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Objective: Scabies is caused by an ectoparasite called Sarcoptes scabiei ( S. scabiei ), which penetrates the epidermis through skin folds and burrows in the stratum corneum, following the development of tunnels (sillion). The disease is specifically characterised by keratosis, allergy and itching that increases at night-time. This study aimed to investigate the frequency of S. scabiei in patients with a pro-diagnosis of scabies., Objective: Between January 2012 and December 2019, a total of 746 [n=388 (52%), female; n=358 (48%) male] patients aged 0-80 years were admitted to Fırat University Hospital Parasitology-mycology Laboratory. Skin scrapings were taken from suspected lesions on anatomic regions such as the hands (wrist, interdigital skin, fingertip and palm), abdomen, penis and legs (thigh and bottom foot). They were examined under a light microscope after adding 15% potassium hydroxide solution., Results: S. scabiei was positive in 139 (18.63%) of 746 patients including a mother and her daughter and a married couple, where 68 (9.11%) were female and 71 (9.52%) were male., Conclusion: To our best knowledge, this is the first comprehensive study of scabies in Elazığ. Despite the recent socio-economic and cultural developments observed in our country, scabies and all other parasitic infestations still remain to be important problems. We believe that improvement of the public vigilance together with early diagnosis will improve sanitation and provide protection against scabies and parasitic infestations.

Ticks and the pathogens they transmit, including bacteria, viruses, protozoa, and helminths, constitute a growing burden for human and animal health worldwide. The ability of some animal species to acquire resistance to blood-feeding by ticks after a single or repeated infestation is known as acquired tick resistance (ATR). This resistance has been associated to tick-specific IgE response, the generation of skin-resident memory CD4+ T cells, basophil recruitment, histamine release, and epidermal hyperplasia. ATR has also been associated with protection to tick-borne tularemia through allergic klendusity, a disease-escaping ability produced by the development of hypersensitivity to an allergen. In addition to pathogen transmission, tick infestation in humans is associated with the α-Gal syndrome (AGS), a type of allergy characterized by an IgE response against the carbohydrate Galα1-3Gal (α-Gal). This glycan is present in tick salivary proteins and on the surface of tick-borne pathogens such as Borrelia burgdorferi and Anaplasma phagocytophilum, the causative agents of Lyme disease and granulocytic anaplasmosis. Most α-Gal-sensitized individuals develop IgE specific against this glycan, but only a small fraction develop the AGS. This review summarizes our current understanding of ATR and its impact on the continuum α-Gal sensitization, allergy, and the AGS. We propose that the α-Gal-specific IgE response in humans is an evolutionary adaptation associated with ATR and allergic klendusity with the trade-off of developing AGS., (© 2021 The Author(s). Published by Portland Press Limited on behalf of the Biochemical Society.)

Costello syndrome is an autosomal dominant disorder that is caused by germline HRAS mutations. Patients with Costello syndrome present craniofacial abnormalities, cardiac defects, and cancer predisposition, as well as skin abnormalities, including papillomas, keratosis pilaris, and eczematous dermatitis. However, the mechanisms underlying the dermatological abnormalities remain unclear. Here, we demonstrated that knock-in mice expressing an Hras G12S mutation (Hras G12S/+ mice) are susceptible to develop atopic dermatitis (AD)-like skin lesions, including eczema, pruritus, elevated serum IgE levels, acanthosis, and the infiltration of mast cells, basophils, and type-2 innate lymphoid cells in the dermis, after stimulation with house dust mite allergens (Dermatophagoides farinae, Dfb). Reduced skin barrier function, increased proliferation of phosphorylated ERK (p-ERK)-positive epidermal cells, and increased Th2-type cytokines as well as epithelial cell-derived cytokines, including IL-33, were observed in the skin tissue of Hras G12S/+ mice compared with Hras +/+ mice. Cultured Hras G12S/+ keratinocytes exhibited increased IL-33 expression after Dfb stimulation. PD0325901, an MEK inhibitor, ameliorated AD-like symptoms in Hras G12S/+ mice, showing decreased proliferation of p-ERK-positive epidermal cells and decreased expression of IL-33. Our findings indicate that the epidermis of Hras G12S/+ mice stimulated by Dfb strongly induced IL-33 expression and type-2 innate lymphoid cells, resulting in AD-like skin lesions. These results suggest that the epidermis of Hras G12S/+ mice are prone to development of eczematous dermatitis stimulated with house dust mite allergens.

Ticks are important ectoparasites which transmit many disease pathogen to animals; these are labelled tick borne diseases (TBD). Tick induced damage to skin and hides has not received attention. Skin and hides are important for the leather product industry, particularly in Pakistan. Due to economic importance and financial loss by ticks in leather industry, the present study was designed to investigate skin and hides damage due to ticks at microscopic level. Naturally tick infested tissue samples of hides and skin were collected from slaughter houses. Primary lesions at tick feeding sites showed epidermal edema with adjacent dermal edema. Histopathological examination revealed degeneration of epidermal layer down to the basal layer. Epidermal and sub dermal layers often displayed focal necrosis infiltrated with neutrophils and mononuclear cells at tick bite sites. Hyperplasia of keratinocytes was also seen at sites of ruptured epidermis. Quality of leather depends upon the grain (Outer) surface skin/hides. Ticks infestation damages the outer surface, due to bites, inflammatory responses, and secondary bacterial infections that often become established at feeding sites. Control of ticks should be given consideration to reduce infestation induced losses in the leather industry in Pakistan.

Disease manifestation after infection with cutaneous Leishmania species is the result of a complex interplay of diverse factors, including the immune status of the host, the infecting parasite species, or the parasite load at the lesion site. Understanding how these factors impact on the pathology of cutaneous leishmaniasis (CL) may provide new targets to manage the infection and improve clinical outcome. We quantified the relative expression of 170 genes involved in a diverse range of biological processes, in the skin biopsies from patients afflicted with CL caused by infection with either L. major or L. tropica . As compared to healthy skin, CL lesions bear elevated levels of transcripts involved in the immune response, and conversely, present a significant downregulation in the expression of genes involved in epidermal integrity and arginine or fatty acid metabolism. The expression of transcripts encoding for cytotoxic mediators and chemokines in lesions was inversely correlated with the expression of genes involved in epidermal integrity, suggesting that cytotoxicity is a major mediator of CL pathology. When comparing the transcriptional profiles of lesions caused by either L. major or L. tropica , we found them to be very similar, the later presenting an aggravated inflammatory/cytotoxic profile. Finally, we identified genes positively correlated with the parasite load in lesions. Among others, these included Th2 or regulatory cytokines, such as IL4 or IL10 . Remarkably, a single gene among our dataset, encoding for tryptophan-2,3-deoxygenase (TDO), presented a negative correlation with the parasite load, suggesting that its expression may restrict parasite numbers in lesions. In agreement, treatment of macrophages infected with L. major in vitro with a TDO inhibitor led to an increase in parasite transcripts. Our work provides new insights into the factors that impact CL pathology and identifies TDO as a restriction factor for cutaneous Leishmania ., (Copyright © 2019 Rodrigues, André, Maksouri, Mouttaki, Chiheb, Riyad, Akarid and Estaquier.)

Schistosomes infect more than 200 million people. These parasitic flatworms rely on a syncytial outer coat called the tegument to survive within the vasculature of their host. Although the tegument is pivotal for their survival, little is known about maintenance of this tissue during the decades schistosomes survive in the bloodstream. Here, we demonstrate that the tegument relies on stem cells (neoblasts) to specify fusogenic progenitors that replace tegumental cells lost to turnover. Molecular characterization of neoblasts and tegumental progenitors led to the discovery of two flatworm-specific zinc finger proteins that are essential for tegumental cell specification. These proteins are homologous to a protein essential for neoblast-driven epidermal maintenance in free-living flatworms. Therefore, we speculate that related parasites (i.e., tapeworms and flukes) employ similar strategies to control tegumental maintenance. Since parasitic flatworms infect every vertebrate species, understanding neoblast-driven tegumental maintenance could identify broad-spectrum therapeutics to fight diseases caused by these parasites., Competing Interests: GW, JC, JP, MP, HB, AL, MB, NG, JC No competing interests declared, (© 2018, Wendt et al.)

The infection of the perch Perea fluviatilis L. with myxosporean Henneguya wolinensis Romuk-Wodoracki, 1990 has been detected. This is the second finding of this parasite after its original descriptin and the first for Russia. Plasmodium of this species develops in the epidermis under scales throughout the body causing the formation of white cysts up to 1 mm. Spores are fusiform, large, their average length constitutes 25.5 μm without the caudal appendages and 62 μm with them. Slight morphological differences in spore structure comparing to original description have been revealed.

Disseminated histoplasmosis most commonly occurs in immunosuppressed individuals and involves the skin in approximately 6% of patients. Cutaneous histoplasmosis with an intraepithelial-predominant distribution has not been described. A 47-year-old man was admitted to our institution with fever and vancomycin-resistant enterococcal bacteremia. He had been diagnosed with T-cell prolymphocytic leukemia 4 years earlier and had undergone matched-unrelated-donor stem cell transplant 2 years earlier; on admission, he had relapsed disease. His medical history was significant for disseminated histoplasmosis 6 months before admission, controlled with multiple antifungal regimens. During this final hospitalization, the patient developed multiple 2-5 mm erythematous papules, a hemorrhagic crust across the chest, shoulders, forearms, dorsal aspect of the fingers, abdomen and thighs. Skin biopsy revealed clusters of oval yeast forms mostly confined to the cytoplasm of keratinocytes and within the stratum corneum; scattered organisms were present in the underlying superficial dermis without any significant associated inflammatory infiltrate. Special stains and immunohistochemical studies confirmed these to be Histoplasma organisms. We highlight this previously unrecognized pattern of cutaneous histoplasmosis to ensure its prompt recognition and appropriate antifungal therapy., (© 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objective: Lernaeids are crustacean parasites that are globally distributed among freshwater and marine fish. Approximately 110 species of Lernaeids have been divided into 14 genera. The most common species of Lernaeids is Lernaea cyprinacea, which has been transmitted to ornamental fish worldwide. The economic importance of L. cyprinacea is increasing because of the epidemic caused by the parasite in most of the ornamental fish breeding centers in different parts of the world. The parasite affects its host's health, decreases growth rate, and causes abnormal metabolic activity. Accumulation of these parasites in some parts of the body causes painful points and has harmful outcomes for the functioning and survival of the host., Methods: The present study was conducted to examine the prevalence of L. cyprinacea among ornamental fish within 1 year from September-October 2011 to September-October 2012. In total, 3520 fish [3380 mollies (Poecilia latipinna) and 140 swordtails (Xiphophorus helleri)] were collected from 10 fish maintenance and breeding centers in Kerman, Iran., Results: Of 3520 fish, only 186 fish (5.3%) were infected with L. cyprinacea, and the remaining fish (94.7%) were not infected. The swordtails (X. helleri) and mollies (P. latipinna) showed the highest (10.7%) and the lowest (5.1%) level of infection, respectively. In other words, there was a significant correlation between species of fish and L. cyprinacea infection (p<0.05). The highest prevalence (39.4%) and the lowest prevalence (0%) of L. cyprinacea were observed during summer and winter, respectively, which can be attributed to the temperature difference between the two seasons. Also, the histopathologic examination of sections revealed some lesions in the epidermis, dermis, and muscles., Conclusion: Considering the existing L. cyprinacea infection in ornamental fish reproduction and breeding centers in Kerman, public knowledge should increase through management methods; physical and chemical treatments should also be applied to inform the public regarding the risk of infection and other internal diseases that may be associated with ornamental fish.

Paratrichosoma-associated helminthiasis has been identified in saltwater crocodiles under intensive farming conditions. The development of sustainable integrated management practices is dependent on a detailed understanding of Paratrichosoma population genetics and infection dynamics. This study investigated the genetic relationships of Paratrichosoma sp in a population of commercially farmed saltwater crocodiles, Crocodylus porosus, in northern Australia. 18S ribosomal RNA gene sequence data were obtained from Paratrichosoma sp eggs present in the epidermis of infected animals. A high level of genetic diversity was distributed within the Paratrichosoma sp population (241 variable positions in the 1094 bp alignment), indicating an accelerated rate of nucleotide base-pair substitutions in this genus of nematodes. Several possible environmental correlates of the incidence and intensity of helminthiasis, including season, rainfall, and mean monthly temperature, were investigated by visual inspection of crocodile skins. Stepwise logistic regression revealed a significant negative linear relationship (P = 0.011, R (2) = 32.69 %) between mean monthly rainfall and the incidence of monthly Paratrichosoma-associated helminthiasis. Variation in the severity of Paratrichosoma-associated helminthiasis could not be explained by any of the independent environmental variables included within an ordinal regression analysis. The large genetic diversity in these nematodes indicates a high probability of anthelmintic resistant alleles occurring in the population. We discuss how the spread of these alleles may be mitigated by adopting targeted treatment protocols.

Infections with the parasitic flagellate Ichthyobodo necator (Henneguy, 1883) cause severe skin and gill disease in rainbow trout Oncorhynchus mykiss (Walbaum, 1792) juveniles. The epidermal disturbances including hyperplasia and mucous cell exhaustion caused by parasitization are known, but no details on specific cellular and humoral reactions have been presented. By applying gene expression methods and immunohistochemical techniques, further details of immune processes in the affected skin can be presented. A population of I. necator was established in the laboratory and used to induce an experimental infection of juvenile rainbow trout. The course of infection was followed by sampling for parasite enumeration, immunohistochemistry (IHC) and quantitative PCR (qPCR) on days 0, 5, 9 and 14 post-infection. IHC showed a significant increase in the occurrence of IgM-positive cells in the skin of the infected fish, whereas IgT-positive cells were eliminated and the number of CD8-positive cells declined. qPCR studies supported the IHC findings showing a significant increase in IgM and a decrease in the CD8 gene expression. In addition, genes encoding innate immune genes such as lysozyme, SAA and cathelicidin 2 were up-regulated. Expression of cytokines (IL-1β, IL-4/13A, IL-6, IL-8, IL-10), the cell marker CD4 and the transcription factor GATA3 showed a significant increase after infection. Cytokine profiling including up-regulation of IL-4/13A and IL-10 genes and transcription factor GATA3 connected to the proliferation of IgM producing lymphocytes suggests a partial shift towards a Th2 response associated with the I. necator infection., (© 2013 John Wiley & Sons Ltd.)

The present study analyzed, by means of confocal laser scanning microscopy, the epidermis of rabbits infested by the brown dog tick Rhipicephalus sanguineus and exposed to concentrations of 50%, 80% and 100% of a selamectin-based commercial acaricide (Pfizer's Revolution(®)). The results demonstrated that rabbits exposed to concentrations of 80% and 100% of the Revolution acaricide, which contains 12% selamectin, showed thinning of epithelial tissue of the epidermis with associated cellular disorganization. Individuals exposed to a 50% concentration showed lower epidermal tissue disorganization when compared to those exposed to the higher doses of the acaricide (80% and 100%). Whereas selamectin, when used in higher concentrations (80% and 100% Revolution(®)) can alter the morphology of the epidermis, at lower concentrations (50%), even though still able to eliminate ectoparasites, it causes less toxicity damage to the host. Selamectin can be considered a dose-dependent toxic agent, since higher concentrations increase the morphological changes in the epidermis of the host rabbits., (Copyright © 2013 Elsevier GmbH. All rights reserved.)

To decipher early promoters of the local microenvironment for Th2-type immunity, we wanted to identify gene patterns that were induced by Leishmania major in the infected skin of susceptible, Th2-prone BALB/c, but not of resistant, Th1-prone C57BL/6 mice. We found a marked up-regulation of the chemokine I-TAC (Cxcl11) during the first 2 d of infection in the epidermis of susceptible but not of resistant mice. Accordingly, local injection of I-TAC (2×1 μg) in resistant mice on the first day of infection resulted in a Th2-driven, sustained deterioration of disease and dramatically enhanced parasite levels. On the cellular level, I-TAC decreased IL-12 production by dendritic cells (DCs) in skin-draining lymph nodes and by DCs in vitro. Thus, we demonstrate for the first time that epidermis-derived I-TAC triggers a sustained Th2-response that determines the outcome of a complex immunological process.

Skin homeostasis is critical to preserve animal integrity. Although the skin of most vertebrates is known to contain a skin-associated lymphoid tissue (SALT), very little is known about skin B-cell responses as well as their evolutionary origins. Teleost fish represent the most ancient bony vertebrates containing a SALT. Due to its lack of keratinization, teleost skin possesses living epithelial cells in direct contact with the water medium. Interestingly, teleost SALT structurally resembles that of the gut-associated lymphoid tissue, and it possesses a diverse microbiota. Thus, we hypothesized that, because teleost SALT and gut-associated lymphoid tissue have probably been subjected to similar evolutionary selective forces, their B-cell responses would be analogous. Confirming this hypothesis, we show that IgT, a teleost immunoglobulin specialized in gut immunity, plays the prevailing role in skin mucosal immunity. We found that IgT(+) B cells represent the major B-cell subset in the skin epidermis and that IgT is mainly present in polymeric form in the skin mucus. Critically, we found that the majority of the skin microbiota are coated with IgT. Moreover, IgT responses against a skin parasite were mainly limited to the skin whereas IgM responses were almost exclusively detected in the serum. Strikingly, we found that the teleost skin mucosa showed key features of mammalian mucosal surfaces exhibiting a mucosa-associated lymphoid tissue. Thus, from an evolutionary viewpoint, our findings suggest that, regardless of their phylogenetic origin and tissue localization, the chief immunoglobulins of all mucosa-associated lymphoid tissue operate under the guidance of primordially conserved principles.

Sheep scab is an intensively pruritic, exudative and allergic dermatitis of sheep caused by the ectoparasitic mite Psoroptes ovis. The purpose of the present study was to investigate the effect of P. ovis infestation on different components of the ovine epidermal barrier within the first 24 hours post-infestation (hpi). To achieve this, the expression of epidermal differentiation complex (EDC) genes and epidermal barrier proteins, the nature and severity of epidermal pathology and transepidermal water loss (TEWL) were evaluated.By 1 hpi a significant dermal polymorphonuclear infiltrate and a significant increase in TEWL with maximal mean TEWL (598.67 g/m2h) were observed. Epidermal pathology involving intra-epidermal pustulation, loss of epidermal architecture and damage to the basement membrane was seen by 3 hpi. Filaggrin and loricrin protein levels in the stratum corneum declined significantly in the first 24 hpi and qPCR validation confirmed the decrease in expression of the key EDC genes involucrin, filaggrin and loricrin observed by microarray analysis, with 5.8-fold, 4.5-fold and 80-fold decreases, respectively by 24 hpi.The present study has demonstrated that early P. ovis infestation disrupts the ovine epidermal barrier causing significant alterations in the expression of critical barrier components, epidermal pathology, and TEWL. Many of these features have also been documented in human and canine atopic dermatitis suggesting that sheep scab may provide a model for the elucidation of events occurring in the early phases of atopic sensitisation.

Background: Transepidermal elimination has been documented in a myriad of infectious diseases; however, its occurrence in cutaneous leishmaniasis has not been evaluated., Methods: Skin biopsies (n = 212) with cutaneous leishmaniasis in Lebanon (n = 46), Syria (n = 53), Saudi Arabia (n = 45) and Pakistan (n = 68) were evaluated. Clinical data collected included age, gender, eruption type (papule, nodule, verrucous or scar), duration and anatomic location. Histopathologically, multiple parameters were recorded including Ridley's parasitic index and pattern, transepidermal elimination, interface changes, ulceration and necrosis. Transepidermal elimination was defined as the presence of amastigotes in the epidermis in all layers, limited to the basal layer or present in a perforating plug. All cases were confirmed by polymerase chain reaction (PCR) analysis followed by restriction fragment length polymorphism analysis for molecular subspeciation., Results: Leishmania tropica was identified in 88.2% and Leishmania major in 11.8% of all cases. Transepidermal elimination was observed in 28.3% of cases (29 perforating plug, 19 all layers and 12 basal layer) with a significant prevalence of L. major in this group (35 vs. 2%, p < 0.001). Cases with transepidermal elimination were associated with interface changes and higher parasitic index (p < 0.001) but not with an increased ulceration rate (p > 0.05). Multivariate analysis showed that transepidermal elimination was independently predicted by L. major [OR (95% confidence interval) = 80 (9-712); p < 0.001], parasitic index [OR = 3.4 (2.1-5.3); p < 0.001], interface changes [OR = 6.24 (2.2-17.8); p < 0.001] and necrosis [OR = 0.2 (0.1-0.8);p = 0.026]., Conclusions: We report the largest multiregional cutaneous leishmaniasis series with a 28.3% documented transepidermal elimination incidence of which 48% were perforating plug; a significant prevalence of L. major was also identified in the transepidermal elimination group. The association of transepidermal elimination with interface changes and a higher parasitic index, without an increased ulceration rate, may reflect a unique biologic alteration in the epidermis, serving to facilitate the extrusion of the parasites through the skin., (Copyright © 2012 John Wiley & Sons A/S.)

The present study assessed the histological changes in the epidermis of Poecilia reticulata induced by the combined effects of an ectoparasite Gyrodactylus turnbulli and differing concentrations of waterborne zinc (Zn). Infected guppies were exposed to 0, 15, 30, 60, or 120 µg Zn l-1 and monitored over 3 wk during the exponential increase in parasite numbers on the fish. The fish epidermis responded within 3 d to G. turnbulli infection with a rapid increase in epidermal thickness and a modest increase in number, but not size or composition, of mucous cells. In contrast, in the presence of combined waterborne Zn and infection, mucous cell numbers declined rapidly. As the parasite numbers increased, the epidermis remained thicker than normal, and the number and size of mucous cells decreased. The addition of Zn led to a dramatic thickening of the epidermis during the exponential growth of the parasite population. Mucous cell numbers remained depressed. Temporal changes in mucous cell size were Zn concentration dependent. At 60 µg Zn l-1, cells returned to normal size as infection progressed, whereas they remained extremely small at 120 µg Zn l-1. Changes in mucin composition previously reported in response to Zn alone were subdued in the presence of the parasite except at 60 µg Zn l-1, where all cells contained only acidic mucins. Together these results demonstrate that, on exposure to both Zn and G. turnbulli infection, the epidermal response is initially a protective response to both stressors, and then mainly driven by the increased parasite burden.

The prevalence of different types of clear cells and of the mite Demodex in the nipple-areola complex of adult autopsies of both sexes not suffering from breast cancer was studied in a total of 140 nipples. The epidermis of the nipple-areola complex shows squamous cells and 3 types of clear cells: Toker cells, pagetoid dyskeratosis cells, and signet ring-like cells. Toker cells were identified by standard light microscopy in 13 of 140 nipples (9.3%). Reactivity of these cells for CK7 was observed in 35 nipples (25%). They are derived from the lactiferous duct epithelium. Pagetoid dyskeratosis cells were identified in 56 of 140 nipples (40%). In 12 nipples, these cells were conspicuous (8.6%). It is suggested that the proliferation of these cells is induced by friction. Signet ring-like cells were identified in 71 nipples (50.7%). In 2 nipples, these cells were conspicuous (1.4%). They are a consequence of artefact related to formalin fixation. The prevalence of all these clear cells has no relationship with gender. Routine histopathological examination is usually enough to distinguish the characteristic features of the clear cells involving the nipple epidermis and permits differentiation of other entities with epidermal pale cells. Demodex mites were observed in 58 nipple-areola complexes (41.4%). They were more common in male nipple-areola complexes (P < 0.05). The prevalence of these mites was seen to remain steady along the years since the third decade. Demodex mites are common parasites of human nipple and are apparently of no pathologic significance.

The first step of Plasmodium development in vertebrates is the transformation of the sporozoite, the parasite stage injected by the mosquito in the skin, into merozoites, the stage that invades erythrocytes and initiates the disease. The current view is that, in mammals, this stage conversion occurs only inside hepatocytes. Here, we document the transformation of sporozoites of rodent-infecting Plasmodium into merozoites in the skin of mice. After mosquito bite, ∼50% of the parasites remain in the skin, and at 24 h ∼10% are developing in the epidermis and the dermis, as well as in the immunoprivileged hair follicles where they can survive for weeks. The parasite developmental pathway in skin cells, although frequently abortive, leads to the generation of merozoites that are infective to erythrocytes and are released via merosomes, as typically observed in the liver. Therefore, during malaria in rodents, the skin is not just the route to the liver but is also the final destination for many inoculated parasites, where they can differentiate into merozoites and possibly persist.

Various strains of Atlantic salmon exhibit different levels of susceptibility to infections with the ectoparasitic monogenean Gyrodactylus salaris. The basic mechanisms involved in this differential ability to respond to this monogenean were elucidated using controlled and duplicated challenge experiments. Highly susceptible East Atlantic salmon allowed parasite populations to reach up to 3000 parasites per host within 6 weeks, whereas less susceptible Baltic salmon never reached larger parasite burdens than 122 parasites per host during the same period. The present study, comprising immunohistochemistry and gene expression analyses, showed that highly susceptible salmon erected a response mainly associated with an increased expression of interleukin-1beta (IL-1beta), interferon-gamma (IFN-gamma), IL-10 and infiltration of CD3-positive cells in the epidermis of infected fins. Less susceptible salmon showed no initial response in fins but 3-6 weeks post-infection a number of other genes (encoding the immune-regulating cytokine IL-10, cell marker MHC II and the pathogen-binding protein serum amyloid A) were found to be up-regulated. No proliferation of epithelial cells was seen in the skin of less susceptible salmon, and IL-10 may play a role in this regard. It can be hypothesized that resistant salmon regulate the parasite population by restricting nutrients (sloughed epithelial cells and associated material) and thereby starve the parasites. In association with this 'scorched-earth strategy', the production of pathogen-binding effector molecules such as serum amyloid A (SAA) (or others still not detected) may contribute to the resistance status of the fish during the later infection phases.

A common clinical sign of ichthyophoniasis in herring and trout is "sandpaper" skin, a roughening of the epidermis characterized by the appearance of small papules, followed by ulceration and sloughing of the epithelium; early investigators hypothesized that these ulcers might be a means of transmitting the parasite, Ichthyophonus sp., without the necessity of ingesting an infected host. We examined the cells associated with the epidermal lesions and confirmed that they were viable Ichthyophonus sp. cells that were readily released from the skin into the mucous layer and ultimately into the aquatic environment. The released cells were infectious when injected into the body cavity of specific-pathogen-free herring. Our hypothesis is that different mechanisms of transmission occur in carnivorous and planktivorous hosts: Planktonic feeders become infected by ingestion of ulcer-derived cells, while carnivores become infected by ingestion of whole infected fish.

Paranucleospora theridion n. gen, n. sp., infecting both Atlantic salmon (Salmo salar) and its copepod parasite Lepeophtheirus salmonis is described. The microsporidian exhibits nuclei in diplokaryotic arrangement during all known life-cycle stages in salmon, but only in the merogonal stages and early sporogonal stage in salmon lice. All developmental stages of P. theridion are in direct contact with the host cell cytoplasm or nucleoplasm. In salmon, two developmental cycles were observed, producing spores in the cytoplasm of phagocytes or epidermal cells (Cycle-I) and in the nuclei of epidermal cells (Cycle-II), respectively. Cycle-I spores are small and thin walled with a short polar tube, and are believed to be autoinfective. The larger oval intranuclear Cycle-II spores have a thick endospore and a longer polar tube, and are probably responsible for transmission from salmon to L. salmonis. Parasite development in the salmon louse occurs in several different cell types that may be extremely hypertrophied due to P. theridion proliferation. Diplokaryotic merogony precedes monokaryotic sporogony. The rounded spores produced are comparable to the intranuclear spores in the salmon in most aspects, and likely transmit the infection to salmon. Phylogenetic analysis of P. theridion partial rDNA sequences place the parasite in a position between Nucleospora salmonis and Enterocytozoon bieneusi. Based on characteristics of the morphology, unique development involving a vertebrate fish as well as a crustacean ectoparasite host, and the results of the phylogenetic analyses it is suggested that P. theridion should be given status as a new species in a new genus.

Stylostomes of the trombiculid mite larvae Neotrombicula pomeranzevi (Schluger), Hirsutiella zachvatkini (Schluger), Miyatrombicula esoensis (Sasa and Ogata) and Euschoengastia rotundata (Schluger) (Acariformes: Trombiculidae), formed in the host skin during feeding of the parasites on their natural hosts (voles) were studied histologically and histochemically. A stylostome is a variously shaped tube formed of solidified mite saliva that extends from the mouthparts of the parasite through the epidermis into the dermis of the host, and allows the mite to obtain its liquid food. The first step of stylostome formation is deposition of an eosinophilic cone, to which the larva's chelicerae are glued. Organization of the stylostome depends on the mite species, and its walls may show weakly expressed longitudinal or transverse stratification. Histochemically, the stylostome is composed of complex glycoprotein with varying tinctorial properties through the width or the length of the stylostome's walls. Beneath the distal end of the stylostome, irrespectively of its localization either in the epidermis or in the dermis of the host, a feeding cavity is formed as a result of the action of the hydrolytic components of the mite's saliva forced through the stylostome into the wound. An inflammatory dermal reaction of moderate intensity is evolved during larval feeding and stylostome formation. It is manifested by the infiltration of the foci with neutrophiles, lymphocytes and macrophages and by dilation of capillaries of the terminal vessel bed and filling them by erythrocytes and other blood elements. Around the stylostome, necrosis of the epidermal cells occurs, leucocytes come to the damaged area and fuse with the necrotic epidermal cells, leading to the formation of the large scabs on the surface of the host's skin. In the case of E. rotundata, single capsules having a terminal opening and containing feeding larva are formed on the abdomen of the hosts. The walls of the capsules are composed of the mite's saliva flowing upon the surface of the host's skin. At the bottom of the capsule, a stylostome perforating the epidermis is also present.

Background: Palisading granulomatous reactions are documented in many diseases. Although subcutaneous cystic echinococcosis (CE) is documented rarely, a subcutaneous palisading, granulomatous, pseudocystic (PGP) reaction to elusive Echinococcus granulosus membranous components, in the absence of cutaneous fistulization, is undocumented., Methods: Seven-year clinicopathological review of subcutaneous echinococcal PGP reactions., Results: Gross: seven thick-walled 'cysts' containing clear or straw-colored fluid were investigated. Histopathology: the pseudocysts contained a palisade of epithelioid histiocytes and giant cells. Focal periodic acid Schiff (PAS)-positive eosinophilic fragments, some resembling keratin 'flakes', were identified within the lumen or within the cellular palisade, consistent with a PGP reaction to fragmented E. granulosus membrane. Clinical correlation: the initial histopathological diagnosis of two patients was ruptured epidermoid cysts with an assumed granulomatous reaction to eosinophilic keratinous debris. Subsequent diagnosis of CE in the liver and cervical soft tissue necessitated review of the 'epidermoid cysts'; PAS-positive E. granulosus membranous fragments masqueraded as keratinous debris. Renal, hepatic and pleuropulmonary CE were confirmed in the remaining patients following confirmation of an echinococcal PGP reaction., Conclusion: Heightened awareness and obsessive appraisal of subcutaneous PGP reactions for subtle, focal, PAS-positive and echinococcal membranous fragments are pivotal to the diagnosis that also serves as a clue to visceral CE.

The biological role of Langerin+ dendritic cells (DCs) such as Langerhans cells and a subset of dermal DCs (dDCs) in adaptive immunity against cutaneous pathogens remains enigmatic. Thus, we analyzed the impact of Langerin+ DCs in adaptive T cell-mediated immunity toward Leishmania major parasites in a Lang-DTR mouse model that allows conditional diphtheria toxin (DT)-induced ablation of Langerin+ DCs in vivo. For the first time, infection experiments with DT-treated Lang-DTR mice revealed that proliferation of L. major-specific CD8+ T cells is significantly reduced during the early phase of the immune response following depletion of Langerin+ DCs. Consequently, the total number of activated CD8+ T cells within the draining lymph node and at the site of infection is diminished. Furthermore, we show that the impaired CD8+ T cell response is due to the absence of Langerin+ dDCs and not Langerhans cells. Nevertheless, the CD4+ T cell response is not altered and the infection is cleared as effectively in DT-treated Lang-DTR mice as in control mice. This clearly demonstrates that Langerin+ DCs are, in general, dispensable for an efficient adaptive immune response against L. major parasites. Thus, we propose a novel concept that, in the experimental model of leishmaniasis, priming of CD4+ T cells is mediated by Langerin- dDCs, whereas Langerin+ dDCs are involved in early priming of CD8+ T cells.

Many fishes possess specialized epidermal cells that are ruptured by the teeth of predators, thus reliably indicating the presence of an actively foraging predator. Understanding the evolution of these cells has intrigued evolutionary ecologists because the release of these alarm chemicals is not voluntary. Here, we show that predation pressure does not influence alarm cell production in fishes. Alarm cell production is stimulated by exposure to skin-penetrating pathogens (water moulds: Saprolegnia ferax and Saprolegnia parasitica), skin-penetrating parasites (larval trematodes: Teleorchis sp. and Uvulifer sp.) and correlated with exposure to UV radiation. Suppression of the immune system with environmentally relevant levels of Cd inhibits alarm cell production of fishes challenged with Saprolegnia. These data are the first evidence that alarm substance cells have an immune function against ubiquitous environmental challenges to epidermal integrity. Our results indicate that these specialized cells arose and are maintained by natural selection owing to selfish benefits unrelated to predator-prey interactions. Cell contents released when these cells are damaged in predator attacks have secondarily acquired an ecological role as alarm cues because selection favours receivers to detect and respond adaptively to public information about predation.

Background: Amebiasis cutis (AC) is reported infrequently. This study assesses the clinicopathological spectrum, co-existent visceral involvement and impact of human immunodeficiency virus (HIV) co-infection on AC., Methods: An 8-year prospective clinicopathological evaluation of patients with AC., Results: Thirty-one biopsies of ulcers, fistulae, fissures, abscesses, polypoid and warty lesions in perianal, penile, scrotal, vulval, buttock, chest and abdominal wall sites were evaluated. Of these, 11 had a 'superficial' (superficial AC) and 20 a 'deep' (deep AC), histopathological pattern. Superficial AC showed predominant epidermal spongiosis, liquefactive necrosis, ulceration and fissures with hematophagous amebic trophozoites (HATs). Deep AC had confluent deep dermal and subcutaneous liquefactive, coagulative or suppurative necrosis and HATs. Seven biopsies showed vasculitis or thrombosis with luminal HATs., Outcome: Fourteen patients died; 9 had concomitant visceral amebiasis, 5 had other co-infections. Six who died were HIV seropositive, three were seronegative; all had deep AC. Of the 17 survivors, 11 (8 HIV positive) had superficial AC that healed with metronidazole treatment; the remaining 6 (one HIV seropositive) required additional surgical intervention., Conclusion: Deep AC is predictive of co-existent, contiguous visceral disease. The effective management, histopathological mimickers and diagnostic pitfalls of superficial and deep AC differ. The outcome in HIV-infected patients is dependent on co-existent systemic diseases.

Experimental leishmaniasis represents a suitable model to analyze Th1-type associated immunity. In C57BL/6 mice healing of leishmaniasis correlates with activation of Th1 cells. Recently, it could be demonstrated that dermal dendritic cells rather than epidermal Langerhans cells are responsible for the activation of Th1 cells after infection, indicating a necessary reconsideration of the role of Langerhans cells. In our current work, epidermal application of Leishmania-antigen prior to infection resulted in an atypical course of disease that is characterized by an impaired Leishmania-specific Th1 response. Consequently, these mice cannot manage an efficient elimination of the parasites at the site of infection. These data point to the activation of immunomodulatory effects by epidermal incorporation of antigen.

Background: Scabies is a contagious skin infestation caused by the human mite Sarcoptes scabiei. The usual reference method for definitive diagnosis is ex vivo identification of the mite with microscopic examination of skin scrapings. We compared diagnostic accuracy of in vivo dermoscopic (DS) mite identification using a pocket handheld low-magnification DS with the reference method., Methods: We conducted a prospective, nonrandomized, evaluator-blinded, noninferiority study to compare sensitivities (main outcome) and other diagnostic properties of DS and microscopic examination of skin scrapings. Among 756 patients with a presumptive diagnosis of scabies consulting in one center, 238 were sequentially submitted to the two diagnostic procedures. Three dermoscopists (one expert, two inexperienced) were involved. Diagnostic strategies using clinical skills only, DS results, and a combination of both were compared., Results: Sensitivities were 91% (95% confidence interval: 86-96) for DS and 90% (95% confidence interval: 85-96) for microscopic examination of skin scrapings (P = .005 for noninferiority). Specificities were 86% (95% confidence interval: 80-92) for DS and 100% (by definition) for microscopic examination of skin scrapings. DS sensitivities were similar for the expert and inexperienced dermoscopists, whereas differences were observed in specificities. However, diagnostic accuracy of inexperienced dermoscopists steadily increased during the study. Compared with clinical-based, DS-based treatment decision rule minimized the number of false-positive and false-negative findings, whereas a treatment decision rule based on combination of clinical presumption and DS result drastically reduced the number of patients with scabies left untreated., Limitations: There is no definitive standard for ruling out the diagnosis of scabies., Conclusions: Standard DS with a handheld DS is a useful tool for diagnosing scabies, with high sensitivity, even in inexperienced hands. It greatly enhances clinical skills for making treatment decisions.

Sarcoptes scabiei (De Geer) mites burrow in the nonliving stratum corneum of the epidermis of their mammalian hosts. These mites ingest extracellular fluid (serum) that seeps into the burrow from the lower vascular dermis. A strong host antibody response occurs when mites die in the skin. This suggests internal immunogenic proteins are released into the host at this time. Vaccination with internal antigens may be an approach to protect against this mite if host antibody to internal antigens that regulate key physiological processes is ingested along with serum. Our study clearly showed that scabies mites ingest host immunoglobulin as evidenced by the localization of fluorescent-labeled antibody to host immunoglobulin in the anterior midgut and esophagus of fresh mites removed from the host. This is the first study that demonstrates that this nonblood-feeding ectoparasitic mite ingests host antibody while feeding on tissue fluid that seeps into the stratum corneum.

The diagnosis of cutaneous leishmaniasis (CL) may depend on the detection of the parasite in histologic sections, the growth of the promastigotes in culture, or the identification of parasite by other techniques. We performed polymerase chain reaction (PCR) on paraffin-embedded biopsies to determine the validity of this technique for diagnosis of CL. PCR was used to detect the parasite using 2 different DNA extraction methods. PCR was positive in all 20 cases when the Leishmania parasite was detected by light microscopy. Twenty-seven of 34 cases that were negative microscopically for the parasite were positive using PCR. The first extraction method of DNA identified leishmanial DNA in 41 of 54 cases (75.9%); the second extraction of DNA was positive in 47 of 54 cases (87%). PCR was negative in all of the nonleishmaniasis cases. The PCR-based method appears to be a useful diagnostic approach for identification of suspected cases of CL.

The migration of Schistosoma japonicum and S. mansoni through mouse skin epidermis and dermis was compared by immunofluorescence techniques from 4 to 22 h after infection. At all times, the percentage of parasites detected in the dermis was significantly higher for S. japonicum than for S. mansoni. Thus, S. japonicum migrates more rapidly very early after infection. This agrees with the quicker migration observed previously by this species for later times. Both species expressed antigens related to the cercarial glycocalyx on the parasite body and antigenically detectable elastase in the acetabular glands, at least until 22 h after infection. Bot sets of antigens were also left as "traces" in cercarial migration channels in the skin as well as in skin tissue in the absence of detectable worms or migration channels. The data further substantiate differences between schistosome species in the speed of migration, and suggest that glycocalyx-related antigens and cercarial elastase continue to be expressed for at least 1 day after infection.

To assess the physiologic interactions between the infective stage of Brugia malayi--one of the extracellular parasites responsible for lymphatic filariasis in humans--and the APC with which they come in contact during their development and routes of travel, we have investigated the interaction between the infective stage (L3) of B. malayi and human Langerhans cells (LC) in the skin. Our data indicate that live L3 result in increased migration of LC from the epidermis without affecting the viability of these cells and up-regulation of the IL-18 cytokine involved in LC migration. Live L3 also result in down-regulation of MHC class I and II on the LC cell surface. Additionally, microarray data indicate that live L3 significantly down-regulated expression of IL-8 as well as of multiple genes involved in Ag presentation, reducing the capacity of LC to induce CD4(+) T cells in allogeneic MLR, and thus resulting in a decreased ability of LC to promote CD4(+) T cell proliferation and production of IFN-gamma and IL-10. These data suggest that L3 exert a down-regulatory response in epidermal LC that leads to a diminished capacity of these cells to activate CD4(+) T cells.

Male Sprague-Dawley rats were dosed orally with nitroxynil at a concentration of 40 mg/kg and adult Fasciola hepatica recovered after 24 h, 48 h and 72 h. Surface changes to the flukes were monitored by means of SEM. After the 24 h treatment, extensive swelling and blebbing of the tegument was observed on both surfaces, although the dorsal anterior region was more severely affected than either the posterior dorsal region or entire ventral surface. At high magnification, microvillus-like projections were evident, giving the surface a roughened appearance. After 48 h, the changes evident at 24 h had become more severe and some tegumental loss had occurred in the oral region of the fluke. Surface disruption was particularly evident along the lateral margins of the fluke in this region. In some specimens a single large swelling was present in the dorsal midbody region. The swelling was a more typical feature of flukes recovered. After 72 h, tegumental loss was more widespread, occurring over the oral cone and anterior midbody on the dorsal surface. Overall the dorsal surface was consistently more severely affected than the ventral surface, and the anterior region of the fluke was more disrupted than the posterior region. After 24 h in vitro incubation, the oral cone and midbody exhibited considerable spine loss and swelling. Overall, the dorsal surface was more disrupted than the ventral surface and the anterior region of the fluke was more disrupted than the posterior region. Regional differences in the response of the fluke to nitroxynil will be compared to previously published data with other fasciolicides. The results indicate that the tegument is an important target for nitroxynil action. Disruption of this, the fluke's main line of defence, would allow the drug access to other internal tissues, leading to more widespread damage.

We report here the case of a metazoan parasite, a strepsipteran, that manipulates host epidermal tissue and wraps itself within it; which probably camouflages the endoparasite and is recognized as "self" by the host. This mechanism is one of immune avoidance among parasitoid insects. The host-derived epidermal "bag" might have enabled Strepsiptera to radiate to disparate hosts compared with the relatively few taxa (596 species) described so far. They have been recorded as parasitizing 34 families belonging to seven orders of Insecta. We also report a mechanism of insect ecdysis between the first- and second-instar larva, while enclosed in the bag.

The weedy sea dragon Phyllopteryx taeniolatus at an aquarium in Kanagawa Prefecture were found infected by protozoan ciliate, 2001. The infected fish in particular, showed sloughing of the epidermis. Fish with intense infections showed sloughing of the dorsal fin, depigmentation of skin, anal distension and accumulation of ascitic fluid in the body cavity. In biopsies, ciliates were detected only in fresh mounts of abdominal dropsy and in the mucus on the body surface. Histopathological studies revealed ciliates mainly infected the dermis, and induced extensive detachment of the epidermis from the skin. Based on the arrangement and shape of the buccal structure and the number of somatic ciliature, ciliates isolated from the fishes belonged to the order Scuticociliatida. We discuss the major factors that bring about the death of weedy sea dragons.

Pfiesteria piscicida and P. shumwayae reportedly secrete potent exotoxins thought to cause fish lesion events, acute fish kills and human disease in mid-Atlantic USA estuaries. However, Pfiesteria toxins have never been isolated or characterized. We investigated mechanisms by which P. shumwayae kills fish using three different approaches. Here we show that larval fish bioassays conducted in tissue culture plates fitted with polycarbonate membrane inserts exhibited mortality (100%) only in treatments where fish and dinospores were in physical contact. No mortalities occurred in treatments where the membrane prevented contact between dinospores and fish. Using differential centrifugation and filtration of water from a fish-killing culture, we produced 'dinoflagellate', 'bacteria' and 'cell-free' fractions. Larval fish bioassays of these fractions resulted in mortalities (60-100% in less than 24 h) only in fractions containing live dinospores ('whole water', 'dinoflagellate'), with no mortalities in 'cell-free' or 'bacteria'-enriched fractions. Videomicrography and electron microscopy show dinospores swarming toward and attaching to skin, actively feeding, and rapidly denuding fish of epidermis. We show here that our cultures of actively fish-killing P. shumwayae do not secrete potent exotoxins; rather, fish mortality results from micropredatory feeding.

Several studies have confirmed that epidermal Langerhans' cells (LC) play a central role in the induction of skin-related immunological events. In order to assess the role of LC in Chagas' disease, guinea-pigs were infected intradermally with Trypanosoma cruzi, sacrificed at different time-points, and their tissues were processed for routine histology, electron microscopy and immunohistochemistry. Parasitaemia was observed earliest at day 6 p.i. with 2 peaks at days 9 and 28, and disappeared on day 56 p.i. Parasite-specific serum IgG and IgM were first detected on day 12 p.i. The level of IgG gradually increased by day 84 p.i. All the infected guinea-pigs showed significant alterations in the distribution and morphology of epidermal LC during parasitacmia. The number of LC had significantly decreased in the epidermis by day 3 p.i., only returning to normal levels by day 56 p.i., although the number of LC in the underlying dermis increased concomitantly. Parasites were carried to the regional lymph node, where clustering of parasite-laden dendritic cells (DC) with lymphocytes was seen by electron microscopy. This evidence suggests that LC might be involved in antigen presentation in Chagas' disease.

Late cutaneous vulvar schistosomiasis (LCVS), which represents the cutaneous response to the deposition of schistosomal ova, is characterized by a range of clinical manifestations. Histopathological descriptions of LCVS have highlighted the hyperplastic epithelial reaction, and a few reports have alluded to the presence of intraepidermal bilharzial ova. Although transepithelial elimination (TEE), a well-known phenomenon whereby the skin rids itself of foreign, potentially dangerous substances, has been documented in a range of infectious processes, it has not been recognized as a distinct process in LCVS. This study not only documents TEE in 23 biopsies of LCVS but also correlates the role of the histopathological inflammatory reaction pattern, density of ova, and pseudoepitheliomatous hyperplasia in the pathogenesis of TEE. The importance of TEE as an additional, hitherto unrecognized mechanism of release and spread of schistosomal ova to the exterior is also highlighted.

Despite the fact that Leishmania are transmitted exclusively by sand flies, none of the experimental models of leishmaniasis have established infection via sand fly bites. Here we describe a reproducible murine model of Leishmania major infection transmitted by Phlebotomus papatasi. Prior exposure of mice to bites of uninfected sand flies conferred powerful protection against Leishmania major that was associated with a strong delayed-type hypersensitivity response and with interferon-gamma production at the site of parasite delivery. These results have important implications for the epidemiology of cutaneous leishmaniasis and suggest a vaccination strategy against this and possibly other vector-borne diseases.

A model of Leishmania major infection in C57BL/6 mice has been established that combines two main features of natural transmission: low dose (100 metacyclic promastigotes) and inoculation into a dermal site (the ear dermis). The evolution of the dermal lesion could be dissociated into two distinct phases. The initial "silent" phase, lasting 4-5 wk, favored establishment of the peak load of parasites in the dermis in the absence of lesion formation or any overt histopathologic changes in the site. The second phase corresponds to the development of a lesion associated with an acute infiltration of neutrophils, macrophages, and eosinophils into the dermis and was coincident with the killing of parasites in the site. The onset of immunity/pathology was correlated with the appearance of cells staining for IL-12p40 and IFN-gamma in the epidermal compartment, and an expansion of T cells capable of producing IFN-gamma in the draining lymph node. Parasite growth was not enhanced over the first 4.5 wk in anti-CD4-treated mice, SCID mice, or C57BL/6 mice deficient in IL-12p40, IFN-gamma, CD40 ligand, or inducible NO synthase. These mice all failed to ultimately control infection in the site, but in some cases (anti-CD4 treated, IL-12p40-/-, CD40 ligand-/-, and SCID) high dermal parasite loads were associated with little or no pathology. These results extend to a natural infection model a role for Th1 cells in both acquired resistance and lesion formation, and document the remarkable avoidance of this response during a prolonged phase of parasite amplification in the skin.

Investigations were conducted on the host response in rainbow trout and the associated changes in mucous cell density during infection with the skin monogenean Gyrodactylus derjavini. Parasite populations increased on all naive hosts and peaked 4-5 weeks p.i. after which infection levels decreased. Introduction of naive fish into responding host populations resulted in heavy infections of the naive fish, whereas parasite expulsion continued in the responding host groups showing an acquired, non-sterile immunity. This non-sterile immunity lasted at least a month as these hosts were refractory to reinfection despite being exposed to a high infection pressure. Mucous cell hyperplasia was seen in some groups during the intermediary phase of infection, but at the termination of the study a significant depletion was evident. Passive immunization of naive host (with sera from immune hosts) did not confer protection. This indicates differences between host responses to G. derjavini compared to responses against other pathogens where such a passive immunity has been described.

Epizootics of scaly leg disease caused by infection with the submacroscopic mite Knemidokoptes jamaicensis (Acari: Knemidokoptidae) in migratory American robins (Turdus migratorius) from a residential area of Tulsa (Oklahoma, USA) are documented during the winters (December through February) of 1993-94 and 1994-95. Estimates of 60 to > 80% of the birds in several different flights arriving in the area had lesions consistent with knemidokoptic mange. Epizootic occurrence of K. jamaicensis also is confirmed incidentally in American robins from Georgia (USA) in 1995 and 1998 and in Florida (USA) in 1991. These are the first confirmed epizootics of scaly leg attributed to infections with mites specifically identified as K. jamaicensis in North America. Severity of observed lesions in American robins ranged from scaly hyperkeratosis of the feet and legs to extensive proliferative lesions with loss of digits or the entire foot in some birds. Histologically, there was severe diffuse hyperkeratosis of the epidermis which contained numerous mites and multifocal aggregates of degranulating to degenerating eosinophilic heterophils; there was mild to severe superficial dermatitis with aggregates of eosinophilic heterophils and some mononuclear cells. Based on limited data from affected captive birds in Florida, we questioned the efficacy of ivermectin as an effective acaricide for knemidokoptiasis and propose that conditions associated with captivity may exacerbate transmission of this mite among caged birds. While knemidokoptic mange apparently can result in substantial host morbidity and possibly mortality, the ultimate impact of these epizootics on American robin populations presently is unknown.

Skin morphology of Atlantic salmon, Salmo salar, parr infected with Gyrodactylus salaris was examined for 3 yr in the river Batnfjordselva in Norway and compared to that of uninfected salmon parr from a neighboring river. The epidermis of the infected population had more cell layers and was thicker than the epidermis of parr from the uninfected population. The number of mucous cells did not differ, and no seasonal changes in morphology of the epidermis were detected in either rivers. Intensity of G. salaris did not correlate to epidermal thickness, epidermal cell layers, or mucous cell concentration.

Both host and parasite determinants influence the outcome of Leishmania infections. Human host responses in cutaneous leishmaniasis of limited duration caused by a single species of the Viannia (V) subgenus were studied in skin biopsies obtained from lesions caused by Leishmania (V) panamensis in 31 male patients from the Colombian Pacific Coast. Dermal infiltrates and histopathologic changes were characterized using monoclonal antibodies and an indirect immunoperoxidase method. Dermal distribution of T-cell subpopulations and B-lymphocytes was nonrandom: CD4+ and CD8+ T cells were most frequent in the upper dermis, and B cells were most abundant in the lower dermis. Parasites, macrophages, and neutrophils were localized predominantly in the middermis. Multiple regression analyses to establish associations between lesion type (ulcer, nodule, or papule), immune response data (Montenegro skin test, indirect fluorescence antibody test titers, lymphocyte blastogenesis), and particular cell populations demonstrated statistically significant correlations between CD4+ lymphocytes and macrophages (p < 0.05). CD8+ lymphocytes were associated with plasma cells (p < 0.001), as was the presence of amastigotes (p < 0.05). These associations and the in situ divergence of CD4 and CD8 ratios suggest that prognostic indicators for disease evolution could be identified by prospective analysis of cellular relationships and response to therapy.