papular-nodular lesions located in feet, hands, and right thigh. Diagnosis was confirmed by dermoscopy and anatomopathological examination.

American tegumentary leishmaniasis - a case of therapeutic challenge

American Tegumentary Leishmaniasis (ATL) is a chronic, non-contagious, infectious disease affecting millions of people worldwide. The timely and proper treatment is of great importance to prevent the disease from progressing to destructive and severe forms. Treatment for ATL recommended by the Brazilian Ministry of Health is similar for the whole country, regardless of the species of Leishmania. It is known that the response to treatment may vary with the strain of the parasite, the immune status of the patient and clinical form. We report the case of a healthy patient, coming from Manaus, Amazonas state, Brazil, who presented resistance to treatment with N-methyl-glutamine and liposomal amphotericin B, only being healed after using pentamidine.

Larva migrans cutánea: reporte de cuatro casos / Cutaneous larva migrans: report of four cases

RESUMEN Introducción: la larva migrans cutánea es una parasitosis que constituye una zoonosis frecuente en zonas tropicales, producida por la penetración y desplazamiento a través de la piel de larvas de nemátodos, como Ancylostoma brazilensis y Ancylostoma caninum. El cuadro clínico es característico y se diagnostica mediante la observación macroscópica de las lesiones serpiginosas debajo de la piel. Los antecedentes están dados por contacto con tierra o arena contaminadas como ocurre en niños que juegan en esos lugares. Objetivo: reportar los hallazgos de esta parasitosis en infantes pertenecientes a dos áreas de salud del municipio Camagüey, durante el período 2010 - 2013. Caso Clínico: en el laboratorio de Microbiología de la policlínica de especialidades pediátricas, se diagnosticaron cuatro niños con larva migrans cutánea de 1, 2, 7 y 11 años de edad, el primero con localización perineal, el segundo, en la espalda, el tercero en glúteos, miembros inferiores y superiores y el cuarto en región glútea y vulvar. En los cuatro casos las lesiones fueron características y se observó el trayecto ondulado del parásito a través de la piel. Los cuatros pacientes evolucionaron satisfactoriamente con tratamiento antiparásito. Conclusiones: dada la molestia, e irritabilidad que ocasiona esta parasitosis, así como la posible evolución tórpida de la misma es importante que en las áreas de salud se tenga en cuenta para su oportuno diagnóstico y tratamiento satisfactorio en bien de los pacientes afectados.

ABSTRACT Background: cutaneous larva migrans is a parasitosis that constitutes a frequent zoonosis in tropical areas. It is produced by the penetration and movement through the skin of larvae of nematodes, like Ancylostoma brazilensis and Ancylostoma caninum. It shows characteristic clinical manifestations and is diagnosed through macroscopic observation of serpiginous lesions under the skin. Causes are given by the contact with contaminated earth or sand, as it happens with the children who play in places like those. Objective: to report the findings of this parasitosis in children that belonged to two health areas in the municipality of Camagüey, during the period 2010-2013. Clinical case: in the microbiology laboratory of the policlinic of pediatric specialties, four children aged 1, 2, 7, and 11 were diagnosed with cutaneous larva migrans. The first one presented lesions with perineal location, the second one in the back, the third one in the lower and upper extremities, and the fourth one in the gluteal and vulvar regions. In the four cases the lesions were characteristic and the undulating trajectory of the parasite through the skin could be observed. The four patients progressed satisfactorily with the antiparasitic treatment. Conclusions: because of the discomfort and irritability that this parasitosis may cause, as well as its possible torpid evolution, it is important that the health areas take it into consideration in order to obtain a timely diagnosis and satisfactory treatment for the good of patients.

Cutaneous protothecosis - case report / Prototecose cutanea - relato de caso

Cutaneous protothecosis is a rare infection caused by achlorophyllic algae of the genus Prototheca. The lesions usually occur on exposed areas, related with trauma, in immunocompromised patients. The most common clinical presentation is a vesicobullous and ulcerative lesion with pustules and scabs, simulating bacterial, fungal or herpetic infections or eczema. The diagnosis is determined by agent identification through histopathology, culture and the carbohydrates assimilation test. The finding of morula-like spherules is characteristic of Prototheca sp. Its rarity and non-specific clinical aspect may difficult the disease diagnosis. We report a case of a diabetic patient, in chronic use of systemic corticosteroids, that developed a skin lesion after trauma to the right leg.

A prototecose cutânea é uma infecção rara causada por algas aclorofílicas do gênero Prototheca. Geralmente as lesões ocorrem em áreas expostas, relacionadas à trauma, em indivíduos imunocomprometidos. A apresentação clínica mais comum é uma lesão vesico-bolhosa e ulcerativa com pústulas e crostas, simulando piodermites, infecções fúngicas, infecções herpéticas ou eczemas. O diagnóstico é realizado pela identificação do agente através do exame histopatológico, da cultura e do teste de assimilação dos carboidratos. O achado de esférulas com aspecto de mórula são características da Prototheca sp. A raridade da doença e o aspecto clínico inespecífico dificultam o diagnóstico da doença. Relatamos um caso em paciente diabética, em uso crônico de corticoide sistêmico, que desenvolveu lesão cutânea após trauma na perna direita.

Canine Demodicosis: A Re-examination of the Histopathologic Lesions and Description of the Immunophenotype of Infiltrating Cells.

Résumé- Cette étude décrit les modelités réactionnelles inflammatoires et l'immunophénotype des lésions histologiques de démodécie canine. Trois modalités principales sont décrites: une folliculite pariétale, une folliculite suppurative et furonculose, et une dermatite modulaire. La folliculite pariétale, réaction inflammatoire ciblée sur la paroi folliculaire, est présente dans tous les cas et constitue la modalité réactionnelle principale dans 17 cas sur 34 (50 pour cent). Le sous-type interface, caractérisé par une dégénérescence hydropique ou une apoptose des kératinocytes folliculaires, avec exocytose lymphocytaire, s'observe dans 15 de ces 17 cas. Une mélanose folliculaire et/ou une incontinence pigmentaire sont présentes sur 10 de ces 17 biopsies. Une dermatite nodulaire, représentée par un granulome périfolliculaire, est présente sur neur biopsies (26 pour cent). Une folliculite suppurative ou une furonculose est la modalité relationnelle dominante dans huit cas (24 pour cent). Tous les lymphocytes dans la paroi folliculaire sont des lymphocytes T CD3+, contre 10 pour cent sculement des cellules périfolluculaires. Les plasmocytes IgG+ constituent jusqu'à 74 pour cent des cellules périfolliculaires, et le pourcentage est encore plus élevé dans les cas de furonculose. Ces faits montrent que la folliculite pariétale est une lésion importante dans la démodécie canine, et suggère qu'une réaction à médiation cellulaire est dirigée spécifiquement contre la paroi folliculaire. [Canine demodicosis: a re-examination of the histopathologic lesions and description of the immunophenotype of infiltrating cells (La démodécie canine: réexamen des lésions histologiques et description de l'inmunophénotype des cellules infiltrantes). Resumen- Este estudio describe los patrones inflamatorios y el immunofenotipo de las lesiones histológicas en la demodicosis canina. Se identificaron tres patrones principales: foliculitis mural, foliculitis y furunculosis supurative, y dermatitis nodular. La foliculitis mural, una reacción inflatatoria dirigida a la pared folicular, se observó en todos los casos y constituia el patrón principal en 17 de los 34 casos (50%). En 15 de estos 17 casos la foliculitis mural era de tipo interfase, caracterizada por degeneración hidrópica o apoptosis de queratinocitos foliculares y exocitosis linfocitica. Se detectó melanosis folicular y/o incontinecia pigmentaria en 10 de estas 17 biopsias. Neuve biopsias (26 por ciento) presentaban dermatitis nodular, caracterizada por granulomas perifoliculares. Ocho casos (24 por ciento) mostraban foliculitis o furunculosis como patrón dominante. Linfocitos T CD3+ constituian la totalidad del infiltrado en la pared folicular, mientras que el mismo tipo celular representaban el 10 por ciento del infiltrado inflamatorio perifolicular. Hasta el 74 por ciento de las células perifoliculares eran células plasmáticas IgG+, con el mayor número en casos con furunculosis. Estos hallaz os indican que la foliculitis mural es una lesion importante la demodicosis canina y sugiere que una reacción mediada por células es dirigida a la pared folicular. [Canine demodicosis: a re-examination of the histopathological lesions and description of the immunophenotype of infiltrating cells (Demodicosis canina: repaso de las lesiones histopatológicas y descripción del inmunofenotipo del infiltrado celular). Abstract- This study describes the inflammatory patterns and immunophenotype of the histologic lesions of canine demodicosis. Three major patterns were identified: mural folliculitis, suppurative folliculitis and furunculosis and nodular dermatitis. Mural folliculitis, an inflammatory reaction targeting the follicular wall, was seen in all cases and was the principle pattern in 17 of 34 cases (50 per cent). The interface subtype of mural folliculitis, typified by hydropic degeneration or apoptosis of follicular keratinocytes and lymphocytic exocytosis, occurred in 15 of these 17 cases. Follicular melanosis and/or pigmentary incontinence occurred in 10 of these 17 biopsies. Nodular dermatitis, represented by perifollicular granulomas, was present in nine biopsies (26 per cent). Suppurative folliculitis or furunculosis was the dominant pattern in eight cases (24 per cent). All lymphocytes within the follicular wall were CD3+ T lymphocytes, compared to 10 per cent of the perifollicular cells. IgG+ plasma cells accounted for up to 74 per cent of perifollicular cells, highest in cases with furunculosis. These findings indicate that mural folliculitis is an important lesion of canine demodicosis, and suggests that a cell-mediated reaction is targeting the follicular wall.