Domenico Galante

Why dermanyssosis should be listed as an occupational hazard

The red mite, Dermanyssus gallinae (Acarina: Mesostigmata), is a temporary blood-sucking ectoparasite of poultry and other avian species, with a worldwide distribution. It can occasionally bite mammals, including humans, and cause dermatitis. Medical textbooks frequently cite itching and cutaneous lesions resulting from red-mite bites as a normal occurrence in subjects working in close conjunction with poultry. In fact, D. gallinae is one of the most common pests and a major cause of economic loss in the poultry industry, with a farm prevalence of up to 90%.1 In the literature, red-mite dermatitis (RMD) is generally regarded as an urban hygiene issue. Not only …

An urban outbreak of red mite dermatitis in Italy

The outbreak involved three adults (two women and one man) and a child living in two apartments in the same building in a city in southern Italy. At the end of March, the married couple (living in the second-floor apartment of the three-story building) noted small, light-colored and/or brownish crawling arthropods on the cordless phone in the bedroom. Because they experienced itching in and around the ear whenever they used the phone, they sprayed it with a commercial insecticide designed to kill ants. After several days, the itching returned. During early April, their 2-yearold daughter developed intensely pruritic skin lesions. The symptoms initially involved the posterior auricular and parietal regions of the head, as well as the neck and extremities, but rapidly generalized. The child slept in the same room as her parents, who noted similar eruptions, first involving the ankles and feet, and then the legs, arms, and trunk. The lesions were accompanied by intense, especially nocturnal, pruritus. Two weeks after the onset of the symptoms, the child was examined by her pediatrician who prescribed cortisone and antimicrobials. The treatment was ineffective. At the end of April, the family left home for a 1-week holiday, and the skin lesions healed almost completely. The pruritic dermatitis returned after one night at home, and actively motile arthropods were found on the bedroom furniture. De-infestation was performed. On May 8th, the mother collected a small brownish parasite from the child’s bed, and a second parasite was accidentally crushed against the pillowcase, producing a blood spot (Fig. 1). Alarmed by the presence of ‘‘blood-feeding insects,’’ the mother also collected parasites from the cordless phone, although they were clearly different in size and color, and took them to the Laboratory of Entomology of the Istituto Zooprofilattico Sperimentale della Puglia e della Basilicata (IZS), Foggia, Italy. On May 9th, the IZS staff found a pigeon’s nest under the gutter between the balconies of the two apartments. Diffuse skin lesions were visible on most of the child’s body (Fig. 2), and the parents showed a few lesions involving the extremities. The owner of the top-floor apartment, a 69-year-old woman, was also found to be afflicted with a generalized, pruritic dermatitis (Fig. 3). On several occasions, she found ‘‘tiny, light-colored, rapidly crawling insects’’ on the television and alarm clock in her bedroom. Her physician prescribed cortisone and tranquilizers. The mites collected from the nest and surrounding areas were identified as Dermanyssus 1119 Figure 1 Blood spot caused by a fed Dermanyssus gallinae (red poultry mite) crushed against the pillowcase

Coxiella-like endosymbiont associated to the "Anatolian brown tick" Rhipicephalus bursa in Southern Italy.

Several different ticks have been reported to harbor microbes related to Coxiella burnetii, the agent of the Q fever. Rhipicephalus bursa is an important vector of tick-borne diseases in livestock in Mediterranean area; it is also abundant in ovi-caprine farms with C. burnetii infection, in Southern Italy. 60 females of Rh. bursa (15 pools) and 40 their eggs (2 pools) were screened for C. burnetii by a conventional PCR targeting the insertion sequence IS1111 and by Loop mediated isothermal amplification assay (LAMP) targeting com1 gene. One of 15 tick pools (1/15) and both egg pools (2/2) were found positive by LAMP assay and negative by PCR targeting IS1111 gene. 16S rRNA gene was amplified by PCR from the LAMP-positive pools, amplicons were sequenced and found 95% similar to the corresponding sequences from C. burnetii. This let us to hypothesize the presence of a new Coxiella-like endosymbiont associated with Rh. bursa which could be vertically transmitted, described here for the first time. The lack of detection of IS1111 in Coxiella endosymbiont of Rh. bursa could be related to the possible absence of the Pathogenicity island of C. burnetii, to which IS1111s are associated.

Outbreaks of Dermanyssus gallinae (Acari, Mesostigmata) Related Dermatitis in Humans in Public and Private Residences, in Italy (2001-2017): An Expanding Skin Affliction

Avian mite dermatitis is a skin affliction of mammals, including humans caused by bites of nidicoulous, haematophagous mites in the suborder Mesostigmata, which naturally parasitize birds. The red-mite, Dermanyssus gallinae is the most common species implicated in episodes of dermatitis in city-dwellers, worldwide. Symptoms manifest in the form of pruritic, erythematous papules on exposed/covered body areas. We report 20 urban outbreaks of red-mite dermatitis occurring in Southern Italy from 2001 to 2017 (June) and diagnosed through parasitological identification by veterinarian entomologists. The patients, a total of 54 subjects, were infested in their homes/ workplaces by both mites emigrating indoors from deserted nests of sinantropic birds close to the infested edifices and from pet canaries. Red-mites may be the explanation of cases of pruriginous dermatitis of obscure origin in citydwellers. The applying of the One Health approach is crucial for diagnosis, treatment and prevention of dermatitis by epizoonotic ectoparasites.

Development and Application of a Loop-Mediated Isothermal Amplification (LAMP) Approach for the Rapid Detection of Dirofilaria repens from Biological Samples.

Dirofilariasis by Dirofilaria repens is an important mosquito vector borne parasitosis, and the dog represents the natural host and reservoir of the parasite. This filarial nematode can also induce disease in humans, and in the last decades an increasing number of cases have been being reported. The present study describes the first loop mediated isothermal amplification (LAMP) assay to detect D. repens DNA in blood and mosquitoes. Two versions of the technique have been developed and described: in the first, the amplification is followed point by point through a real time PCR instrument (ReT-LAMP); in the second, the amplification is visualized by checking UV fluorescence of the reaction mixture after addition of propidium iodide (PI-LAMP). The two variants use the same set of 4 primers targeting the D. repens cytochrome oxidase subunit I (COI) gene. To assess the specificity of the method, reactions were carried out by using DNA from the major zoonotic parasites of the family of Onchocercidae, and no amplification was observed. The lower limit of detection of the ReT-LAMP assay was 0.15 fg/μl (corresponding to about 50 copy of COI gene per μl). Results suggest that the described assay is specific, and its sensitivity is higher than the conventional PCR based on the same gene. It is also provide a rapid and cost-effective molecular detection of D. repens, mainly when PI-LAMP is applied, and it should be performed in areas where this emerging parasitosis is endemic.

First report of Coxiella burnetii and Borrelia burgdorferi sensu lato in poultry red-mites, De rmanyssus gallinae (Acari, Mesostigmata) related to urban outbreaks of dermatitis, in Italy

The poultry red mite (PRM), Dermanyssus gallinae, is a nonburrowing haematophagous nest-dwelling ectoparasite of birds; occasionally it bites humans, inducing dermatitis. The possibility that this parasite may also be involved in transmission of pathogens is an additional concern. We investigated the presence of zoonotic agents in PRMs from bird nests and pets, and related them to urban outbreaks of dermatitis. A total of 98 PRMs from 12 outbreaks of PRM dermatitis that occurred in Italian cities from 2001 to 2017 were molecularly investigated for detection of Coxiella spp. (16S rRNA), Chlamydophila spp. (16S rRNA), Rickettsia spp. (17 kDa protein-encoding gene), Borrelia burgdorferi sensu lato (groEL gene) and Bartonella spp. (16S–23S rRNA intergenic spacer). Of the 12 tested mite pools, one was positive for Coxiella burnetii (100% identity) and two for B. burgdorferi sensu lato (99% with Borrelia afzelii). For the first time, the presence of B. burgdorferi sensu lato and C. burnetii is reported in PRMs from urban areas. Birds, mainly pigeons, can harbour both pathogens. Therefore, birds and their nest-dwelling PRMs may play a role in the epidemiology of these infections.

Spotted fever group rickettsiae associated with ixodid ticks in wild environment in Southern Italy

Ixodidae ticks are vectors and reservoirs of several species of rickettsiae, and tick‐borne rickettsioses are reported worldwide. This study was aimed to verify the distribution of spotted fever group rickettsiae associated with ticks in a wild environment, the National Park of Gargano, where there is proximity between wild and domestic animals, and which is within an endemic area for rickettsiosis. Ticks were collected from animals or vegetation, morphologically identified and tested by a PCR targeting the 17kDa gene, and by a loop‐mediated isothermal amplification (LAMP) targeting ompB gene. Out of 34 tested tick pools, 2 from Dermacentor marginatus, 1 from Ixodes ricinus, and 1 from Rhipicephalus turanicus resulted positive. Nucleotide sequences of amplicons showed high similarity with sequences from Rickettsia slovaca, Rickettsia raoultii, Rickettsia helvetica, and Rickettsia felis. The overall calculated infection rate was 26.19 per 1,000, while it rose up to 107.77 when only D. marginatus was considered. The results highlight the association among Ri. slovaca, Ri. raoultii, D. marginatus and wild boars from which infected ticks were collected. Finally, the study shows the low efficacy of the previously described LAMP method for the detection of Rickettsia spp., when compared to PCR, making urgent the development of most effective LAMP protocols.

Dermatitis due to Mesostigmatic mites (Dermanyssus gallinae, Ornithonyssus [O.] bacoti, O. bursa, O. sylviarum) in residential settings

Since early recorded history, people who live in urban areas have shared their environment with pets and synanthropic animals, mainly birds and rodents. These animals harbor zoonotic parasites, including mites of the suborder Mesostigmata [ 1 ] . Among them, the avian mites Dermanyssus (D.) gallinae , Ornithonyssus (O.) sylviarum, O. bursa and the tropical rat-mite, O. bacoti are the most dermatologically relevant species. They are non-burrowing, bloodsucking ectoparasites of similar shape and size (about 1 mm in length) [ 1 ] . With the exception of O. sylviarum, which usually lives permanently on its host, they are temporary and nocturnal visitors of their victims, hiding in daytime in their close proximity. The resting/breeding sites of birds/ rodents, mainly pigeons and feral rats/mice and occasionally pets, act as mite reservoirs [ 2, 3 ] ; in the absence of their natural host, hungry mites may migrate into nearby human buildings and bite their inhabitants. Patients develop itching urticarial papules, often bearing a red punctiform mark, on covered and/or exposed body areas. These lesions are usually unrecognized unless there is a high degree of clinical suspicion. From 2001 to September 2017, we used transmission light microscopy and/or scanning electron microscopy to analyze the arthropods supposedly related to 26 urban outbreaks of pruritic dermatitis, with a total of 66 subjects (60 adults and 6 children) living and/or working in southern peninsular and insular Italian regions (Campania, Molise, Basilicata, Apulia and Sicily). The dermatitis had started in spring/summer and lasted from a week to nine months. In eleven cases, it remained undiagnosed for more than four weeks and underwent several relapses after systemic and local treatment with antihistamines and corticosteroids. The patients presented with eruptions of urticarial papules, most of which had a central red puncture mark, readily detectable with a magnifi cation lens (Figures 1, 2 ). The clinical picture was highly suggestive of mite bite dermatitis and the parasites were searched for. They were collected from the patients’ bedrooms, workplaces (hospitals, offi ces, animal facilities) and from the patients’ skin. In a few cases, the parasites were delivered to our laboratory by the patients themselves, who had found them crawling on their skin and/or in their bedrooms or workplaces. The parasites were identifi ed as D. gallinae (20/26; peninsular regions), O. bacoti (4/26; Sicily/peninsular regions), O. bursa and O. sylviarum (both 1/26; Sicily) based on morphological key characters [ 1, 4 ] (Figure 3 ). Abandoned bird nests (20/26; pigeon/sparrow/ swallow) close to buildings, pet canaries (1/26) and poultry in backyards (1/26) were the sources of avian mite species; the source of O. bacoti was ascribed to laboratory holdings (1/26) or colonies of wild rats (3/26). Considering the patients’ medical histories, clinical fi ndings and laboratory data, we diagnosed Mesostigmata mite infestation in all cases. Showering and washing clothes, removal of mite sources and

Oral hirudiniasis in a stray dog, first report in Italy.

In June 2014, a male stray dog was recovered at Ente Nazionale di Protezione Animali (ENPA) kennel of Manfredonia, Apulia region, showing oral bleeding and physical prostration. The dog fell in a water canal and was trapped. During the clinical examination, a specimen of leech was revealed into its oral cavity. The parasite, probably entered by drinking unfiltered and contaminated water, has been identified as an adult of aquatic leech Limnatis nilotica. Leeches could overrun wide variety of animals, and few reports about blood sucking leech infestations in mammals are available in literature. This paper describes here the first oral hirudiniasis in a dog in Italy and highlights the possibility of human nasopharyngeal leech-related infection in Apulia region.