Ectoparasites and Parasites On Human's Skin/body Surface Parasitology Department
Ectoparasites and Parasites On Human's Skin/body Surface Parasitology Department
Ectoparasites and Parasites On Human's Skin/body Surface Parasitology Department
Learning Objectives
Parasites that causes infestation in the skin and human surface:
Agents of disease: Sarcoptes scabiei, Pediculus humanus, Phtirus pubis Pathogenesis Preventive treatment
Miasis
Reference
Roberts LS, Janovy Jr J (ed): Gerald D. Schmidt & Larry S. Roberts Foundations of Parasitology, 7th edition, McGraw Hill, New York, 2005
SARCOPTES SCABIEI
Sarcoptes scabiei
Agent was already covered in BBS-Parasitology Causing scabies
Synonims: seven-year itch, Norwegian itch Contagious skin disease Transmitted by a close-prolonged contact with:
Infested companion Infested bedding
Sarcoptes scabiei
Scybala
male
female
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Rash characteristics
Epidermal curved or linear ridges Follicular papules Pruritus palms: more intense and unbearable at night White visible epidermal ridges by mite burrowing into outer layers of skin Hypersensitivity reaction Excoriated erythematous papules Pustules, crusted lesions
Distribution of rash
Circle of Hebra Imaginary circle intersecting sites of prediliction: wrists, finger webs, umbilicus, lower abdomen, genitalia, elbow flexures, areolae, axillae.
Pathogenesis
Mites mate in hosts skin; males inseminating immature females Immature females move rapidly over the skin transmissible between hosts Males remain on the skin surface with nyhmphs Mature females burrow tunnels in the skin with her mouthparts for about 2 months Eggs are placed in the burrows with hatched larvae, ecdysed cuticles, excrement Symptoms are usually noticed in the well advanced case
Pathology
Papular and burrow-type lesions Face and scalp spared in adults, but not in infants or immunosuppressed Burrows may be barely visible Dull red nodules persist in groin, called nodular scabies, may persist after cure, histology is similar with pseudolymphoma Norwegian heavy crusting, scaling most common in malnourished, immuno-suppressed or patients with neurologic diseases.
Clean the house and fabrics used by the patients thoroughly Avoid contact or cloths and fabrics with patients during illness
ANOPLURA
Anoplura
Agents (covered in BBS-Parasitology):
Pediculus capitis Pediculus corporis Pediculus pubis (Phtirus pubis)
Causing pediculosis/phtiriasis
Pathology
Attach to skin, hair, or clothes, and suck blood Saliva is antigenic and creates dermatitis Pediculosis is not life threatenig, but lice may transmit endemic typhus, relapsing fever or trench fever
Pediculosis capitis
Agent: Pediculus capitis More common in children and women Sides and back of scalp, pruritic Diagnosis straight forward:
Visible white flecks (nits) Matting and crusting of scalp Foul odor
Pediculosis capitis
Pediculosis corporis
Agent: Pediculus corporis Synonims: pediculosis vestimenti or Vagabonds disease. Preferable sites: pressure areas beneath collar, belt or in bedding. Rarely found on skin Lice live and lay eggs in clothing Signs & symptoms: generalized itching, parallel scratch marks, hyperpigmentation, red macules Assess for excoriation on trunks, abdomen, and extremities
Pediculosis pubis
Agent: Pthirus pubis (crab louse) More common found in adults, STD patiens Preferable site is genitalia but may invade chest, hypogastrium, axilla or eyelashes Lice commonly found on skin Signs & symptoms: intense pruritus, maculae ceruleae, bluish or slate colored papules, blancheable on sides of trunk or inner thighs, vulvar region and perirectal.
PARASITIC DERMATITIS
Parasitic dermatitis
Filarial dermatitis is caused by Onchocerca volvulus, transmitted by black flies (Simulium sp.) Schistosomal dermatitis (swimmers itch):
Cercarial penetration through the skin Develops after 24 post exposure, and lasts within 2-3 days
Cutaneous leishmaniasis:
Caused by Leishmania tropica transmitted by sand fly (Phlebotomus sp.) Parasites found in the skin near lymph nodes
Pathogenesis
Contact with soil containing infective larvae (filariform larvae) that are capable of penetrating the skin. This cant occur after first exposure but follows reinfection only after several weeks, this infection suggests that the disease is due to hypersensitivity to larval secretions (Provic and Croese, 1996) The larva produces a number of enzymes which may assist in dermal invasion; such as metaloprotease, minor protease and hyluronidase (Hotez, Hawdon and Capello,1995)
Pathology
Lesions may also become vesiculated, encrusted, or secondarily infected. The larvae eventually die and become absorbed without treatment. The cutaneous symptoms typically last for days to months. Only 29% of patients had lesions that persisted for 1 month, but in occasional patients had lesions in follicles and cause disease for as long as 2 years. Slightly increase of eosinophilia and normal IgE
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Treatment
Application of 15% thiabendazole ointment for 5 days. Systemic treatment with albendazole or ivermectin may also be used, especially in severe cases.
MYIASIS
Myiasis
Definition: an infestation of the organs and tissue of human or animal by fly maggots that, at least for a period of time, feed on the hosts dead or living tissue, liquid body-substances or ingested food (Herms, 1971) Myiasis can occur in many organs: urogenital, dermal/subdermal, nasofaring, ophthalmic, furuncular, and cutaneous myiasis.
Cutaneous myiasis
Treatment
Surgical debridement
Surgical incision & extraction of the larvae is usually done under local anesthesia.
Suffocation approaches
Several substance which may used to block larvaes respiratory such as Vaseline, or similar material.