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Answer to question 1
The answer is B, Dermanyssus gallinae. After microscopic identification of the mite Dermanyssus gallinae by a microbiologist in the above case (figure 5), the home of the siblings was fumigated, resulting in complete remission of symptoms. When the parents were informed that the agent is usually an avian parasite, they recalled removing pigeon nests from the attic of their house 2 days before the onset of symptoms. Patients can develop clinical hypersensitivity to insect bites and injuries caused by mites. Identifying the aetiological agent is a challenge, which can make it difficult to convince parents of the cause of the lesions. Dermanyssus gallinae is a mite found worldwide that can promote skin lesions in humans.1 Infestation is characterised by papules with haemorrhagic centres in exposed areas of the skin; vesicles, urticarial plaques and diffuse erythema have also been reported.1 ,2 The itching is nocturnal because the mite feeds at night, and sometimes the patient can find the agent moving over the skin.1 ,2 Contact with poultry, hamsters or with people who have had contact with these animals must always be questioned. The presence of pruritic …
Footnotes
Collaborators Tania Portella Costa and Patricia Weckerlin e Silva Trindade.
Competing interests None.
Patient consent Obtained.
Ethics approval The Comitê de Ética em Pesquisa do Hospital de Clínicas—UFPR approved this work.
Provenance and peer review Not commissioned; internally peer reviewed.