See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/276028359
Intractable pruritus caused by pigeon mites
Article in Indian Journal of Dermatology · May 2015
DOI: 10.4103/0019-5154.156402
CITATIONS
2
READS
332 2 authors:
Some of the authors of this publication are also working on these related projects:
Snake bite in Himachal PradeshView project
Mycology in HPView project Vivek Chauhan
Indira Gandhi Medical College 114PUBLICATIONS 1,029CITATIONS
SEE PROFILE
Suman Thakur
Indira Gandhi Medical College 48PUBLICATIONS 150CITATIONS
SEE PROFILE
All content following this page was uploaded by Vivek Chauhan on 18 May 2015.
The user has requested enhancement of the downloaded file.
Correspondence
312 Indian Journal of Dermatology 2015; 60(3)
Intractable Pruritus Caused by Pigeon Mites
Vivek Chauhan, Suman Thakur, Vikram Mahajan
From the Department Of Medicine, Dr. RPGMC (Rajendra Prasad Government Medical College), Kangra at Tanda, Himachal Pradesh, India. E-mail: [email protected] Indian J Dermatol 2015:6(3):312-313
Sir,
Among the causes of intractable pruritus, pigeon mite or tropical mite infestation is considered to be one, which is rarely diagnosed accurately by the general physicians.
Pigeons are found everywhere in India. People are suffering badly from these infestations and in extreme conditions may even lead to mental distress, especially in elderly and children who spend most of their time indoors. A patient presented to OPD with history of intense itch at different sites all over the body lasting for few minutes for past 2 weeks. The pruritus was more prominent during resting hours at home. Similar itch was complained by the other members of the family for same duration. They noted that during the daytime, at office, or at school, there was no itching. The itch used to wake up the children from the sleep. We expected to find the lesions of scabies but the typical web space lesions suggestive of scabies were absent. The children were also examined who showed only few papular lesions on the trunk and some excoriation marks produced by itching. We were not able to isolate any scabies mite from the papular lesions on the skin. Still, keeping a high possibility of scabies, we treated the family for scabies.
Even after 1 week of completion of the scabies treatment, there was no relief of symptoms. The patient returned with some tiny insects, barely visible to naked eye, isolated from the site of itch. He spotted first insect while it was crawling on the trunk of his daughter when she complained of severe itch. The insect was brownish in colour but unable to jump or fly, so it was easy to catch. We examined the insects microscopically and to our surprise, they were the tropical fowl mites also called pigeon mites (Ornithonyssus bursa Figure 1). The patient was advised to look for pigeon nests on his roof and remove them. In just 2 days, the family was relieved of the intractable pruritus going on uninterrupted for past 3 weeks.
Ornithonyssus bursa or the tropical fowl mite, is the most common bird mite that attacks humans but some closely related species coming in human contact are Ornithonyssus sylviarum (Northern fowl mite) and Dermanyssus gallinae (Chicken mite).[1]
The bird mites are barely visible to naked eye and move quite fast on skin. They are transparent and difficult to
notice on skin. But once they ingest blood, which gives them color upon digestion, they get easily noticeable to an observant eye. They have a short life cycle of 7 days and can replicate very fast. Pigeon mites lay eggs in the pigeon nests on rooftops of buildings. Larvae emerge from eggs in 3 days and then develop into nymph stages. The nymphs and adults feed on the nestlings when they hatch out of pigeon eggs and are resting in their nests. They feed preferentially on nestlings which are unfeathered.[2] Up to 50,000 mites can be found in a nest.[2] When the birds leave their nests, mites move toward inhabitants of the house. The pigeon mites are harmless as far as the nature of the infestation is concerned. They don’t transmit any disease and the bite lesions are short lasting. They are attracted to humans by sensing heat and vibration.[3]
The physicians have very little knowledge about these mites and their effects and so the victims are helpless as they get very little support from medical personnel. Pigeons are found everywhere in India and mostly they roost on the roofs of houses. Mites are not easy to spot, and mostly the victims are unaware of the cause of their intense pruritus, which may lead to unnecessary treatment with various drugs. The problem has a simple solution i.e. finding and removing the nests in the vicinity of house.
Some typical features of bird mites are
• Produce pruritus and paresthesias
• Visible to observant naked eye once they have taken a blood meal
• Cannot jump or fly
• Cannot survive on human body (or any other mammal), so they do not establish true infestation
• Limited temporally to spring and early-summer, when nestlings fledge
To conclude, we recommend that physicians should have this entity in their mind when they are diagnosing causes of intense pruritus especially in spring and summer months, especially in people living on top floors.
Figure 1: Light microscopic view of pigeon mite Ornithonyssus bursa [Downloaded free from http://www.e-ijd.org on Thursday, May 07, 2015, IP: 14.139.58.180]
Correspondence
313 Indian Journal of Dermatology 2015; 60(3)
Simply searching for nests and removing them from the vicinity of humans can put an end to an unbearable agony of the victims.
References
1. Halliday RB, OConnor BM, Baker AS. “Global Diversity of Mites”. In Peter H. Raven and Tania Williams. Nature and human society: The quest for a sustainable world: Proceedings of the 1997 Forum on Biodiversity. Washington DC: National Academies; 2000. p. 192-212.
2. Ralph GP. Effects of the haematophagous mite Ornithonyssus bursa on nestling starlings in New Zealand. New Zealand J Zool 1977;4:1.
3. Owen JP, Mullens BA. Influence of heat and vibration on the movement of the northern fowl mite (Acari: Macronyssidae).
J Med Entomol 2004;41:865-72.
Access this article online Quick Response Code:
Website: www.e‑ijd.org
DOI: 10.4103/0019‑5154.156402
Idiopathic Thrombocytopenic Purpura Masquerading Paediatric SLE
Meenu Barara, Taru Garg
From the Department of Dermatology and STD, Lady Hardinge Medical College, New Delhi, India. E-mail: [email protected]
Indian J Dermatol 2015:6(3):313-314 Sir,
Idiopathic Thrombocytopenic purpura (ITP) is an auto-immune disease characterized by accelerated clearance of auto-antibody sensitized platelets and suboptimal platelet production. It is a diagnosis of exclusion established after ruling out secondary causes like medication, Auto-immune diseases, Lympho-proliferative disorders and chronic infection. We report a case of paediatric Systemic Lupus Erythematosus (SLE) which initially manifested as thrombocytopenia and was diagnosed as ITP. Development of cutaneous involvement followed the diagnosis of ITP a year later.
A 4 year old girl child was diagnosed as ITP at the age of 2.5 years when she presented with petechiae and thrombocytopenia (Platelet count = 34000). Her bone marrow biopsy revealed a hypercellular marrow with increased number of megakaryocytes. Direct Coombs and ANA at presentation were negative. She underwent multiple (eight) admissions in subsequent 1 year wherein she was treated with systemic steroids which led to fluctuating platelet levels (varying
from 2000- 35000). ANA repeated twice during the treatment course was negative. After 1.5 years; child started developing asymptomatic multiple erythematous annular plaques on face and extremities which were misdiagnosed at several occasions with possibility of Tinea and Seborrhoic dermatitis. Six months after onset of skin lesions she started developing lesions of different morphology. She developed annular erythematous papules and plaques on bilateral malar area and petechiae, purpura on lower extremities. Many discrete papules on face and extremities developed central necrosis resembling targetoid lesions. Lesions healed with evidence of epidermal atrophy. She had cold extremities with dusky erythematous macules topped with ulceration on tips of fingers and toes [Figure 1].
Oral examination revealed erosions. Fundus examination revealed evidence of healed choroiditis. Rest of her systemic examination was normal. Based on these findings, her work up was done for probable diagnosis of Vasculitis in setting of SLE with or without lupus pernio and Rowell’s syndrome.
Investigations revealed mild anemia and thrombocytopenia (Platelet: 60000) without any evidence of hemolytic anemia. Her ANA was now positive in a speckled pattern. She had highly positive dsDNA (>1000) suggestive of high disease activity, positive anti Smith antigen (suggestive of disseminated LE) and positive AntiRib P protein. Her coagulation profile, ANCA, β2 microglobulin, complement levels and renal function were normal. Lesional biopsy revealed features of immune vasculitis. Since she fulfilled 4 out of 11 ARA criteria, she was diagnosed as a case of SLE and started on daily oral Prednisolone at dose of 1mg/kg and Hydroxychloroquine at 6mg/kg. Steroids were gradually tapered with response. Treatment led to stabilization of platelet count, clearance of skin lesions and fall in titre of dsDNA to 160 within 2 months of therapy.
Figure 1: Clinical photograph of patient showing targetoid lesions on face; healing with epidermal atrophy and purpuric lesions on extremities with central necrosis and ulceration
[Downloaded free from http://www.e-ijd.org on Thursday, May 07, 2015, IP: 14.139.58.180]
View publication stats
