About discovery

About given discovery

I was far from dermatology and allergology. In 1973 I started collecting material for degree of PhD in the Gastroenterological Department of the Republican Clinical Hospital. At the same time quite accidentally I became an observer of the highly contagious of patient with chronic active hepatitis and co-existing discoid lupus erythematosus. A huge amount of Demodex was allocated on the affected area of patient. Meanwhile, the dermatologists-consultants assured that patient is safe to others. However, the words of dermatologists were not assured me, therefore I became very carefully to watch for skin of exposed parts of body of all people who had any contact with this patient.

Other theme of basic scientific work (Diet therapy of patients with chronic hepatitis), and the complexity of relations in the Department (human factor) not allowed to inform the colleagues immediately about this fact. Study of a skin clinical condition in dynamics of treatment was one of the leading methods of observation in my thesis research. Because of that, it was not so difficult for me to notice those smallest changes on previously healthy skin, which were occurred in the result of Demodex affect of persons, who had contact with the patient with discoid lupus erythematosus. At first it was necessary to make sure in accuracy of my supervision. Therefore, I independently continued the observation of Demodecosis in its natural distribution; selectively conducted antimite Demodex treatment of affected patients, and then compared the results of their treatment with the results of treatment of patients, who were not received the similar antimite treatment. At that time I am not supposed that all my professional work in future will be devoted to study of demodectic acariasis.

In the beginning the research was performed unscheduled in the clinic of Research Institute of Endemic Pathology. Different subject of the fundamental research paper (diet therapy for patients with chronic hepatitis) and complexity of situation in the department (human factor) forbade informing the colleagues about discovered fact publicly and immediately. At first it was necessary to make sure in accuracy of the supervision. The independent observation for progress of natural dissemination of Demodecosis has been continued: selectively put patients with Demodecosis on antimite treatment and compared treatment results with condition of similar patients, who got no antimite treatment at all. However, the apparent inadequacy of the high level of medical science and technology development with presence of unrecognized infection by clinical medicine was not allowed to believe into observed facts completely. The doubts were assuaged by autoinfection with Demodecosis performed on August 10, 1980. Generalized Demodecosis which have affected my body, was recognized neither by the chief dermatologist of the republic nor by the dermatologist of an outpatient clinic. In their opinion it was “non-communicable generalized erythroderma or generalized neurodermatitis”. However, this opinion was disproved by infecting two kittens by Demodecosis by material sampled from my infected skin. Thus the accurateness of these observations was proved to myself.

About the results of the research started to apprise to corresponding healthcare authorities since January 1981. They required the proofs. As evidence was performed examination of the whole skin covering of people in outpatient clinics, colleges, hospitals, schools, nurseries, among staff and at various facilities. In crowded areas (transport, theaters, parks, etc.) was calculated percentage of people affected by Demodecosis, judging by the condition of their skin on exposed parts of the body. The evidence was finished with accurate specific indication of 42 places of localization of Demodexes in the skin of various parts of the body (back, feet, nape, neck, thighs, shoulders, shanks, hands, etc.) of 37 inpatients and outpatients of the Republican Institute of Dermatovenerology to seven members of special committee from the Ministry of Health. Laboratory doctors of this institute immediately sampled the material from indicated places over the patient’s body, and all samples in the microscope demonstrated Demodexes at various stages of development. However, the administration of the Institute of Dermatovenerology “explained” to the Academic Board of the Ministry of Health that Demodex is a saprophyte and it can be found on the skin of every single person. In that case why they allowed to the seven members of special committee to waste their time? Could the presence of Demodex colonies in the skin testify to their symbiotic stay in human body, moreover - in dermatologic patient’s body? The treatment of patients with Demodecosis was not allowed. The request to open a laboratory for study Demodecosis was dismissed. Also it was denied me in position of common dermatologist in Almaty city.

The observation was continued in the country town Kentau in a post of an allergist of children’s health maintenance organization and concurrently as a dermatologist of Municipal Dermatovenerologic Dispensary. In accordance with the existing Legislation, my know-how was added to the treatment of admitted patients with various clinical masks of Demodecosis and obtained magic results in the truest sense of the word. Later on, in conditions of capital city, there was a possibility to extend observations over patients with various clinical masks of Demodecosis. After break-up of the Soviet Union (since 1991), appeared а possibility to become the individual entrepreneur by profession.

Each patient was able to receive any clinical, instrumental or laboratory examination, and also a specialist’s consultative checkup. The acarological examination was arranged for 17824 mity patients and 28 persons with healthy skin. Biotope was studied at 412 patients. Within 1993 to 1997, the work was realized together with the acarologist, Doctor of Biological Sciences V.N. Kusov to perform specific identification of mites and with a laboratory technician to obtain sample material from patient’s biotope. Outpatient medical assistance was given to 43198 admitted patients.

Study of a skin clinical condition in treatment progress was one of the leading methods of observation in my thesis research. Because of that, it was not so difficult for me to notice those smallest changes on previously healthy skin, which are occurred in the result of Demodex affect of persons, who contacted a patient with discoid lupus erythematosus. Comparative study of treatment results with (137 persons) and without (131 persons) antimite means rechecking on 49 affected persons, proved the efficiency of specific means. The clinical aspects of Demodecosis incipience was studied in natural conditions of its dissemination among patients, hospital visitors, medical staff, friends, etc. Among 342 persons in course of the disease, 13 persons were examined after 23 years, 10 of them had Demodecosis II and III stage.

Positive result of clinical experiment and wrong interpretation of skin condition developed after it by dermatologists testified, on the one hand, to specialists’ unfamiliarity with Demodecosis and, on the other hand, to the fact that erythrosis and neurodermatitis were clinical masks of Demodecosis. Extended observation of the whole skin covering of 112700 persons in 1981 revealed presence of skin affected by Demodex among 96% of them. By this time the whole skin covering was examined with respect to Demodecosis presence among 388780 persons. Demodecosis definitely affects skin on face and exposed parts of the body that is why examination of these parts of the body started in January 1981 was continued in the following years. In January 1981 among 18070 patients subject to examination of exposed parts of the body 27% had skin free of mite invasion. As the months rolled by the number of people with healthy skin of exposed parts of the body was reduced. In August 1981 among 23175 examined people only 0.2% of persons had healthy skin. Henceforth people with skin free from Demodex affection could not be found. By this time the examination of skin of exposed parts of the body was conducted at more than 2 million persons all over the world.

The masterful knowledge of clinical picture of Demodecosis allowed to show precise localization of Demodex colonies in the skin of patients to the members of competent committee of the Ministry of Health. Absolute reliability of my research was also proven by miraculous healing of patients in Kentau from allergy, pollinosis, mastopathy, psoriasis, cancer of female organs, kraurosis vulvae, skin diseases and some other clinical masks of Demodecosis. For example, an inpatient of Dermatovenerologic dispensary with foot psoriasis complicated by consecutive infection, who had no possibility to walk during three months because of the pain, returned to his occupational work (worker at a transformer work) after three medical manipulation; a patient, who moved from Togliatti due to pollinosis with asthmatic complications after 27-day of treatment course recovered from symptoms of the disease and later on moved back to Kentau.

It is worth emphasizing, that among inpatients the number of those who affected with Demodecosis was always higher than among the persons in public areas. Moreover in serum department percentage of those who affected with Demodecosis was always higher (93%) than in other departments of the Republican Clinical Hospital (for example, 70% in urology department). Besides, in that time a mirrored type of skin affected with Demodecosis allowed to judge the corporal intimacy of examined people, which permitted to refer Demodecosis to sexually transmitted infections. Following the total affect of people with Demodecosis, became noticeable the gradual reduction of cases with early symptoms of Demodecosis affect on skin. For example, in 1982 Demodecosis incipience could be observed among 89% of examined patients against 100% in the end of August 1981. In 1983 incipience of Demodecosis could be observed among 78% of examined patients. In 1991 among patients seeking medical attention Demodecosis incipience could be observed among 91%, from them 85% denied any subjective symptoms. In 2006 Demodecosis incipience could be diagnosed among 12% of admitted patients, and only 27% of them had no subjective symptoms. Among 18700 patients, who were examined in functional diagnostics office of No.4 Hospital of Almaty city in 1986-1988 Demodecosis incipience had 40%, a phase of developed disease had 52% and 8% had a complicated phase of Demodecosis. All 319 dispensary cases of rheumatologic office suffered from one or another Demodecosis complication. Among 124 examined newborns at a maternity hospital in 1982-1983 nine had symptoms of congenital Demodecosis. Deterioration of clinical course affected the results and period of treatment. For example, in 1991 to completely recover patients needed only one month, in 2006 to recover they already needed at least six months. If in the beginning of the given observations was the possibility for clearly could define Demodecosis among 49285 persons and Dermatophagoidosis - among 12590 persons, today is no possible to differentiate these two acariasis because by this time take place a mixed mite-born invasion. It is worth emphasizing that today invasion by Sarcoptes scabiei is not rare, but it proceeds in a veiled way and often affect the skin on the faces of both adults and children.

Blood analysis of patients with Demodecosis incipience sometimes showed insignificant eosinophilia. Developed disease showed hyper-alpha2- and/or hyper-gamma-globulinemia and lymphocytosis. Complicated stages were characterized by those deviations in blood analysis, which could be observed in case of relevant clinical masks (for example, anemia, leukopenia and/or thrombocytopenia in case of systemic lupus erythematosus). During acarological examination Demodex was typically (96.6%) discovered using a scrape method among 7817 persons. Search of mites over the skin surface in vivo using zooming devices allowed revealing mites among 66% of 1428 examined persons. This method requires time consuming (at least 10 minutes) and is informative only during hot seasons. Provocation method revealed 25849 mite colonies over the smooth skin surface among 8551 patients with Demodecosis, in 92% among 1927 enucleated colonies by D.K. Polyakov’s method from 1927 examined people Demodex at different stages of development was revealed. In acarofauna of biotope of 412 patients with Demodecosis only very mobile Dermatophagoidesses were discovered. On and in the skin of healthy patients the mites were not revealed by any of the mentioned methods. In 2.4% of the acarological researches several genuses of mites (Demodex, Dermatophagoides, Sarcoptes) were revealed. In very rare cases some other mites were revealed. In 0.3% of the acarological researches the mites were not revealed at all.

During 39 years 30413 adults and 12567 children sought medical advice. 92% of them underwent treatment without effect in various medical facilities and/or with healers with the following diagnosis: 57.7% - allergological, 37.4% - dermatological, 1.4% - ophthalmological, 1.2% - rheumatological, 0.5% - oncological, 0.4% - gynecological, 0.4% - endocrinological, 0.3% - surgical, 0.2% - urologic, 0.1% - psychic, 0.4% - other or applied without diagnosis.

Recommendations given for treatment of patients (according to the achievements of modern medicine and Legislation of Kazakhstan):

1/ Antiallergic diet with regard to the condition of the gastrointestinal tract. As far as recovery dietary limitations reduced down to their complete cancellation.

2/ Antihistamines on the basis of the following pathogenesis of acariasis. Sooner or later an organism affected by mites starts producing antibodies to the components of bodies and excrements of mites. Various triggers causing death of mites result in release and further absorption of a huge amount of mite allergens in the host’s blood. Reaction “allergen plus antibody” developed in the blood results in development of immune response with the release of mediators which cause the expansion of symptoms of allergic reactions and/or allergic disease. Besides, the mites in their habitat cause cellular breakdown of host’s tissues. Residues of host’s tissue components also absorb into the blood but they can be recognized by his organism as foreign (that is as self antigen). And host’s organism produces antibodies but they are autoantibodies already. Absorption of self-antigens and the production of autoantibodies over an extended period (before diagnostics of developing complicated clinical mask of acariasis in the form of NCD) results in development of autoimmune disease. In such a way observe the development of systemic clinical masks of demodectic acariasis which are recognized by clinicians as simply systemic diseases (varieties of non-communicable diseases) and due to the unrecognized essence of the disease resist treatment and eradication.

3/ Etiotropic (antimites) means with obligatory elimination of patient’s biotope against house dust mite allergens. Dosage, mode, frequency and period of application of antimite means depends on massiveness and depth of affect of a certain organism with mites.

4/ Treatment of concurrent conditions (if active).

5/ Training patients how to prevent acariasis reinvasion.

The complete course of ethiopathogenetic treatment with further observation within more than two years was conducted in 8712 patients. Among them there were 1666 patients with allergy and 3460 patients with allergodermathosis. Before they admitted to us they received treatment for: food or drug allergy – 763 patients, allergic blepharoconjunctivitis – 86, allergic perennial rhinitis – 178, pollinosis – 471, asthmatic bronchitis – 12, exudative diathesis – 712, acute urticaria – 42, chronic recurrent urticaria – 114, eczema – 149, neurodermatitis – 179, generalized dermatitis – 912, focal dermatitis – 972, contact dermatitis – 255, psoriasis – 117, parapsoriasis – 72, discoid lupus erythematosus – 49, photodermatosis – 43 patients. As a result of the ethiopathogenetic treatment 70% patients with allergodermatosis and 95% of patients with allergy were completely recovered. Disease recurrence was not observed within two years. Absence of disease recurrence within more than 10 years was recorded also in series of incidentally traced cases. The results received allow making the following conclusion: in 70% of cases allergodermatosis and in 95% of cases allergy were clinical masks of demodectic acariasis.

More detailed results of conducted observations are set in publications which started to be published only after the break-up of the Soviet Union. The numbers on dissemination of various clinical masks of demodectic acariasis, given in these works, were calculated on the basis of appealability of patients to allergist-dermatologist and not to healthcare facility in general that is why they fail to describe the integral presentation of Demodecosis among population. Demodecosis is not diagnosed by clinical medicine in its integral appearance that is why its clinical masks constitute a significant part of skin, allergic, oncologic and other non-communicable disesases.

The application of the results of the stated researches in wide medical practice could provide the considerable decrease of non-communicable disesases at the expense of liquidation of their variants which are actual clinical masks of Demodecosis. But it has not occurred throughout 34 years (since 1981) of my unsuccessful appeals to authorities.

Acknowledgements

Many thanks for a professional advice, for the possible assistance and for the encouragement to academicians: [B.A.Atchabarov], M.E.Zeltzer; to professors: M.Bertrand, P. Schausberger, I.T. Pak, K.Solarz, A.B.Shatrov, [JA.A.Klebanov], A.D.Djusekeev, T.S.Teleuova; to doctors: R.G.Masheeva, L.Soloveva, A.M.Malikov; V.V. Harchenko and anothers.

E-mail: zhax-rd@mail.ru

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