The patient is a 35-year-old male reporting to a dermatology clinic at a veterans’ hospital complaining of sleeplessness for the past two weeks. He is visibly weathered in his appearance but otherwise appears healthy. His sleeplessness is attributed to what he says is a constant feeling that something or things are crawling all over his body that fulminates in an intense pruritus of his arms and abdominal area.
Some of his personal history is as follows. He served two tours of duty in Afghanistan and has since been back in the United States for the past 4 years with nothing significant in his medical history. He lives alone and just recently moved to a small studio apartment because he could not afford his previous apartment. He has no reported psychiatric problems and has no history of drug use. He is asked if he has recently been using any drugs and strongly denies he has used any previously or presently. He has been in a monogamous relationship for the past two years.
His physical examination is significant only for areas of what can be described as macules or reddish spots on the abdominal area as well as his arms. Some papules are present as well. He describes the areas as itchy and uncomfortable. He is diagnosed as having contact dermatitis and is prescribed a cortisone cream to apply as needed and instructed to call the clinic if the condition worsens or does not resolve within a week. He is also instructed to control his urge to scratch the area to prevent any secondary infection that may make the condition worse. Currently there appears to be no evidence of a secondary infection.
Approximately four days later the patient was back at the clinic with the same symptoms. He is adamant that there is something he feels crawling on his skin. Skin scrapings are sent to the laboratory for fungus and for parasitic/arthropod analysis. He was now diagnosed as having a possible case of formication or tactile hallucination. However, as a precaution the patient was instructed to apply clear tape, sticky side down, to the area when/where he felt the crawling sensations later that night and to place the tape on two class slides, sticky side down, that were provided to him. He was instructed to bring the slides back to the clinic in two days … collecting a sample each night.
The initial skin scrapings sent to the laboratory were negative for any arthropods and were negative for fungal elements when examined by a KOH/calcofluor white preparation. The fungal cultures eventually were resulted as “negative for fungus after 28 days”.
Two days later after providing the tape/slide material and instructions to the patient for collecting a specimen, the patient came to the clinic to submit two slides with tape on the slides as instructed. The slides were forwarded to the Microbiology Laboratory where they were observed under a dissecting microscope. The image below is a video of what was seen on the slide utilizing the dissecting scope. Note that the objects are about .8-.9mm long.
What is organism is visible on this slide?
What could be a source and what recommendation should be made to detect the source?
What do they feed on?
Are the organisms captured on the tape considered vectors of any diseases?
What particularly common ectoparasite is a member of the same group as the group this one belongs to?
What are some of the differences between this ectoparasite and the common one we tend to be more familiar with that is a member of the same family?
As always … looking forward to answers/comments!