Posted by Librarian on 4/2/2002, 12:08 pm

Conclusions There is no reason to suspect that this case is of an endocrine nature, but it seems to be related to environmental exposures in the wooded rural setting which may have involved pet/animal associations and perhaps fungal infection. Insects appear to be merely aggravating occupants of facial lesions that present favorable habitats. The formation of the initial sores may have involved tick bites (Table 1). Fungi-infected sores clearly attracted those arthropods (and perhaps others that were missed) to S.P.'s face. Other less documented "skin parasitosis" in the same county are known and county health officials have sent out relevant notices/alerts to local physicians. NBC aired a news segment of an "outbreak" of "skin parasites" in a neighboring county on January 16, 1995. Urticaring hairs of caterpillars (Table 1.) are known to cause papular dermatitis and generalized urticarial eruptions. Affliction can be caused by direct and indirect contact (environmental and airborne) with the irritating setae. The presence of open sores and skin cuts is known to attract some arthropods, e.g. botflies, among others, to these sites for feeding and breeding. S.P. has been heavily medicated for about 4 years during which she used more than 90 prescriptions. The relation between heavy medications and attraction of arthropods is not known, but the effect of antibiotics on the immune system and host resistance are well documented. To the best of my knowledge, this is the first case of its kind to be reported in the literature. Over one (100) hundred related cases are logged with the National Pediculosis Association. Many of these cases appear to involve a "predisposing" fungal infection. The closest published reference to the presented case (1, 2,) reported springtails (INSECTA Collembola) causing pruritic dermatitis in humans; collembolans are generally regarded as saprophagous and phytophagous insects. Acknowledgments I would like to thank the following colleagues (listed in alphabetical order) for their contributions to the clinical and biological diagnoses, treatments, follow-ups, and/or opinions regarding the presented case. Deborah Z. Altschuler, National Pediculosisis Association, Newton, Massachusetts, and F. Edward Herbert School of Medicine, Bethesda, Maryland, Carl L. Davis, DVM, Coweta Veterinary Clinic, Coweta, Oklahoma, Terry S. Friedmann, M.D., Phoenix Health and Medical Center, Paradise Valley, Arizona; Michael W. Hastriter, Missouri Department of Health, Jefferson City, Missouri; Mark H. Grosserode, M.D., Inter I.D., Inc., Tulsa, Oklahoma; Khris L. Keller, DVM, Department of Veterinary Diagnostic Investigation, College of Veterinary Medicine, Kansas State University, Manhattan, Kansas; Rene J.; Koesler, Tulsa City-County Health Department, Tulsa, Oklahoma, Michael Kramer, M.D., MPH, Division of Parasitic Diseases, NCIP, CDC, Atlanta, Georgia; Walter L. LaMar, MD, Regional Medical Laboratories, Inc, Tulsa, Oklahoma; Sandra T. Mullins, The Boren Veterinary Medicine Teaching Hospital, Oklahoma State University, Stillwater, Oklahoma; Linda L. Nassif, MD, Hillcrest South Physicians, Tulsa, Oklahoma' Richard Reeder, Ph.D., Zoology Department, University of Tulsa, Tulsa, Oklahoma. ____________________________________________________________________ R E F E R E N C E S 1. Hunter, G.W., Frye, W.W. ,Schwartzwelder, J.C., 1960.A Manuel of Tropical Medicine. Philadelphia; W. B. Saunders. 2. Scott, H. G., Wiseman, J. S., Stojanovich, C. J., 1962. Collembola infesting man. Ann. Entomol. Soc. Am; 528-530.