ECTOPARASITES

AND PARASITES ON HUMAN’S

SKIN/BODY SURFACE
Parasitology Department
Learning Objectives
 Parasites that causes infestation in the skin and human surface:
 Agents of disease: Sarcoptes scabiei, Pediculus humanus, Phtirus
pubis
 Pathogenesis
 Preventive treatment
 Cercarial dermatitis and filarial dermatitis
 Cutaneous larva migrans:
 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 BBS-
Parasitology
 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 Acry-Mount

on a glass slide with cover
slip on top

 Scybala
 male female
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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
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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 host’s 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, immuno-suppressed 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
Vagabond’s 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

 Treat social contacts
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 (swimmer’s 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 can’t 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 host’s dead or living
tissue, liquid body-substances or ingested food
(Herm’s, 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 larvae’s
respiratory such as Vaseline, or similar material.
 Thank You

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