Correspondence Clinical Letter

Clinical Letter

Dermatitis due to Mesostigmatic mites

(Dermanyssus gallinae, Ornithonyssus [O.]
bacoti, O. bursa, O. sylviarum) in residential
settings

DOI: 10.1111/ddg.13565

Dear Editors,

Since early recorded history, people who live in urban areas Figure 1 Ornithonyssus sylviarum (northern fowl mite)
have shared their environment with pets and synanthropic infestation. Eruption of erythematous papules on the trunk,
animals, mainly birds and rodents. These animals harbor marked by a central red puncture (a). Detail of (a); (b).
zoonotic parasites, including mites of the suborder Mesos-
tigmata [1]. Among them, the avian mites Dermanyssus
(D.) gallinae, Ornithonyssus (O.) sylviarum, O. bursa were delivered to our laboratory by the patients themsel-
and the tropical rat-mite, O. bacoti are the most dermato- ves, who had found them crawling on their skin and/or in
logically relevant species. They are non-burrowing, blood- their bedrooms or workplaces. The parasites were identified
sucking ectoparasites of similar shape and size (about 1 mm as D. gallinae (20/26; peninsular regions), O. bacoti (4/26;
in length) [1]. With the exception of O. sylviarum, which Sicily/peninsular regions), O. bursa and O. sylviarum (both
usually lives permanently on its host, they are temporary 1/26; Sicily) based on morphological key characters [1, 4]
and nocturnal visitors of their victims, hiding in daytime (Figure 3). Abandoned bird nests (20/26; pigeon/sparrow/
in their close proximity. The resting/breeding sites of birds/ swallow) close to buildings, pet canaries (1/26) and poultry
rodents, mainly pigeons and feral rats/mice and occasio- in backyards (1/26) were the sources of avian mite species;
nally pets, act as mite reservoirs [2, 3]; in the absence of the source of O. bacoti was ascribed to laboratory holdings
their natural host, hungry mites may migrate into nearby (1/26) or colonies of wild rats (3/26). Considering the pati-
human buildings and bite their inhabitants. Patients develop ents’ medical histories, clinical findings and laboratory data,
itching urticarial papules, often bearing a red punctiform we diagnosed Mesostigmata mite infestation in all cases.
mark, on covered and/or exposed body areas. These lesions Showering and washing clothes, removal of mite sources and
are usually unrecognized unless there is a high degree of
clinical suspicion.
From 2001 to September 2017, we used transmission
light microscopy and/or scanning electron microscopy to
analyze the arthropods supposedly related to 26 urban out-
breaks of pruritic dermatitis, with a total of 66 subjects (60
adults and 6 children) living and/or working in southern
peninsular and insular Italian regions (Campania, Molise,
Basilicata, Apulia and Sicily). The dermatitis had started in
spring/summer and lasted from a week to nine months. In
eleven cases, it remained undiagnosed for more than four
weeks and underwent several relapses after systemic and
local treatment with antihistamines and corticosteroids. The
patients presented with eruptions of urticarial papules, most
of which had a central red puncture mark, readily detectable
with a magnification lens (Figures 1, 2). The clinical picture
was highly suggestive of mite bite dermatitis and the parasi-
tes were searched for. They were collected from the patients’ Figure 2 Dermanyssus gallinae (poultry red mite) infestation
bedrooms, workplaces (hospitals, offices, animal facilities) in 55 years-old male: multiple skin reactions on trunk (a).
and from the patients’ skin. In a few cases, the parasites Detail of (a); (b).

© 2018 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd. | JDDG | 1610-0379/2018 1
 Correspondence Clinical Letter
Figure 3 Ventral view of Ornithonyssus sylviarum. Gna-
thostoma (gn), sternal shield (s.s.), genital shield (g.s.) and
anal shield (a.s.) (a). Detail: sternal shield showing two
pairs of setae (blue arrows); the third pair of setae is on the
unsclerotized integument (red arrow) (scanning electron
microscope, Phenom World Pro) (b).
disinfestation with pyrethroids achieved complete and stable
regression of the dermatitis.
Dermatitis due to zoonotic Mesostigmata mites is cur-
rently an increasing but neglected problem in urban life. It
is not limited to southern Italy, but extends far beyond the
confines of our peninsula and has been reported in several
European countries and many other parts of the world [3,
5]. Mesostigmatic involvement should be suspected when
unexplained, recurrent, arthropod-bite-like eruptions occur
in humans in urban settings and symptomatic therapies are
unsuccessful. More severe skin manifestations develop under
favorable conditions (darkness, victim hideouts, high humidi-
ty), for example when bedrooms and bedding are colonized,
and the parasites can feed for a suitable time. By contrast, in
workplace infestations, cutaneous reactions are mostly ob-
served on exposed skin. In such cases, mites are more likely to
be disturbed and perform quick exploratory bites with saliva
inoculation, but with little or no engorgement. Mesostigma-
ta seem to have the potential for zoonotic pathogen/disease
transmission: in fact, some circumstantial evidence shows
that Dermanyssus spp. and O. bacoti mites may play a role
in Bartonella spp. transmission [6, 7], and Lyme disease/Q
fever agents have recently been detected in D. gallinae and
related to outbreaks of dermatitis in Italian city-dwellers [8].
As demonstrated by our experience, recognition of
dermatitis due to Mesostigmata bites and detection of the
parasites are challenging tasks and require a high degree
of awareness and thorough knowledge of mite biology/
taxonomy. Such cases of dermatitis may be confused with
2 © 2018 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd. | JDDG | 1610-0379/2018
scabies (from Sarcoptidae); with baker’s itch (from Acaridae);
with bites of Cheyletiella (in pet owners); and with infestati-
on by Trombiculidae, the latter recognizable by the presence
of attached chiggers at the center of some papules. Inflamed
lesions, especially if arranged in linear arrays, may simulate
reactions to bites from Cimex lectularius [1, 9]. Finally, pru-
rigo and insect-bite-like lymphoma [10] should be considered
in the differential diagnosis. Consequently, close collabora-
tion between dermatologists, microbiologists/parasitologists
and veterinarian entomologists is advisable in order to detect
mites rapidly and manage the mite sources appropriately in
order to prevent recurrence.
This study lists O. sylviarum as a new agent of human
mite dermatitis in Italy, in addition to the recently registe-
red O. bursa and O. bacoti [11, 12]. It also suggests that
maintenance of this dermatitis is ensured by an urban cycle,
in which synanthropic birds/rodents serve as natural hosts/
reservoirs of the above-mentioned mites, and city dwellers
and/or their pets are accidental victims [2, 13].
Conflict of interest
None.
Maria Assunta Cafiero1, Enza Viviano2, Michele
Lomuto1, 3, Donato Antonio Raele1, Domenico
Galante1, Elena Castelli2
(1) Istituto Zooprofilattico Sperimentale della Puglia e della
Basilicata, Foggia, Italy
(2) Dipartimento di Dermatologia (Policlinico Paolo
Giaccone), Università degli Studi di Palermo, Palermo, Italy
(3) Dermatologist consultant, Istituto Zooprofilattico
Sperimentale della Puglia e della Basilicata, Foggia, Italy
Correspondence to
Maria Assunta Cafiero, DVM, PhD
Istituto Zooprofilattico Sperimentale della Puglia e della
Basilicata
Via Manfredonia
20–71100 Foggia, Italy
E-mail: mariaassunta.cafiero@izspb.it
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