Human otoacariasis caused by Amblyomma testudinarium: Diagnosis and management: Case report

Ear Mites as an Overlooked Source of Ear Itching and Tinnitus - A Case Series

Otoacariasis is a rare condition characterized by ticks and mites in the ear canal. Human otoacariasis remains underrepresented in literature as otoacariasis is more common in animals. Systemic diseases being transmitted by these arachnids pave the way for potential complications. This case series sheds light on this uncommon condition by highlighting the diverse symptomatology and difficulties in diagnosis and treatment. Three different presentations highlight the diversity of this condition. A 40-year-old male exhibited itching and tinnitus, revealing a mite on the tympanic membrane on otoscopy. A 35-year-old female with persistent itching and tinnitus showed multiple whitish mites on examination. A 50-year-old female complained of ear pain and was found to have a tick attached to the external auditory canal. The relevance and rarity of human otoacariasis are highlighted in this study, thereby encouraging caution in situations of earache. We aim to increase clinician awareness about this condition and the necessary interventions required by conducting a thorough literature review.

Unusual Presentation of Otoacariasis: A Prospective Study at Referral Teaching Hospital

Otoacariasis is the presence of ticks and mites within the ear canal. Though the coexistence of ticks and humans is known for thousands of years, tick infestation is relatively rare in urban population. The most common presenting symptoms are usually itching, otalgia and a foreign body sensation and less frequent ones are tinnitus and otorrhoea. We report cases of otoacariasis with unusual presentation. A total of 43 cases presented to the ENT clinic in our hospital over a period of three years from 2018 to 2021. We present patients who presented with unusual symptoms of conductive hearing loss, ear bleed, and facial palsy. Total of 6 cases of otoacariasis had unusual presentation. 2 cases presented with lower motor neuron palsy, 1 case with ear bleed, and 3 cases with hearing loss. Otocariasis can present with unusual symptoms of hearing loss, ear bleed or facial palsy and this should be included in the differential diagnosis of a patient with history of close proximity to domestic or wild animals. Detailed examination often reveals the presence of the tick and identification and complete removal along with appropriate medication for associated symptoms often results in complete recovery.

Comparative mitogenomics elucidates the population genetic structure of Amblyomma testudinarium in Japan and a closely related Amblyomma species in Myanmar

Ticks are the second most important vector capable of transmitting diseases affecting the health of both humans and animals. Amblyomma testudinarium Koch 1844 (Acari: Ixodidae), is a hard tick species having a wide geographic distribution in Asia. In this study, we analyzed the composition of A. testudinarium whole mitogenomes from various geographical regions in Japan and investigated the population structure, demographic patterns, and phylogeographic relationship with other ixodid species. In addition, we characterized a potentially novel tick species closely related to A. testudinarium from Myanmar. Phylogeographic inference and evolutionary dynamics based on the 15 mitochondrial coding genes supported that A. testudinarium population in Japan is resolved into a star-like haplogroup and suggested a distinct population structure of A. testudinarium from Amami island in Kyushu region. Correlation analysis using Mantel test statistics showed that no significant correlation was observed between the genetic and geographic distances calculated between the A. testudinarium population from different localities in Japan. Finally, demographic analyses, including mismatch analysis and Tajima's D test, suggested a possibility of recent population expansion occurred within Japanese haplogroup after a bottleneck event. Although A. testudinarium has been considered widespread and common in East and Southeast Asia, the current study suggested that potentially several cryptic Amblyomma spp. closely related to A. testudinarium are present in Asia.

The Bacterial Community in Questing Ticks From Khao Yai National Park in Thailand

Ticks are known vectors for a variety of pathogens including bacteria, viruses, fungi, and parasites. In this study, bacterial communities were investigated in active life stages of three tick genera (Haemaphysalis, Dermacentor, and Amblyomma) collected from Khao Yai National Park in Thailand. Four hundred and thirty-three questing ticks were selected for pathogen detection individually using real-time PCR assays, and 58 of these were subjected to further metagenomics analysis. A total of 62 ticks were found to be infected with pathogenic bacteria, for a 14.3% prevalence rate, with Amblyomma spp. exhibiting the highest infection rate (20.5%), followed by Haemaphysalis spp. (14.5%) and Dermacentor spp. (8.6%). Rickettsia spp. were the most prevalent bacteria (7.9%) found, followed by Ehrlichia spp. (3.2%), and Anaplasma spp. and Borrelia spp. each with a similar prevalence of 1.6%. Co-infection between pathogenic bacteria was only detected in three Haemaphysalis females, and all co-infections were between Rickettsia spp. and Anaplasmataceae (Ehrlichia spp. or Anaplasma spp.), accounting for 4.6% of infected ticks or 0.7% of all examined questing ticks. The prevalence of the Coxiella-like endosymbiont was also investigated. Of ticks tested, 65.8% were positive for the Coxiella-like endosymbiont, with the highest infection rate in nymphs (86.7%), followed by females (83.4%). Among tick genera, Haemaphysalis exhibited the highest prevalence of infection with the Coxiella-like endosymbiont. Ticks harboring the Coxiella-like endosymbiont were more likely to be infected with Ehrlichia spp. or Rickettsia spp. than those without, with statistical significance for Ehrlichia spp. infection in particular (p-values = 0.003 and 0.917 for Ehrlichia spp. and Rickettsia spp., respectively). Profiling the bacterial community in ticks using metagenomics revealed distinct, predominant bacterial taxa in tick genera. Alpha and beta diversities analyses showed that the bacterial community diversity and composition in Haemaphysalis spp. was significantly different from Amblyomma spp. However, when examining bacterial diversity among tick life stages (larva, nymph, and adult) in Haemaphysalis spp., no significant difference among life stages was detected. These results provide valuable information on the bacterial community composition and co-infection rates in questing ticks in Thailand, with implications for animal and human health.

Human Otoacariasis in Two Climatically Diverse Districts in Sri Lanka: Seasonality, Risk Factors, and Case Notes

PURPOSE

Otoacariasis is a parasitic otopathy reported in many parts of the world. This study presents the seasonal pattern, risk factors, and case notes on human otoacariasis in two climatically different districts: Anuradhapura and Kandy in the Dry and Wet/Intermediate zone of Sri Lanka, respectively.

METHODS

Ticks removed from the ear canal of patients were collected. Risk factors of otoacarisis were determined by a case/control follow-up study.

RESULTS

Nymphal Dermacentor auratus (90.8%) was the main tick species associated otoacariasis. In the Kandy District, infestation was year-round, while in the Anuradhapura District, it was seasonal with a peak in December-February. Children < 10 years were a risk group in both districts. Females were a risk group in the Kandy District. Engagement in outdoor activities was a risk factor in both districts. In addition, the presence of wildlife and domesticated animals were risk factors in the Kandy and Anuradhapura districts, respectively. The treatment protocols in the two hospitals were different. An infant with otoacariasis from the Anuradhapura District developed rickettsia.

CONCLUSIONS

Although the tick species was the same, seasonality, risk groups, and risk factors in the two districts were different which could be due to the establishment and persistence of tick populations influenced by biotic and abiotic factors.

An annotated checklist of the eukaryotic parasites of humans, exclusive of fungi and algae

The classification of "parasites" in the medical field is a challenging notion, a group which historically has included all eukaryotes exclusive of fungi that invade and derive resources from the human host. Since antiquity, humans have been identifying and documenting parasitic infections, and this collective catalog of parasitic agents has expanded considerably with technology. As our understanding of species boundaries and the use of molecular tools has evolved, so has our concept of the taxonomy of human parasites. Consequently, new species have been recognized while others have been relegated to synonyms. On the other hand, the decline of expertise in classical parasitology and limited curricula have led to a loss of awareness of many rarely encountered species. Here, we provide a comprehensive checklist of all reported eukaryotic organisms (excluding fungi and allied taxa) parasitizing humans resulting in 274 genus-group taxa and 848 species-group taxa. For each species, or genus where indicated, a concise summary of geographic distribution, natural hosts, route of transmission and site within human host, and vectored pathogens are presented. Ubiquitous, human-adapted species as well as very rare, incidental zoonotic organisms are discussed in this annotated checklist. We also provide a list of 79 excluded genera and species that have been previously reported as human parasites but are not believed to be true human parasites or represent misidentifications or taxonomic changes.