Ambiguous skin ulcer on the ear pinna.

Cutaneous leishmaniasis (CL) is a parasitic disease which has a biphasic life cycle; infection by promastigotes from the sandfly reaches a wound where it is phagocytosed by macrophages, producing the amastigote (the Leishmania donovani body) in the host. A protozoan parasite transmitted by the phlebotomous sandfly causes human leishmaniasis. Cutaneous forms include classical cutaneous, mucocutaneous and post-kala-azar dermal leishmaniasis. It affects c. 300 million individuals in more than 90 nations around the globe. The cutaneous form in the Old World is caused at low altitudes mainly by L. major (which has an animal reservoir, rodents such as mouse) and in swampy regions and high altitudes by L. tropica (which has no animal reservoir). L. aethiopica and L. major lead to disseminated ulcers in Saudi Arabia, Yemen, Iraq, Iran, Pakistan, India, Tunisia, Sudan and Ethiopia, whose main electrophoretic isozyme pattern Zymodeme in Saudi Arabia is LON-4.

Miasis auricular / Aural myiasis

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Myiasis of the ear: a review with entomological aspects for the otolaryngologist.

OBJECTIVE: Myiasis is the infestation of live humans (or animals) by fly larvae. Although the diagnosis is relatively straightforward, how to best treat aural myiasis has not been well described in the literature. This comprehensive literature review, therefore, was performed to identify current management principles in aural myiasis, especially with regard to the causative fly family. In addition, we explore the possible relationship between aural myiasis and the highly lethal intracranial myiasis. DATA SOURCES: Literature review using the Medline database (PubMed), Scopus, and Google Scholar. REVIEW METHODS: Manuscripts published in the English language between January 1, 1992, and December 31, 2012, were included. RESULTS: Forty-five cases of aural myiasis were reported in 34 manuscripts. Most cases were caused by species of the Sarcophagidae family (n=26/45, 57.8%). The majority of cases (n=40/45, 88.9%) were successfully treated with simple aural toilet and topical treatments alone. No deaths were reported and no cases were seen in conjunction with intracranial myiasis. CONCLUSION: Aural myiasis is a rare but benign fly infestation of the ear, most commonly by species of the Sarcophagidae family. The overwhelming majority of cases can be successfully managed without the need for surgical intervention.

Infección del lóbulo auricular por Leishmania en el Viejo Mundo: una localización excepcional / Old World Leishmaniasis on the Ear Lobe: A Rare Site

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Scabies mites alter the skin microbiome and promote growth of opportunistic pathogens in a porcine model.

BACKGROUND: The resident skin microbiota plays an important role in restricting pathogenic bacteria, thereby protecting the host. Scabies mites (Sarcoptes scabiei) are thought to promote bacterial infections by breaching the skin barrier and excreting molecules that inhibit host innate immune responses. Epidemiological studies in humans confirm increased incidence of impetigo, generally caused by Staphylococcus aureus and Streptococcus pyogenes, secondary to the epidermal infestation with the parasitic mite. It is therefore possible that mite infestation could alter the healthy skin microbiota making way for the opportunistic pathogens. A longitudinal study to test this hypothesis in humans is near impossible due to ethical reasons. In a porcine model we generated scabies infestations closely resembling the disease manifestation in humans and investigated the scabies associated changes in the skin microbiota over the course of a mite infestation. METHODOLOGY/PRINCIPAL FINDINGS: In a 21 week trial, skin scrapings were collected from pigs infected with S. scabies var. suis and scabies-free control animals. A total of 96 skin scrapings were collected before, during infection and after acaricide treatment, and analyzed by bacterial 16S rDNA tag-encoded FLX-titanium amplicon pyrosequencing. We found significant changes in the epidermal microbiota, in particular a dramatic increase in Staphylococcus correlating with the onset of mite infestation in animals challenged with scabies mites. This increase persisted beyond treatment from mite infection and healing of skin. Furthermore, the staphylococci population shifted from the commensal S. hominis on the healthy skin prior to scabies mite challenge to S. chromogenes, which is increasingly recognized as being pathogenic, coinciding with scabies infection in pigs. In contrast, all animals in the scabies-free cohort remained relatively free of Staphylococcus throughout the trial. CONCLUSIONS/SIGNIFICANCE: This is the first experimental in vivo evidence supporting previous assumptions that establishment of pathogens follow scabies infection. Our findings provide an explanation for a biologically important aspect of the disease pathogenesis. The methods developed from this pig trial will serve as a guide to analyze human clinical samples. Studies building on this will offer implications for development of novel intervention strategies against the mites and the secondary infections.

A case of auricular, anal and umbilical myiasis caused by the larvae of Phormia regina (Meigen) (Diptera: Calliphoridae) in neonatal kittens.

The occurrence of feline myiasis is rare. Massive infestations of dipteran larvae can lead to death if not treated at an early stage. Auricular, anal and umbilical myiasis was detected in three neonatal kittens. The dipteran larvae were collected, fixed in 70% alcohol and clarified with 10% KOH for a few days. Later, larvae were dissected under the stereomicroscope, mounted on slides and then identified as the third instar of the black blowfly, Phormia regina (Meigen) (Diptera: Calliphoridae), according to their stigmatic and cephaloskeleton structures. Original measurements and figures are presented. Treatment included mechanical removal of larvae and cleansing of the area by applying polyvinylpyrrolidone-iodine complex. The presence of P. regina in cats has been reported here for the first time in Turkey.

A combined luciferase-expressing Leishmania imaging/RT-qPCR assay provides new insights into the sequential bilateral processes deployed in the ear pinna of C57BL/6 mice.

Leishmania/L. major was identified as the etiological agent of human localized cutaneous leishmaniasis. L. major metacyclic promastigotes/MP - the infectious form transmitted by sand flies - were enriched from axenically-derived cultures and inoculated into the dermis of mice (10(3) or 10(4) luciferase-expressing L. major MP inoculated into the C57BL/6 mouse ear pinna). Quantitative readout assays were then combined with imaging of this L. major-hosting skin site and established i) that a specific period of time - depending upon the L. major load used for the inoculation - is required for the L. major-hosting ear pinna to be continuously populated by a balanced population of functional regulatory and effector T lymphocytes, and that ii) this balance coincides with persisting low numbers of amastigotes in more or less rapidly healing skin. This approach also established that, whatever the MP inoculum load delivered to the primary site, the immune processes that reduce the L. major amastigote population also account for concomitant immunity, namely remodelling of the secondary site - where 10(4) MP were delivered - as a clinically silent niche hosting a small L. major population.

Lice and ticks of the eastern rufous mouse lemur, Microcebus rufus, with descriptions of the male and third instar nymph of Lemurpediculus verruculosus (Phthiraptera: Anoplura).

Sucking lice and ticks were collected from live-trapped eastern rufous mouse lemurs, Microcebus rufus Geoffroy, in and around the periphery of Ranomafana National Park, southeastern Madagascar, from 2007 to 2009. Samples of 53 sucking lice (Insecta: Phthiraptera: Anoplura) and 28 hard ticks (Acari: Ixodidae) were collected from 36 lemur captures representing 26 different host individuals. All of the lice were Lemurpediculus verruculosus (Ward) (6 males, 46 females, 1 third instar nymph). Only the holotype female was known previously for this louse and the host was stated to be a "mouse lemur." Therefore, we describe the male and third instar nymph of L. verruculosus and confirm M. rufus as a host (possibly the only host) of this louse. All of the ticks were nymphs and consisted of 16 Haemaphysalis lemuris Hoogstraal, 11 Haemaphysalis sp., and 1 Ixodes sp. The last 2 ticks listed did not morphologically match any of the Madagascar Haemaphysalis or Ixodes ticks for which nymphal stages have been described.

Leishmaniasis of the auricle mimicking carcinoma.

Leishmaniasis of the auricle has been rarely reported in our region of the world, where it is labeled as "Old World Leishmaniasis." It may mimic other pathologies, such as malignancies or other infectious processes. We present a case of an auricular Leishmania lesion which was first suspected to be a carcinoma. Four previous auricular Old World Leishmania cases have been reported. The epidemiology, clinical presentation, diagnosis, and treatment of this entity are briefly reviewed.