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On-line version ISSN 1806-4841
An. Bras. Dermatol. vol.78 no.1 Rio de Janeiro Jan./Feb. 2003
Dermatological manifestations caused by mites of the cheyletidae family: a case report*
Oscarina da Silva EzequielI; Gilberto Salles GazêtaII; Nicolau Maués da Serra FreireII
Degree in Parasitic Biology. Medical specialist at the Sociedade Brasileira
de Alergia e Imunopatologia. Assistant Professor at Universidade Federal de
Juiz de Fora
IIPh.D. (Universidade Rural do Rio de Janeiro). Researcher at FIOCRUZ-IOC (Ixodide Laboratory)
Cheyletidae mites are of great importance in the veterinary sciences, as they are associated with parasitism in birds and mammals. Yet they are barely studied as etiological factors to human dermatitis in spite of being referred to since the beginning of the 20th century. The authors propose to analyze a clinical case of dermatitis caused by mites of the Cheyletidae family in a six-month old patient. The discovery of three species of that family in the patient's domiciliary ecosystem, associated to the cutaneous manifestations correlated with its definitive cure after this environment was sanitized, leads the authors to believe in the need to consider this diagnostic hypothesis for human dermatitis.
Key words: mites; dermatitis; dust.
Mites and ticks are intimately associated with anthropic ecologies that allow them the special ability to directly or indirectly affect human health.12,14,19,28
Mites of the Pyroglyphidae, Glycyphagidae, Acaridae and Cheyletidae families are most prevalent in domiciliary ecosystems. The first three families are linked to making patients vulnerable to extrinsic bronchial asthma, allergic rhinitis and atopical dermatitis. The Cheyletidae mites are, in turn, predators of other mites. They are associated with parasitism in birds and mammals, but have been studied little as to their role in human dermatitis.2,8,25,30
The Cheyletidae mites, especially species associated with the domiciliary ecosystem, appear to be best adapted to humid climates. This may explain the higher prevalence in specific physiographic regions in which humans are more exposed to them and the increased possibility of their association with aggravating human health.13 The Danish M.D., Lomholt, first described human dermatitis as caused by Cheyletidae mites in 1917. In reported cases, the species involved was Cheyletiella sp, which is the same parasite found in cats living in the homes of the patients in question.8 Yoshikawa30 reported the potential of Cheyletus malaccensis and Chelacaropsis sp in causing papular urticaria in humans through contact with straw tatamis, probably by insertion of the gnathostoma parts, or mouth and saliva injection, which would be responsible for the allergic response in susceptible individuals.
The aim of this paper was to point out the importance of mites from the Chelyletidae family as etiological agents in a case report of the dermatological manifestation in humans. The objective was to orient future research toward a better understanding of the biology and interaction of these mites with humans.
During the study of acarofauna in the domiciliary ecosystem of a randomly chosen home in the municipality of Juiz de Fora, the grandfather of LNS reported that the six-month-old female child, had shown signs four weeks earlier of popular macular erythematous lesions associated with edematous pruriginous plaques, with post-inflammatory discoloration (Figure 1). It was observed that removing the child from the environment led to regression of the lesions referred to, with the appearance of new dermatological manifestations when she was again returned home. While at home, the child remained in an old upholstered kitchen chair for most of the time. The most affected regions were the back and, in lower intensity, the abdominal region. There were no significant lesions in exposed areas, such as the face, and upper or lower limbs. The use of anti-histamines and topical corticoids led to temporary improvement. After evaluation of the house dust sample gathered at the site, three species of the mite family were identified: Cheyletus malaccensis, Cheyletus fortis and Cheletonella caucasica. The advice to sanitize the space associated with the symptomatic treatment led to a definitive cure of the patient's clinical case.
Cheyletidae mites have been found in house dust around the world, with a predominance in climatically humid regions.10,18,21,23,24,26,27
In Brazil, the presence of mites of the Cheyletidae family have been reported in diverse studies in virtually the entire country since 1979. The following species have already been registered: Cheyletus malaccensis, Cheyletus eruditus, Cheyletus fortis, Ker bakeri, Cheyletonella vespertillionis and Cheyletonella caucasica.1,3,4,6,7,15,16,17 The latter two species were first reported in Brazil in the domiciliary ecosystem owing to an analysis the authors made of house dust samples in the municipality of Juiz de Fora, Minas Geras state.11
From the identification of Cheyletidae family mites in humid tatamis, Yoshikawa30 suggested that these mites would be the probable agent responsible for pruriginous episodes in humans. He thereby confirmed the hypothesis reached subsequent to performing an experimental study in which he demonstrated that Cheyletus malaccensis and Chelacaropsis sp are able to bite persons and provoke cutaneous histopathological changes similar to those caused by mites classically known for this behavior, like the Ornythonissus bacoti. This fact was not confirmed during the experiment for the other family species, like Dermatophagoides farinae, Dermatophagoides pteronyssinus and Tyrophagus putrescentiae. Yoshikawa29 confirmed the presence of human corporal fluid in the stomach of Cheyletidae mites, which had bitten a human during a five to six hour exposure to human skin.
The cutaneous lesions associated with cheyletidae are generally in the form of erythematous papules and urticariform plaques, which on a smaller scale are able to occur as blisters or eczematous lesions.8,29,30
The patient in question presented a case of dermatitis without the classical natural history for scrofulous prurigo or for cases of usual urticarias, mainly due to the local distribution of lesions and their characteristics, in addition to the temporary response to systemic anti-histamine and topical corticoid use. But what really draws attention is the significant improvement caused by removing the child from her domiciliary ecology. The fact that three species of Cheyletidae mite family were found in her home, Cheyletus malaccensis, Cheyletus fortis and Cheletonella caucasica, especially in places of direct contact with the patient's back region, or in other words, in the upholstered kitchen chair where she spent most of her time, and in mattresses, as well as the definitive cure of the clinical case reached through measures for reducing the mite populations, leads the authors to believe in the diagnosis of dermatitis by Chelyletidae.
Therefore, it is important to stress that in anthropoid settings, mites should be considered positively responsible for other dermatozoonoses, in addition to mite infestations.
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Oscarina da Silva Ezequiel
Av. Barão do Rio Branco 2370 - Sala 1014
Juiz de Fora MG
Tel: (32) 3213-1971
Received in January, 25th of 2001.
Approved by the Consultive Council and accepted for publication in February, 22th of 2002.
* Work done at "Universidade Federal de Juiz de Fora".