Is demodex really non-pathogenic?

Although usually considered a non-pathogenic parasite in parasitological textbooks, Demodex folliculorum has been implicated as a causative agent for some dermatological conditions, such as rosacea-like eruptions and some types of blepharitis. Several anecdotal reports have demonstrated unequivocal tissue damage directly related to the presence of the parasite. However, this seems to be exceedingly rare, in contrast with the marked prevalence of this infestation. We have had the opportunity to observe one of such cases. A 38-year-old woman presented with rosacea-like papular lesions in her right cheek. Histopathological examination revealed granulomatous dermal inflammation with a well-preserved mite phagocytized by a multinucleated giant cell. This finding may be taken as an evidence for the pathogenicity of the parasite, inasmuch as it does not explain how such a common parasite is able to produce such a rare disease.

Hepatic granulomatous response to Schistosoma mansoni eggs in BALB/c mice and olive baboons (Papio cynocephalus anubis).

Hepatic granulomatous inflammation is one of the key pathological lesions of a patent Schistosoma mansoni infection. This study was concerned with the sequential induction, formation and eventual modulation of the schistosome egg granuloma in the mouse, which develops schistosome-induced hepatic fibrosis, and the olive baboon, which usually does not. Six baboons were each infected with 1500 S. mansoni cercariae and liver biopsies were collected at weeks 6, 9, 13 and 17 post-infection (p.i.). The mice (n=25) were each infected with 100 cercariae and killed in groups of five at weeks 6, 9, 12, 18 and 21 p.i. Peak granuloma size was observed at week 6 p.i. in baboons (mean 355 +/- 65.6 microm) but at week 12 p.i. in mice (299 +/- 40.5 microm). Eosinophils were more abundant in the baboon (60.6 +/- 8.9%) than in the mouse (41.2 +/- 8.4%) at the time of maximal granuloma size (P < 0.01). Neutrophils formed 21.1 +/- 6.3% of peak mouse granulomata but were virtually absent in baboon granulomata. A feature of the modulating baboon granulomata was the emergence of multinucleated giant cells (MGCs); modulating mouse granulomata, on the other hand, were characterized by infiltration of fibroblasts and collagen deposition. Thus, by week 21 p.i. mouse granulomata were 92 +/- 16.0 microm in diameter and well delineated by concentric layers of fibrous tissue. Granulomata, however, were present in only two of the baboons at week 17 p.i. (44 +/- 61.2 microm in diameter). The other four had peri-portal cellular infiltration without granuloma formation, implying that baboon granulomata resolve spontaneously. These data suggest that high tissue eosinophilia and MGC formation are particularly efficient in bringing about the destruction of schistosome eggs and subsequent resolution of the egg granuloma without fibrosis. In conclusion, the baboon model more closely mimics the pathogenesis observed in man than does the mouse model.

Is Demodex really non-pathogenic?

Although usually considered a non-pathogenic parasite in parasitological textbooks, Demodex folliculorum has been implicated as a causative agent for some dermatological conditions, such as rosacea-like eruptions and some types of blepharitis. Several anecdotal reports have demonstrated unequivocal tissue damage directly related to the presence of the parasite. However, this seems to be exceedingly rare, in contrast with the marked prevalence of this infestation. We have had the opportunity to observe one of such cases. A 38-year-old woman presented with rosacea-like papular lesions in her right cheek. Histopathological examination revealed granulomatous dermal inflammation with a well-preserved mite phagocytized by a multinucleated giant cell. This finding may be taken as an evidence for the pathogenicity of the parasite, inasmuch as it does not explain how such a common parasite is able to produce such a rare disease.

Schistosoma japonicum-like ova in liver and rectal biopsies of three cases in Sabah, Malaysia.

Three cases of schistosomiasis in 2 Filipinos and one Chinese in Sabah are reported. Diagnosis was based on incidental histological findings of Schistosoma japonicum-like ova in the liver and rectal biopsies. As these 3 patients are immigrants to Sabah, it is assumed that they are imported cases, and that Sabah has been free of the disease from 1970 to 1977.

Cerebral Paragonimiasis.

The first case of cerebral paragonimiasis was reported by Otani in Japan in 1887. This was nine years after Kerbert's discovery of the fluke in the lungs of Bengal tigers and seven years after a human pulmonary infection by the fluke was demonstrated by Baelz and Manson. The first case was a 26-year-old man who had been suffering from cough and hemosputum for one year. The patient developed convulsive seizures with subsequent coma and died. The postmortem examination showed cystic lesions in the right frontal and occipital lobes. An adult fluke was found in the occipital lesion and another was seen in a gross specimen of normal brain tissue around the affected occipital lobe. Two years after Otani's discovery, at autopsy a 29-year-old man with a history of Jacksonian seizure was reported as having cerebral paragonimiasis. Some time later, however, it was confirmed that the case was actually cerebral schistosomiasis japonica. Subsequently, cases of cerebral paragonimiasis were reported. However, the majority of these cases were not confirmed histologically. It was pointed out that some of these early cases were probably not Paragonimus infection. After World War II, reviews as well as case reports were published. Recently, investigations have been reported from Korea, with a clinicla study on 62 cases of cerebral paragonimiasis seen at the Neurology Department of the National Medical Center, Seoul, between 1958 and 1964. In 1971 Higashi described a statistical study on 105 cases of cerebral paragonimiasis that had been treated surgically in Japan.