Biomedical subjects
Publications and source records attributed to S A Estes.
Lipedematous alopecia is an unusual disorder characterized by short, brittle scalp hairs associated with thickening of the scalp by adipose tissue. All except one reported case have been in African-American females. It is our purpose to report the seventh case of this condition.
Cutaneous granulomatous vasculitis manifesting as a postherpetic reaction pattern is uncommon hand has previously been reported as a delayed complication of varicella-zoster virus infection. We describe three patients who had persistent, painful, postherpetic papules in a zosteriform distribution that histologically demonstrated a small vessel granulomatous vasculitis. Herpes simplex virus DNA detected by the polymerase chain reaction technique was demonstrated in two cases.
The scabies mite Sarcoptes scabiei and the Dermatophagoides house dust mites (HDM) are related phylogenetically and are the sources of several cross-reactive antigens. The purpose of this study was to investigate the immune response to S. scabiei and HDM in scabietic patients. Skin test sensitivity and serum IgE to both S. scabiei and HDM were determined for patients who had or previously had confirmed ordinary scabies. A retrospective group included nine subjects who had received successful treatment three weeks to one year prior to the study. A prospective group included 16 subjects with active scabies. Allergic histories were obtained, serum was collected, and skin prick tests (SPTs) were performed at enrollment for all and periodically over the next 12 months for the prospective patients. None of the individuals in either group reported a known sensitivity to HDM. Six of the nine retrospective patients were SPT positive to both S. scabiei and HDM and two of these showed circulating IgE specific for these antigens. At diagnosis, 13 of 16 patients with active scabies were SPT positive to S. scabiei and 12 of these were also SPT and/or radioallergosorbent test positive to HDM. Six patients had circulating IgE directed at both S. scabiei and HDM antigens while one subject had IgE to S. scabiei only and another had IgE directed at HDM only. Twelve of the 15 subjects tested also showed IgE and/or IgG binding to one or more bands on Western blots of an S. scabiei-specific protein fraction. This study indicated that approximately half of the patients with active scabies had S. scabiei- and HDM-specific circulating IgE while most patients cured of scabies lacked S. scabiei- and HDM-specific serum IgE. The data also suggested that antibodies to S. scabiei in scabietic patients also recognize HDM; however, some antibodies were directed at scabies-specific antigens.
Scabies epidemics in nursing homes, acute and chronic care hospitals, residential facilities, and communities have become commonplace. Patients with keratotic (crusted, Norwegian) scabies are highly contagious and often initiate outbreaks in institutions. This is a review of problems associated with the management of scabies epidemics in health care facilities. A model treatment plan, readily customized to suit specific epidemic scenarios, is detailed.
The life cycle of canine scabies has been studied extensively. Currently studies are focusing on mite behavior, physiological requirements, host specificity, mite survival, and clinical complications of scabies. Investigations are giving insight into immunologic responses to infestation and cross-reactivity with house dust mites. A diagnostic blood test or vaccine may become a future reality, if a unique antibody response can be isolated. Can scabies transmit the human immunodeficiency virus (HIV)? This controversial area needs prompt definitive exploration.
This study demonstrated that antigens of the parasitic mite Sarcoptes scabiei (SS) cross-react with antigens of the house dust mite Dermatophagoides pteronyssinus (DP). Crossed immunoelectrophoresis (CIE) reaction of SS extract with rabbit anti-DP serum resulted in multiple immunoprecipitates. Reciprocal CIE reactions gave similar results. Immunoprecipitates from both reactions bound IgE in the sera of dust-mite-sensitive patients who had no history of scabies. Sodium dodecyl sulfate-polyacrylamide gel electrophoresis resolved protein/peptide bands of both SS and DP also bound serum IgE from dust-mite-allergic patients following immunoblotting. Non-allergic control sera gave no IgE binding to either SS or DP antigens. These results indicate that patients with atopy to dust mites exhibit circulating antibodies built to DP but that recognize determinants on SS antigens. It is highly probable that scabietic patients build antibodies to SS antigens that also recognize DP antigens. These results raise questions concerning the reported isotypic antibody responses to SS because the sensitivity of scabietic patients to house dust mites has not been previously evaluated. This cross-reactivity may play an important role in the susceptibility to scabies and its clinical manifestations.
This study determined the prevalence of Sarcoptes scabiei in the home environment of 37 confirmed cases of scabies and in five nursing homes with scabietic patients. Dust samples from 44% of infested patients' homes contained scabies mites. Live mites at the time the dust samples were analyzed were present in 64% of these homes. Live mites were recovered most often from bedroom floors or overstuffed chairs and couches. The density of live and dead mites ranged from 1 to 5 mites/0.1 gm of dust or 1 to 9 mites/m2 of surface area sampled. The presence of mites in fomites coupled with survival and host-seeking behavior indicate that it is possible for a person to become infested by dislodged mites in contaminated home, school, and work environments. By contrast, only a small number of mites were recovered from beds, furniture, and floors of scabies-infested nursing homes. Mite-contaminated fomites may be less important in the transmission of scabies in nursing homes than in private homes.
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A case of pemphigus vulgaris confined to the oral cavity, larynx, and hypopharynx for two years with subsequent involvement of the entire esophagus is presented. Histopathology and direct immunofluorescence of the esophagus confirmed the diagnosis.
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Familial multiple glomus tumors are rare. A family is reported here with the disease documented in three generations. While this type of glomus tumor is not classically associated with pain, all members of this family who exhibited multiple glomangioma were symptomatic. Treatment with both the argon laser and carbon dioxide laser was successful in relieving symptoms and improving the appearance of only the more superficial glomus tumors.
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Porokeratosis plantaris, palmaris, et disseminata is a unique clinical entity characterized by the familial occurrence of multiple porokeratoses predominantly on the palms and soles but also on both sun-exposed and non-sun-exposed areas of the body. Since its original description in 1971 by Guss and colleagues, there has been only one other report of this syndrome. We have discovered a third family with this disorder and have used isotretinoin successfully to control the condition in one of the family's symptomatic members.
We report on a young man with a congenital mutilating keratoderma in whom three epitheliomata cuniculata occurred during a two-year period. The clinical findings, associated disease states, and treatment of epithelioma cuniculatum (EC) are reviewed.
Sarcoptes scabiei var. canis served as a suitable model for the study of S. scabiei var. hominis survival. S. scabiei var. canis and var. hominis mites were found to survive off the host for 24 to 36 hours at room conditions (21 degrees C and 40% to 80% relative humidity [RH]), and the canine variety survived 19 days at 10 degrees C and 97% RH. Female mites survived decidedly longer than male mites at comparable conditions. Generally, higher RH values and lower temperatures favored survival, whereas higher temperature and lower RH led to early death. Most canine scabies mites that were held off the host for 36 hours at 75% RH and 22 degrees to 24 degrees C remained infective and penetrated when returned to the host. Live mites of the human variety that were recovered from bed linen slept on by infested patients would also penetrate a host after being held off a host for 96 hours in alternating 12-hour periods of room conditions and refrigeration. Penetration required less than 30 minutes for all life stages of both varieties, and it was accomplished by a mite secretion that dissolved the host tissue. Dislodged mites, particularly those in close proximity to the source, can be a likely source of infestation.
Sarcoptes scabiei mites perceive specific host stimuli and are attracted to the host. Mites dislodged from the host respond to both host odor and a thermal stimulus and seek its source. The response to thermal and host odor stimuli are independent. Mites in close proximity to the body respond to both stimuli and show no preference for either. At greater distances from the host, odor is the more important stimulus.
Sarcoptes scabiei var. canis was successfully transferred from the dog to New Zealand White Rabbits, Oryctologus cuniculus. Natural and experimental transfers were accomplished between rabbits. The dog strain transferred to rabbits showed no morphologic changes and was readily transferred back to dogs. Experimental transfer of var. canis to guinea pigs and pigs resulted in only temporary infestation. Attempts to infest haired and hairless mice, thymus-deficient (nude) mice, and rats were unsuccessful. The unsuccessful or transient nature of cross-infestations between some host species and complete cross-infestation in others leads to the conclusion that all S. scabiei varieties are not host-specific but that they do possess some degree of host preference and that physiologic differences between varieties exist.