A case of cutaneous larva migrans presenting in a pregnant patient

Cutaneous larva migrans (CLM) is a pruritic dermatitis caused by migration of animal hookworm larvae into the skin. We present a case of CLM in a 31-year-old pregnant woman. The treatment of CLM relies on antihelminthic agents, such as thiabendazole, albendazole, and ivermectin. This case was interesting in that the standard treatment options previously mentioned were contraindicated owing to the patient's pregnancy. Cryotherapy with liquid nitrogen resulted in complete resolution of her lesion and symptoms.

Imported tungiasis: a report of 19 cases and review of the literature

Tungiasis is an infestation caused by penetration in the skin of the gravid female of the flea Tunga penetrans. In the period 1991-2006, 19 patients with imported tungiasis were observed at our Institute. All patients were subjected to general and dermatological examination, laboratory tests (including bacteriological examinations) and surgical excision of the lesions with histopathological examination. In all patients tetanus prophylaxis was made. All patients were followed up for at least six weeks. Thirteen patients were males (68.4%) and 6 females (31.6%). The age ranged from 3 to 71 years (average age: 37.8 years). Eleven patients (57.9%) contracted the infestation in Central and South America and 8 (42.1%) in Africa. In 17 patients (89.5%) tungiasis was localized to the feet, in one to the hands and in one to a thigh. In 13 patients (68.4%) the infestation was characterized by a single lesion; in the other 6 patients (31.6%) the lesions were two. In 15 patients (78.9%) tungiasis was characterized by a papular or nodular lesion. Crusted (2 patients), pustular (2 patients) and bullous (1 patient) lesions were also observed; furthermore, one patient presented with a plantar wart-like lesion. In only one patient bacteriological examinations showed the growth of Staphylococcus aureus and Escherichia coli. All patients healed without complications.

Morbidity assessment in sand flea disease (tungiasis)

Tungiasis, caused by the sand flea Tunga penetrans, is a health problem in many impoverished communities in Latin America, the Caribbean, and sub-Saharan Africa. Sand flea disease is associated with a broad spectrum of clinical and histological pathology. The factors determining the disease burden in endemic communities are not well understood, and severity of clinical pathology has never been assessed quantitatively. Thus, two severity scores were developed: one for acute disease and one for chronic sequels. These scores were evaluated in a cohort of 70 severely infested patients living in a shantytown in Fortaleza, a capital city in Northeast Brazil. Patients were examined during a period of 25 days and followed-up after a twice daily application of a plant-based repellent to prevent reinfestation. The severity score for acute disease symptoms significantly correlated with the infestation rate and the number of embedded fleas. It turned zero when reinfestation was prevented. The score for chronic disease also significantly correlated with the infestation rate. Tungiasis is associated with considerable acute and chronic morbidity. The degree of acute morbidity is directly related to the number of embedded sand fleas. When transmission is interrupted, the chronic morbidity reflects the infestation rates individuals have experienced in the past.

A plant-based repellent protects against Tunga penetrans infestation and sand flea disease

Tungiasis is a parasitic skin disease prevalent in impoverished populations in the tropics and associated with considerable morbidity. Treatment options are limited and prophylaxis has never been attempted. We assessed the effectiveness of a plant-based repellent to prevent infestation with Tunga penetrans and sand flea disease in an urban squatter settlement in Fortaleza, Northeast Brazil. Two cohorts were formed. One cohort started with the intervention while another served as control. The plant-based repellent Zanzarin was applied twice daily on the skin of the feet. After 4 weeks and a wash-out-phase of another 2 weeks, cross-over was performed. Study members were examined twice per week for the presence of newly embedded sand fleas. The number of viable and dead sand fleas and the total number of sand flea lesions were determined. Sentinel rats were used to assess local transmission dynamics. Outcome measures were the number of newly embedded sand fleas per individual per day, number of sand flea lesions per individual according to the stage, as well as type and degree of clinical pathology. Zanzarin applied twice daily on the feet reduced the number of newly embedded fleas by 92% (interquartile range 81-100%), the total number of lesions by 87% (81-98%) and reversed tungiasis-associated clinical pathology almost completely. In conclusion, in a setting in which tungiasis is an important health threat, the daily application of a plant-based repellent prevented the infestation with T. penetrans and sand flea disease.

Interdigital skin lesions of the lower limbs among patients with lymphoedema in an area endemic for bancroftian filariasis

OBJECTIVES

An estimated 15 million persons suffer from lymphoedema of the leg in filariasis-endemic areas of the world. A major factor in the progression of lymphoedema severity is the incidence of acute dermatolymphangioadenitis (ADLA), which is triggered by bacteria that gain entry through damaged skin, especially in the toe web spaces ('interdigital skin lesions'). Little is known about the epidemiology of these skin lesions or about patients' awareness of them.

METHODS

We interviewed and examined 119 patients (89% women) with lymphoedema of the leg in Recife, Brazil, an area endemic for bancroftian filariasis.

RESULTS

We detected 412 interdigital skin lesions in 115 (96.6%) patients (mean, 3.5 lesions per patient, range 0-8). The number of interdigital skin lesions was significantly associated with lymphoedema stage (P<0.001) and frequency of ADLA (P<0.0001). Only 20 (16.8%) patients detected their own interdigital skin lesions or considered them abnormal. Patients reported a mean of 3.6 ADLA episodes during the previous 12 months (range, 0-20); reported ADLA incidence was associated with lymphoedema stage (P<0.0001) and the number of interdigital skin lesions detected by the examining physician (P<0.0001).

CONCLUSIONS

These data suggest that interdigital skin lesions are a significant risk factor for ADLA and that persons with lymphoedema in filariasis-endemic areas are unaware of their presence or importance. Prevention of ADLA through prompt recognition and treatment of interdigital skin lesions will require that patients be taught to identify lesions, especially between the toes and to recognize them as abnormal.

Tunga penetrans. A case report and review of the literature

Tungiasis is an infection caused by infestation of Tunga Penetrans into the epidermis. Although, at the moment, presentation of this condition seems rare in Europe and Northern America, tungiasis is highly endemic in other parts of the world. We describe a case of Tunga Penetrans infection in the foot of a 22-year old Dutch female returning from Kenya, and present a review of the literature. Now that intercontinental travel is increasing, physicians in other parts of the world will be expected to recognize and treat this exotic infection. Knowledge of human tungiasis is mandatory in order to recognize the symptoms, achieve correct diagnosis and ensure adequate medical treatment to our patients.

Chigger mite infestation

This article reports on a 45-year-old woman who presented with pruritus and was diagnosed as having chigger mite infestation, a rare condition. The chigger mite larvae were encountered while the patient was traveling in South America. A small erythematous area with a well-circumscribed papule in the sulcus of the second digit of the right foot was incised and drained. Follow-up examination showed relief of all symptoms, including pain and pruritus. This unusual case presentation underscores the need for all podiatric physicians to obtain a comprehensive history, including history of travel, along with performing a thorough physical examination.

[Diagnostic image (102). A man with an itching foot. Larva migrans cutanea]

A 27-year-old man presented with larva migrans cutanea on his left foot after a journey to the Philippines.

Papillomatous pastern dermatitis with spirochetes and Pelodera strongyloides in a Tennessee Walking Horse

Papillomatous digital dermatitis is a common disease in cattle. The pastern dermatitis observed in a horse shared many of the gross characteristics of papillomatous digital dermatitis in cattle. Lesions included a mixture of proliferative and erosive changes, with a verrucose appearance in some areas. Microscopic similarities included pseudoepitheliomatous and papillomatous epidermal hyperplasia with hyperkeratosis, spongiosis of the epidermis, and intraepidermal spirochetes. The horse was also concurrently infected with Pelodera strongyloides. Papillomatous digital dermatitis in cattle is associated with poor husbandry practices. The environment of the affected horse was heavily contaminated with urine, manure, and other organic debris. Verrucous pododermatitis of horses may be the same as or similar to bovine papillomatous digital dermatitis, and these conditions have similar etiologies.

Cutaneous larva migrans infection in the pediatric foot. A review and two case reports

Cutaneous larva migrans is the result of infestation of human skin by helminth larvae, which burrow through the epidermis. This route of infestation makes the foot a typical site for origination of this infection. Children, who frequently play barefoot in locations where the most common of the helminth larvae, the dog and cat hookworms, are endemic, are at particular risk for this disorder. This article reviews the differential diagnosis of cutaneous larva migrans and current concepts in management. Two cases of related children who presented to their pediatricians with this condition are reported.

Aggressive hydatid disease of the foot and ankle

An extremely rare case of aggressive hydatid disease of bone is described in a 29-year-old male. Although the disease was limited to the talus at initial presentation, it spread through the entire foot and ankle after surgical treatment. The unusual aggressive nature of the recurrence was attributed to the spread of infestation during the first surgery. Amputation of the foot and ankle was performed due to the invasive nature of the bone and soft tissue involvement.

The role of Hyalomma ticks in foot infestations and temporary lameness of sheep in a semi-arid region of South Africa

An outbreak of lameness amongst Merino lambs, associated with the presence of Hyalomma ticks, was investigated on a farm in the south-western Free State, South Africa. The purpose was to follow the progress of the condition and to determine the extent of involvement of the two Hyalomma species which occur in the region. The flock of experimental sheep (n = 460) ranged free in natural veld under extensive farming conditions. During September and October 1993, adult ewes and lambs in this flock were examined at weekly intervals to determine tick identity, abundance and attachment-site preferences on lame and unaffected animals. Lameness occurred only among lambs, of which 68 were affected during the 8-week period. Hyalomma ticks tended to aggregate and mean numbers of ticks/aggregation were significantly higher on lame lambs (mean = 11.3) than on either the unaffected lambs (mean = 6.9) or the ewes (mean = 7.1). Most tick aggregations (72.4%) on the lame lambs occurred on the lower legs and feet, 34 out of 55 of these on the fetlocks or interdigital clefts. Hyalomma truncatum dominated (> 97%) on all animals examined. Only 15.8% of the Hyalomma marginatum rufipes recovered from the lame animals were attached to the legs. At two other localities at which H. marginatum rufipes was more abundant, or even dominant, few ticks attached to the lower legs or feet. Those that did were mostly H. truncatum (> 90%). Both H. marginatum rufipes and H. truncatum may attach to the same ventral and anogenital body regions, but H. truncatum has a tendency to attach also to the feet and lower legs. Although attachment of one or a few ticks in the axillar region or upper legs may cause lameness in sheep, the attachment of ticks to the interdigital clefts and fetlocks almost always causes lameness. The latter condition is more likely to occur in regions where H. truncatum dominates.

Case report: an unusual cutaneous myiasis of the foot

A case of rare cutaneous myiasis, which has not heretofore been described in the foot, is presented. The unusual life cycle is described in order to understand the clinical presentation. The treatment options are discussed and recommendations are made to avoid treatment pitfalls.

Ultrasound diagnosis of plantar fasciitis

There is currently no objective reliable diagnostic test for plantar fasciitis inasmuch as diagnosis cannot be made on the basis of finding a heel spur on radiography (x-ray). In this single-blind observational study, ultrasonography was used to measure plantar fascia thickness in subjects with clinically suspected plantar fasciitis and in control subjects. It was concluded that the population mean plantar fascia thickness is greater for people with plantar fasciitis than for people without heel pain (P < .0005) and that the difference is clinically significant. The ultrasonic appearance of the plantar fascia in plantar fasciitis indicated inflammatory changes.

Two unusual predisposing factors for diabetic pedal ulceration in Nigerians

Two unusual predisposing factors to indolent foot ulceration seen in Nigerian diabetic patients are presented. These are guinea-worm infestation (dracontiasis) affecting the dorsum of the foot and lichenification with fissuring of the sole of the foot during the cool, dry weather of the harmattan season. These two preventable and treatable conditions are widely prevalent in sub-Saharan African countries. While there was severe hyperglycaemia in both cases, one was associated with diabetic ketoacidosis and resulted in limb amputation. Both patients stayed 4-5 months in hospital. A case is made for early recognition and specific management of these lesions to prevent undue morbidity and prolonged hospitalisation.

[The third case of dirofilariasis conjunctivae in Turkey]

An Immature female Dirofilaria (Nochtiella) conjunctivae has been obtained from a nodule located in fifth finger of right foot of a 8 years-old girl.

Dracunculiasis in Igbon, Oyo State, Nigeria

Studies conducted between 1978 and 1979 to determine the prevalence and site of guinea-worm transmission in Igbon, Nigeria, showed that in less than 5 years of the introduction of dracunculiasis into this community, the infection rate had reached over 75% among the economically active group. Multiple infections were rampant and the frequency of occurrence of severe incapacitation was correspondingly high as reflected by prolonged and excessive absenteeism from schools, inability to engage in farming, trading and domestic work. The peak of transmission occurred in November which coincided with the retreat of rain and the abundance of Thermocyclops nigerianus in the two adjacent ponds where active transmission occurred. While ignorance was primarily responsible for annual transmission, secondary infection resulting from unsanitary methods of local treatment, seemed to be the major cause of prolonged and severe incapacitation.