Ectoparasites and parasites on humans 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

Cercarial dermatitis and filarial dermatitis Cutaneous larva migrans:

Agents of disease: hookworms larvae, Gnathostoma spinigerum 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

Mineral oil or Acry-Mount on a glass slide with cover slip on top

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.

Treatment and prevention

Treat the whole family or person in close contact with patient
Topical sulfur preparations One-two applications daily

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.

Treatment and prevention

Treatment Pediculicides: apply Permethrin 1% Cream Rinse (Nix) to dry hair, then rinse out after 30-60 minutes. Do not shampoo for 24 hours afterwards.s Hand pick or fine tooth comb to comb lice and nits out Launder bed linens & vacuum Seal infested items (cloths, linen, fabrics) in plastic bags for 14 days Laundering clothing and bedding, 1% Malathion powder, 10% DDT may be dusted onto inner surface of underwear Best to discard clothing altogether as lice may live in clothing for 1 month without a blood meal Repeat above in 10-14 days Avoid contact or sharing clothes and fabrics with patients Treat social contacts

Filarial dermatitis Schistosomal dermatitis Cutaneous leishmaniasis

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

CUTANEOUS LARVA MIGRANS

Cutaneous larva migrans

Synonim: creeping eruption, ground itch Causativa agents: nematodes (zoonotic hookworms): Ancylostoma braziliense, Ancylostoma caninum, Ancylostoma ceylanicum, Strongyloides stercoralis Filariform larvae penetrate human skin, usually feet and hands invade epithellium aimless wandering through the skin red, itchy wound usually infected by pyogenic bacteria

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.