Eradication of avian mites from the environment of patient
Management of symptoms
Gamasoidosis, also known as dermanyssosis, is a frequently unrecognized form of
dermatitis, following human
infestation with avian mites of the genera Dermanyssus or Ornithonyssus. It is characterized by pruritic
erythematouspapules,
macules and
urticaria, with itching and irritation resulting from the saliva the mites secrete while feeding. These bites are commonly found around the neck and areas covered by clothing, but can be found elsewhere on the body. The avian mite Dermanyssus gallinae can also infest various body parts, including the
ear canal and
scalp.
Diagnosis is challenging due to the small size of the mites, requiring microscopic examination by a
medical entomologist for species identification. Misdiagnosis is also common due to ignorance and misinformation among medical professionals, scientists and pest controllers. Gamasoidosis is linked to avian mites infesting residential, public and agricultural spaces, with a potential health threat due to the transmission of
zoonotic pathogens by D. gallinae. Treatment involves eradicating mites from the environment, with resistance to pesticides posing a challenge. The condition's
epidemiology raises concerns about its impact on
public health, emphasizing the need for awareness, interdisciplinary collaboration, improved diagnostic tools and a "
One Health" approach.
Signs and symptoms
Avian mite bites induce a non-specific
dermatitis.[2] The most common symptoms are pruritic
erythematouspapules,[3] with a size of 1–3 mm,[4] and a central punctum,[5] as well as
macules and
urticaria.[2] Itching and skin irritation are reactions to the saliva the mites secrete when feeding.[6]
Bites are normally located in groups around the neck and body areas covered by clothes (waist, trunk, upper extremities and abdomen),[4][7][8] but can also be found on the legs,[4] finger webs,
axillae, the
groin, and
buttocks.[8] If feeding occurs while a patient is sleeping, bedding may show red spots caused by droppings or crushed mites.[4]
The species
Dermanyssus gallinae is capable of infesting the ear canal, with symptoms including itching, internal inflammation and discharge.[9] It can also infest the scalp, with severe itching, particularly at night, as the primary symptom,[10] as well as "the
nares,
orbits and
eyelids, and
genitourinary and
rectal orifices."[11]
Gamasoidosis occurs after human contact with avian
mites which
infest birds, such as
canaries,[13]sparrows,
starlings,
pigeons[14] and
poultry[15] and is caused by two genera of mites: Ornithonyssus and Dermanyssus.[16] Avian mite species implicated include the red mite (Dermanyssus gallinae),[17] tropical fowl mite (Ornithonyssus bursa)[6] and northern fowl mite (Ornithonyssus sylviarum).[17] Dermatitis is also associated with rodents infested with the tropical rat mite (Ornithonyssus bacoti),[7][18] spiny rat mite (Laelaps echidnina)[19] and house-mouse mite (Liponyssoides sanguineus), where the condition is known as
rodent mite dermatitis.[20] Urban gamasoidosis is associated with window-sills, ventilation and air-conditioning intakes, roofs and
eaves, which serve as shelters for nesting birds.[21] Gamasoidosis in farm workers is associated with
poultry farms, with a "19% incidence of contact dermatitis reported in a two-year survey of workers on 58 European poultry farms";[22]D. gallinae exposure is so common that it is considered an "occupational hazard" for these workers.[23]
Diagnosis
Diagnosis can be challenging as the small size of avian mites make them "barely visible to the unaided eye".[24] Identification of the species is best carried out by a
medical entomologist using a
microscope;[17] positive identification of species is critical for recommendation of suitable treatment methods.[4]
Diagnoses of gamasoidosis have a long history, with "cases [...] reported since the 17th century, documented in the leading medical literature since at least the 1920s."[23] Avian and rodent mites have been documented as infesting residential buildings, work spaces, schools and hospitals.[7][23] Despite this, there is considered to be widespread ignorance and misinformation "regarding human infestation with D. gallinae across healthcare, science and pest control fields", which in turn has led to increasing numbers of infestations and a dangerous propagation of the disease.[12]
Many cases of gamasoidosis go unreported, suggesting that the actual incidence is higher than generally believed.[15] As a result, in cases of unexplained bites in residential areas, the involvement of D. gallinae should always be considered,[25] especially during late spring and early summer when wild birds make their nests.[8]
The life cycle of the mite is another important method of diagnosis.[12]Hematophagic mites generally feed at night,[26] but may also feed during the day if the room is sufficiently dark.[27] Attacks in public and office buildings tend to occur during the daytime.[4]O. bursa is an exception as it generally remains on its hosts and will feed during the day.[28]D. gallinae may be commonly found in the bedroom or where the patient sleeps, as they prefer to stay close to their host for optimal feeding.[29]D. gallinae generally visit their host for up to 1–2 hours, leave after completing their blood meal,[citation needed] and typically feed every 2–4 days.[23] They are able to move extremely quickly,[5] and can take less than 1 second to bite; enough time to inject their saliva and to induce rash and itching.[citation needed] They locate potential hosts through temperature changes, vibrations, chemical signals and
CO2.[23]
It has been hypothesized the D. gallinae is capable of 'learning'[30] "to associate non-host skin with a blood-meal if the host selection process permitted feeding."[23] Combined with a generalist approach to finding hosts and the capability of digesting non-avian blood could potentially explain their documented host expansion to mammals and humans.[23]
There is documented "co-occurrence of gamasoidosis and various immunosuppressive disorders"[23] and physicians should bear in mind that immunocompromised patients, patients that take corticosteroids, and patients with dementia may have a more severe infestation than healthy patients,[12] Despite this, while immunosuppression can "increase susceptibility, it is not necessarily a pre-requisite for infestation".[23]
Pets such as canaries,[13] cats,[32] dogs,[33] hamsters,[citation needed] and gerbils[5] can be infested also. As a result, it has been argued that veterinarians should be aware that non-avian attacks of D. gallinae are possible, and may be underestimated, and that there is a need for increased awareness among practitioners.[33]
Prevention
Preventing gamasoidosis in residential areas is achieved by avoiding the proliferation of avian mites, by refraining from feeding birds and utilizing nets on building terraces to deter nesting in close proximity to human homes. It is crucial to remove and clean nests during the nesting season before birds can establish them and lay eggs.[34]
Treatment
Treatment of gamasoidosis can be difficult; avian mites have developed resistance to multiple pesticides and the different species concerned display varied ecologies that necessitate divergent treatment approaches.[12]
For a patient to achieve full recovery, the mites must be eradicated from the person's environment through the removal of nests and appropriate disinfestation of infested areas by a
pest control professional.[21] Total eradication can be difficult to achieve as D. gallinae can survive for longer than nine months without a blood meal,[35][36] and is capable of both digesting,[37] and completing its life cycle on human blood alone.[10] Additionally, populations can expand rapidly, with a single female capable of laying up to "30 eggs in their lifetime";[38] prolonged darkness has been found to significantly promote mite population growth.[39]
Remove the source of the mites, such as bird nests.
Perform regular intensive vacuum cleaning and steam cleaning — the vacuum bag should be placed in a sealed bag and thrown away outside in a contained bin.
In the case of scalp infestation, treatments with 1%
permethrin shampoo can be used to remove the mites.[26] For ear canal infestation, aural toilet is recommended with a course of 1% permethrin to be used as ear drops and for infected wax to be removed by a professional.[9]
Ineffective and often prolonged attempts to eradicate infestations can result in economic issues, due to a significant financial outlay when patients relocate or attempt to control these infestations, as well as psychological problems such as
depression.[12]
For pets, there are currently no registered products for treating gamasoidosis in mammals. The scientific literature documents medications which have been used
off-label to treat the condition, including
sarolaner in dogs,
selamectin in cats and
permethrin in horses.[41]
Epidemiology
Gamasoidosis, particularly caused by D. gallinae, is source of growing concern in
human medicine, due to factors such as limited awareness among medical specialists, lack of interdisciplinary collaboration, misdiagnoses, and an absence of diagnostic tools.[4] Occurrences of gamasoidosis have become more frequent in recent years, especially in residential environments, often linked to
synanthropic birds.[23] A "
One Health" approach has been recommended to remedy this, with microbiologists, veterinarians, parasitologists, epidemiologists, environmental scientists, and clinicians working together to treat the disease.[4]
^Kowalska M, Kupis B (1976). "Gamasoidosis (gamasidiosis)-not infrequent skin reactions, frequently unrecognized". Polish Medical Sciences and History Bulletin. 15–16 (4): 391–4.
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abcKong, Tak K.; To, Wing K. (April 2006). "Images in clinical medicine. Bird-mite infestation". The New England Journal of Medicine. 354 (16): 1728.
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abSulzberger MB (1936-01-01). "Avian Itch Mites as a Cause of Human Dermatoses". Archives of Dermatology and Syphilology. 33 (1): 60.
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^Sparagano OA, George DR, Harrington DW, Giangaspero A (2014). "Significance and control of the poultry red mite, Dermanyssus gallinae". Annual Review of Entomology. 59: 447–66.
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abCafiero MA, Camarda A, Galante D, Mancini G, Circella E, Cavaliere N, Santagada G, Caiazzo M, Lomuto M (2013). "Outbreaks of red mite (Dermanyssus gallinae) dermatitis in city-dwellers: an emerging urban epizoonosis". Hypothesis in Clinical Medicine: 413–24.
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abPezzi M, Leis M, Chicca M, Roy L (October 2017). "Gamasoidosis caused by the special lineage L1 of Dermanyssus gallinae (Acarina: Dermanyssidae): A case of heavy infestation in a public place in Italy". Parasitology International. 66 (5): 666–670.
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^Bardach H (January 1981). "[Acariasis due to dermanyssus gallinae (gamosoidosis) in Vienna (author's transl)]". Zeitschrift für Hautkrankheiten. 56 (1): 21–6.
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^Williams RW (November 1958). "An infestation of a human habitation by Dermanyssus gallinae (Degeer, 1778) (Acarina: Dermanyssidae) in New York City resulting in sanguisugent attacks upon the occupants". The American Journal of Tropical Medicine and Hygiene. 7 (6): 627–9.
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^Di Palma A, Leone F, Albanese F, Beccati M (April 2018). "A case report of Dermanyssus gallinae infestation in three cats". Veterinary Dermatology. 29 (4): 348–e124.
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abRamsay GW, Mason PC, Hunter AC (July 1975). "Letter: Chicken mite (Dermanyssus gallines) infesting a dog". New Zealand Veterinary Journal. 23 (7): 155–6.
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^Nordenfors H, Höglund J, Uggla A (January 1999). "Effects of temperature and humidity on oviposition, molting, and longevity of Dermanyssus gallinae (Acari: Dermanyssidae)". Journal of Medical Entomology. 36 (1): 68–72.
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^Chauve C (November 1998). "The poultry red mite Dermanyssus gallinae (De Geer, 1778): current situation and future prospects for control". Veterinary Parasitology. 79 (3): 239–45.
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