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The eradication of a large scabies outbreak using community-wide health education.

The successful experience in eradicating a large outbreak of scabies in an underdeveloped Arabic village community in Western Galilee of about 3,000 people is reviewed. In this village the number of cases of scabies increased over a five-year period to a maximum of 22 per cent of the entire village population, representing 66 per cent of all the families. A seven-person health team with a strong background in health education was entrusted with the task of eradicating scabies in the community. A plan, conceived and carried out by the team, consisted of four phases: data gathering, information giving, treatment, and evaluation and summary. The goal of eradicating scabies in this community was achieved. The strategy of the campaign emphasized the following points: the entire community was the target group and was involved maximally throughout the campaign; the professional responsibility was concentrated in the hands of the team.

Child↗

[Taxonomical approach to scabies mites of human and animals and their prevalence in Korea].

Three types, hitherto commonly known as varieties of Sarcoptes scabiei (Linnaeus, 1758) were collected from scabietic patients, pigs and dogs to confirm their taxonomic status. As a result, we consider that the mites of human and pig scabies are different subspecies [S. scabiei scabiei (Linnaeus, 1758) and S. scabiei suis Megnin, 1880, respectively], and that of dog scabies is a different species, S. canis Gerlach, 1857. Infestation rate of human scabies in Korea peaked in 1981-1982 and showed nearly 10% of prevalence rate among outpatients of the dermatology clinic, but decreased dramatically during the past ten years and now lowered below 1% since 1990. On the other hand, dog scabies seems to be increasing recently.

Adolescent↗

Prevalence of pediculosis and scabies in preschool nursery children of Afyon, Turkey.

Scabies and pediculosis are ubiquitous, contagious, and debilitating parasitic dermatoses. The tendency of high prevalence of pediculosis and scabies among school and preschool age children has prompted us to conduct a head louse and scabies prevalence survey among preschool nursery children in our district. A school-based, crosssectional study was performed, with 1,134 children chosen for evaluation. All cases were evaluated by physical examination and a detailed, structured questionnaire. The infestation was found in 14 (1.2%) of 1,134 children; 9 (0.8%) with pediculosis capitis and 5 (0.4%) with scabies. We found that infestations were more frequent in children with mothers whose education levels were low. This indicates the necessity of an improvement in the economic and sociocultural status of the community and the promotion of hygiene concepts and practices in order to improve health of preschool age children.

Animals↗

Scabies: an epidemiologic reassessment.

Scabies is a highly contagious parasitic infestation whose exact nature is unknown. A reassessment of epidemiologic data questions accepted ideas such as that scabies is a sexually transmitted disease; 30-year cycles of scabies epidemics exist; changes in the immune status of the host population (herd immunity) are epidemiologically significant; fomite transmission is rare; and blacks are resistant to the mite. Scabies epidemics are due to several factors and improved surveillance is needed before the disease can be better controlled.

Disease Outbreaks↗

Norwegian scabies in the immunocompromised patient.

Norwegian, or crusted, scabies can be defined as a generalized severe scabies (Sarcoptes scabiei var. hominis) infestation usually affecting the immunocompromised patient that is most commonly seen with the leukemia-lymphoma group of neoplasms. The diagnosis is commonly missed, which can lead to mismanagement. We describe a patient with Norwegian scabies involving the lower extremities. The patient circumstances and treatment, as well as a review of the literature, are presented. The diagnosis of scabies should always be considered in patients with advanced malignancies and associated pruritus.

Aged↗

Psoroptic scabies in bignorn sheep (Ovis canadensis mexicana) in New Mexico.

Prior to 1978, no reports were made of scabies lesions or mites recovered from any Mexican bighorn sheep (Ovis canadensis mexicana) examined in the San Andres National Wildlife Refuge in southern New Mexico. In 1978, all of five rams harvested by hunters had live mites of the genus Psoroptes and active lesions of scabies in their ears and/or on their bodies. Deaths due to scabies were not documented during this outbreak although aerial helicopter surveys conducted in March, June and September, 1979 recorded less than half the sheep observations of five previous and similarly conducted surveys. After measurement of the length of the outer opisthosomal setae of the male mites, they appear to be Psoroptes ovis (Hering), the common scabies mite of domestic sheep, cattle and horses. Final specific determination must await proposed transmission studies with domestic livestock.

Animals↗

The rise and fall of psoroptic scabies in bighorn sheep in the San Andres Mountains, New Mexico.

Between 1978 and 1997, a combination of psoroptic scabies (Psoroptes spp.), mountain lion (Puma concolor) predation, and periodic drought reduced a population of native desert bighorn sheep (Ovis canadensis) in the San Andres Mountains (SAM), New Mexico, from >200 individuals to a single ewe. In 1999, this ewe was captured, ensured to be Psoroptes-free, and released back into the SAM. Eleven radio-collared rams were translocated from the Red Rock Wildlife Area (RRWA) in New Mexico into the SAM range and monitored through 2002 to determine whether Psoroptes spp. mites were still in the environment. None of these sentinel rams acquired scabies during this period, and no additional native sheep were found to be present in the range. In 2002, 51 desert bighorn sheep were translocated into the SAM from the Kofa National Wildlife Refuge in Arizona (n = 20) and the RRWA in New Mexico (n = 31). Twenty-one bighorn sheep have died in the SAM since that time, but Psoroptes spp. mites have not been detected on any of these animals, nor have they been found on mule deer (Odocoileus hemionus) sampled since 2000. We conclude that psoroptic scabies is no longer present in the San Andres bighorn sheep population and that psoroptic scabies poses a minimal to nonexistent threat to the persistence of this population at this time.

Animals↗

[Effective scabies control system in Moscow].

The analysis using the systems approach, analogue simulation, practical conclusions of the probability theory, mathematical statistical methods, programme-oriented work organization revealed and eliminated a number of neglects that had put bounds to scabies morbidity reduction among Moscovites. In 1998, the number of the foci that dermatovenereological facilities were unaware of substantially showed a 6.9-fold decrease. Therefore, the incidence of scabies reduced by 14.6% in the city in 1998. The paper presents the guidelines developed by the authors, which will ensure that the incidence rates of scabies be 25.07 per 100,000 Moscovites by 2005. It analyzes the scabies epidemiological situation among the homeless and possible measures to promote health in this group of persons.

Animals↗

Scabies associated with radiation therapy for cutaneous T-cell lymphoma.

Scabies, infection with Sarcoptes scabiei, is known to be predisposed to by poor body hygiene, environmental exposure, and systemic immunodeficiency. We report the case of an 83-year-old man with Sezary's syndrome who developed scabies limited to the skin of the upper chest, the same location where he had previously received electron beam radiation treatments for cutaneous T-cell lymphoma. Histologic and immunohistochemical studies demonstrated that sections of the previously irradiated right and left chest skin, compared to non-irradiated chest, abdominal, and leg skin, had infestation by scabies, diminished involvement by T-cell lymphoma, and notably reduced numbers of Langerhans cells. These findings suggest that the development of scabies may be predisposed to by local cutaneous radiation therapy, and that it may be mediated by local cutaneous immunodeficiency secondary to reduced numbers of Langerhans cells.

Aged↗

[Scabies].

The aim of this review is to draw attention to the fact that scabies still causes clinical problems and gives rise to epidemics in hospitals and institutions. We describe the clinical aspects of ordinary and crusted scabies and newer diagnostic methods, such as epiluminescence microscopy and PCR. The current treatment of scabies in Denmark is mentioned, and the importance of simultaneous preventative treatment of household contacts and hygienic measures in the surroundings is emphasised. The role of ivermectin in the treatment and prevention is briefly described. A series of scabies epidemics in hospitals and institutions are discussed with emphasis on factors influencing the spread and subsequent interruption of the epidemic. It is concluded that each institution should have guidelines for the handling of such epidemics and that the local hygiene unit should be involved immediately in the case of an epidemic.

Humans↗

Atypical crusted scabies in an Iranian man.

Crusted scabies has been defined as a scabies-induced psoriasiform dermatosis on the hands and feet with dystrophy of the nails and an erythematous scaling eruption that may be generalized. This case report demonstrates a patient who presented with widespread psoriasiform plaques that were teeming with scabies mites and eggs, but who had absence of nail and palmar involvement. While patients with crusted scabies may have nail dystrophy and involvement of the palms, this involvement is not necessary.

Abdomen↗

Current trend in ivermectin usage for scabies.

Ivermectin, an anti-parasitic agent widely used for onchocerciasis in humans, is emerging as an oral antiscabietic that is as safe and effective as the topical antiscabietics. In the recent reports, all groups of population responded to ivermectin in the treatment of scabies, including immunocompetent, immunocompromised, and other high-risk populations such as individuals with Down's syndrome. This report reviews the efficacy, the mechanism of action, and the safety profile of ivermectin in the treatment of scabies, particularly its utility in crusted scabies and outbreaks of scabies in institutional settings.

Adult↗

Nosocomial outbreak of scabies.

Scabies is a common infestation caused by the human itch mite Sarcoptes scabiei. Small outbreaks in communities or hospitals are not uncommon, but are rarely documented. In this paper, we report on a nosocomial outbreak of scabies originating from a patient with Norwegian scabies at the Intensive Care Unit in Taiwan Provincial Tainan Hospital. Twenty-nine individuals including four inpatients and 25 hospital personnel were involved. The diagnosis was based on history, clinical findings or a positive skin scraping. Unfamiliarity with the clinical manifestations delayed the diagnosis and the highly contagious nature of Norwegian scabies precipitated this outbreak. Early initiation of effective control measures with extensive therapeutic and prophylactic treatment of all contacts resulted in successful eradication of the outbreak.

Aged↗

Pediculosis and scabies.

Pediculosis and scabies are caused by ectoparasites; patients usually present with itching. Head and pubic lice infestations are diagnosed by the visualization of insects or viable nits (eggs). Primary treatment is topically administered 1 percent permethrin. Malathion is one alternative for treatment failures. The importance of environmental measures to prevent infestation is a matter of controversy. Pubic lice are treated the same as head lice, but this finding should prompt evaluation for other sexually transmitted diseases. Body lice infestation should be suspected when symptoms of generalized itching occur in persons who do not change or wash their clothing or bedding regularly; lice may be found in the seams of their clothing. Topically administered permethrin may help to eradicate body lice, but personal hygiene measures are essential for successful treatment. Classic scabies in adults can be recognized by a pruritic, papular rash with excoriations; in infants, small children, and the immunocompromised, the rash may include vesicles, pustules, or nodules. Primary treatment for scabies is permethrin cream and environmental measures are important to prevent recurrent infestation. Generalized crusted scabies is best treated with oral ivermectin.

Humans↗

PCR-based assay to survey for knockdown resistance to pyrethroid acaricides in human scabies mites (Sarcoptes scabiei var hominis).

Permethrin, in the form of a topical cream, is being increasingly used for community-based programs to control endemic scabies. The development of resistance has reduced the use of pyrethroids for the control of many arthropods of economic and health importance. The best recognized form of pyrethroid resistance, known as knockdown resistance or kdr, has been linked to specific mutations in the target of these agents, the para-homologous voltage-sensitive sodium channel gene (Vssc). To develop tools to study resistance to pyrethroid acaricides, we cloned 3711 and 6151 bp, respectively, of cDNA and genomic fragments of the Vssc gene from scabies mite, Sarcoptes scabiei. The sequence encompasses the major polymorphic amino acid residues associated with pyrethroid resistance. A polymerase chain reaction-based strategy has been developed that enables genotyping individual scabies mites. This will facilitate early detection and monitoring of pyrethroid resistance in scabies mite populations under drug selection pressure.

Amino Acid Sequence↗

Scabies presenting with bullous pemphigoid-like lesions.

A wide range of clinical manifestations may be seen in scabies, from classic pruritic papules and burrows to secondary features such as impetigo. Bullus lesions are a less frequent. Twenty cases of scabies presenting with bullae have been reported so far in the medical literature. Differentiating this subtype of scabies from the immunobullous disease bullus pemphigoid is a diagnostic challenge. A 42-year-old man was referred to our dermatology outpatient clinic with 3-month history of severe pruritus and tense blisters affecting mainly the lower trunk, arms and legs. An initial biopsy was suggestive for bullous pemphigoid. Close physical examination revealed small excoriated papules and a few burrows on borders of the hands and wrists. Skin scraping of the lesions on wrists was positive for Sarcoptes scabiei. Another biopsy specimen from a recent blister revealed subepidermal bullae with fibrin and inflammatory cells, particularly eosinophils. Direct immunofluorescence exam was negative. The patient was treated with lindane lotion followed by crotamiton cream with near complete resolution of the lesions. Scabies must be considered in patients presenting with recent onset of unexplained pruritic bullous lesions. Biopsy and immunofluorescence studies together with skin scrapings for Sarcoptes scabiei could help to differentiate these cases from bullous pemphigoid. Antiscabietic treatment results in resolution of bullous lesions in the affected patients.

Administration, Topical↗

Scabies mite inactivated serine protease paralogues are present both internally in the mite gut and externally in feces.

The scabies mite, Sarcoptes scabiei, is the causative agent of scabies, a disease that is common among disadvantaged populations and facilitates streptococcal infections with serious sequelae. Previously, we encountered large families of genes encoding paralogues of house dust mite protease allergens with their catalytic sites inactivated by mutation (scabies mite inactivated protease paralogues [SMIPPs]). We postulated that SMIPPs have evolved as an adaptation to the parasitic lifestyle of the scabies mite, functioning as competitive inhibitors of proteases involved in the host-parasite interaction. To propose testable hypotheses for their functions, it is essential to know their locations in the mite. Here we show by immunohistochemistry that SMIPPs exist in two compartments: 1) internal to the mite in the gut and 2) external to the mite after excretion from the gut in scybala (fecal pellets). SMIPPs may well function in both of these compartments to evade host proteases.

Animals↗

The changing patterns of scabies among in-patients in Singapore (1982-1989).

One hundred and fourteen patients with scabies admitted to a dermatological ward between 1982 and 1989 were studied retrospectively. There was a change in the epidemiological pattern over the eight-year period. We noticed an increase of two to three fold in the incidence of in-patients with scabies. At the beginning of the decade the majority of the patients were below 20 years but towards the end of the decade the same proportion of patients were above 50 years. There was also a change in the racial distribution of scabies from a Malay predominance to a Chinese predominance. We also noticed a change in the residential status of these patients; more patients admitted towards the end of the decade came from institutional homes. The changing epidemiological pattern brought with it new problems both in diagnosis and in the prevention of scabies.

Adolescent↗