ECTOPARASITES

AND PARASITES ON HUMANS

SKIN/BODY SURFACE
Parasitology Department

Learning Objectives

Parasites that causes infestation in the skin and human

surface:

Cercarial dermatitis and filarial dermatitis

Cutaneous larva migrans:

Agents of disease: Sarcoptes scabiei, Pediculus humanus,

Phtirus pubis
Pathogenesis
Preventive treatment

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 BBSParasitology
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 AcryMount on a glass

slide with cover slip
on top

Scybala

male
7

female

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, immunosuppressed 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

Parasitic Dermatitis
Filarial dermatitis
Schistosomal dermatitis
Cutaneous leishmaniasis

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.

Thank You

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