RESUMO
Dermoscopy has been used for the non-invasive diagnosis of demodicosis. Several studies have evaluated the usefulness of this tool in the diagnosis, however, there are differences in the gold standard (SSSB or KOH test) and criteria of positivity used between studies. Added to this, is the lack of controls and objective quantification of the usefulness of dermoscopic signs in clinically observable and relevant ranges. To validate the usefulness of dermoscopy for the diagnosis of demodicosis by calculating the performance indicators for the different dermoscopic signs. Retrospective intrapatient case-control study, which included adults with suspicion of demodicosis. Dermoscopic photographs and scraping of healthy and lesional skin were obtained. Samples were analyzed microscopically by trained personnel. Photographs were evaluated by determining the presence of Demodex tails (DT), dilated follicular openings (DFO) and dilated blood vessels (DBV) in pre-defined ranges. 64 patients were included (total = 256 samples); the presence of demodex on skin scraping was seen in 69%. Under dermoscopy, the presence of DT in range 11-20/field had a positive likelihood ratio (LR) of 12.10 (95%CI 6.52-22.45) and negative LR 0.32 (95%CI 0.23-0.45). Combined and dichotomized performance for at least one positive sign under dermoscopy (DT > 10/field, DFO > 10/field or DBV > 50% of the field): positive LR 7.14 (95%CI 4.80-10.62) and negative LR 0.11 (95%CI 0.06-0.22). The presence of DT, DFO or DBV has a high correlation with a positive mite test, so the diagnosis of demodicosis could be made only through dermoscopy.
Assuntos
Dermoscopia , Infestações por Ácaros , Ácaros , Humanos , Infestações por Ácaros/diagnóstico , Estudos Retrospectivos , Feminino , Adulto , Estudos de Casos e Controles , Masculino , Pessoa de Meia-Idade , Animais , Idoso , Pele/patologia , Pele/parasitologia , Pele/diagnóstico por imagem , Adulto JovemRESUMO
Blepharitis is a very common disease in ophthalmology, dermatology and allergy practice. It generally follows a chronic course and is frequently associated with objective and/or subjective symptoms such as epiphora, red eye, dandruff, gritty sensation, itching, burning, photophobia, and blurred vision. The purpose of this study is to analyze the prevalence of Demodex spp. in patients with symptoms of chronic blepharitis. An analytical cross-sectional study was conducted in the period between 2016 and 2020. All patients with symptoms of chronic blepharitis who underwent a parasitological test of eyelashes (Rapitest) in the Dermatology Department of the Hospital Italiano de Buenos Aires were included. Those with previously established blepharitis due to another infectious cause were excluded. We analyzed 972 patients. Sixty percent (n=585) underwent a positive Rapitest for the presence of Demodex spp. Seventy five percent (n=728) were women. There were no significant differences in the prevalence associated with sex (p=0.38). Among the patients positive for Demodex spp., 65% (n=628) were older than 60 years old. The most frequently associated symptom was itching, present in 35% (n=342). A statistically significant decrease in the number of consultations was observed during the cold months of the year (May-June-July-August). Our results show a high prevalence of Demodex spp. in patients with chronic blepharitis. As its presence reveals a direct association with age, we recommend looking for this parasite in this age group.
Assuntos
Blefarite , Infestações por Ácaros , Ácaros , Animais , Humanos , Feminino , Pessoa de Meia-Idade , Masculino , Infestações por Ácaros/epidemiologia , Prevalência , Estudos Transversais , Blefarite/epidemiologia , Blefarite/parasitologia , Prurido/complicaçõesRESUMO
BACKGROUND: To evaluate the efficacy of topical ivermectin 1% ointment, for the treatment of Demodex blepharitis. METHODS: A retrospective study was designed to review electronic medical records of patients seen between January 2017 and December 2022, who had a diagnosis of Demodex blepharitis, treated with topical ivermectin 1% with at least 6 months of follow-up (Centro de Ojos Quilmes, Buenos Aires, Argentina). The presence of collarettes was graded from 0 to 4. An imaging system (Keratograph) was used, to evaluate tear meniscus height (TMH), non-invasive tear break-up time (NIKBUT), and degree of conjunctival redness. In addition, the ocular surface disease index (OSDI) test was performed. Results were compared before and after ivermectin treatment, which was performed once a day for 2 months. RESULTS: A total of 2157 patients (4314 eyes) were included. The mean age was 50.43 ± 15.3 years, and the follow-up time was 26.1 ± 8.5 months. No one discontinued treatment due to intolerance, although 14 cases (0.6 %) reported occasional discomfort. The grade of collarettes decreased with statistical significance, from 3.37 ± 0.7 to 0.1 ± 0.3 (p < 0.01), as well as conjunctival redness from 1.32 ± 0.3 to 0.94 ± 0.4 (p < 0.01) and OSDI score from 58.74 ± 17.9 to 17.1 ± 10.5 (p = 0.02). TMH and NIKBUT improved without statistical difference. CONCLUSION: Treatment with ivermectin 1% topical ointment, once daily for 2 months, was effective in reducing the presence of collarettes and in improving symptoms in patients with Demodex blepharitis.
Assuntos
Blefarite , Infestações por Ácaros , Humanos , Adulto , Pessoa de Meia-Idade , Idoso , Ivermectina , Estudos Retrospectivos , Blefarite/diagnóstico , Blefarite/tratamento farmacológico , Infestações por Ácaros/diagnóstico , Infestações por Ácaros/tratamento farmacológico , PomadasRESUMO
Objetivo: Evaluar el efecto de la ivermectina sobre Demodex folliculorum in vitro. Materiales y métodos: Bajo microscopio de luz se evaluó el movimiento y anatomía de los parásitos durante 90 minutos. En una lámina portaobjetos no se aplicó nada y sirvió como control. En las otras láminas se aplicó ivermectina al 0.6 y 1%, respectivamente. Resultados: Los parásitos en la placa de control no presentaron cambios en su movilidad ni en su estructura anatómica. Los parásitos a los que se les aplicó ivermectina en concentraciones de 0.6% presentaron alteraciones de movilidad y estructura después del minuto 30 y aquellos sometidos a la concentración al 1% presentaron alteraciones de movilidad y estructura después del minuto 15. Conclusiones: Nuestro estudio demuestra que la ivermectina al 0.6 y 1% afecta la estructura y función de Demodex folliculorum in vitro.
Objective: To evaluate the effect of Ivermectin on Demodex folliculorum in vitro. Materials and methods: Under a light microscope, the movement and anatomy of parasites was evaluated during 90 minutes. On one plate nothing was applied and served as a control. In the other two plates, ivermectin was applied at 0.6% and 1%, respectively. Results: The parasites on the control plate showed no changes in their mobility or anatomical structure. The parasites to which ivermectin was applied in concentrations of 0.6% presented alterations of mobility and structure after the 30th minute and those subjected to the 1% concentration presented alterations of mobility and structure after the 15th minute. Conclusions: Our study shows that ivermectin at 0.6 and 1% affects the structure and function of Demodex folliculorum in vitro.
Assuntos
HumanosRESUMO
BACKGROUND: Demodex folliculorum is a mite that causes human demodicosis, which is characterized by producing lesions on the face, and its infestation could be associated with factors that alter the immune response, including Type 2 Diabetes (T2D). This study aimed to evaluate the relationship between T2D and D. folliculorum infestation in patients attended at a hospital in Peru in 2021. METHODS: A cross-sectional study enrolling patients who were classified according to the presence (n = 100) and absence (n = 100) of T2D was conducted. Information was obtained on age, sex, domestic animal husbandry, and symptoms and signs associated with demodicosis. Demodicosis was determined to be present when counts of D. folliculorum greater than five mites per cm2 were found in superficial facial skin biopsies. RESULTS: A frequency of demodicosis in 76 and 35 patients with and without T2D, respectively, was observed. In the multivariate analysis adjusted for confounders age, sex, and domestic animal husbandry, T2D was found to be associated with D. folliculorum infestation (PR: 2.13; 95% CI95: 1.42-3.19). CONCLUSIONS: T2D was associated with D. folliculorum infestation. In this sense, it is important to strengthen surveillance to identify of D. folliculorum infestation in people with T2D.
Assuntos
Diabetes Mellitus Tipo 2 , Infestações por Ácaros , Ácaros , Animais , Humanos , Infestações por Ácaros/epidemiologia , Infestações por Ácaros/complicações , Infestações por Ácaros/diagnóstico , Estudos Transversais , Peru/epidemiologia , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/complicaçõesRESUMO
PURPOSE: To evaluate the safety and efficacy of lotilaner ophthalmic solution, 0.25% for the treatment of blepharitis due to Demodex infestation compared to vehicle control. METHODS: In this phase II, randomized, controlled, double-masked clinical trial, 60 eligible participants with Demodex blepharitis were randomly assigned in a 1:1 ratio to receive either topical lotilaner ophthalmic solution, 0.25% (Tarsus Pharmaceuticals, Inc., Irvine, CA) (study group) or the vehicle without lotilaner (control group) bilaterally twice a day for 28 days. Participants were followed at Days 7, 14, 28, 60 and 90. The efficacy parameters were change in collarette grade and Demodex density at Day 28. Safety parameters were adverse events, changes in corrected distance visual acuity (CDVA), intraocular pressure (IOP) and slit-lamp biomicroscopy. RESULTS: The study group showed a statistically significant decrease in collarette grade compared to the control group beginning at Day 14 (p = 0.003) in the upper eyelid and at Day 28 (p = 0.003) in the lower eyelid. Decreases in both lids were maintained through Day 90 (p < 0.001). At Day 28, mite eradication was achieved in 66.7% and 25.9% of eyes in the study and control group (p = 0.005); at Day 90, these proportions were 68.2% and 18.5% (p = 0.001), respectively. No serious adverse events or clinically significant changes in CDVA and IOP were observed. CONCLUSION: For Demodex blepharitis, treatment with lotilaner ophthalmic solution, 0.25% for 4 weeks is safe and effective. The improvement in collarette grade and mite density observed during the treatment period persisted for at least two months following treatment cessation.
Assuntos
Blefarite , Pestanas , Infestações por Ácaros , Ácaros , Animais , Blefarite/diagnóstico , Blefarite/tratamento farmacológico , Blefarite/etiologia , Humanos , Infestações por Ácaros/complicações , Infestações por Ácaros/tratamento farmacológico , Soluções Oftálmicas , Oxazóis , TiofenosRESUMO
Background: Demodicosis is a parasitic dermatopathy often found in dogs and considered rare in felines. It is caused by the mite of the genus Demodex. In cats, it can be caused by 3 species: Demodex cati, Demodex gatoi, and another Demodex species not yet named. Demodicosis can be associated with systemic diseases, which can compromise the animal's immune system, as is the case of demodicosis caused by Demodex cati. The present case report describes 3 cases of demodicosis, 2 by D. cati and 1 by D. gatoi, with pruritic lesions and abrasions in different parts of the animals' bodies, but which showed improvement with common treatment. Cases: The first 2 cases refer to feline patients treated in Curitibanos and the third in Blumenau, both municipalities located in Santa Catarina. The first patient, a 6-year-old female, SRD, IVF/FeLV-negative, presented abrasions and alopecia in the cervical region, at the base of the auricle and submandibular region, with pruritus for 3 months. Skin scraping was performed revealing presence of Demodex cati. The second patient, a 11-year-old male, SRD, FIV-negative and FeLVpositive, presented alopecic lesions with mild pruritus, one on the dorsal region of the head and 2 others slightly oval on the tail. A skin scraping was performed for parasitological examination which demonstrated the presence of mites of the species Demodex cati. The third patient, a 10-month-old male Persian, IVF/FeLV-negative, had alopecic and pruritic lesions on the back and head near the auditory canal, as well as signs of external otitis. The lesions on the skin were scaly and presented a blackish appearance, with evolution of a few weeks. Skin scraping was performed for parasitological examination, confirming the presence of Demodex gatoi. In all cases, fungal cultures were negatives. For the 3 patients, fluralaner was used transdermally, as a pipette with a single application, and all showed complete improvement within 30 days after administration. Discussion: Demodicosis is considered a rare disease among felines and the literature suggests involvement when linked to immunosuppressive causes, such as viral diseases or systemic comorbidities. Still, it can become the cause of bacterial or fungal co-infections due to immunological impairment. In the 3 cases reported, only 1 patient was positive for FeLV. Parasitological examination of the skin by deep or superficial skin scraping, considered as the diagnostic method of choice for demodicosis, was performed in the 3 patients and demonstrated the presence of mites. Although the literature does not provide treatment considered to be of choice for felines, fluralaner was prescribed transdermally for the 3 patients reported here due to its practicality and prolonged time of action, administered in single application as antiparasitic therapy, achieving success and complete improvement up to 30 days after its use. The animals that presented co-infections were treated according to the type of infections they presented and their therapies of choice.
Assuntos
Animais , Gatos , Dermatopatias Parasitárias/terapia , Dermatopatias Parasitárias/veterinária , Infestações por Ácaros/veterinária , Ácaros/parasitologiaRESUMO
Los ácaros ectoparásitos del género Demodex spp (>140 especies) pertenecen a la familia Demodicidae, superfamilia Cheyletoidea, suborden Prostigmata, orden Trombidiformes, superorden Acariformes. Fueron descritos por primera vez en 1841 por Henle y Berger. El término Demodex deriva del griego: demos = grasa y dex = gusano incrustado. Tienen una longitud de 0.2- 0.4 mm, son transparentes y elongados. Su cuerpo se divide en tres secciones principales: 1) gnatosoma, región anterior, en donde se encuentra la apertura bucal; 2) podosoma, región en la que se encuentran sus cuatro pares de patas; y 3) el opistoma, región caudal o cola. Se adquieren poco después del nacimiento y se consideran parte del microbiota normal de muchos mamíferos, así como también del ser humano, en particular de la unidad pilosebácea. Por lo tanto, se ubican principalmente en el rostro, cuero cabelludo y región superior del tronco. Todas estas áreas corporales se caracterizan por la alta secreción sebácea, alimento primordial para el crecimiento y desarrollo de este ácaro; razón por la cual, además, su densidad aumenta durante la pubertad, periodo cuando proliferan las glándulas sebáceas. Dentro de las especies del género, encontramos exclusivamente en humanos, a D. folliculorum (440 µm), habitando frecuentemente el infundíbulo folicular y D. brevis (240 µm), que se localiza predominantemente en los ductos sebáceos y glándulas tarsales a nivel ocular.(AU)
Assuntos
Humanos , Infestações por Ácaros/diagnóstico , Infestações por Ácaros/parasitologia , Metronidazol/administração & dosagem , Infestações por Ácaros/tratamento farmacológicoRESUMO
Among the skin disorders of dogs, scabies is notable for its high occurrence rate and the need for veterinary interventions. There are two obstacles to making this diagnosis through direct investigation under a microscope (DIM): the continual need to make new slides when the results are negative and the long time needed for reading these slides. Thus, the objective of the present study was to compare efficacy between DIM and the technique of centrifugation-flotation in sucrose solution (CFSS) in samples from dogs in the semiarid region of the state of Paraíba, Brazil. Samples from 136 dogs were used, and three slides were made for each examination (DIM and CFSS). The readings were halted in cases of positivity. Positive samples were obtained from 56.6% of the dogs (77/136), of which 76.6% (59/77) were positive through both techniques, 13% (10/77) only through DIM and 10.4% (8/77) only through CFSS. The positivity rate did not differ statistically between the techniques. CFSS showed higher quality of readings, due to the considerably fewer artifacts on the slides, thereby optimizing the reading time. Sensitivity (85.6%), specificity (88.1%), accuracy (86.8%), positive predictive value (88.1%) and negative predictive value (85.1%) were obtained and the kappa coefficient (0.73) was considered substantial. It was concluded that CFSS showed high diagnostic capacity for scabies, similar to that of DIM, with optimized reading time, fewer artifacts and better display of mites.
Assuntos
Doenças do Cão , Escabiose , Animais , Centrifugação , Técnicas de Laboratório Clínico , Doenças do Cão/diagnóstico , Cães , Sarcoptes scabiei , SacaroseRESUMO
Purpose: To evaluate the efficacy of topical lotilaner ophthalmic solution, 0.25%, in patients with Demodex blepharitis. Methods: Eighteen adults with Demodex blepharitis, defined as >10 collarettes on the upper lid and/or mite density of ≥1.5 mites per lash (upper and lower), were treated bid for 42 days with the topical lotilaner ophthalmic solution, 0.25%. Contact lens wear, artificial eyelashes, and lid structural abnormalities were among the exclusion criteria. No other antibacterial, antiparasitic, or anti-inflammatory treatment or lid hygiene products were permitted. One eye of each patient was selected for analysis and assessed on day 7, 14, 28, and 42. Collarettes were graded at each visit, and mite density was evaluated by microscopy at each visit except day 7. Outcome measures were collarette elimination (≤2 lashes with collarettes) and mite eradication (0 mites). Drop tolerability, adverse events, visual acuity, and slit-lamp biomicroscopy were assessed. Results: Collarette elimination was achieved in 13/18 participants (72.2%) by day 42. Mean collarette grade (upper lid) declined from 3.56 ± 0.17 to 0.28 ± 0.11. Mite eradication was achieved in 14/18 participants (77.8%) by day 42. Mean mite density decreased from 2.63 ± 0.39 to 0.12 ± 0.08 mites/lash. Participants reported good tolerability. Adverse events were mild and transient and did not result in treatment discontinuation. Conclusion: Six weeks of at-home topical therapy with the lotilaner ophthalmic solution, 0.25%, was effective in eliminating the most common objective signs of Demodex blepharitis, with a collarette elimination rate of 72% and mite eradication in 78% of eyes by day 42. ISRCTN registration #: 24398865.