DERMATOLOGIC MANIFESTATIONS OF PARASITIC DISEASES

Pulmonary Hemorrhage Secondary to Disseminated Strongyloidiasis in a Patient with Systemic Lupus Erythematosus

Introduction. Pulmonary hemorrhage secondary to disseminated strongyloidiasis is an unusual, well-recognized entity in immunocompromised patients with autoimmune disease, which is associated with the hyperinfection syndrome, sepsis, and a high mortality rate. Case Presentation. We present a case of a 44-year-old Mexican woman with systemic lupus erythematosus and acute bacterial meningitis who developed pulmonary hemorrhage with acute respiratory failure requiring mechanical ventilation, treated with broad spectrum systemic antibiotics and high dose methylprednisolone, who subsequently developed a characteristic purpuric skin eruption and septic shock and died two days later of refractory hypoxemia caused by massive pulmonary bleeding. The postmortem examination reports filariform larvae of S. stercolaris in lung, skin, and other organs. Conclusion. This case highlights the importance of considering disseminated strongyloidiasis in the differential diagnosis of diffuse alveolar hemorrhage in systemic lupus erythematosus, and screening for S. stercolaris infection before initiation of immunosuppressive therapy should be considered, especially in endemic areas. Disseminated strongyloidiasis has a high mortality rate, explained in part by absence of clinical suspicion.

Cutaneous Myiasis from Panama, South America: Case Report and Review

Background:

Myiasis is a cutaneous infestation with larvae of Diptera, the two-winged arthropod order. Eggs and/or larvae are transmitted directly from the environment or via arthropod vectors. Larvae are able to burrow into the dermis of intact skin or external body orifices. Three clinical variants of myiasis are furuncular, migratory (creeping), and infestation of wounds.

Methods:

A 35-year-old male presented with a 1-month history of worsening furuncles on the left knee and posterior thigh following his return from Panama, South America. Clinical examination revealed tender 6 cm and 2 cm erythematous to violaceous furuncles with surrounding desquamation and central puncta draining serosanguinous fluid. Five-millimeter punch biopsies and tissue swabs were performed.

Results:

All larvae were of the Dermatobia hominis species. The patient was empirically treated with cephalexin and ciprofloxacin for secondary bacterial cellulitis. Tissue swabs later cultured group B streptococcus. A tetanus booster was recommended.

Conclusion:

This case report describes a relatively rare cutaneous infestation with D. hominis, a Central and South American endemic larva of the human botfly. Increasing trends toward immigration and global travel to tropical and subtropic areas will likely increase the frequency of encounters with such parasitic cutaneous infestations in North American outpatient dermatology clinics.

Dermatologic signs

BACKGROUND

Dermatology signs serve as important clues to primary skin disorders and internal conditions.

OBJECTIVE AND METHODS

To highlight major cutaneous signs based on a MEDLINE literature search from 1966 to March 2006.

RESULTS AND CONCLUSIONS

A multitude of signs exist in dermatology. Appreciation and knowledge of cutaneous signs will enhance the care of patients with dermatologic manifestations.

Cutaneous onchocerciasis in an American traveler

A case report of cutaneous onchocercias acquired during travels to Africa is presented. The salient epidemiologic, clinical, diagnostic, and therapeutic aspects are reviewed. Clinical and laboratory differences between onchocerciasis patients who are inhabitants of endemic areas and those who are occasional visitors to such areas are discussed. Parasitic infections, including onchocerciasis, should be considered in the differential diagnosis of pruritic eruptions in patients with a history of foreign travel to Africa, Central and South America.

Autochthonous furuncular myiasis in the United States: case report and literature review

Most cases of furuncular myiasis in the United States are acquired during travel to other countries. Autochthonous cases are infrequently reported and are most often due to accidental infestation of humans by larvae of flies belonging to the genus Cuterebra, commonly known as "rabbit bot flies" or "rodent bot flies." We describe a case of furuncular myiasis due to Cuterebra larvae in the hand of a patient residing in Wisconsin. The infestation was acquired while the patient gardened near a seepage lake during August. The patient developed papular lesions on the hand and received therapy for presumed bacterial furunculosis, which did not lead to improvement. Retrieval of one of the larvae from the patient permitted identification of the causative agent, and application of an occlusive ointment resulted in complete cure. North American cuterebrid myiasis is rare, and the diagnosis is frequently delayed. Myiasis should be considered when treating patients with refractory furunculosis.

Skin problems in the traveler

Skin lesions are common in travelers and include a mix of mundane dermatologic problems and rare diseases acquired only in remote or tropical regions. The morphology, distribution, and progression of the lesions are useful in assessing possible causes. Early in the evaluation it is important to determine whether the patient might have a process that is rapidly progressive, treatable, or transmissible. In addition to routine laboratory studies, biopsy and serologic tests are often necessary to confirm a specific diagnosis.

Success of a scabies control program in an Australian aboriginal community

OBJECTIVE

To adapt, implement and evaluate a model of scabies control in an Australian Aboriginal community.

METHODS

After initially examining the population, we offered all residents treatment with 5% permethrin cream. Visits were made during the ensuing 25 months to rescreen and to treat new-cases of scabies and contacts.

RESULTS

The prevalence of scabies was reduced from 28.8% before the program to < 10% during the entire period (from 32.3% to < 10% in children) (P < 0.01 for each visit). The initial prevalence of pyoderma in children was 69.4%, which was reduced and maintained at approximately one-half that rate during the last 16 months (P < 0.004 for the last 4 visits). Residual pyoderma in children was significantly less severe and no longer scabies-related.

CONCLUSIONS

This simplified model of scabies control had a substantial effect on scabies prevalence and on pyoderma prevalence and severity which was sustained for > 2 years. It could prove useful for other communities with high rates of scabies and pyoderma.