Comet Sign (and Other) in Pyemotes Dermatitis

To the Editor: Recently, Pascal Del Giudice et al. published an interesting article (1) about dermatitis in France caused by Pyemotes ventricosus in which they highlight the presence of the comet sign in a number of their patients. It is, they assert, a sign that because of its peculiarity could be useful for diagnosing this type of dermatitis in outbreaks and sporadic cases. 
 
Some years ago, we studied 3 outbreaks (with >100 cases) of dermatitis caused by P. ventricosus parasitic mites in Castellon, Spain, produced by different infected materials (2). When we published the results, we concentrated on the epidemiologic characteristics and the discovery of the mite; perhaps we paid too little attention to the appearance of the lesions, of which we did not provide images. Nevertheless, we also observed the descriptions by Del Giudice et al., which we now show in the Figure. In 2 patients (Figure, panels A and B), the comet sign can be clearly assessed; the patients were 2 women who had had direct contact with the infected material against their legs. The other patient (Figure, panel C) displayed 56 macules with 1 pruritic central vesicle. We did not observe facial lesions on any of the case-patients (but we did observe lesions on the necks of some patients). 
 
 
 
Figure 
 
Photographs of 3 persons with skin lesions of Pyemotes dermatitis during the same outbreak in Castellon, Spain, showing the comet sign in 2 affected women (panels A, B), and macular form of the lesions in 1 of the affected investigators (panel ... 
 
 
 
Our data coincided with those of the French study and reinforce the specificity of this dermatologic sign. However, this was not the only coincidence; cases also occurred among the investigators after contact with the infected material in each of the outbreaks. Perhaps both signs may characteristic this dermatitis: the comet sign and “the sign of the infected investigators” of the outbreaks.


Comet Sign (and Other) in Pyemotes Dermatitis
To the Editor: Recently, Pascal Del Giudice et al. published an interesting article (1) about dermatitis in France caused by Pyemotes ventricosus in which they highlight the presence of the comet sign in a number of their patients. It is, they assert, a sign that because of its peculiarity could be useful for diagnosing this type of dermatitis in outbreaks and sporadic cases.
Some years ago, we studied 3 outbreaks (with >100 cases) of dermatitis caused by P. ventricosus parasitic mites in Castellón, Spain, produced by different infected materials (2). When we published the results, we concentrated on the epidemiologic characteristics and the discovery of the mite; perhaps we paid too little attention to the appearance of the lesions, of which we did not provide images. Nevertheless, we also observed the descriptions by Del Giudice et al., which we now show in the Figure patients (but we did observe lesions on the necks of some patients).
Our data coincided with those of the French study and reinforce the specifi city of this dermatologic sign. However, this was not the only coincidence; cases also occurred among the investigators after contact with the infected material in each of the outbreaks. Perhaps both signs may characteristic this dermatitis: the comet sign and "the sign of the infected investigators" of the outbreaks. To the Editor: Helicobacter pylori infection is the principal cause of chronic active gastritis and peptic ulcer disease and a major contributor for gastric adenocarcinoma and mucosa-associated lymphoid tissue lymphoma (1). Approximately 50% of the world's population is infected (2), but only 10%-20% of infected persons become symptomatic (3). The annual incidence rate of H. pylori infection is ≈4%-15% in developing countries, compared with ≈0.5% in industrialized countries (4). Studies in the Republic of Georgia (ROG), a developing country with an economy in transition, suggested that >70% of adults are infected with H. pylori (5,6) and that the prevalence rate of gastric cancer is 18 cases per 100,000 population, ≈6to 9-fold higher than in the United States (National Center for Disease Control, Tbilisi, ROG, unpub. data, 2003). We investigated the prevalence of infection in patients in ROG in whom gastritis, peptic ulcer, and gastric cancer had been diagnosed.

Juan B. Bellido-Blasco, Alberto Arnedo-Pena, and Francisca Valcuende
We performed a cross-sectional study of patients referred for upper endoscopy from all regions of ROG to 23 tertiary-care medical centers in the capital, Tbilisi, during 2003-2005. Patients whose medical records and gastric biopsy slides were available were eligible for inclusion. Two pathologists reviewed hematoxylin and eosin-stained slides prepared from formalin-fi xed, paraffi n-embedded gastric biopsy specimens. Pathologists graded the amounts of H. pylori, acute and chronic infl ammation, intestinal metaplasia, and atrophy according to the visual analogue scale of the Updated Sydney Classifi cation System for Gastritis (7). Histologic characteristics were dichotomized as presence (grades >1) or absence (grade = 0) of a feature.
We conducted statistical analyses in SAS version 9.0 (SAS Institute, Inc., Cary, NC, USA). The human subjects committees at the National Center for Disease Control and Medical Statistics of ROG and the Centers for Disease Control and Prevention (Atlanta, GA, USA) approved the study.
H. pylori requires gastric mucus for growth, and mucus produced by the metaplastic and neoplastic cells is postulated to lack characteristics that sustain growth of H. pylori. When H. pylori has been observed in patients with ulcers, intestinal metaplasia, and adenocarcinoma, the bacteria usually are present in areas of the stomach that do not have these lesions.
In this cohort of patients, 14 (16%) had dysplasia or adenocarcinoma. Dysplasia and eventually cancer occur in a small group of susceptible persons with atrophy and intestinal metaplasia (8,9). Thus, H. pylori is now considered a type-1 carcinogen, and the ab-