Tungiasis under dermoscopy: in vivo and ex vivo examination of the cutaneous infestation due to Tunga penetrans*
Identifieur interne : 003A99 ( Pmc/Corpus ); précédent : 003A98; suivant : 003B00Tungiasis under dermoscopy: in vivo and ex vivo examination of the cutaneous infestation due to Tunga penetrans*
Auteurs : Paulo Ricardo Criado ; Gilles Landman ; Vitor Manoel Silva Dos Reis ; Walter BeldaSource :
- Anais Brasileiros de Dermatologia [ 0365-0596 ] ; 2013.
Abstract
The female flea Tunga penetrans is responsible for a cutaneous parasitosis known as
Tungiasis. We report the clinical case of a 12 year-old Caucasian boy who sought
treatment in a dermatological private office due to a painful lesion in the plantar
area and whose dermoscopic examination, without skin contact, allowed the
visualization of parasite's movement inside the skin. The diagnosis of tungiasis is
clinical, but it can be aided by
Url:
DOI: 10.1590/abd1806-4841.20132071
PubMed: 24068146
PubMed Central: 3760950
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Tungiasis under dermoscopy: <italic>in vivo</italic> and <italic>ex
vivo</italic> examination of the cutaneous infestation due to <italic>Tunga
penetrans</italic><xref ref-type="fn" rid="fn01">*</xref></title><author><name sortKey="Criado, Paulo Ricardo" sort="Criado, Paulo Ricardo" uniqKey="Criado P" first="Paulo Ricardo" last="Criado">Paulo Ricardo Criado</name><affiliation><nlm:aff id="aff01"> MD, PhD in Dermatology at the University of São Paulo Medical School (FMUSP) - Member of the Dermatology Department at the University of São Paulo Medical School Clinics Hospital (HC-FMUSP) - São Paulo (SP), Brazil.</nlm:aff></affiliation></author><author><name sortKey="Landman, Gilles" sort="Landman, Gilles" uniqKey="Landman G" first="Gilles" last="Landman">Gilles Landman</name><affiliation><nlm:aff id="aff02"> MD, PhD, Full Professor of Pathology at the Federal University of São Paulo (UNIFESP) - São Paulo (SP), Brazil.</nlm:aff></affiliation></author><author><name sortKey="Dos Reis, Vitor Manoel Silva" sort="Dos Reis, Vitor Manoel Silva" uniqKey="Dos Reis V" first="Vitor Manoel Silva" last="Dos Reis">Vitor Manoel Silva Dos Reis</name><affiliation><nlm:aff id="aff03"> MD, Full Professor at the University of São Paulo Medical School (FMUSP) - Dermatologist at the Dermatology Department at the University of São Paulo Medical School Clinics Hospital (HC-FMUSP) - São Paulo (SP), Brazil.</nlm:aff></affiliation></author><author><name sortKey="Belda, Walter" sort="Belda, Walter" uniqKey="Belda W" first="Walter" last="Belda">Walter Belda</name><affiliation><nlm:aff id="aff04"> MD, PhD, Full Professor in Dermatology at the University of São Paulo Medical School (FMUSP) and the Campinas State University Medical School (UNICAMP) - Associated Professor at the Dermatology Department at the University of São Paulo Medical School (FMUSP) - São Paulo (SP), Brazil.</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">24068146</idno><idno type="pmc">3760950</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3760950</idno><idno type="RBID">PMC:3760950</idno><idno type="doi">10.1590/abd1806-4841.20132071</idno><date when="2013">2013</date><idno type="wicri:Area/Pmc/Corpus">003A99</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">003A99</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Tungiasis under dermoscopy: <italic>in vivo</italic> and <italic>ex
vivo</italic> examination of the cutaneous infestation due to <italic>Tunga
penetrans</italic><xref ref-type="fn" rid="fn01">*</xref></title><author><name sortKey="Criado, Paulo Ricardo" sort="Criado, Paulo Ricardo" uniqKey="Criado P" first="Paulo Ricardo" last="Criado">Paulo Ricardo Criado</name><affiliation><nlm:aff id="aff01"> MD, PhD in Dermatology at the University of São Paulo Medical School (FMUSP) - Member of the Dermatology Department at the University of São Paulo Medical School Clinics Hospital (HC-FMUSP) - São Paulo (SP), Brazil.</nlm:aff></affiliation></author><author><name sortKey="Landman, Gilles" sort="Landman, Gilles" uniqKey="Landman G" first="Gilles" last="Landman">Gilles Landman</name><affiliation><nlm:aff id="aff02"> MD, PhD, Full Professor of Pathology at the Federal University of São Paulo (UNIFESP) - São Paulo (SP), Brazil.</nlm:aff></affiliation></author><author><name sortKey="Dos Reis, Vitor Manoel Silva" sort="Dos Reis, Vitor Manoel Silva" uniqKey="Dos Reis V" first="Vitor Manoel Silva" last="Dos Reis">Vitor Manoel Silva Dos Reis</name><affiliation><nlm:aff id="aff03"> MD, Full Professor at the University of São Paulo Medical School (FMUSP) - Dermatologist at the Dermatology Department at the University of São Paulo Medical School Clinics Hospital (HC-FMUSP) - São Paulo (SP), Brazil.</nlm:aff></affiliation></author><author><name sortKey="Belda, Walter" sort="Belda, Walter" uniqKey="Belda W" first="Walter" last="Belda">Walter Belda</name><affiliation><nlm:aff id="aff04"> MD, PhD, Full Professor in Dermatology at the University of São Paulo Medical School (FMUSP) and the Campinas State University Medical School (UNICAMP) - Associated Professor at the Dermatology Department at the University of São Paulo Medical School (FMUSP) - São Paulo (SP), Brazil.</nlm:aff></affiliation></author></analytic><series><title level="j">Anais Brasileiros de Dermatologia</title><idno type="ISSN">0365-0596</idno><idno type="eISSN">1806-4841</idno><imprint><date when="2013">2013</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>The female flea Tunga penetrans is responsible for a cutaneous parasitosis known as
Tungiasis. We report the clinical case of a 12 year-old Caucasian boy who sought
treatment in a dermatological private office due to a painful lesion in the plantar
area and whose dermoscopic examination, without skin contact, allowed the
visualization of parasite's movement inside the skin. The diagnosis of tungiasis is
clinical, but it can be aided by <italic>in vivo </italic>and <italic>ex vivo
</italic>dermoscopic examination of the lesion.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Heukelbach, J" uniqKey="Heukelbach J">J Heukelbach</name></author><author><name sortKey="Sahebali, S" uniqKey="Sahebali S">S Sahebali</name></author><author><name sortKey="Van Marck, E" uniqKey="Van Marck E">E Van Marck</name></author><author><name sortKey="Sab Ia Moura, Rc" uniqKey="Sab Ia Moura R">RC Sabóia Moura</name></author><author><name sortKey="Feldmeier, H" uniqKey="Feldmeier H">H Feldmeier</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Yotsu, Rr" uniqKey="Yotsu R">RR Yotsu</name></author><author><name sortKey="Tamaki, T" uniqKey="Tamaki T">T Tamaki</name></author><author><name sortKey="Ujiie, M" uniqKey="Ujiie M">M Ujiie</name></author><author><name sortKey="Takeshita, N" uniqKey="Takeshita N">N Takeshita</name></author><author><name sortKey="Kanagawa, S" uniqKey="Kanagawa S">S Kanagawa</name></author><author><name sortKey="Kudo, K" uniqKey="Kudo K">K Kudo</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Vallarelli, Afa" uniqKey="Vallarelli A">AFA Vallarelli</name></author><author><name sortKey="De Souza, Em" uniqKey="De Souza E">EM de Souza</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Dunn, R" uniqKey="Dunn R">R Dunn</name></author><author><name sortKey="Asher, R" uniqKey="Asher R">R Asher</name></author><author><name sortKey="Bowling, J" uniqKey="Bowling J">J Bowling</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Bauer, J" uniqKey="Bauer J">J Bauer</name></author><author><name sortKey="Forschner, A" uniqKey="Forschner A">A Forschner</name></author><author><name sortKey="Garbe, C" uniqKey="Garbe C">C Garbe</name></author><author><name sortKey="Rocken, M" uniqKey="Rocken M">M Röcken</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Di Stefani, A" uniqKey="Di Stefani A">A Di Stefani</name></author><author><name sortKey="Rudolph, Cm" uniqKey="Rudolph C">CM Rudolph</name></author><author><name sortKey="Hofmann Wellenhof, R" uniqKey="Hofmann Wellenhof R">R Hofmann-Wellenhof</name></author><author><name sortKey="Mullegger, Rr" uniqKey="Mullegger R">RR Müllegger</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Bakos, Rm" uniqKey="Bakos R">RM Bakos</name></author><author><name sortKey="Bakos, L" uniqKey="Bakos L">L Bakos</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Cabrera, R" uniqKey="Cabrera R">R Cabrera</name></author><author><name sortKey="Daza, F" uniqKey="Daza F">F Daza</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">An Bras Dermatol</journal-id><journal-id journal-id-type="iso-abbrev">An Bras Dermatol</journal-id><journal-id journal-id-type="publisher-id">An Bras Dermatol</journal-id><journal-title-group><journal-title>Anais Brasileiros de Dermatologia</journal-title></journal-title-group><issn pub-type="ppub">0365-0596</issn><issn pub-type="epub">1806-4841</issn><publisher><publisher-name>Sociedade Brasileira de Dermatologia</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">24068146</article-id><article-id pub-id-type="pmc">3760950</article-id><article-id pub-id-type="doi">10.1590/abd1806-4841.20132071</article-id><article-categories><subj-group subj-group-type="heading"><subject>Imaging in Tropical Dermatology</subject></subj-group></article-categories><title-group><article-title>Tungiasis under dermoscopy: <italic>in vivo</italic> and <italic>ex
vivo</italic> examination of the cutaneous infestation due to <italic>Tunga
penetrans</italic><xref ref-type="fn" rid="fn01">*</xref></article-title><trans-title-group xml:lang="pt"><trans-title>Tungíase sob dermatoscopia: exame <italic>in vivo</italic> e <italic>ex
vivo</italic> da infestação cutânea pela <italic>Tunga penetrans</italic></trans-title></trans-title-group></title-group><contrib-group><contrib contrib-type="author"><name><surname>Criado</surname><given-names>Paulo Ricardo</given-names></name><xref ref-type="aff" rid="aff01">1</xref><xref ref-type="corresp" rid="c01"></xref></contrib><contrib contrib-type="author"><name><surname>Landman</surname><given-names>Gilles</given-names></name><xref ref-type="aff" rid="aff02">2</xref></contrib><contrib contrib-type="author"><name><surname>dos Reis</surname><given-names>Vitor Manoel Silva</given-names></name><xref ref-type="aff" rid="aff03">3</xref></contrib><contrib contrib-type="author"><name><surname>Belda</surname><given-names>Walter</given-names><suffix>Junior</suffix></name><xref ref-type="aff" rid="aff04">4</xref></contrib></contrib-group><aff id="aff01"><label>1</label> MD, PhD in Dermatology at the University of São Paulo Medical School (FMUSP) - Member of the Dermatology Department at the University of São Paulo Medical School Clinics Hospital (HC-FMUSP) - São Paulo (SP), Brazil.</aff><aff id="aff02"><label>2</label> MD, PhD, Full Professor of Pathology at the Federal University of São Paulo (UNIFESP) - São Paulo (SP), Brazil.</aff><aff id="aff03"><label>3</label> MD, Full Professor at the University of São Paulo Medical School (FMUSP) - Dermatologist at the Dermatology Department at the University of São Paulo Medical School Clinics Hospital (HC-FMUSP) - São Paulo (SP), Brazil.</aff><aff id="aff04"><label>4</label> MD, PhD, Full Professor in Dermatology at the University of São Paulo Medical School (FMUSP) and the Campinas State University Medical School (UNICAMP) - Associated Professor at the Dermatology Department at the University of São Paulo Medical School (FMUSP) - São Paulo (SP), Brazil.</aff><author-notes><corresp id="c01"><bold>MAILING ADDRESS:</bold> Paulo Ricardo Criado, Rua Carneiro Leão 33 - Vila
Scarpelli, 09050-430 - Santo André - SP, Brazil, E-mail:
<email>prcriado@uol.com.br</email></corresp></author-notes><pub-date pub-type="ppub"><season>Jul-Aug</season><year>2013</year></pub-date><volume>88</volume><issue>4</issue><fpage>649</fpage><lpage>651</lpage><history><date date-type="received"><day>17</day><month>8</month><year>2012</year></date><date date-type="accepted"><day>24</day><month>10</month><year>2012</year></date></history><permissions><copyright-statement>©2013 by Anais Brasileiros de Dermatologia</copyright-statement><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by-nc/3.0/"><license-p>This is an open-access article distributed under the terms of the Creative
Commons Attribution License, which permits unrestricted use, distribution, and
reproduction in any medium, provided the original work is properly
cited.</license-p></license></permissions><abstract><p>The female flea Tunga penetrans is responsible for a cutaneous parasitosis known as
Tungiasis. We report the clinical case of a 12 year-old Caucasian boy who sought
treatment in a dermatological private office due to a painful lesion in the plantar
area and whose dermoscopic examination, without skin contact, allowed the
visualization of parasite's movement inside the skin. The diagnosis of tungiasis is
clinical, but it can be aided by <italic>in vivo </italic>and <italic>ex vivo
</italic>dermoscopic examination of the lesion.</p></abstract><trans-abstract xml:lang="pt"><p>A fêmea da pulga Tunga penetrans é responsável pela dermatose ectoparasitária
denominada Tungíase. Relatamos o caso clínico de um adolescente branco de 12 anos de
idade, o qual procurou atendimento em consultório dermatológico devido à lesão
dolorosa na planta e cujo exame dermatoscópico sem contato com a pele permitiu
visualizar o movimento do parasita dentro da pele. O diagnóstico da tungíase é
clínico, porém pode ser auxiliado pelo exame dermatoscópico <italic>in vivo
</italic>e <italic>ex vivo </italic>da lesão.</p></trans-abstract><kwd-group><kwd>Communicable diseases</kwd><kwd>Dermoscopy</kwd><kwd>Ectoparasitic infestations</kwd><kwd>Siphonaptera</kwd></kwd-group></article-meta></front><body><p>The female flea Tunga penetrans is responsible for a cutaneous parasitosis known as
Tungiasis.<sup><xref ref-type="bibr" rid="B01">1</xref></sup> This small;
one-millimeter long flea is endemic in countries of Latin America, Caribbean and
sub-Saharan Africa.<sup><xref ref-type="bibr" rid="B01">1</xref>,<xref ref-type="bibr" rid="B02">2</xref></sup> It may evolve with complications, such as secondary
infections, lymphedema, bone exposing ulcerations, gangrene and tetanus.<sup><xref ref-type="bibr" rid="B01">1</xref></sup> The parasite lives in dry soil, so that it
can, especially during drought seasons, disperse in the ambient and penetrate the skin of
the hosts (feline, swine and rodent), where it produces thousands of eggs whilst feeding on
blood.<sup><xref ref-type="bibr" rid="B02">2</xref>,<xref ref-type="bibr" rid="B03">3</xref></sup> The diagnosis of tungiasis is clinical, but it can, however be aided
by <italic>in vivo </italic>and <italic>ex vivo </italic>dermoscopic examinations as
described in the following case.<sup><xref ref-type="bibr" rid="B03">3</xref>,<xref ref-type="bibr" rid="B04">4</xref></sup></p><p>A 12 year-old male patient reported since two weeks before, the presence of a painful
lesion on the left plantar area. There was a history of traveling to the rural area in the
countryside of São Paulo State. The clinical exam showed a 0.5 cm papule, yellowishwhite,
with a black dot in its center (<xref ref-type="fig" rid="f01">Figures 1A</xref> and <xref ref-type="fig" rid="f01">1B</xref>). With the aid of the dermatoscope (DermLite DL3,
3Gen, EUA), and without any skin contact we could observe a white halo, with bluish-gray
areas and one central orifice containing a light-brown structure (<xref ref-type="fig" rid="f01">Figures 1C</xref> and <xref ref-type="fig" rid="f01">1D</xref>). It was
possible to observe movements on the bluish-gray areas inside the white halo (see video).
We proceeded with the saucerization of the lesion, followed by hemostasis by
fulguration.</p><fig id="f01" fig-type="other" orientation="portrait" position="float"><label>FIGURE 1</label><caption><p><bold>A</bold> - Yellowish-white plantar papule with a central black dot
<bold>1B:</bold> Figure <bold>1A</bold> seen in greater detail. <bold>1C:</bold>In vivo dermoscopy performed without skin contact showing a white halo with a central
orifice containing a light-brown structure (original augmentation 10x).
<bold>1D:</bold> Figure <bold>1C</bold> seen in greater detail, showing
bluish-grey areas (likely corresponding to the parasite’s exoskeleton or his gut)
(●), White halo (corresponding to the parasite’s dilated abdomen containing the eggs)
(❋) Light-brown structure appearing in the center of the orifice (posterior segment
of the parasite) (◆)</p></caption><graphic xlink:href="abd-88-0649-g01"></graphic></fig><p>The specimen was placed in a 4% formol solution and in the ex vivo observation it was
possible to note the white ventral helical structures ("whitish chains"), as described
initially by Bakos (<xref ref-type="fig" rid="f02">Figures 2A</xref> and <xref ref-type="fig" rid="f02">2B</xref>) 5-8 The material was sent to histopathological
analysis (<xref ref-type="fig" rid="f02">Figures 2C</xref> and <xref ref-type="fig" rid="f02">2D</xref>).</p><fig id="f02" fig-type="other" orientation="portrait" position="float"><label>FIGURE 2A</label><caption><p>Aspect of the saucerized lesion, embed in formol, the external portion of the lesion
is seen through the dermatoscope. <bold>2B:</bold> Ventral portion of the specimen,
where oval structures corresponding to the eggs can be seen through the dermatoscope
(❋) (original augmentation 10x). <bold>2C:</bold> Histopathological examination of
the excised skin showing the parasite, the host’s skin exhibiting compact
hyperkeratosis and just below the epidermis, the parasite’s body involved by a chitin
structure (HE, 100x). <bold>2D: Figure 2C</bold> seen in greater detail where it can
be observed: the patient’s straighten epidermis (●), the parasite’s chitin
exoskeleton (◆), the flea’s intestinal lumen (■) the eggs inside the abdomen (✝)</p></caption><graphic xlink:href="abd-88-0649-g02"></graphic></fig></body><back><fn-group><fn id="fn01" fn-type="other"><label>*</label><p>Work performed at Alergoskin Alergia e Dermatologia SS Ltda - São Paulo (SP),
Brazil.</p></fn><fn id="fn02" fn-type="conflict"><p>Conflict of interest: None</p></fn><fn id="fn03" fn-type="financial-disclosure"><p>Financial funding: None</p></fn></fn-group><ref-list><title>REFERENCES</title><ref id="B01"><label>1</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Heukelbach</surname><given-names>J</given-names></name><name><surname>Sahebali</surname><given-names>S</given-names></name><name><surname>Van Marck</surname><given-names>E</given-names></name><name><surname>Sabóia Moura</surname><given-names>RC</given-names></name><name><surname>Feldmeier</surname><given-names>H</given-names></name></person-group><article-title>An unusual case of ectopic tungiasis with pseudoepitheliomatous
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the white halo.</td></tr></table></table-wrap></floats-group></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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|wiki= Wicri/Sante
|area= LymphedemaV1
|flux= Pmc
|étape= Corpus
|type= RBID
|clé= PMC:3760950
|texte= Tungiasis under dermoscopy: in vivo and ex
vivo examination of the cutaneous infestation due to Tunga
penetrans*
}}
Pour générer des pages wiki
HfdIndexSelect -h $EXPLOR_AREA/Data/Pmc/Corpus/RBID.i -Sk "pubmed:24068146" \
| HfdSelect -Kh $EXPLOR_AREA/Data/Pmc/Corpus/biblio.hfd \
| NlmPubMed2Wicri -a LymphedemaV1
| This area was generated with Dilib version V0.6.31. |  |