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Solving the Mystery Rash in Schools
by Sheila O'Leary*

From October of 2001 through April of 2002, schools in the United States and Canada reported outbreaks of a mysterious, superficial, skin rash sometimes accompanied by eye inflammation/ swelling (conjunctivitis), and naso-sinus congestion. Itchy pin-prick dots to papular-macular lesions appeared most often on the face, neck, arms and hands, but erupted on covered areas too. The children also had skin inflammation without lesions that appeared and disappeared very quickly. The condition didn't produce fever or systemic signs.
 
The problem appeared to be infectious, but not contagious. Children who were symptomatic at school cleared up at home, and did not infect family members. Upon return to school, some became symptomatic again. Contact with paper, books, instructional materials, backpacks, coats, furniture and carpet was implicated in the outbreaks. Investigators who removed ceiling tiles and did structural checks developed rashes themselves.
 
Epidemiological teams have eliminated known infective agents and pollutants/contaminants from consideration, and have ruled out blood feeding arthropods. Some spokespersons announced they may never solve the cases.
 
The epidemic offers several clues to what it is. The agent survives unnoticed in the human environment. where it infests a wide range of organic materials. A probably misidentified fallout of "dandruff," "skin particles," "sparkly dust," and "itching powder" is reported.  The organism attacks during the day and produces a non-contagious, skin-orifice infection. It presents a fast-fading skin sign as well as a rash. Acute symptoms are self-limiting and last approximately 16 days barring reinfection..
 
Although it doesn't often come to mind, a parasitic infection can be very much like the better known ones in appearance and location. For example, skin parasitism easily produces eczema, papular lesions, swelling, and itching dermatitis. A parasitic conjunctivitis may look no different than a viral or allergic conjunctivitis. Therefore, a parasite may be the answer.
 
A very successful parasite is unsuspected, doesn't kill the host, and overrides the immune response so that its presence is masked. The mystery perpetrator just misses accomplishing all this. Most likely, it is a non-biting, minor filth fly that is parasitic during its life cycle.
 
Infected staff and students may have suffered what is known as a cutaneous, ocular, naso-sinus myiasis probably caused by the domestic phorid Megaselia scalaris. Its larvae are known to be predatory, parasitoid or parasitic depending on the size of the host, but it has never been thought medically important. Phorid infections involving the skin and the body openings are in the literature as medical curiosities.
 
Investigators would not have considered phorid samples worthy of their attention. Doctors would not have felt compelled to try a pesticide based medication to test for an arthropod. They wouldn't have occluded the skin rash to attempt recovery of a parasite, nor have taken skin scrapings, nasal aspirate, and eye exudate samples for screening. To have overlooked parasitism may have kept the infection beyond their reach.
 
Why did the outbreaks occur? The children and staff have always been exposed to Megaselia scalaris uneventfully. This isn't to say they were never parasitized before. It could have occurred subliminally.What changed the situation had to be exposure to excessive concentrations of larvae. It breeched their level of tolerance and caused symptoms to appear. Excessive larvae naturally point to breeding flies, but a phorid colony can be quite surreptitious and very difficult to find.

*Sheila O'Leary is an active member of the National Unidentified Skin Parasite Association (NUSPA).  NUSPA advocates for research into skin complaints, and skin-orifice complaints attributed either to unknown causes or to Delusions of Parasitosis (DOP). O'Leary's proposed, arthropod disease model is based solely on her experience as a patient and that of others reporting to the NUSPA site.

O'Leary suggests that the epidemics overlap with USP and DOP in important ways. In each situation, females are more likely to be affected than males. The cause(s) cannot be isolated, and psychogenic factors enter the analysis. To assure the public the outbreaks do not have a lasting effect is merely a guess. If students have the identical problems of USP/DOP patients in the acute phase, there is a long range danger. Patients who become chronic are always environmentally ill, and there is a suicide statistic attached to chronic Delusions of Parasitosis.

2002 Sheila O'Leary