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17 oktober 2016

house dust mites, Dermatophagoides pteronyssinus (Trouessart) and D.

farinae Hughes (Pyroglyphidae)
Among the many constituents of house dust that cause allergic reactions of the
respiratory tract (rhinitis and asthma), the most potent allergens were found by
European investigators to be contained in, certain pyroglyphid mites,
principally Dermatophagoides pteranyssinus (Voorhorst et al., 1964). On the other
hand, all mites found in dust samples in Ohio were classified by D. G. Larson as
the closely related species D. farinae, although F. T. M. Spieksma, of Leiden, the
Netherlands, identified D. pteronyssinus in some of the Ohio samples (Mitchell et
al., 1969). Samgihak et al. (1972) found D. farinaeto be the dominant species in
Czechoslovakia. They believed that D. pteronyssinus favored the coastal climate,
whereas D. farinae favored the drier central European climate. The taxonomic
positions of the species of Dermatophagoides were clarified by Fain (1967).
Although Dermatophagoides was not experimentally demonstrated to be a cause of
common house dust allergen until 1964 (Voorhorst et al., 1964), a review of the
world literature in 1971 already disclosed 103 references (van Bronswijk and
Sinha, 1971).
Dermatophagoides pteronyssinus and D. farinae are cosmopolitan, and are
sometimes found in enormous numbers (Voorhorst et al, 1964; Miyamoto et al.,
1969b). The fecal pellets of either species are comparable to the mites, or extracts
from them, as sources of allergen. Fortunately, most people are not sensitive to
these mites fewer than 5% of children under 17 years old and even fewer adults
(Spieksma, 1967; Larson et al., 1969; Mitchell et al., 1969; Miyamoto et al.,
1969b; Halmai and Alexander, 1971).
In one survey of 64 samples of house dust obtained from Connecticut, New York,
New Jersey, Georgia, Washington, California, Nebraska, Wisconsin, and Illinois,
39 contained house dust mites. Twenty-one had D. farinae only, 5 had D.
pteronyssinus only,
and
11
had D.
farinae and D.
Pteronyssinus. Dermatophagoides farinae was not only found in more samples, but
also in greater numbers: up to 69 per gram compared with 9 per gram for D.
pteronyssinus. Besides being found in house dust, Dermatophagoides species are
also found on birds, in bird nests, on various animals, and humans, as well as in
stored food products. Dermatophagoides evansi Fain and D. chelidonis (Hull) were
found most commonly in bird nests (Wharton, 1970). Mites were found in 10 out
of 26 house dust samples randomly collected from floors and mattresses with

vacuum cleaners in Canadian homes of persons with or without allergies. Four of

the 10 samples had D. farinae, 3 had D. pteronyssinus, and 1 had both species. Of
the 57 mites collected, 48% were D. farinae, 17% were D. Pteronyssinus, and most
of the others were stored-product species (Sinha et al., 1970). Based on published
and unpublished reports of house dust mites in the United
States, Dermatophagoides species, principally farinae and pteronyssinus, had been
isolated from house dust samples in 22 states by 1971. Dermatophagoides
evansi, D. chelidonis, D. bakeri Fain, and D. scheremetewskyi Bogdanov were
found in very small numbers. House dust samples ranged from 32 to 100% positive
for species of the genus, and they constituted from 43 to 100% of the mite fauna.
In California, these mites were found in house dust samples from 24 widely
scattered areas (Furumizo and Mulla, 1971).
In Hawaii, house dust was collected with vacuum cleaners over an 8-month period
in 40 houses. Dermatophagoides was found in all the samples obtained, D.
pteronyssinus being much more abundant thanD. farinae. The maximum number
of Dermatophagoides in a 5-gram dust sample was 4,390, a much higher density
than any reported from house dust in other parts of the world. Dust from carpets
(wool, cotton, or svnthetic fibers) always had more mites than dust from floors
without carpeting or with other types of coverings. Old carpets not cared for had
more mites than newer ones or those often cleaned and washed (Sharp and
Haramoto, 1970).
Dermatophagoides pteronyssinus was found in all of 250 homes visited throughout
New Zealand, except for one in which the occupant had been treating the mattress
at frequent intervals with sulfur dust. Except for this one house, the number of
mites varied from 2 to 480 per 0.1 gram of dust in the 300 dust samples (Corners,
1972).
Description. The mites are extremely small. The adult female mites of D. farinae
(figure 330) are about 0.5 mm long; tritonymphs and males, about 0.4;
protonymphs (figure 331), 0.3; larvae, about 0.2; and eggs, close to 0.3 mm long.
The adult mites are light cream-colored, except for a few areas of sclerotized
integument (propodosomal dorsal plate and parts of the appendages), which are
light beige (G. W. Wharton, correspondence).
Life Cycle. Pyroglyphids have 5 distinct life stages: egg, larva, protonymph,
tritonymph, and adult. For D. farinae and D. pteronyssinus, the developmental
period from egg to adult ranges from 23 to 30 days. Males and females of both
species have a premating period of 1 to 3 days. The male remains fertile for life,
but mating results in egg-laying only during the first half of the adult life of the
female.
At a temperature of 25 C, the first oviposition period for D. farinae lasts about 30
days, with 0.8 to 1.4 eggs laid per day. The first oviposition period for D.

pteronyssinus is 20 days, with 1.2 to 2.5 eggs laid per day. Both species have a
second and even a third oviposition period, but fewer eggs are laid (van Bronswijk
and Sinha, 1971).
The life cycle of D. farinae is very similar to that of D. pteronyssinus, but the
period from egg to adult averages 4 days longer. In both species, no eggs are laid
unless copulation has occurred (Larson et al., 1969).
Habitat. Both the mite species are found principally in cotton-stuffed mattresses
and furniture (Cunnington and Gregory, 1968; Mitchell et al., 1969).
In a hospital in England, it was shown by means of a cyclone dust extractor that the
mites could become airborne during bedmaking, including turning the mattress
(Cunnington and Gregory, 1968). In other investigations, it was shown that mites
could be inhaled (Carter et al., 1944; Taboada, 1954; Spieksma, 1967).
In central Ohio, Mitchell et al. (1969) made a survey of dust samples and, using a
dissecting microscope, they removed all mites and all recognizable cuticles or
exoskeletons of mites from 0.1 g samples of fine dust. They never found living
mites in dry dust. Mite cuticles or dead mites were found in 21 out of 30 samples
of dust from mattresses and padded furniture, and 17 samples had more than 15
mites per 0.1 g. Floor sweepings and dust from commercial buildings contained
either no mites or negligible numbers. Articles which were used by humans both
day and night, such as day beds, contained the most mites. Mites were rare or
absent in articles of furniture that had not been used by humans or were not stuffed
with vegetable fibers.
Mitchell et al. (1969) believed that the mites probably fed primarily on dander
(skin scales) from humans and pets. However, they have also been reared on
human whiskers in a special microchamber (Shamiyeh et al., 1971). Additional
information on possible food sources was provided by van Bronswijk (1973a) in an
investigation of 470 Dermatophagoides pteronyssinus from mattresses and 147
from bedroom floors. Their alimentary canals contained pollen, spores of
microorganisms, fungal mycelia, bacteria, and fibers of plant origin, probably from
cotton bedsheets. This indicated that the mites were not so strictly monophagous
on human skin scales as was sugested by Spieksma (1967).
Laboratory tests revealed that optimal development of D. pteronyssinus took place
at 25 C (77 F). After 8 weeks at 30 C (86 F), the number of mites was 40%,
and at 20 C (68 F), it was only 15% of the number at 25 C. The mites can
develop within a range of 50 to 90% relative humidity, the optimum being 70 to
80%. In the Netherlands, only in summer is relative humidity in houses high
enough to allow rapid increase in the mite population. Although the average
temperature on floors in summer is usually below 20 C (68 F), in occupied beds

and upholstered chairs optimal temperatures are soon reached, and relative
humidity is increased by 5 to 8% (Koekkoek and van Bronswijk, 1972).
In the Netherlands, D. pteronyssinus is present in greatest numbers in old houses,
and that is where most of the people live who are hypersensitive to house dust
allergen (Voorhorst, 1969). In Europe, "house dust atopic asthma" patients find
relief in the dry conditions at altitudes of about 1,000 m (3,300 ft) or higher. The
cold air, soil conditions, and a type of construction providing good protection
against the penetration of water result in dry conditions in houses. The dryness
prevents the development of large numbers of allergen-producing D.
pteronyssinus (Voorhorst, 1970; Spieksma et al., 1971).
Dust Mites and Inhalant Allergy
Although the allergen is formed by living mites, dead mites or their fragments or
feces are allergenic as well as live ones. Maunsell et al. (1968) observed that
asthmatic patients who reacted negatively to house dust were negative to the mites.
Mitchell et al. (1969) found that 93% of the patients who showed positive skin
reactions to house dust extract also showed positive reactions to the extract of
mites, and vice versa. Out of 100 patients who showed reactions to dust mites, 61
reacted positively to 1 or more insects and/or spiders. Bernecker (1970) observed
that a certain cross-antigenicity existed, not only between mites occurring in house
dust, but also among mites in general, including species such as Tetranychus
urticae, Panonychus ulmi, and Dermanyssus gallinae, which are not ordinarily
found in house dust.
Mites constitute the major antigenic substance in house dust in Japan. More than
35 species of mites were found in house dusts collected from 9 different parts of
Japan, and 1 g of dust contained from several hundred to over 2,000 mites. The
major allergen was possessed by D. pteronyssinus (27.2% of the total number of
mites) and D. farinae (4% of the total), the 2 species having a close antigenic
relationship. Cross-antigenicity was found from skin testing, and in vitro
neutralization of skin-sensitizing antibody, among the 6 species of mites
investigated. Molds were found to be of little importance as allergens
(Miyamoto et al., 1969b). The molecular weight of the allergen produced
by Dermatophagoides farinae is greater than 10,000 but less than 69,000 (most
likely around 40,000 to 50,000), and it is probably a protein and polysaccharide
conjugate. Work on the chemistry of the allergen is continuing. Dermatophagoides
farinae develops readily on dog meal, and is available in larger quantities for
scientific investigations than is D. pteronyssinus, which must be reared more
slowly on human dandruff (Miyamoto et al., 1969a).
Reactions to Various Tests. In England, tests with extracts of D.
pteronyssinus were made on skin, bronchi, nasal mucosa, leucocytes, and on
normal human tissue passively sensitized by the patient's serum, on 21 patients

with asthma and house dust allergy. Fourteen patients gave positive reactions to
every test. In 18 patients, attacks were readily induced by inhalation of the mite
extract. In 18, nasal reactions were provoked, and were not followed by asthmatic
symptoms. A serum test was positive in all patients, and a leucocyte test was
positive in 19. In 6 patients, delayed asthmatic responses to bronchial tests were
observed. An extremely small amount of allergen was capable of causing a
reaction. In view of the wide distribution of D. pteronyssinus, it was concluded that
it was an important factor in allergic asthma (McAllen et al., 1970).
Desensitization tests were made with 34 persons suffering from bronchial asthma
and showing positive skin reactions to house dust and D. farinae. Eighteen patients
were given mite extracts and 16 were given house dust vaccine in weekly
subdermal injections of 0.1 to 1.0 ml, followed by semimonthly maintenance doses
for 6 to 9 months. Hyposensitization with D. farinae extracts was found to be safe
and effective, but patients did not benefit from house dust vaccine in the doses
administered (Maunsell et al., 1971). The absence of positive results with house
dust vaccine was not in accord with the results obtained by another investigator,
who desensitized 11 patients with house dust extract and 13 others
with Dermatophagoides pteronyssinus extract. Skin reactions to both extracts
decreased to about the same extent over the period of 1.5 to 2 years of the tests
(Voorhorst, 1970).
In a hospital in England, patients with asthma and rhinitis who were clinically
sensitive to house dust mites were treated with a pyridine-extracted, alumprecipitated extract of house dust to which D. farinae had been added before
extraction. Among 52 patients, 43 (83%) showed improvement. Symptoms were
worse or unchanged in 9 patients (17%) (Munro Ashman et al., 1971). In a
"double-blind" controlled trial, 11 asthmatics allergic to house dust who were given
an aqueous extract of D. pteronyssinus improved and 5 remained well for a year,
whereas 11 control patients, given an extract of human skin scales, showed little
change (Smith, 1971).
Other Mites Causing Allergy
The family Acaridae (=Tyroglyphidae) contains species best known as pests of
stored food products (see chapter 7, under "Acarid Mites"), but some species also
cause dermatitis in people handling infested commodities, as well as causing
inhalant allergy or bronchial asthma. Acarus siro L. causes a rash known as
"vanillism" in vanillapod handlers. Tyrophagus castellani (Hirst) causes "copra
itch" among workers handling copra and a dermatitis in people who handle cheese.
In the family Glycyphagidae, Glycyphagus domesticus (De Geer) causes "grocer's
itch" in workers handling dried fruits, skins, and other heavily infested products.
Allergen from Glycyphagus destructor (Schrank) was found in chaff (Voorhorst,
1970). Allergen obtained from G. destructor differs materially from that of the 2

house dust mites, Dermatophagoides pteronyssinus and D. farinae, whereas the

allergens of the latter 2 species are identical (Voorhorst and Spieksma, 1969).
In the family Pyroglyphidae, Dermatophagoides scheremetewskyi attacks bats,
rodents, and sparrows in the eastern United States. Several cases of human
infestation resulting in severe and persistent dermatitis have been reported (Traver,
1951; Baker et al., 1956). However, species of this genus are best known as the
ones causing inhalant allergy.
Control of Mites Causing Inhalant Allergy
The 4 sources of dust mite allergen in houses are floors, mattresses, furniture, and
clothes (van Bronswijk and Sinha, 1971). The number of mites on floors can be
reduced by keeping the house dry. The optimal relative humidity for pyroglyphid
mites is from 75 to 95%. Under conditions suitable for all mite
species, Dermatophagoides can survive only in small numbers in cracks and
crevices,
but
at
lower
humidities
not
suitable
for Acarus and Glycyphagus, Dermatophagoides may greatly increase in numbers.
None of these mites can survive under very dry conditions (van Bronswijk et al.,
1971). Motile stages of D. farinae and D. microceras were eradicated by 6 hours of
exposure to -15 C (5 F), whereas D. chelidanis, D. pteronyssinus,
and Euroglyphus maynei (Correman) required -28 C (-18 F) for the same period
of exposure. One-day exposure of mattresses to the outdoor air has been suggested
for the control of pyroglyphid mites in areas where sufficiently low temperatures
are reached (van Bronswijk and Koekkoek, 1972).
Small cracks and crevices in the floor and under plinths should receive greater
attention when vacuum-cleaning. Under conditions obtaining in the Netherlands, it
was observed that the habit ofDermatophagoides to hide in cracks and crevices
tended to favor these mites, relative to Acarus, Glycyphagus, and Tyrophagus,
when a floor was vacuum-cleaned, thus eliminating the latter 3 genera as
competitors and also eliminating large numbers of the predatory mite Cheyletus.
Thus, it was sometimes possible to find the highest numbers
of Dermatophagoides in regularly vacuum cleaned rooms (van Bronswijk et al.,
1971).
After mattresses were vacuum-cleaned, there was an 8-fold reduction in the
number of mites that became airborne during bedmaking. Dead mites and mite
excreta possessed as much allergen as live mites, and vacuum-cleaning was
necessary after the mites were killed. Ultraviolet radiation for 2 hours almost
completely removed the allergen (van Bronswijk,and Sinha, 1971). Mattresses
appear to be the reservoirs from which bedroom floors are reinfested by dust mites
for a brief period during the year (van Bronswijk, 1973a). The mites apparently
live only in the surface layer of the mattress (Hughes and Maunsell, 1970; van
Bronswijk, 1973a). It is reasonable to expect that control of dust mites in bedrooms

inhabited by persons who are allergic to dust mites may be accomplished by

preventing penetration of moisture and accumulation of food in the upper few
centimeters of the mattress, as with the aid of a plastic sheet. Experiments on this
approach to dust mite control are in progress (van Bronswijk, 1973a). Also, the
application of fungicides to eliminate microorganisms that are essential to the
mites appears to be a promising approach (van Bronswijk and Koekkoek, 1971;
van Bronswijk, 1973b).
Frankland (1972) recommended that environmental mite control should always be
attempted in the home of an allergic person before hyposensitization. Feather and
kapok pillows and eiderdowns should be removed. Blankets should be dry-cleaned,
and the linen washed whenever possible. At least once a week, the house should be
vacuumed and the bedroom more often, paying special attention to cracks and
crevices. Helson (1971) suggested ventilation, vacuum-cleaning, dusting of 1%
lindane dust into cracks and crevices and, if an acaricide were used, the removal of
all dead mites, cast skins, and fecal pellets. On the other hand, van Bronswijk et al.
(1971) reported little effect from a 24-hour exposure of Dermatophagoides to
residues of 0.1% and 1.0% of lindane and DDT, in acetone, that had been applied
to the ceilings of cages containing approximately 20 mites. Other mites
(Acarus and Glycyphagus) were very susceptible to the residues.