Clinical dermatology · Concise report

Avian mite dermatitis

D. I. Orton, L. J. Warren and J. D. Wilkinson
Department of Dermatology, Amersham Hospital, Amersham, UK

Summary Avian mite infestation is a rare cause of pruritic dermatoses in humans. The mites spend
the majority of their life cycle on the avian host but may be transmitted to man as a
result of direct contact and also through airborne spread. We describe a case of
infestation with the Northern Fowl Mite (Ornithonyssus sylviarum) from an abandoned
birds nest in the roof of a patients home. This caused a pruritic erythematous papular
eruption on exposed sites that settled with topical steroids. We discuss the diagnosis and
range of clinical manifestations produced by avian mites.

®rm to explore the attic the presumed source of the

Report
A 58-year-old woman presented with a 5-day history of a
widespread urticated pruritic eruption over her trunk
and limbs associated with excoriated erythematous
papules most in keeping with insect bites. Notably,
there was sparing of the interdigital webs and burrows
were not visible. She had no domestic pets. At the same
time as the appearance of the rash the patient had
noticed numerous `black dot' like insects moving in her
bathroom sink that appeared to be streaming from a
crack in the ceiling, leading directly to the attic. She had
never noticed the `insects' in direct contact with her skin
but had felt that they were responsible for her rash.
The patient brought some of the `insects' into the
department for closer inspection. Under the light micro-
scope each was about 0.5 mm long (Fig. 1a) with the
typical mite morphology consisting of four pairs of legs
and an ill-de®ned body (Fig. 1b).
The mites were subsequently identi®ed as Ornithonys-
sus sylviarum (the Northern Fowl Mite) by a medical
entomologist (Fig. 1c).
The patient responded quickly to treatment with
antihistamines and mild topical corticosteroids. She
was advised to contact the local environmental health
of®cer who in turn suggested contacting a pest control
Correspondence: D. I. Orton, Dermatology Department, 2nd Floor Out
patient Building, Royal London Hospital, Whitechapel, London E1 1BB, UK.
Accepted for publication 12 October 1999
mites. Within the attic, a hole in the roof and a heavily
infested but deserted birds nest were found. When the
nest was vacated and the mites lost their source of food,
they had tracked down from the ceiling crack into the
bathroom. The nest was removed and the roof repaired.
On the advice of the pest control ®rm the attic and
bathroom were treated with malathion.
Gamasoidosis is the term used to describe human skin
disease caused by nonburrowing blood sucking mites
from birds and other animals.1 Avian mites usually
spend their entire life cycle on the bird, but can infest
man as an accidental host under certain circumstances.
Mites that infest chickens, ducks, pigeons, canaries,
sparrows, starlings and tiger ®nches have all been
reported to cause dermatoses in man.2 The onset of
human dermatoses is often related to the life-cycle of
the mite: mites that feed on ¯edgling birds must ®nd an
alternative food source when ¯edglings leave the nest
and nests can act as a reservoir for humans if built in
close proximity to human dwellings.3
Avian mites can be divided into two genera Derma-
nyssus and Ornithonyssus. Ornithonyssus species include
Ornithonyssus sylviarum (Northern Fowl Mite) and
Ornithonyssus bursa (Tropical Fowl Mite). Theses mites
spend most of their life cycle on the avian host in
particular its feathers. However, numbers can be so
great that they can also be found in the surrounding
habitat. Studies show that they can survive for up to 3
weeks without a host.2

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Avian mite dermatitis · D. Orton et al.
Figure 1 (a) Life-size appearance of Northern Fowl Mite (Ornitho-
nyssus sylviarum) compared to the tip of a pen. (b) Light micro-
scopy appearance of Northern Fowl Mite (Ornithonyssus sylviarum).
(c) Northern Fowl Mite (Ornithonyssus sylviarum) (from E. W. Baker
National Pest Control Association Inc., Vienna, Virginia).
130
In contrast, the Chicken Mite, Dermanyssus gallinae, is
a parasite found exclusively on the host bird at night.
During the daytime it is usually found in the nesting
material and in close proximity to the nest. It is more
resilient and can survive for up to 5 months without a
host under laboratory conditions. The temperature and
humidity provided by the host seem to be extremely
important for its survival.2
These life cycle differences have important treatment
implications. For Dermanyssus infestation, removal of the
nests and treatment of the habitat is usually adequate.
With Ornithonyssus both the habitat and the birds must
be treated simultaneously. Elimination of the mite from
the patient's environment is usually curative since they
are only temporary visitors to the human skin and
incapable of living and reproducing on the human
host. Careful attention must always be given to looking
for the preferred nesting sites of birds such as attics,
ventilation ducts and air-conditioning systems.
Cutaneous reactions in man are nonspeci®c and
dif®cult to diagnose without a degree of clinical suspi-
cion. The morphology of the lesions range from papules
to a grouped papular urticarial or papulovesicular erup-
tion. Salzberger and Kaminstein reported the common
®ndings of dermographism in association with the urti-
carial lesions.4 In contrast with scabies infestation, the
interdigital spaces and genitalia are usually spared and
burrows are never seen. Mites cannot usually be found
on the human host as they quickly leave after their blood
meal. Those most at risk of developing avian mite
dermatitis include poultry workers but there have also
been sporadic case reports from the USA and Japan
including multiple infestations within a family and sev-
eral hospital outbreaks.5±9 In all cases, the mites usually
gained access to humans from neighbouring birds' nests,
either directly or through air-conditioning systems.
In view of the lack of awareness of this condition and
the small size of the mites, the diagnosis may often be
missed; it should, however, always be considered in the
context of unexplained bite like eruptions.l
References
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4 Sulzberger MB, Kaminstein I. Avian itch mites as a cause
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60.
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