Sporotrichoid Abscesses: A Rare Form of Recurrent Cutaneous Leishmaniasis in an Infant's Face

An 8-month-old infant presented with a 3-month history of two swellings on her left cheek. Past history revealed cutaneous leishmaniasis (CL) of the same site 8 months earlier; the patient was treated with intralesional infiltrations of meglumine antimoniate over 4 months, leaving behind an atrophic scar. The current lesions started 1 month after the healing of the initial ones and gradually increased in size and later became fluctuant. She had been treated with several antimicrobial agents, without any improvement. Her examination revealed two subcutaneous inflammatory and renitent nodules of 2-3 cm in diameter on the left cheek, associated with a cribriform scar under the external angle of the left eye, corresponding with the CL. The abscesses were aspirated, revealing yellowish pus. Culture was negative for bacterial growth. Smears for Leishmania bodies performed, using Leishman and Giemsa stains and taken from both the subcutaneous abscesses and the dystrophic scar; were positive. The diagnosis of a lymphatic dissemination was established based on the previous history of CL treated with local therapy. The patient was started on intramuscular injections of meglumine antimoniate (60 mg/kg/day) for 21 days, and she responded well to the treatment, with complete disappearance of the lesions. Repeat skin smears were negative for Leishmania bodies.

[Cutaneous leishmaniasis of the vermilion border of the upper lip extending to the oral mucosa]

BACKGROUND

Cutaneous leishmaniasis is endemic in Morocco. Mucosal involvement is rare. We report a case in Morocco of cutaneous leishmaniasis of the vermilion border of the upper lip extending to the oral mucosa due to Leishmania tropica.

PATIENTS AND METHODS

A 15-year-old girl was seen with 2 ulcerated lesions, present for 4 months, situated on the left cheek and vermilion border and extending to the oral mucosa. The diagnosis of leishmaniasis was confirmed by direct examination revealing high numbers of Leishmania amastigotes. Culture of the offending organism in NNN medium and isoenzymatic characterization resulted in identification of L. tropica. Treatment with meglumine antimoniate (Glucantime) was ineffective. The outcome was good after treatment with fluconazole.

CONCLUSION

In Morocco, cutaneous leishmaniasis with mucosal involvement is rare, and usually develops as a complication of cutaneous leishmaniasis via direct extension.

Nodular Demodicosis in a Pregnant Woman Treated with Oral Ivermectin and Metronidazole

A 32-year-old woman presented at 12 weeks' gestation with a severe nodulopustular reaction involving the central region of the forehead and the right cheek (Figures 1 and 2). This had progressively worsened over a several-week period despite use of topical metronidazole. A Demodex preparation revealed numerous Demodex mites from each pustule that was sampled. Based on the clinical findings and the positive Demodex preparations, the woman was diagnosed with nodular demodicosis.

Rosacea and Demodicosis: Little-known Diagnostic Signs and Symptoms

Papulopustular rosacea and demodicosis are characterized by non-specific symptoms, which can make clinical diagnosis difficult. This retrospective study of 844 patients assessed the diagnostic importance of clinical signs and symptoms that are poorly recognized as being associated with these conditions. In addition to well-known signs (vascular signs (present in 80% of patients), papules (39%), pustules (22%) and ocular involvement (21%)), other signs and symptoms (discreet follicular scales (93%), scalp symptoms (pruritus, dandruff or folliculitis; 38%) and pruritus (15%)) may also suggest a diagnosis not only of demodicosis, but also of papulopustular rosacea. Facial Demodex densities (measured by 2 consecutive standardized skin biopsies) were higher when ocular or scalp involvement was present, suggesting more advanced disease, but further investigations are needed to confirm this hypothesis. Recognition of these clinical signs and symptoms should encourage dermatologists to perform a Demodex density test, thus enabling appropriate diagnosis to be made.

Diffuse Papular Eruption of the Face and Eyelids

A 68-year-old Caucasian woman presented with a 1-month history of a facial and neck eruption (Figure 1A). Her face was covered with 3-mm monomorphic, pink, shiny, papules and rare pustules on an erythematous background. The eruption extended down the neck, her conjunctivae were injected, and her lid margins were inflamed. She had no history of rosacea.

Demodicosis Treatment with Systemic Ivermectin

A 23-year-old white man presented to our dermatology department complaining of pruriginous and erythematous papulopustules on the right cheek that had developed 6 months previously. He had a history of chronic blepharitis, complicated by a recurrent hordeolum that had been treated with warm compresses and topical antibiotic ointment (chloramphenicol) for approximately 2 years. The patient had oily skin and atopy (allergic rhinitis) and did not experience photosensitivity or flushing or have previous exposure to immunosuppressants or topical/systemic corticosteroids.

Extreme Ophthalmomyiasis externa with simultaneous facial and scalp involvement

BACKGROUND

Ophthalmomyiasis is a rare entity seen mainly in immunocompromised host with neglected wounds under poor hygienic conditions.

CASE

We report a case of extreme ophthalmomyiasis with extensive facial and scalp involvement in an old rural inhabitant following evisceration.

CONCLUSION

Proper wound care and personal hygiene are of paramount importance for good wound healing.

Two Consecutive Standardized Skin Surface Biopsies: An Improved Sampling Method to Evaluate Demodex Density as a Diagnostic Tool for Rosacea and Demodicosis

Diagnosing papulopustular rosacea is not always straightforward; no specific diagnostic test is currently available. A high density of Demodex mites is consistently observed in this condition. This retrospective study assesses an improved method for evaluating Demodex density among 1,044 patients presenting to our dermatology practice. The skin was cleaned with ether and Demodex densities were measured in 2 consecutive standardized skin surface biopsies taken from the same site. Mean densities in patients with rosacea and demodicosis were much higher than those in healthy controls and patients with other facial dermatoses. The optimal cut-off values for the 2 biopsies were combined and the resultant criterion (presence of a first biopsy density < 5 Demodex/cm2 or a second biopsy density < 10 Demodex/cm2) enabled confirmation of a diagnosis of rosacea or demodicosis with a sensitivity of 98.7% and specificity of 95.5%, making this a valuable diagnostic tool for dermatologists in routine clinical practice.

An unusual erysipelas-like presentation

A 61-year-old man presented with erysipelas-like cutaneous leishmaniasis.

Cutaneous leishmaniasis in Tunisia: results of the iso-enzymatic characterization of 71 strains

Three clinico-epidemiological forms of cutaneous leishmaniasis (CL) exist in Tunisia: zoonotic cutaneous leishmaniasis (ZCL; epidemic in the centre and the south-west); sporadic cutaneous leishmaniasis (SCL; found in the north); and chronic cutaneous leishmaniasis (CCL; originally described from Tataouine, in the south-east). As few isolates of Leishmania from Tunisian cases of CL have been typed, isolates were collected, using NNN medium, from 71 such cases. Most (59) of the cases investigated came from the north of the country, including 16 from Sidi Bourouis, where there was an epidemic outbreak of SCL in early 2001; the other 12 cases were natives of the centre or south of the country. The 71 strains were then characterized, at the Centre National de Référence des Leishmania, in Montpellier, France, by iso-enzyme analysis. This revealed four zymodemes: two of L. infantum and one each of L. major and L. killicki. The MON-1 zymodeme of L. infantum, which is more usually associated with visceral leishmaniasis, was recovered from seven of the cases, including six natives of Sidi Bourouis. The MON-24 zymodeme of this species, which appears to be responsible for the SCL, was isolated from 48 cases, all of whom lived in the north of the country. Another 15 cases (nine from the centre, four from the north, and two from the south-east of the country) were found to be harbouring L. major MON-25, the zymodeme usually causing ZCL. Only a single isolate of L. killicki was made; this was of the MON-8 zymodeme responsible for the CCL, and came from a native of Gafsa, in the south-west. Six of the cases investigated (five infected with L. infantum MON-24 and one with L. major MON-25) showed involvement of their nasal and labial mucosae. These results increase the number of strains typed from Tunisian cases of CL more than four-fold, and should help to elucidate the geographical distribution and epidemiology of the various forms of the disease.

Demodex: commensal or pathogen?

Demodex mites are considered commensals of human pilosebaceous units. Their role in skin disease is controversial. The aim of our study was to investigate the Demodex infection in patients with characteristic skin lesions and to correlate the level of infestation with epidemiological and clinical features.

MATERIAL AND METHODS

we have studied 120 symptomatic patients, diagnosed between January 2012 and December 2012; the detection of mites was realized by microscopic examination of potassium hydroxide preparations from biological samples taken by scraping and squeezing method.

RESULTS

The total prevalence rate of infection in our study group was 40.83%. We did not find statistical significant correlation with gender or age or with the type of lesions.

CONCLUSIONS

Prevalence of Demodex infestation in facial dermatitis is high and its detection must be taken into consideration in routine diagnostic of facial suggestive lesions.

Demodicidosis: an uncommon erythema after cranio-maxillofacial surgery

Demodex mites are commonly found in the healthy population, but the pathogenesis of demodicidosis has still not been clarified, though it is usually found in cases of immune deficiency. A 45-year-old man presented with an unusual outbreak of erythema and swelling 6 months after resection and chemoradiotherapy for a squamous cell carcinoma of the anterior floor of the mouth. The cheek was biopsied and histological examination showed demodicidosis. In cases of erythema with a normal blood cell count and no history of allergy, particularly in patients with reduced immunity, demodicidosis should be considered as a diagnosis and should be confirmed by examination of a biopsy specimen.

[Facial Demodex infestation among urban and rural residents in Shangqiu City of Henan Province]

A survey with improved transparent tape method indicated that the prevalence of demodex infestation among 565 urban and rural residents in Shangqiu was 21.2% (120/565). Farmers (32.3%, 53/164) and service employees (33.7%, 29/86) showed higher prevalence than other occupations (P < 0.05). Among age groups, lowest prevalence was found in people under 20 years old (4.8%, 5/105), while the highest in people over the age of 50 (44.4%, 40/90). Prevalence among females, the rural residents and those sharing public toiletries and people with oily skin and acne or other facial sickness was statistically higher than others (P < 0.05). Among the couples with demodex infestation, 79.6% of the couples only had one side infested while both sides got infested in 20.4% of the couples.

Cavernous sinus thrombosis in a patient with facial myiasis

Cavernous sinus thrombosis is a severe encephalic complication of the cervicofacial infections that can lead to death if not treated in adequate time. Among the several etiologies related to the development of this infection, myiasis has not been reported, enforcing the importance of the report of a case of thrombosis of the cavernous sinus developed from a facial myiasis.

[Facial Demodex infection among college students in Tangshan]

A survey indicated that the prevalence of Demodex infection among 512 college students in Tangshan was 36.3% (186/512), that of males and females was 39.3% (81/206) and 34.3% (105/306) respectively (P>0.05). The infection of Demodex folliculorum accounted for 82.3% (153/186), followed by D. brevis (7.5%, 14/186) and mixed infection (10.2%, 19/186). The prevalence was 47.0% (93/198) in subjects with oily skin, 26.6% (37/139) in those with dry skin, and 33.9% (56/165) in mixed-type skin (P<0.05). Subjects with facial diseases (62.0%, 75/121), such as rosacea and acne, were more likely to be infected with Demodex than those with healthy skin (27.6%, 80/290) (P<0.05). Prevalence in those lived in humid environment (67.9%, 95/140) was higher than those lived in the desiccating environment (24.5%, 91/372) (P<0.05).

Diffuse cutaneous leishmaniasis in HIV

Cutaneous leishmaniasis is caused by the intracellular protozoan parasite belonging to the genus leishmania and is characterized by a myriad of clinical lesions including papules, nodules, and ulcers. Diffuse cutaneous forms of leishmaniasis are rare. We report a rare case from South India of diffuse cutaneous leishmaniasis masquerading as lepromatous leprosy in the context of HIV infection.

[Outbreak of cutaneous leishmaniasis: about 213 cases in the province of Tizi-Ouzou]

Leishmaniases are parasitic diseases frequent in the Mediterranean Basin. In Algeria they occupy the first place among parasitic diseases and represent 35% of diseases with compulsory notification. This is an alarming situation because the extension of the disease can also deteriorate the epidemiological situation of the tuberculosis and the HIV/AIDS because of coinfection. The authors report a series of 213 cases of Aden ulcers listed in the wilaya of Tizi-Ouzou within nine years, region known for endemia of infantile visceral leishmaniases.

[Cutaneous leishmaniasis caused by Leishmania infantum MON-24 in Tunisia: extension of the focus to the center of the country]

Three clinico-epidemiological forms of cutaneous leishmaniasis (CL) were described in Tunisia: the zoonotic CL (ZCL) epidemic which occurred in the centre of the country caused by Leishmania major MON-25, the chronic CL (CCL) In the south-east of the country caused by Leishmania killicki MON-8 and the sporadic CL In the North (SCL) caused by Leishmania infantum MON-24. The latter form, described in 1991, prevails in northern Tunisia with approximately thirty cases per year. Its vector, unknown for a long time could be according to the last publications, Phlebotomus perfiliewi or Phlebotomus langeroni; however, its reservoir remains unknown until now. The systematic isoenzymatic characterization permits to identify a great number of strains improving then knowledge on the eco-epidemiology of the disease. Indeed, changes were noted in the geographical distribution of these clinical forms: extension of the ZCL to the North and South, extension of the CCL to North and the SCL to the centre. We report in this note the first mention of L. infantum MON-24 in the two provinces of the centre of Tunisia: Kairouan and Sidi Bouzid, confirming the extension of the SCL to the Centre.

[Human subcutaneous dirofilariosis due to Dirofilaria repens. A case diagnosed in Strasbourg, France]

We report a case of human dirofilariosis in a 35 year-old man living in Alsace (North-East France), who presented a subcutaneous nodule of the left cheek, strongly simulating an epidermic cyst. Surgical excision and histopathological examination unexpectedly established the diagnosis by the presence of nematode worm sections identified as Dirofilaria (Nochtiella) repens. This patient living in a rural area of Strasbourg spent one week in Toulon, Southern France. This new observation of cutaneous dirofilariosis constitutes the third Alsatian case described in literature, and emphasizes the presence of this parasitic disease in Southern France.

Mite-related bacterial antigens stimulate inflammatory cells in rosacea

BACKGROUND

Patients with papulopustular rosacea have a higher density of Demodex folliculorum mites on their faces than normal subjects but the role, if any, of their mites in initiating inflammation is disputed. Selective antibiotics are effective in reducing the inflammatory changes of papulopustular rosacea, but their mode of action is unknown.

OBJECTIVES

To investigate whether a D. folliculorum-related bacterium was capable of expressing antigens that could stimulate an inflammatory immune response in patients with rosacea.

METHODS

A bacterium (Bacillus oleronius) was isolated from a D. folliculorum mite extracted from the face of a patient with papulopustular rosacea, and was investigated further.

RESULTS

This bacterium produced antigens capable of stimulating peripheral blood mononuclear cells proliferation in 16 of 22 (73%) patients with rosacea but only five of 17 (29%) control subjects (P = 0.0105). This antigenic preparation was fractionated into 70 subfractions and the proteins in each fraction were visualized by sodium dodecyl sulphate-polyacrylamide gel electrophoresis. Western blot analysis revealed the presence of two antigenic proteins of size 62 and 83 kDa in fractions when probing with sera from patients with rosacea. No immunoreactivity to these proteins was recorded when probing with sera from control patients. Two-dimensional electrophoretic separation was used to isolate these proteins and matrix-assisted laser desorption/ionization time-of-flight analysis was employed to identify the relevant peptides. The 62-kDa immunoreactive protein shared amino acid sequence homology with an enzyme involved in carbohydrate metabolism and signal transduction while the 83-kDa protein was similar to bacterial heat shock proteins.

CONCLUSIONS

Antigenic proteins related to a bacterium (B. oleronius), isolated from a D. folliculorum mite, have the potential to stimulate an inflammatory response in patients with papulopustular rosacea.

[Clinical polymorphism of cutaneous leishmaniasis in centre and south of Tunisia]

The cutaneous leishmaniasis (CL) is an affection which is quite well known in Tunisia. The zoonotic cutaneous leishmaniasis caused by Leishmania major by far the more frequent, is endemo-epidemic in the centre and south of the country. It is characterized by clinical polymorphism. The aim of our study is to precise the different clinical aspects of the CL in our region through a prospective study of 102 cases. The average age was 37.8 years old (from 4 to 78 years old) with a slight female predominance. All of our cases lived or stayed in an endemic zone. Various clinical forms were noted in our series. The ulcerated and crusted form was predominant: 54,9% of the cases, the lupoid form was noted in 15.7% of the cases and the sporotrichoid form was observed in 18.6% of the cases. Other rare forms were noted (papular erysipeloid, verrucous, vegetant, erythematous, ulcerated, necrotic and linear) were noted in 25.5% of the cases. Our series is characterized by the multiplicity of clinical forms. Besides, the classical form (ulcerated and crusted form), other clinical form can be individualised: lupoid, loco regional spreading (sporotrichoid form, satellite papules). Some atypical forms can be found which are due to variation of host immune responses and to the strain of the parasites involved.

Mucocutaneous leishmaniasis presenting as facial cellulitis

We report a case of mucocutaneous leishmaniasis caused by Leishmania viannia braziliensis. Despite several courses of both oral and intravenous antibiotics no improvement was seen. This case highlights the importance of taking a thorough history, including details of recent travel, and considering rarer causes when no improvement with antibiotics is seen. Our patient was infected with a particularly virulent strain and destruction of the mucous membranes is not uncommon. Rapid diagnosis and treatment are therefore crucial.

A study on Demodex folliculorum mite density and immune response in patients with facial dermatoses

In the present study, 40 patients with facial skin lesions and Demodex folliculorum (DF) mite density > 5/cm(2) by SSSB were evaluated for their immune response through counting T-cell subsets (CD3-CD4-CD8) and NK cells (CD16) numbers and IgG, M, D concentrations in peripheral blood in relation to DF mite density. They were 26 females and 14 males with overall mean age was 48.57+/-15.33 years. A control group of 40 healthy individuals without any skin diseases was enrolled. The mean DF mite density (MD) was 11.82+/-3.72/cm(2) in patients compared to 1.77+/-2.39 /cm(2) and a prevalence of 47.5% in controls. The difference was statistically significant. MD significantly correlated with age both in study and controls, but not with sex. A significant decrease in the absolute numbers of lymphocytes, T-cell subsets and NK cells was found in the study group in comparison with controls. Mean IgM level was significantly higher in patients. No significant correlation was observed between MD and the immune response. So, DF mites modulate the host cellular immune response to their advantage, as T-cell subsets and NK cells seem to be the target of immuno-suppression, favouring dermatosis development.

[The cutaneous leishmaniasis of the face in Gafsa area, Tunisia]

The cutaneous leishmaniasis is a frequent affection in Tunisia. In the Gafsa region it is a endemoepidemic infection. Our prospective study was carried out on 225 cases of cutaneous leishmaniasis of the face collected over two years in the outpatients' department of dermatology at Gafsa hospital. The aim of our study was to know more about the evolutive epidemio-clinical particularities of the cutaneous leishmaniasis of the face. The relative frequency of the cutaneous leishmaniasis of the face for the new patients reached 5%. An equal distribution between the two sexes was noted. The average age of our patients was 24 years old and 6 months old with extremes ranging from 3 months to 77 years. The nodular and ulcerated forms were the most frequent (35.3%), followed by impetiginoid forms (23%), then the lupoid forms (15%). The papular form was quite frequent (13%). Impetiginoid lesions occurred frequently in the child. Lupoid lesions appeared particularly on the nose. The complicated forms: the cutaneuos necrosis or erysipelas of the face appeared after intralesional injections of meglumine antimoniate (Glucantime). The intramuscular meglumine antimoniate was used in 172 patients, among them 47 needed two treatments or more because of a particular resistance of the lesions of the face. The pimple of Gafsa, term initially used for ulcerated skin nodules, was actually characterised by a lesional polymorphism. The prognosis was good however the risk of in aesthetic scar of the face was important.

[Experimental and clinical studies on the effect of sodium dodecylbenzene sulfonate in in vitro killing Demodex and in treating demodicidosis]

OBJECTIVE

To observe the effect of sodium dodecylbenzene sulfonate (SDBS) in killing Demodex in vitro and in the treatment of demodicidosis.

METHODS

(1) The experiment of in vitro killing Demodex with 1% and 2% SDBS was conducted. (2) A clinical trial was carried out to evaluate the therapeutic effect in the treatment of demodicidosis with 2% SDBS and 2% metronidazole emulsion. Patients with demodicidosis were randomly divided into trial and control groups (31 cases each). They were treated with 2% SDBS ointment and 2% metronidazole ointment twice a day in the early morning and evening respectively for eight weeks consecutively. Inflammatory lesions of face, Demodex infestation and scores of erythema were measured to evaluate the effect before and after treatment. (3) Follow-up was carried out for two months to evaluate the effect and side effects after 8 weeks' treatment.

RESULTS

(1) 2% SDBS killed all Demodex in vitro after 5 h, there was significant difference between the 2% SDBS and 2% metronidazole (69.4%), or between SDBS and peanut oil (9.1%) (P < 0.05). There was no significant difference in killing Demodex folliculorum and Demodex brevis with 2% SDBS. (2) Clinical observation showed that there was a significant difference in facial inflammatory lesions, Demodex infestation and scores of erythema before and after treatment with 2% SDBS (P < 0.05). The effective rate was 87.1%, 65.5% in 2% SDBS group and 2% metronidazole group respectively, with a significant difference between the two groups (P < 0.05). Follow up showed same results. (3) A slight burning sensation was the only side-effect in 3 cases with 2% SDBS ointment.

CONCLUSION

Sodium dodecylbenzene sulfonate has the effect of in vitro killing Demodex and is highly effective in the treatment of demodicidosis.

[Neurocysticercosis complicating the treatment of cutaneous cysticercosis in a traveller]

Cysticercosis is an helminthic disease which is usually observed in endemic areas or in immigrants coming from these areas. Cases described in travellers coming back from endemic areas are rare. We describe a case of neurocysticercosis that was revealed by a paradoxical reaction. This reaction occurred during the early phase of the treatment of cutaneous cysticercosis by albendazole in a tourist coming back from the sub Indian continent. This case report leads to discuss the modes of infestation in tourists, and the management of cutaneous cysticercosis and paradoxical reaction that may impair the outcome of cysticercosis during the treatment with antihelminthic drugs.

Rosacea and the pilosebaceous follicle

The pathophysiology of rosacea remains unknown. A leading theory suggests a vascular basis; however, clinical observations and histopathologic studies suggest that inflammation of the pilosebaceous follicle may be central to the pathogenesis of rosacea. Demodex folliculorum is a frequently seen commensal in the follicles of facial skin. According to evidence from biopsies of the skin surface, individuals with rosacea have a higher density of this parasite. This increased mite density may play a role in the pathophysiology of rosacea by triggering inflammatory or specific immune reactions, mechanically blocking the follicles, or acting as a vector for bacteria. Ongoing research has shown that bacteria from patients with rosacea may behave differently at the higher skin temperature that may be present in patients with rosacea. Another group has isolated bacteria from the Demodex mites; these bacteria may play a pathogenic role in papulopustular rosacea by facilitating follicular-based inflammatory changes.

[Studies of di-n-butyl phthalate-OP emulsion in the treatment of demodicidosis]

OBJECTIVE

To observe the curative effect of di-n-butyl phthalate-OP emulsion in the treatment of demodicidosis.

METHODS

447 cases with Demodex infection on face were treated with di-n-butyl phthalate-OP emulsion. Among them, 30 cases suffering from acne, tetter and pustule were also randomly observed. 20 days after treatment negative conversion rate and the therapeutic effect were evaluated. At the same time, the effect of this solution was compared with that of other three medicaments (FuManLing, 2% metronidazole and 8% metronidazole preparations). In vitro test of mites-killing, toxicity test in experimental animals and the safety evaluation for local application were also performed.

RESULTS

Results showed that the negative conversion rate was 92.8% (415/447), effective rate for the cases showing evident face damage was 90.0% (27/30). The result also indicated that the OP emulsion medicament was more effective than other three medicaments (P < 0.01). In vitro test showed that this medicament killed all mites within 1 hour. Toxicity test in animals showed that its LD50 was in safe range. It showed no evident stimulation and hypersensitivity by local use.

CONCLUSION

Di-n-butyl phthalate-OP emulsion is promising to be developed as a safe, effective therapeutic medicament on demodicidosis.

[Infective dermatitis and recurrent strongyloidiasis in a child]

INTRODUCTION

Infective dermatitis is a chronic childhood dermatosis, associated with HTLV-1 infection. We report the observation of a young Haitian girl in French Guyana.

OBSERVATION

An 8 year-old girl presented recurring dermatosis on the scalp and armpits since she was 2 years old. The initial clinical examination showed the presence of centro-facial micro-papules, associated with a nasal pyodermatitis. A bacteriological culture isolated a Staphylococcus aureus. Phenotypic analysis did not indicate any production of exfoliatin or leucocidin. Serologic tests for HTLV1 were positive. In addition, the child presented recurring symptomatic anguillulosis, despite numerous antihelmintic treatments. A clinical and parasitological cure was obtained with a monthly treatment of ivermectin.

COMMENTS

This is the first case of infective dermatitis reported in french Guyana. The clinical analysis that led to this diagnosis showed a minor form of this dermatosis. The phenotypic analysis of the Staphylococcus aureus isolated from the cutaneous lesions did not indicate any factors of virulence habitually associated with pyodermatitis in Guyana. This is the first case of chronic digestive anguillulosis (a parasitic complaint usually associated with an adult HTLV-1 infection) associated with an infective dermatitis.

[A case of dirofilariasis in the town of Magnitogorsk of the Cheliabinsk region]

A local case of dirofilariasis was first reported in a 70-year-old female in Magnitogorsk, Chelyabinsk Region, in November 2002. The primary diagnosis is atheroma of the skin of the forehead. A round mass having a smooth surface and slightly solid gray-whitish walls was surgically excised, which yielded a mobile rolled nematode measuring 7 cm in length and 0.8 mm in width. The parasitological diagnosis is an immature Dirofilaria repense female. It has been found that the female has neither dogs nor cats in her flat and she had not been left Mangitogorsk for approximately 18 years. A histological examination of the fibrotic capsule around the parasite revealed inflammation in the inner layer of the capsule, which was regarded as proliferative and having no signs of a granulomatous process. Fragments of cuticles of a round helminth having a well-defined alimentary tube was found. To encode the case, the authors have used Category B74.8 "Other types of filarisis (dirofilariasis)" of the first class, ICD-10.

Treatment of human Demodex folliculorum by camphor oil and metronidazole

A total of 15 females suffering from erythematotelangiectatic rosacea and 12 females free from other dermatological lesions were selected. Demodex folliculorum infestation density in both patients and control were evaluated by non-invasive skin surface biopsies. Five facial sites were selected. The daily topical application of 1/3 diluted camphor oil with glycerol and 500 mg metronidazole orally were given for fifteen days. The results were very successful with no clinical side effects.

Dirofilarial infection presenting as a facial mass: case report of an emerging zoonosis

Dirofilariasis is a parasitic infection caused by nematodes. Human infection remains rare but is increasing in scope, particularly in endemic areas. Dirofilariasis typically presents as a subcutaneous mass or with pulmonary nodules. Here, we present the case of a 73-year-old woman whose asymptomatic facial mass was caused by dirofilarial infection. The pathophysiology, diagnosis, and treatment of dirofilariasis of the head and neck will be discussed. In endemic areas, dirofilariasis must be considered in the differential diagnosis of facial masses.

Deposition of IgD, alpha-1-antitrypsin and alpha-1-antichymotrypsin on Demodex folliculorum and D. brevis infesting the pilosebaceous unit

A total of seven routinely processed biopsy specimens of facial skin lesions with infestation of Demodex folliculorum or D. brevis were immunostained for plasma proteins and secretory proteins. The cuticular layer of the mites located within the pilosebaceous unit was selectively immunoreactive for IgD (delta chain), alpha-1-antitrypsin and alpha-1-antichymotrypsin. Negative results were obtained for IgG, IgA, IgM, IgE, albumin, fibrinogen, C3, amyloid P component, prealbumin, lysozyme and lactoferrin. These findings suggest a novel function of IgD and serum protease inhibitors as a protective host response to the mite.