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1/41. delusions of parasitosis. An approach to the problem.

    One of the most frustrating problems in clinical dermatology is the patient with a delusion of parasitosis. Over the years, very little realistic and practical advice has been offered to the perplexed dermatologists. We describe an approach that is based on the thesis that dermatologists can and often should treat such patients. By considering each patient as an individual, and by working to build rapport, the dermatologist is in the best position to offer help. We report two illustrative cases and discuss guidelines to treatment. ( info)

2/41. Delusion of infestation with post-partum onset: case report.

    Compared with men, women have a greater lifetime risk of delusions of infestation, with the risk appearing to increase around the menopause, when the blood levels of reproductive hormones are decreasing. women also have a greater lifetime risk of depression and an increased incidence of depressive symptoms post partum, when the blood levels of these hormones are decreasing as well. The first case of a delusion of infestation with post-partum onset is described, and possible associations with reproductive function in women are discussed. ( info)

3/41. tungiasis in a 3-year-old child.

    tungiasis is an infestation of the skin caused by the flea tunga penetrans. It is not rare in western europe because of tourism to tropical and subtropical countries. However, tungiasis has been very rarely reported in children. We describe a case of tungiasis in a 3-year-old child. The infestation was localized to the second toe of the left foot and was characterized by an atypical clinical presentation. ( info)

4/41. Misidentification of onchocerca volvulus as guinea worm.

    Over the past 10 years, the status of human infection with guinea worm (Dracunculus medinensis) in the central african republic (CAR) has been difficult to ascertain. It is unclear if indigenous cases are occurring and whether cases are migrating into the CAR from surrounding countries. A team of investigators visited the CAR in July-August 2000, to attempt to ascertain the presence of indigenous transmission. No cases of true guinea-worm infection (i.e. dracunculiasis) were detected, but three cases of human infection with onchocerca volvulus, each of which had been misidentified as dracunculiasis, were detected. The unusual presentation of skin blisters and extraction of an intact female O. volvulus are described. As a result of this investigation, and the confusion of onchocerciasis being misidentified as dracunculiasis, the presence of endemic transmission of guinea worm in the CAR remains in question. ( info)

5/41. Stowaways with wings: two case reports on high-flying insects.

    More people than ever before are traversing continents, either for business purposes or on holiday. Because 3-10 percent of these travelers experience skin, hair, or nail disorders related to these trips there is an increasing likelihood that Western physicians will be expected to treat exotic conditions imported from different countries. tungiasis and furunculoid myiasis are two typical disorders of intertropical regions. They represent nuisances induced by the presence of arthropod larvae or eggs in the skin. We describe a case of tungiasis, caused by the sand flea tunga penetrans (TP), and a case of myiasis, caused by Dermatobia hominis (DH), and briefly discuss the epidemiology, biologic life cycles, vectors, reservoirs, and clinical presentations of these parasites. ( info)

6/41. Localized scalp hair shedding caused by Pheidole ants and overwiew of similar case reports.

    Localized hair shedding caused by Pheidole ants is reported as a newly recognized type of hair loss, mimicking alopecia areata. We report two cases from Kerman, iran. This sudden hair loss demonstrates that ants such as the Pheidole dimorphic species can cause hair shedding. Fairly clean cutting of the scalp hair takes place just a few micrometers above the skin surface and simulates alopecia areata or mechanical shaving of scalp hair. This infestation has not been reported from other countries, and this report is the second from iran. ( info)

7/41. Severe tungiasis in underprivileged communities: case series from brazil.

    tungiasis is caused by infestation with the sand flea (tunga penetrans). This ectoparasitosis is endemic in economically depressed communities in South American and African countries. tungiasis is usually considered an entomologic nuisance and does not receive much attention from healthcare professionals. During a study on tungiasis-related disease in an economically depressed area in Fortaleza, northeast brazil, we identified 16 persons infested with an extremely high number of parasites. These patients had >50 lesions each and showed signs of intense acute and chronic inflammation. superinfection of the lesions had led to pustule formation, suppuration, and ulceration. Debilitating sequelae, such as loss of nails and difficulty in walking, were constant. In economically depressed urban neighborhoods characterized by a high transmission potential, poor housing conditions, social neglect, and inadequate healthcare behavior, tungiasis may develop into severe disease. ( info)

8/41. delusional parasitosis: folie a deux and attempted murder of a family doctor.

    A 58-year-old woman suffering from delusional parasitosis tried to kill her general practitioner. Her husband shared in her beliefs but lost all delusional conviction after she was compulsorily admitted to a special hospital. The case illustrates the intractable nature and potential dangerousness of some of these cases, and their affinity to paranoia. ( info)

9/41. Atypical antipsychotics in the treatment of delusional parasitosis.

    delusional parasitosis is the false belief that one's body is infested with one or many different living organisms. Historically, it has been treated with conventional antipsychotics with only moderate success. The conventional antipsychotic most commonly used has been pimozide. We report a series of five cases of patients with delusional parasitosis. Our patients' demographic characteristics were similar to those in previously published case reports, but instead of being treated with older antipsychotics, they were all treated with atypical antipsychotic agents with favorable results. We will discuss the rationale for this treatment choice, and will review the role of serotonin/dopamine antagonists in the treatment of delusional parasitosis. We will also comment on the possible role of serotonergic antidepressants in the treatment of these patients. ( info)

10/41. Aquatic leech infestation: a rare cause of severe anaemia in an adolescent Tanzanian girl.

    We report on a 15-year-old girl who presented with a history of chest pain, coughing, intermittent haemoptysis, fever, pallor and vomiting to a rural hospital in tanzania. She was severely anaemic with signs of cardiorespiratory distress. Haemoglobin was 4.8 g/dl; the chest x-ray film was normal. She required one unit of blood. After 3 days, she vomited up a small parasite which proved to be an aquatic leech. Oesophagogastroscopy, then performed, revealed four small mucosal lesions in the pharynx and upper oesophagus. No other leeches were seen. Further oesophagogastroscopy 4 days later showed a normal mucosa. The girl was discharged on iron and folic acid supplements. A small lake near her village was identified as the likely source of her infestation. The family had used the water for drinking without any precautions-Terrestrial leeches can cause profound, life-threatening anaemia, but even more so do aquatic leeches. This type is acquired while bathing or drinking unfiltered water. They attach themselves to mucous membranes, having been described in sites like conjunctiva, nose, pharynx/larynx, trachea/bronchi, oesophagus, vagina, and rectum. Especially in the airways, they can cause even fatal bleeding or obstruction. Treatment consists of removal of the leech. CONCLUSION: In developing countries, even unusual causes like leech infestation have to be considered in the differential diagnosis of severe anaemia in children. ( info)
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