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2009, Cilt 33, Sayı 3, Sayfa(lar) 242-244
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Case Report: Dermanyssus gallinae in a Patient with Pruritus and Skin Lesions
Cihangir AKDEMİR1, Erim GÜLCAN2, Pınar TANRITANIR3
1Dumlupinar University, School of Medicine Department of Parasitology, Kütahya, Türkiye
2Dumlupinar University, School of Medicine Department of Internal Medicine, Kütahya, Türkiye
3Yuzuncu Yil University, College of Health, Van, Türkiye
Keywords: Pruritus, itching, dermatitis, skin lesions, Dermanyssus gallinae
Abstract
A 40-year old woman patient who presented at the Dumlupınar University Faculty of Medicine Hospital reported intensified itching on her body during evening hours. During her physical examination, puritic dermatitis lesions were found on the patient's shoulders, neck and arms in particular, and systemic examination and labaratory tests were found to be normal. The patient's story showed that similar signs had been seen in other members of the household. They reside on the top floor of a building and pigeons are occasionally seen in the ventilation shaft. Examination of the house was made. The walls of the house, door architraves and finally beds, sheets and blankets and the windows opening to the outside were examined. During the examination, arthropoda smaller than 1 mm were detected. Following preparation of the collected samples, these were found to be Dermanyssus gallinae. Together with this presentation of this event, it is believed cutaneus reactions stemming from birds could be missed and that whether or not of pets or wild birds exist in or around the homes should be investigated.
  • Top
  • Abstract
  • Introduction
  • Case Presentation
  • Disscussion
  • References
  • Introduction
    A great majority of mites belonging to Acarina order and Arachnida class live roaming freely in nature, while some others attach themselves to animals or plants and thus constituting an indispensable part of natural life4.

    Dermanyssus gallinae, a part of Mesostigmata superfamily, was first identified by De Geer in 1778, and first report of human infestation was reported by Willian in 1809. In 1828, Saint-Vincent spotted this parasite on the skin of a human, but first observation of its feeding on human blood was published by Williams in 19581. This disease is named gamasoidosis, psoradermanyssica, pseudogale, or fowl mite dermatitis; and the agent is called as chicken mite, poultry red mite or roost mite1,6,7,9.

    D.gallinae turns yellow-brown when hungry and turns redblack when full. It prefers pigeons, hens, starlings, and lovebirds as hosts. When these normal hosts are unavailable, various mammals including humans serve as parasitic objects. D.gallinae may be found almost all over the globe throughout all seasons; however human infestation cases are generally reported in late spring and summer months15.

    Mature ones measure about 0.5-0.7 mm with oval, flattened dorso-ventral forms. Their life cycles consist of egg, nymph (proto, deuto) and mature periods, with blood sucking at all times except the larvae phase. They go under optimal development at 20-25 ºC temperature and 70% humidity and complete a biological cycle in about one week3,6,7,9. It is reported that these ectoparasites can live up to 8 months without feeding, under right conditions, with resistance to dry weather and no tolerance against high humidity3. These mites reside in obscure nooks and crannies of columbaries, coops, and cages during day time and become active at night time infesting winged animals in general but also attacking mammals including humans for blood sucking6,7,9.

  • Top
  • Abstract
  • Introduction
  • Case Presentation
  • Disscussion
  • References
  • Case Presentation
    A female patient, aged 40, applied to Dumlupinar University Faculty of Medicine Hospital and reported itching all over her body intensifying particularly at evening hours. In her physical diagnosis, pruritic dermatitis lesions were observed on her neck, shoulders, and arms; with her body temperature at 37 ºC, arterial blood pressure at 118/79 mm Hg, heart rate at 80 beats/min, and respiratory rate at 16 breaths/min which were considered normal system values. At laboratory tests of the patient, white blood corpuscle count was found to be within normal range and erytrocite sedimentation rate at 100 mm/hour; and no abnormalities were detected in routine biochemical parameters, total IgE, urine and stool examinations. Her medical history and records showed no chronic condition.

    As the patient reported similar complaints by other family members in her home, and stated her apartment to be at the top floor of the building with a few pigeons using the roof of air ventilation hole as their nest, an investigation of the house was planned. Since the symptoms intensified at evening hours, the visit was made at these hours and primarily the windows opening to the hole on top of which pigeons perch, and the walls of the house, door frames, and bedclothes were examined carefully. The observations revealed the existence of white, yellow, brown, and black colored arthropods in a variety of sizes smaller than 1 mm, some moving, some at rest, in window and door frames of the bathroom and the restroom that have air ventilation windows opening to the hole, and all over the walls of the house, while bedclothes contained very few organisms. Some arthropods were collected with the help of a soft watercolor brush into 10 cc glass bottles containing a mixture of alcohol and glycerine. A total of 95 mites were collected.

    The specimens were identified through microscopic examination in the Parasitology Laboratory of the hospital as D.gallinae. The patient and family members were informed of the findings and further contacts were made with the rest of the apartments in the same building to determine the spread of the infestation. After the examinations it was found out that mites reached as far as three stories lower through air ventilation windows. The residents of infested apartments stated some itching in recent days, but mites were found in these apartments in much less amount than the first house. Immediately after these findings were told to the residents of the building, pigeons were blocked from the entry to the premises and the area was disinfected with pulverized dichlorvos (10ml/lt) accompanied by bathroom and restroom disuse for a while. The disinfection procedure was repeated after one week, and in the aftermath, no D.gallinae were detected in inspections.


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    Figure 1: Dermanyssus gallinae male, 2. D. gallinae female (with egg)

  • Top
  • Abstract
  • Introduction
  • Case Presentation
  • Disscussion
  • References
  • Discussion
    In general, pin's head size papules and vesicles accompanied by intense itching would emerge on people after 1-3 days of contact with infested organisms; and while some infection cases stay limited with navel area, armpits, and forearms, in many other cases the infection starts from the nape, the neck, and the arms and spread to other body surfaces. Papules can also be covered with a bloody crust due to violent itching9,14. It is reported that D.gallinae function as vectors for some bacteria such as Salmonella, Spirocheta, Ricketsia, Pasteurella in addition to being ectoparasitic activities13. Winged mites stay inactive within bird nests or nearby nooks and crannies during daytime, and suck blood from natural host birds during night time. If they cannot reach these natural hosts or host population is in a low level in the vicinity, they may attack humans. In such cases, pruritic dermatitis which sometimes is mistaken for scabies or pediculosis, erythematous maculopapular, or bites forming urticaria and pruritic papulovesicles would emerge10. Additionally, otitis externa is also reported under similar conditions12.

    Lucky et al.5 report a long-lasting condition in two children with pruritic papules, non-responsive to treatment, that was discovered to be originating from Ornithonyssu sylvarium and D.gallinae found on pet gerbils kept at their home; and natural recovery from the condition by expulsion of the gerbils out of that home.

    Mites can be demonstrated on patients not only by microscopic means but also by Punch biopsies. D.gallinae could be demostrated in specimens taken from patients by hematoxylineosin and immunofluoroscent staining method16.

    Prins et al.10 found D.gallinae infestation at birds in coops nearby homes of people with persistent pruritus condition and pointed to longevity of the conditions resulting from attacks from those places.

    Studies report dermatitis outbreaks with painful bites in hospitals and schools with D.gallinae infestation, rapid reproduction, and leeched people2,8,11. One of these studies report observation of pruritic erythematous maculopapular rash on both patients and employees of the hospital with mites spotted in bedclothes and pillows11. Researchers2,8,11 report end of infestations with removal of birds nesting in the related buildings.

    D.gallinae infestation is rarely mentioned among infection diseases since it is relatively infrequent, and parasitology manuals describe this parasite and its infestation smatteringly1. Pruritic dermatitis visible with papules and vesicles which sometimes is mistaken for scabies or pediculosis, may be chronic or recurrent with erythematous maculopapular or papulovesicular lesions11.

    As a result, it is concluded that pruritic dermatitis cases would be more frequent than the reports made to medical centers as in this case; and cutaneous reactions resulting from avian mites are generally gone unnoticed. It may be necessary to require a detailed anamnesis in applications to hospitals upon such symptoms. It is also concluded that existence of birds inside or nearby human inhabited places should be questioned.

  • Top
  • Abstract
  • Introduction
  • Case Presentation
  • Discussion
  • References
  • References

    1) Auger P, Nantel J, Meunier N, Harrison RJ, Loiselle R, Gyorkos TW, 1979. Skin acariasis caused by Dermanyssus gallinae (de Geer): An in-hospital outbreak. CMA Journal, 120: 702- 703.

    2) Bellanger AP, Bories C, Foulet F, Bretagne S, Botterel F, 2008. Nosocomial dermatitis caused by Dermanyssus gallinae. Infect Control Hosp Epidemiol, 29: 282-283.

    3) Chauve C, 1998. The poultry red mite Dermanyssus gallinae (DeGeer, 1778): current situation and future prospects for control. Vet Parasitol, 79: 239-245.

    4) Evans GO, 1992. Principles of Acarology. CAB Interantional Wallingford Oxon OX 8DE UK.

    5) Lucky AW, Sayers CP, Argus JD, Lucky A, 2001. Avian mite bites acquired from a new source-pet gerbils. Arch Dermatol, 137: 167-170.

    6) Merdivenci A, 1974. Medikal Entomoloji. İ.Ü Cerrahpaşa Tıp Fakültesi Yayınları. No: 2445, İstanbul.

    7) Mimioğlu M, 1973. Veteriner ve Tıbbi Artropodoloji. Ankara Ünversitesi Basımevi, Ders Kitabı, s.196.

    8) Nagakura K, Osaka F, Tazume S, 1988. Detection of fowl mites inside two hospital rooms. Tokai J Exp Clin Med, 23: 173-176.

    9) Özçelik S, 1997. Allerji ve dermatid nedeni olabilen akarlar Edit. Ozcel MA, Daldal N, Parazitolojide artropod hastalıkları ve vektörler. Türkiye Parazitoloji Derneği Yayınları No: 13.

    10) Prins M, Go IH, van Dooren-Greebe RJ, 1996. Parasitic pruritus: bird mite zoonosis. Ned Tijdschr Geneeskd, 140: 2550-2552.

    11) Regan AM, Metersky ML, Craven DE, 1987. Nosocomial dermatitis and pruritus caused by pigeon mite infestation. Arch Intern Med, 174: 2185-2187.

    12) Rossiter A, 1997. Occipational otitis externa in chicken catchers. J Laryngol Otol, 111: 366-367.

    13) Vaiente MC, Chauve C, Zenner L, 2007. Experimental infection of Salmonella enteritidis by the poultry red mite, Dermanyssus gallinae. Vet Parasitol, 146: 329-336.

    14) Varma MGR, 1993. Ticks and mites (Acari). Edit.Lane RP, Crosskey RW. Medical insects and arachnids The Natural History Museum. Chapman and Hall. British Museum (Natural History), UK.

    15) Watson CR, 2003. Human infestation with bird mites in Wollongong. Commun Dis Intel, 27: 259-261.

    16) Yassien NA, Ghoraba HM, Doghaim NN, Afify EM, 1996. Immunohistopathological status of the skin in cases infested with three species of mites. J Egypt Soc Parasitol, 26: 567-573.

  • Top
  • Abstract
  • Introduction
  • Case Presentation
  • Discussion
  • References
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