Re: Detailed report of mites from the 1940s

[Guest guest]

Kihun, wow! Thank you!

ES

>

> Found a very interesting article. I read it w/ great interest.

> Perhaps we can use the info here.

>

> http://members4.boardhost.com/Kritters/msg/2040.html

>

> Proceedings of the Entomological Society of Washington

> Vol. 53, February, 1951, No. 1.

> Unusual Scalp Dermatitis in Humans Caused by the Mite,

> Dermatophagoides (Acarina, epidermoptidae)

> By Jay Traver, Department of Zoology, University of Massachusetts,

> Amherst

>

> The writer and two other members of her immediate family, all of us

> adult females, have been for the past several years the unwilling

> hosts to the mite, Dermatophagoides scheremetewskyi Bogdanow. Since

> the published reports on this mite as a parasite of humans are not

> numerous, it seems desirable to present an account of the activities

> of the mite from first hand information. Symptoms, treatment

> employed in the attempt to control or eradicate the mite, reaction

> of certain members of the medical profession to this problem, and

> the present status of the situation are therefore set forth.

>

> It is to Dr. Baker of the Division of Insect Identification,

> Bureau of Entomology and Plant Quarantine, Washington, D.C., that we

> owe the identification of this mite, and the synonymy herewith is

> presented. It is to him also that the writer owes her contact with

> Dr. Gaines W. Eddy of the same Bureau in Washington, who has

> suggested the use of certain new synthetic organic compounds as

> scabicides in the treatment of this mite. Had it not been for Dr.

> Baker's interest in this problem, expressed in personal

> correspondence, it is quite possible that no attempt would have been

> made to publish this personal account of an infestation with the

> mite Dermatophagoides.

>

> Personal Observation of the Activity of the Mite.

> Small itching red papules on the scalp were noted as early as 1934.

> This condition persisted without much change in spite of sporadic

> efforts to control it, until the spring and early summer of 1943. At

> this time, the sensations as of some arthropod crawling, scratching

> and biting became very pronounced, and occurred over wide areas of

> the scalp. The idea that Pediculus humanus capitus might be the

> causative agent was not borne out since at no time was it possible

> to 'comb out' a louse nor to locate nits on the hairs. Further, the

> infestation did not yield to treatment known to be effective against

> pediculosis. The itching and crawling sensations were most

> pronounced between 10 p.m. and the early hours of the morning.

>

> By the middle of August, 1943, the annoyance had become excessive

> and more strenuous efforts were made to clear up the infestation and

> to locate the causative agent. Three areas of the scalp were

> principally involved, a space as large as the palm of the hand above

> and behind each ear, and an even larger area on the top of the head

> in the frontal region. The sensations as of something biting,

> scratching, and crawling from place to place were now almost

> continuous, becoming apparent as early as 10 a.m. and continuing all

> day and far into the night, increasing in intensity from 11 p.m.

> onward. Sound sleep was quite impossible. The principal areas

> involved were also painful and swollen, and as was discovered later,

> the epidermis over each of them was extremely thickened. On the

> suggestion of a druggist, a soap containing 1% mercuric iodide was

> employed as a shampoo. This seemed to irritate the mites, which

> became very active after the use of this soap. Many of them began to

> move down out of the scalp, and some of the thickened epidermis

> began to slough off.

>

> Those that continued down on to the body soon became embedded in

> itching red papules reminiscent of trombiculid infestations. Treated

> with strong sulphur ointment, they apparently did no further damage.

> They could be found on the shoulders, under the arms, beneath the

> breasts, on chest and both upper and lower back, occasionally around

> the umbilicus. The sensations of crawling and biting which were felt

> on legs and feet, in the latter case often on but seldom between the

> toes, indicated that some of the mites had migrated to the lower

> extremities.

>

> Others of the mites, however, moved down on to the face, invading

> eyes, ears and nostrils. It was the mites in these locations that

> did the most damage. Both eyes became so badly swollen that it was

> impossible to move the eyeballs; to look to right or left it was

> necessary to move the entire head. Invasion of the eyes was not

> confined to the period immediately following the use of the mercuric

> iodide soap, but continued for many days thereafter, this invasion

> occurring mostly between midnight and 3 a.m. The victim of their

> attack would have fallen into a light sleep, when a sharp pin-prick-

> like sensation in one eye, followed by an immediate response on the

> part of the already badly swollen eye would drive sleep away quite

> effectively. The movements of a mite that had entered under the

> eyelid could be felt as it crawled slowly about, then began to 'dig

> in' at which moment the eye suddenly became even more swollen than

> before. An almost continuous flow of lachrymal secretion seemed to

> attract the mites and made vision difficult. At no time, however,

> was there evidence of the formation of pus in the affected eyes.

>

> Invasion of the nostrils produced quite distressing symptoms, as of

> something crawling and scratching in the mucus membrane; ofthen this

> accompanied by a distinct irritation of the throat, trachea and

> bronchi. Early invasions of the ears seemed confined to the region

> of the pinna, in the folds of which the mites burrowed, producing

> the usual itching red papules. Their prresence in the ears was the

> cause of some concern on my part, as it is well known that certain

> species of mites may cause great damage in the ears of small

> animals. Apparently we may consider ourselves most fortunate that

> his particular mite did not choose to invade the external auditory

> meatus, from which location it might easily have pierced the

> eardrum. The difficulty of controlling such an infestation in the

> ear, had it occurred, is at once apparent, since as yet we have

> found no drug that is completely effective against the mites. Even

> had such a drug been known, its use in the ears might have been

> inadvisable. Unfortunately for humans, medical doctors ar much less

> versed in dealing with such situations than are the veterinarians

> who care for our dogs and cats.

>

> In addition to the trouble caused directly by the mites, a certain

> amount of allergic reaction and probably also of secondary bacterial

> or fungicidal reaction were also present. It is difficult if not

> impossible to determine how much additional injury and discomfort

> may have resulted from these secondary infections.

>

> The most acute phase of the infestation yielded to control measures

> within six weeks. Henceforth, the symptoms previously mentioned

> became less sever and somewhat chronic, exhibiting an increase in

> activity more or less periodically every two and one-half to three

> months. This condition has continued up to the present time. Even

> this summer (1950) live mites have been taken from all three members

> of the family. July and August are their periods of greatest

> activity.

>

> In spite of my optimistm in regard to the limited activity of those

> mites that invaded the ears, there is still a question as to whether

> or not the difficulty I am now having with my ears, and the rather

> sudden onset of deafness on the part of the other infested members

> of my family, may have been aggravated at least by the presence of

> the mites. Likewise, I wonder if the chronic sinusitis to which I

> have been heir for some time may also have been increased by those

> mites which entered the nostrils.

>

> The much-thickened epidermis had sloughed off from the thre most

> heavily infested areas of the scalp before the end of the the period

> of acute symptoms, and since that time no such unusual thickening in

> these or other parts of the body has been noted. Itching red papules

> continue to occur irregularly on the scalp, the pinna of the ears,

> on the face, and occasionally on neck chest and back. Such areas

> frequently become covered with small incrustations. The mites

> succeeded in establishing themselves temporarily on one writst,

> between the third and fourth finger of one hand, just below one ear,

> on the ventral surface of one knee, and just below the hair line

> above the left temple. Applications of 2 to 5% aqueous solution of

> gentian to each of these affected areas except the one above the

> temple, repeated daily for a week or ten days, finally cleared up

> each of these sites of infestation, some of which were reminiscent

> of the behavior of scarcoptes scabiei. The network of red lines and

> itching swellings above the left temple seems also to have been

> brought under control, largely through the use of sulphur ointment

> and lysol. There still remain infested areas on the face, in the

> upper corner of the lower lip and in the right eyebrow, which have

> not yet been brought under control. Tunnels or burrows, presumably

> in the dermis, could be seen on the wrist, in the soft skin between

> the fingers, on the knee, below the ear, above the temple, and on

> the lower lip. On wrist and knee, these burrows took the form of one

> or more or less straight central tunnel, visible as a slightly

> raised reddish line, from which extended at right angles, several

> shorter lateral tunnels. Above the temple, as noted, a network of

> raised red lines with small swellings here and there, indicated the

> presence of the mites. In other areas mentioned, the tunnels were

> more or less U-shaped, somewhat wider at one end, and apparently

> without lateral branches. Inasmuch as it has never been possible to

> locate a mite in the sloughed-off epidermis or in the small

> incrustations which form over infested areas, it seems probable that

> the burrows are actually in the dermis. Further evidence for this

> belief is the fact that live mites have been captured from the

> deeper regions underlying such an incrustation when the latter had

> been removed. Certainly, during the period of acute symptoms, when

> mites could be felt running about below the thickened epidermal

> masses, and causing their host almost to tear off bits of the scalp

> in an effort to get at them, none were even inconvenienced by any

> substance used against them until the mercuric iodide soap was

> employed. One of the most annoying runways occupied by the mites,

> the entire length of the right eyebrow, with extensions to and from

> the adjacent hairline, does not show on the surface any indication

> of its presence save a slight swelling. Even when such a burrow does

> not show externally, however, its presence it readily ascertainable

> by reason of the activity of the mites, which habitually travel from

> one area to another along certain well-defined highways. If these

> highways were in the epidermis, it should seemingly have been

> possible to capture mites in them, as the mites moved from place to

> place.

> Symptoms experienced by other members of the family.

>

> It was no until some time after my acute symptoms had subsided that

> other members of the family began to feel the effects of the mites.

> Whether they were less susceptible to the mites, from whatever

> source these were originally obtained, or whether they were infested

> from my infestation, we shall never know. As I had not at any time

> discussed the details of my symptoms with either of them, it is

> evident that they did not develop symptoms 'in sympathy' with mine.

> Only now and then, one of them would mention her particular symptoms

> as of the moment. One has had more difficulty with mites invading

> the pinna of the ear than I have had. These mites, when driven from

> the ear by the use of sulphur ointment or some other substance,

> moved down on to the body and became embedded there, particularly on

> the chest, shoulders and lower back. This member has also had much

> trouble with mites invading the nostrils. The other member of the

> family had more difficulty with mites embedded on the neck and

> shoulders. At no time have either of them suffered acutely from the

> presence of the mites.

>

> The medical profession.

>

> Aid was of course sought from the medical profession, but very

> little help in treatment for the symptoms was forthcoming from this

> source. A reliable oculist who was consulted during the period of my

> acute symptoms reported the finding of some foreign objects embedded

> in the eye, but as these were apparently not in the cornea, he

> thought they would do no serious damage. A dermatologist,

> recommended by a local physician, was apparently convinced without

> more than a very casual examination, that the patient's symptoms

> were largely imaginary, those that did exist having been caused by

> an ill-advised attempt on the part of the patient to rid herself of

> something that was not there. Not until three days after my visit to

> his office, however, did he tell me this. Even he could not fail to

> note the greatly swollen eyes and the three areas of thickened

> epidermis on the scalp. He X-rayed the eyes and the affected scalp

> areas, and recommended several days' stay in the hospital,

> ostensibly for further treatment of the eyes. Actually, such

> treatment consisted solely of applications of hot boric acid

> compresses to the eyes, and theuse of cold boric acid as an eye wash

> treatment which I could have rendered myself at home fully as well.

> After the third day in the hospital, he turned me over to a

> neurologist for treatment of my 'psychoneurotic' condition. The

> patient, however, succeeded in convincing the neurologist that she

> had no need of his services. The local physician now suggested the

> use of sulphur ointment on the scalp, such as had been used

> effectively by the patient against mites embedded elsewhere on the

> body. She also suggested the use of sulfathiazole, which seemed to

> aid materially in reducing the allergic reactions and possible

> secondary infections. The complete amazement of this physician, when

> she was later shown some of the first mites to be captured,

> indicated full well that she, too, had accepted at face value the

> dermatologist's diagnosis of 'Just imagination.' Hence any real aid

> in the treatment of the scabitic condition, other than the suggested

> use of sulphur on the scalp, came from the patient herself or from

> parasitologists. It is doubtful if the X-raying of eyes and scalp

> had much effect on the mites, although it may certainly have aided

> materially in clearing up secondary infections.

>

> Treatment.

> To date, no treatment applied has been able to bring about complete

> eradication of the mites. However, many substances used on the scalp

> and elsewhere on the body have afforded welcome even though

> temporary relief from the annoying sensation produced by the mites.

> It would seem that a certain number of the substances employed have

> actually killed some or all of the adult mites, but have had no

> effect on the ova. Any substance used on the scalp was applied with

> sterile cotton or with a pipette, usually being then well rubbed in

> with the finger tips. Twenty-four to 48 hours was the usual length

> of time between the application of any one substance and its removal

> by means of a shampoo, although some substances were left on the

> scalp for at least a week. The scalp was always shampooed as a

> preliminary to the application of any substance, and no other

> substance was used until the preceding one had been thoroughly

> washed out. After the use of certain of these compounds, a period of

> two to three months often elapsed before renewed symptoms indicating

> the presence of the mites were apparent. On circumstantial evidence

> this might be taken to indicate that the length of time required for

> the maturation and hatching of a young mite from the ovum is

> approximately two to three months. There is always the possibility,

> however, that the young mites may not make their presence felt at

> once, and that the growth period is really somewhat shorter.

> Attempts at control have continued actively from 1943 up to the

> present time.

>

> Many substances employed as a possible means of control proved

> useless for that purpose. Among these may be mentioned: DDT powder,

> 10% used as for pediculosis; kerosene emulsion with vinegar;

> Seargant's Mange Cure, which had been of value in treating mange on

> two pet cats some years before, but was of no help in the present

> situation; ethyl, normal butyl and isopropyl alcohols, used

> separately and in varying strengths from 70 to 100%; ether, applied

> to the scalp a few drops at a time; 3% phenol, also as used for

> pediculosis.

>

> The following chemicals have proved of value in bringing relief,

> sometimes of a very temporary nature, from the activities of the

> mite:

>

> Sulphur ointment, 15% USP, applied to the scalp or other parts of

> the body. This could be left on for several days after application.

> It is one of the most helpful substances employed to date. In the

> early treatment of mites on the body, a stronger preparation of

> sulphur was used, made by mixing flowers of sulphur with Crisco or

> Spry. The exact percent of the sulphur so used was never determined.

> At one time only during the period of acute symptoms was any

> sensitivity to sulphur noticed. The ointment used at that time was

> made up in lanolin. This sensitivity soon disappeared and no

> indication of it has been felt since that time. Mites treated with

> sulphur seem to die in situ.

>

> Gentian violet, 2 to 5% aqueous solution. This, if left on any

> affected part of the body for a week or 10 days, and if constantly

> augmented by additions of the same every few days, proved completely

> effective in eradicating the small colonies already mentioned, on

> wrist, knee, fingers and below one ear. Unfortunately it was never

> feasible to leave this dye on the scalp for more than two days at

> the most, as it is by no means desirable to go about with one's

> scalp and hair painted purple. There is also some question as to

> whether or not gentian violet would prove as effective over areas in

> which the mites were more deeply located or where they had been " at

> home " for a considerable period of time.

>

> Lysol, a relatively strong solution (4 teaspoonfuls to the pinte, or

> even somewhat stronger) has proved to be one of the most effective

> methods of killing the adult mites. It can be used, at this

> strength, on small areas only. It has the disadvantage of possessing

> a strong odor and is also hard on the skin. The epidermis usually

> peels off from any area so treated some time after the use of this

> solution. In a weaker solution it has been used over the entire

> scalp following a shampoo, usually being rinsed off in a few hours.

> It is also by the use of lysol solution that some of the mites have

> been captured, as noted below.

>

> Zemo, both regular and extra strength solutions, has proved of value

> in reducing the irritation caused by the mites' activities, and may

> even have killed some of the adult mites.

>

> Germicidal soap, 1% mercuric-iodide, used as a shampoo, appears to

> be quite effective against the mites, but does not eliminate all of

> them, nor does it appear to have any effect upon the ova. This soap

> is used quite regularly as a shampoo, and since no ill effects have

> followed its use except at one period of acute symptoms, it seems

> evident that this soap cannot have been the causative substance

> which precipitated the acute attack. No evidence of sensitivity to

> this soap has been noted. It often causes the mites to migrate,

> however, which is not desirable if the migration is toward eyes or

> ears.

>

> Zinc oxide ointment. This has been used at times alone or in

> combination with sulphur ointment, as is sometimes recommended, to

> alleviate itching on areas of the face and neck. Painted around each

> eye, it served to prevent the entrance of many mites into the eyes,

> as they could be felt moving up to this barrier but going no further.

>

> In addition, certain other compounds known to be of value in the

> control of sarcoptic and other forms of mange, have been employed.

> Of these, the first two were suggested by Dr. Gaines W. Eddy, who

> has recently published the results of a series of experiments with

> some new synthetic organic compounds as scabicides (Jour. Investig.

> Dermatology 12(2): 117-123, 1949). He likewise sent me samples of

> several of these substances, enough for two or more treatments with

> each. It seems quite possible at the present writing that one or

> both of these new chemicals may eventually prove effective in the

> eradication of our mites.

>

> Benzyl salicylate. An aqueous solution of salicylic acid and benzyl

> ester 10%, in 2% of Tween 20, is the first of these two drugs.

> Samples of the Tween 20 were kindly donated by the Atlas Powder

> Company of Wilmington, Del. This has been used on my own scalp for

> several different doses during the past two months. After each such

> use, the symptoms were temporarily eliminated, but migration of the

> mites was quite noticeable. It has recently been employed in the

> treatment of one of the members of my family, but living mites are

> still present on her scalp.

>

> 2-phenylcyclohexanol 10%, and Tween 20, 2% as an aqueous solution,

> is the second chemical recommended by Dr. Eddy. The Dow Chemical

> Company of Midland, Mich., was kind enough to provide me with

> samples of this compound. It has recently been used on my own scalp.

> As yet, the results are inconclusive, but again the symptoms are

> temporarily alleviated. Migration of mites occurs after its use.

> Ultimate success might be achieved by the frequent repetition of

> this substance to the scalp and other affected areas, if used

> repeatedly over a sufficient period of time so as to kill all newly

> hatched larvae before they reach maturity.

>

> Benzyl benzoate. This has been employed in two forms: first as a

> liquid, and second as an emulsion, the Wellcome brand, which was

> much used by British scientists during World War II in the treatment

> of human scabies. Some relief was obtained from its use,

> particularly when the emulsion was employed. It seemed especially

> effective against those mites which had located in the pinna of the

> ears. Migration of the mites after the use of this compound was most

> pronounced. Recently, the emulsion has been used on small areas of

> the scalp at double the strength recommended. Some migration has

> been caused, but many of the mites seem to have been killed in situ.

> As it is probably unwise to use benzyl benzoate at double strength

> except on very limited areas, and as it fails to effect complete

> cure even when so used, this drug cannot be relied upon to control

> the mite under consideration.

>

> Tetraethylthiuram monosulphide. Another remedy much used, and with

> good success according to the literature on the subject, against

> human and animal scabies. Used as an alcoholic solution as

> recommended, it has not proved as useful in the treatment of our

> mite as have several other substances. It is stated to give

> excellent control against Sarcoptes and Notoedres, but it seems not

> to be the answer when used against Dermatophagoides.

>

> Gamma isomer of hexachlorocyclohexane. This was used in the form of

> an ointment sold under the commercial name of KWELL. Ticks and mites

> are reported to be killed readily by this substance, but not so the

> mite Dermatophagoides. It was left on the scalp for several days

> before removal with a shampoo, and almost immediately thereafter the

> mites could be felt moving about in their accustomed places.

>

> 40% aqueous hypo (sodium hyposulfite). This was allowed to dry on

> the scalp, and was followed by a second application, which was also

> allowed to dry. Sometimes hypo was used alone, or again was followed

> by 5% HCl after the second application was thoroughly dry. Both

> methods often brought relief for several days, even for a week or

> more. But again the ova were evidently not destroyed. Although this

> treatment has been repeated many times during the past four years,

> the mites are still with us. However, it did give temporary relief,

> and caused only a moderate amount of migration on the part of the

> mites.

>

> Considering the above list of chemicals, many of which are purported

> to eradicate several species of mites commonly infesting man and

> domestic animals, it would seem that the mite presently under

> consideration is much more difficult to deal with than are such

> other genera as Sarcoptes, Notoedres, Psorptes and Chorioptes.

> Whether or not this is due to an inherent ability of

> Dermatophagoides to withstand strong chemicals or whether, as it

> seems more likely, this mite inhabits the dermis and is therefore

> less subject to contact with chemicals which are employed against

> it, we cannot say. At any rate, we have first-hand information that

> this mite is not easily eradicated.

> Capturing the Mite.

>

> This was a tedious process, and the number of mites actually

> captured is surprisingly low. This does not mean, to me at least,

> that there were not many more mites present at any given time, which

> could not be captured by any method employed.

>

> My first attempt at locating the causative agent by examining

> sloughed-off epidermis and incrustations from infested areas, after

> treating these with KOH, was completely negative. Hence it followed

> that similar material which was collected from my scalp and body and

> sent away to two different parasitologists for examination also

> yielded negative results. Both of the parasitologists were

> interested in the case, and anxious to help if possible, but they

> were located many miles away from the individual who had the

> infestation.

>

> During the period of the acute symptoms, my eyes were so badly

> swollen that it would have been impossible for me to recognize a

> mite had I been able to capture it. Furthermore, during that summer

> I did not have a micrscope at my disposal. A few months after the

> acute symptoms had subsided, however, I captured two very small

> Hymenoptera which had been felt crawling about on the scalp. These

> have been identified by Mr. C. F. W. Muesebeck, Chief of the

> Division of Insect Identification Bureau of Entomology and Plant

> Quarantine, in Washington, as members of the Trichogrammatidae, know

> to be egg parasites. There will never be any certainty as to whether

> or not these Trichogrammatidae bore any relationship to the mite

> infestation, but of course there is always at least a possibility

> that they were parasitic upon the ova of Dermatophagoides. The

> technic, if one may call it that, of their capture was the same as

> that which was soon successful in the capture of the first mite

> found. It consisted of holding a bit of sterilized cotton, dipped in

> lysol solution, firmly in place for several minutes directly over a

> spot where a mite or some other arthropod could be felt moving

> about. Success by this method was never very great, but at least it

> was thus that most of the few mites taken directly from the scalp

> have been captured. If successful, the mite still alive and moving

> sluggishly, would be found adhering to the cotton when the latter

> was removed from the scalp.

>

> A rather amazing number of other arthropods have likewise been

> captured from the scalp in the same fashion. Among these were:

> several Hymenoptera of a considerably larger size than the

> Trichogrammatidae; an oribatid mite; small portions of the skeleton

> of an unknown arthropod bearing feathered hairs similar to those of

> a trombiculid mite; what appears to be the cast skin of a small

> spider; an apparent jassid; and of course, many small gnats and

> other Diptera, among these being the psychodids and ceratopogonids.

> Pollen of various sorts was also found commonly. Perhaps a study of

> the flora and fauna of the human scalp in summer might be

> interesting.

>

> A modification of the method of capture indicated above also yielded

> several mites of Dermatophagoides. Immediately following a shampoo,

> especially when the mercuric iodide soap had been employed for that

> purpose, mites could be felt moving and scratching at various places

> on the scalp. Sometimes, following such activity, there would occur

> a sharp pin-prick-like sensation in a different spot than the

> original one, and the appearance at that spot of one of the

> customary itching red papules which often increased in size later.

> This I interpret to mean that the mite, disturbed but not killed by

> the substance used in the shampoo, had come up from its " den " in the

> dermis, and when on the surface of the skin had moved to a new

> location, when again it burrowed in, perhaps using a hair follicle

> as its point of entrance. If now the saturated cotton was applied

> before the second burrowing-in took place, there was a good chance

> of capturing the mite.

>

> Another method of capture that has been met with greater success is

> as follows. After treatment of the scalp or face with sulphur or

> indeed with almost any of the chemicals listed as being of value,

> mites could sometimes be found the following morning on the pillow

> of the individual using this treatment. These mites, collected by

> means of a bit of cotton moistened with water, were usually dead

> when taken, but recently several live, active impregnated females

> have been captured in this manner.

>

> At one time only did I succeed in " digging out " a mite from my own

> scalp, by means of an exploratory fingernail applied to the area

> beneath an incrustation, the latter having been forcibly removed.

> The mites had been felt moving about under this incrustation. When

> thus captured, the mite was quite alive and healthy, and waved its

> legs lustily as it was being examined under the microscope.

>

> It is perhaps worthy of note that even a small mite, when moving

> about actively in or on one's scalp feels " as large as a cat. " A

> peculiar sensation as of pressure sometimes occurs synchronously

> with the activities of a mite which has been annoyed by treatment

> with some chemical. This has been especially noticeable after the

> use of sulphur ointment. Then there is another peculiar sensation

> sometimes felt: a " streaming " activity, as though many mites,

> perhaps small ones, were leaving some common center, due to the use

> on the scalp of some chemical distasteful to them, and " fanning out "

> in various directions from this center. In fact, some mites may

> later be located in red papules that had not been there before, on

> face, neck or shoulders, following such a streaming. I venture to

> preduct that if any dermatologist should become the host of this

> mite, he would not diagnose his case as " Just imagination. "

>

> Possible Source of the Infestation.

>

> The source of the infestation is completely unknown. Two possible

> sources are: (1) two pet cats of the household, the last one of

> which died at least ten years ago; these cats suffered from what we

> called " mange " for which ailment we treated them, with some degree

> of success, with Seargant's Mange Cure; and (2) a neighbor's doc,

> which for years suffered from some sever skin infection which

> several good veterinarians tried in vain to bring under control, so

> that the dog had finally to be destroyed. It is possible that our

> cats acquired their infestation from the dog, and that we acquired

> ours from either the cats or the dog.

>

> At the time of the most acute symptoms, in the summer of 1943, I

> tended toward the belief that the infestation had been acquired, in

> my case, from a woodchuck which I had used to obtain material for

> some histological preparations. That the woodchuck did have

> ectoparasites, I know for a certainty, as I not only removed from

> its body some lice (apparently Enderleinellus marmotae) but also

> some immature or nymphal Ixodes. I noted some of the latter climbing

> my arm as I worked on the woodchuck, and later captured one nymphal

> Ixodes, probably cookei, from my own scalp. However the fact that I

> had noticed itching papules in my scalp for some years previous to

> this time, leads me to believe now that the mite Dermatophagoides

> did not come to me from the woodchuck. This mite has been rather

> recently reported from rats, but I have had no occasion to work with

> rats other than to kill an occasional white rat for histological

> purposes. The same mite has been reported from the skin of birds.

> But I have had occasion to come in contact with birds only to pick

> off a few ectoparasites from such dead specimens as may have been

> brought into the laboratory, and most of this has been done since

> 1943.

>

> The fact that the infestation has lasted for so many years seems to

> indicate that the mite can adjust itself readily to life on or in

> the human skin, and maintain itself there once it is well

> established.

>

> Taxonomic Considerations.

> This mite belongs to the family Epidermoptidae, which may be easily

> distinguished from its nearest ally, the family Psoroptidae, by the

> fact that the females of the Epidermoptidae possess suckers on all

> the tarsi, whilst females of the family Psoroptidae have long

> whiplike setae on the third tarsi.

>

> Dermatophagoides Bogdanow, 1864

> Dermatophagoides Bogdanow, 1864. Bull. Soc. Imp. Nat. Moscou 37 (1):

> 341-348, pl. 7, figs. 1-2.--Vitzhum, 1929. Tierreich Mitteleuropas,

> Acar, Bd. 3, 1f. 3,102--Sasa, 1950. Japanese Journal of Experimental

> Medicine 20:519-525.

> Pachylichus Canestrini, 1894. Prospetto del' Acarofauna Italiana,

> fasc. 6:824-829, pl. 77, figs 1-4.--Berlese, 1897. Acari, Myriopoda,

> Scorpiones, Cryptostigmata, Sacroptidae, fasc. LXXXII, no 12.--

> Oudemans, 1904, Ent. Bericht. 20:190-195 (synonomy with

> Dermatophagoides.)

> Mealia Berlese, 1897. Acari, Myriopoda, Scorpiones, Cryptostigmata,

> Sarcoptidae 1:104.--Berlese, 1898. Idem., fasc. LXXXIX, no. 10, and

> XCII, no. 3 and no. 4--Canestrini and Kramer, 18999, Das Tierreich,

> Demodicidae and Sarcoptidae, 137-138.--Trouessart, 1901, Bull. Soc.

> Zool. France XXVI:82-84.

> Viscopteres Sasa, 1947. Nisshin Igaku 34(3):167-170.

>

> Type: Dermatophagoides scheremetewskyi Bogdanow, 1864. Bogdanow

> described two forms of mites. The first of these, designated D.

> scheremetewskyi, is a female, depicted in dorsal and ventral views

> in figs. 1a and 1b. It occurred on the surface of the skin of humans

> suffering from the itch. The mite of the second type, found on a

> single occasion on a child suffering from herpes farinosus, and

> designated by Bogdanow as " Acarus de l'Herpes farinosus, " is

> depicted in figs. 2a and 2b. It is a male, very probably that of D.

> scheremetewskyi as Bogdanow himself suggested; certainly it belongs

> in the same genus as the previously described female mite. Bogdanow

> compares his new genus with Dermatophagus, saying that it has " une

> grande resemblance ave selui des acriens due genre Dermatophagus,

> decrit en detail par Furstenberg. "

>

> He notes two differences between Dermatophagoides and Dermatophagus:

> (1) the conformation of two lyre-shaped chitinous arcs near the

> genital opening of the female; and (2) differences in the termini of

> the third legs of the females. (Dermatophagus Furstenberg, 1861, is

> a synonym of Chorioptes Gervais, according to Ewing, 1929.)

>

> Dr. Menber, an M.D., reports on the finding of a species of

> parasitic mite infesting the human skin and causing a sever

> dermatitis. This mite he describes and figures, as: " Acarus

> incapsulator or Sarcoptes trichogenetos (Boeking). " The mite is said

> to have been found also in capsules beneath the skin of the same

> patient and was thought to be related to or be the causative agent

> of trichinosis, hence the specific name applied to it.

>

> North American records are: Texas; in a house in Kentucky; from a

> rat in Florida; from a house in Chester, N.H., causing an itch; and

> from New York. These, combined with the European distribution,

> indicate a rather widespread range and eventually the mite should be

> found throughout most of the world.

>

> Several other species have been placed in Dermatophagoides, but much

> work is needed before the exact status of the various species can be

> determined with certainty. Dr. Manabu Sasa, of the Institute of

> Infectious Diseases, University of Tokyo, Japan (The Japanese

> Journal of Experimental Medicine, vol. 20, pp. 519-525, 1950),

> discuss the genus Dermatophagoides in Japan. D. saitoi (Sasa) was

> taken in sputum of a patient with typical Loeffler's syndrom, D.

> takeuchii was found in urine, and an undertermined species was

> obtained from a patient with chronic bronchial asthma.

>

> Generic characters. Body oval. Dorsal shield present. Prominent

> transverse groove anterior to middle of body, the two hind pairs of

> legs posterior to this groove. Sexual dimorphism evident, especially

> noticeable in legs of male; however, all legs in both sexes are well

> developed. Posterior end of body more or less rounded, not lobed in

> either sex. A pair of copulatory suckers present on anal plate of

> male. Genital openings of female between third coxae; surrounded by

> a crescentic anterior and two curved lateral sclerotized supports.

> Corresponding opening of male somewhat more posterior, lying between

> fourth coxae. Penis short, conical. Epimera of first legs not

> united. All tarsi in both sexes with short terminal stalks

> (peduncles) which bear cup-shaped suckers. Claws, where present,

> small and not easily discernible. Two pairs of long, strong

> posterior setae, the outer pair longer. One pair of vertical setae,

> also long and strong, arise from anterior portion of dorsal shield.

> Chelicerae powerful, terminating in paired chelate cutting surfaces

> which are dentate on the inner margins. Legs I and II directed

> forward; legs III and IV directed backward.

>

> Dermatophagoides scheremetewskyi Bogdanow

> Dermatophagoides scheremetewsky Bogdanow, 1864. Bull. Soc. Imp. Nat.

> Moscou 37(1):341-348.

> Mealia pteronyssina Berlese, 1897. Acari, Myripoda, Scorpiones,

> Cryptostigmata, Sarcoptida 1:104.

> Acarus incapsulator Menger, 1896. Texas Medical News, San ,

> Texas, Sept. 24:1-20 (attributed to Boeking).

> Sarcoptes, trichogenetos Menger, 1896. Texas Medical News, San

> , Texas, Sept. 25:1-20 (attributed to Boeking).

>

> Eleven females and nine males, all adults, were available for study.

> Three of the females, taken alive, were observed before being

> killed. On larva and two nymphs are also present in the available

> material. Mites were mounted (a) in clarite, after clearing in

> xylol, or ( in modified Berlese's medium, usually direct from 35%

> alcohol. Some mites were cleared in KOH previous to mounting;

> others, including most of those mounted by the second method, did

> not undergo such preliminary treatment. Male mites are almost

> transparent, but female mites, unless cleared, show well only such

> structures as are on the surface which is uppermost. Certain

> morphological features are seen more clearly in mites mounted by the

> first method; others, by the second.

>

> Size. Female: 10 specimens measured. Average length, 355.2 u, from

> tips of mouthparts to tip of abdomen; average width 196.8u. Longest,

> 400u; shortest 320u; widest 240u; narrowest 160u. Male: 8 specimens

> measured. Average length 296u; av width 180u. Longest: 352u;

> shortest 256u; widest 208U; narrowest, 128u.

>

> Mouthparts. See Plate III, figs. 15, 16, 17, 18 and 19. These are

> quite complicated, heavily sclerotized, and interpretation of some

> of th parts is difficult. Two large chelicerae are present, each

> bearing distally a pair of cutting surfaces, the inner margins of

> which are dentate or serrate, as indicated in figures 15, 16, 17 and

> 18. From ventral view, two large triangular or conical structures

> are seen; from beneath these, the cutting surfaces are visible.

> Perhaps these represent a bilobed hypostome or rostrum. These

> structures are shown in the ventral views of male and female mites,

> Pl. I, figs. 3 and 4. Viewed from above, a very similar pair of

> triangular structures lying directly beneath the basis capituli

> almost obscures the cutting surfaces, which can be seen only by

> focussing downward. These are perhaps the basal portions of the

> chelicerae, on which the cutting surfaces are bone. It appears,

> then, that there are two sets of sclerotized, conical sturcutres, on

> pair dorsal, the other ventral, with the cutting surfaces between

> them, and attached to the uppermost pair of sclerotized cones. A

> pair of well-developed palps is present, on palp lying on each side

> of the conical structures. Each is four-segmented, if the basal

> segment <CLIP from this page (15) to page 22>

>

> One mite was kept alive for two days, at the end of which period it

> was as lusty and active as when first caught. Immersion in water, in

> which the cotton was kept moist, did not seem to disturb the mite.

> Occasionally a mite would leave the cotton and try to crawl about on

> the floor of the watch glass, but made little progress.

>

> One mite was killed in warm, not hot, water in which it died very

> quickly. A second was immersed in lysol solution of the strength

> used for treatment of the scalp. For 30 seconds it swam actively,

> then became quiescent. At 45 seconds, no movement could be detected.

> It is thus evident that the mites are susceptible and easily killed,

> if the killing substance can be brought into contact with them. But

> when in or under the epidermis, they are well protected.

>

> Opportunity is taken here to mention a similar situation in which

> another mite, Bdellonyssus sylviarum (C. & F.), family Laelaptidae

> (Dermanyssinae) was the causative agent. Several years ago a Mrs. X

> wrote me in regard to a difficulty which she and other members of

> her family had been experiencing. They had been suffering

> considerably from the attacks of an unknown " something " which was

> present on their scalps and bodies, and which they had been unable

> to eradicated. Mrs. X, on the advice of her physician, had consulted

> a dermatologist, who told her she was merely suffering from

> a " phobia " and to go home and forget it. Two days later, Mrs. X was

> fortunate enough to capture two dead mites that fell from her scalp.

> These she took to the dermatologist, who now became interested in

> her case, and prescribed some lotion as a treatment. Meantime he

> sent the two mites off for identification, and in due time they came

> to me. I believed them to be Bdellonyssus sylviarum, but sent them

> to Dr. W. Baker for confirmation. He concurred in the above

> identification.

>

> I have had some further correspondence with Mrs. X on this subject.

> The last letter, written several months ago, indicated that she was

> still suffering from the effects of the parasites, and that nothing

> prescribed by doctor or dermatologist had been of permanent value in

> controlling her trouble. On the theory that English sparrows nesting

> under the eaves might have brought the mites into their home, the

> family had had the entire house fumigated, repainted and repapered

> and still Mrs. X suffered from the mites. The other members of her

> family had meantime recovered from their unpleasant experience with

> the arthropods.

> Here, then, is another instance in which humans, attacked by mites

> other than Sarcoptes, have received scant attention from the medical

> profession. Had Mrs. X not been fortunate enough to capture the two

> mites, she might really have come to believe that she did have

> a " phobia, " whatever that expression may be taken to mean. And even

> with the causative agent at hand, and identified, the dermatologist

> was unable to treat the infestation successfully.

>

> A certain parasitologist, in conversation on the subject of mites,

> has told me that he has had several experiences similar to the

> above, in which persons fairly frantic from the attacks of some

> unknown creature had been unable to obtain aid from their doctors,

> and had written him or come to him for help.

>

> What, on the other hand, could a medical adviser or dermatologist

> prescribe, in the present state of our lack of knowledge, in such a

> case? So little is known of the activity and behavior of many mites

> that may occasionally infest man, and so little also as to the

> effective methods of treatment. This is, I believe, a subject which

> is in great need of further investigation. I suggest that the

> medical profession might do well to take the lead in such a study.

>

> The mite dermatophagoides scheremetewskyi Bogdanow, a member of the

> family Epidermoptidae, is herewith reported as attacking humans,

> infesting the scalp as well as other parts of the body. Its behavior

> is not similar to that of such mites as Sarcoptes. It is believed

> that the mites burrow down into the dermis, in which they make their

> runways, and that they occasionally come to the surface from these

> runways. In general, movements of the mites from place to place are

> believed to occur within the shelter of these runways.

>

> To date, no treatment employed against the mite has been completely

> effective, in the sense of killing the ova as well as the adult

> mites. Nor has repeated re-application of any of the substances

> used, proved effective in eradication. Many different substances

> known to be highly effective against Sarcoptes and Notoedres have

> been employed as scabicides over the past seven years, in attempts

> to bring about control or eradication of the mites. Of these, the

> old standby, sulphur ointment 15%, is the one to which we return

> again and again, after other substances have failed. Yet it, too,

> has been unable to eradicate these arthropods. Three compounds which

> have been most recently used, benzyl salicylate, 2-

> phenylcyclohexanol, and benzyl benzoate used at double strength, may

> perhaps be the answer to our problem, but it is still too soon to

> know. Certain other substances known to be effective against

> sarcoptic scabies have proved of little value in the treatment of

> Dermatophagoides. Among these are tetraethylthiurum monosulfide, and

> benzyl benzoate used at the usual strength.

>

> The infestations here reported have lasted ofver a period of at

> least seven years, and have occurred on three adult members of the

> same family. The source from which the infestation was originally

> obtained is unknown. If, as we surmise, infested cats or a dog

> suffering from mange may have been the source or sources, there has

> been no chance for reinfestation for some years, as these animals

> have long since died. But there is no certainty that the " mange "

> from which they suffered was produced by the same causative agent as

> that which has infested us. It seems probable that the human

> infestation has lasted for this period of time due to continued self-

> reinfection of each individual concerned, since the ova are

> apparently never destroyed by any treatment we have employed. It

> should be noted that the mites seem to thrive on cleanliness, if

> weekly, sometimes semi-weekly, shampoos during the entire period of

> time can be used as a criterion. The mites, be it recalled, occur

> principally on the scalp.

>

> It is to be hoped that members of the medical profession may soon

> come to realize that it is possible for humans to be infested with

> mites other than Sarcoptes, give the patient the benefit of the

> doubt and try to determine the real cause of the ailment. It is not

> too easy for a person infested with said mites to make a diagnosis

> himself, nor to prescribe treatment if he is fortunate enough to

> locate the causative agent. The medical adviser and the

> dermatologist, on the other hand, are in a position to add much

> valuable information in regard to the habits and activities of this

> and other human-infesting mites, as well as to determine methods of

> control or eradication, if only they are willing to do so. We can

> but echo Bogdanow, when he states: " Il serait a desirer que les

> observations prochains de M. Scheremetewsky et des autres

> dermatologues nous donnent plus des details sure les acaricides,

> parasites de la surface de la peau de l'homme. "

>

> Had it not been that the writer of this article was (1) unwilling to

> accept the dermatologist's verdict of " Just imagination " ;(2) had

> sufficient knowledge of parasitology and access to enough literature

> on this subject so that she was able to proceed " on her own " in

> quest of the invading organisms; and (3) knew how to preserve and

> mount the mites when found, this mite would in all probability not

> have been located, and the difficulties experienced would never have

> been attributed to their real cause. It is quite possible that the

> mite Dermatophagoides infests humans more often than anyone has

> known, but that its attacks are usually of a minor order, so that

> the itching and other annoyances caused by its presence may be

> attributed by the human host to (1) " imagination, " as the doctors

> would have us believe; (2) " summer heat, " since the mites are most

> active during hot weather; or perhaps (3) " dandruff. " A wide-open

> field exists for anyone enterprising enough to do some real

> investigation on this subject.

>

> The presence of the mite Bdellonyssus sylvarium as a causative agent

> of dermatitis in the human scalp and on the human body is likewise

> reported. At last reports, the unfortunate host of this mite was

> still suffering from its depredations. In this case, the diagnosis

> has been: " Just a phobia. " Here is another field in which to date

> there has been no competition in the matter of studying the mite as

> an occasional human parasite.

>

[Guest guest]

Ki,

That was an incredible article! Thank you for passing it along!

All my best,

Trly

>

> Found a very interesting article. I read it w/ great interest.

> Perhaps we can use the info here.

>

> http://members4.boardhost.com/Kritters/msg/2040.html

>