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A study on prevalence of scabies in a resettlement colony (slum area) and its association with some sociocultural and environmental factors.

A house to house survey as a part of mass treatment of scabies was done in one of the resettlement colonies of Delhi with a population of 9341 in 2035 families, to study some of the sociocultural and environmental factors in families having scabies patients. It was observed that overcrowding, sleeping habits due to limited sleeping space, sharing of linen, clothes and towels were some of the factors associated with scabies. There was no association between the size of the family and persons affected by scabies. The majority of the population were ignorant about the etiology and mode of spread of the disease.

Demography↗

Disseminated scabies evolving in a patient undergoing induction chemotherapy for acute myeloblastic leukaemia.

We report on a 34-year-old refugee from the Balkans presenting with a generalized papular rash during induction chemotherapy for acute myeloblastic leukaemia (AML M4eo). This rash appeared on day 5 of the chemotherapy and was diagnosed as disseminated scabies. It was successfully treated with a combination of oral ivermectin and topical lindane. Scabies disappeared completely despite ongoing neutropenia and other severe infectious complications. Disseminated scabies should be included in the differential diagnosis of rash in severely immunosuppressed patients coming from poor housing conditions.

Adult↗

Scabies: new future for a neglected disease.

Scabies is a disease of global proportions in both human and animal populations, resulting from infestation of the skin with the "itch" mite Sarcoptes scabiei. Despite the availability of effective chemotherapy the intensely itching lesions engender significant morbidity primarily due to secondary sepsis and post-infective complications. Some patients experience an extreme form of the disease, crusted scabies, in which many hundreds of mites may infest the skin causin severe crusting and hyperkeratosis. Overcrowded living conditions and poverty have been identified as significant confounding factors in transmission of the mite in humans. Control is hindered by difficulties with diagnosis, the cost of treatment, evidence for emerging resistance and lack of effective vaccines. Historically research on scabies has been extremely limited because of the difficulty in obtaining sufficient quantities of the organism. Recent molecular approaches have enabled considerable advances in the study of population genetics and transmission dynamics of S. scabiei. However, the most exciting and promising development is the potential exploitation of newly available data from S. scabiei cDNA libraries and EST projects. Ultimately this knowledge may aid early identification of disease, novel forms of chemotherapy, vaccine development and new treatment possibilities for this important but neglected parasite.

Animals↗

Treatment of scabies and pediculosis with lindane preparations: an evaluation.

Risks and benefits involved in the use of lindane preparations for the treatment of scabies and head louse infestations are evaluated. Although lindane per si is moderately toxic, capable of inducing neurotoxic and hemotoxic effects, there is little evidence that the preparations used in the treatment of scabies and pediculosis give rise to toxic symptoms when applied according to directions. Current evidence does not support the view that lindane is intrinsically carcinogenic, although very high doses have induced hepatomas in mice. It is concluded that the benefits obtained in the use of lindane as a scabicide and pediculicide outweigh risks involved in its use for these purposes. Comparison with other preparations available for the control of scabies and pediculosis indicate that lindane is probably the most effective scabicide, although it also shows the greatest toxic potential. Malathion and pyrethrin preparations seem equally effective against head lice. Suggestions for even safer use of lindane are discussed.

Animals↗

A comparative trial of three treatment schedules for the eradication of scabies.

A trial of three treatment schedules, consisting of 1% gamma benzene hexachloride (GBH) lotion applied head to toe and left on the body for 2, 6, or 12 to 24 hours was conducted on an island of 2,076 persons, approximately 70% of whom had clinical evidence of scabies. The island is situated off the north coast of the Republic of Panama. Examination at 1 month after therapy showed that both the 6-hour and 12- to 24-hour cure rate was high (96% and 98%). There was a significantly lower cure rate in the 2-hour group, in which only 82% were cured. Eleven to twelve percent of the subjects became infested in all groups, presumably due to contact with untreated persons with scabies on the island. A single 6-hour application of 1% GBH lotion appears to be adequate therapy for scabies if properly applied. The entire population at risk should be treated at the same time if possible to reduce or eliminate the risk of infestation. No adverse reactions to 1% GBH lotion were observed.

Administration, Topical↗

Unusual features of scabies complicating human T-lymphotropic virus type III infection.

Four cases of "exaggerated scabies" are described in patients who were immunodeficient secondary to human T-lymphotropic virus type III (HTLV-III) infection. As in classical scabies, these patients had a pruritic dermatitis but lacked the usual distribution of the eruption. The rash was initially misdiagnosed in all four patients. Scabies should be considered in pruritic dermatitis in patients at risk for HTLV-III infection.

Acquired Immunodeficiency Syndrome↗

Atypical scabies in HIV-positive patients.

Five cases of Norwegian or keratotic scabies in HIV-positive patients are described. One of these patients was the source of an outbreak in a hospital, ultimately involving 72 persons. Three of our patients had a markedly pruritic eruption. This is unusual in crusted scabies in which pruritus is usually slight or absent. Two of the five patients had unusual CD4 counts of more than 200 cells per cubic millimeter. All our patients responded to lindane and keratolytic agents. When generalized papular, crusted, or eczematoid lesions are observed in HIV-positive patients, particularly if the CD4 count is less than 200/mm3, scabies should be included in the differential diagnosis.

Adult↗

Hidden scabies: diagnosis by polymerase chain reaction.

Diagnosis of scabies infection can be difficult as in many cases only few mites are present on an infected person, and in some cases the skin manifestations can be subtle or atypical. We describe the use of polymerase chain reaction (PCR) to amplify Sarcoptes scabiei DNA in a patient presenting with clinically atypical eczema. Cutaneous scales were PCR positive for S. scabiei DNA before, and negative 2 weeks after, therapy. This method facilitates fast and very sensitive diagnosis of clinically atypical or inapparent scabies infection and therapy control in severely affected patients and may help to identify previously unrecognized scabies cases.

Animals↗

Norwegian-type scabies mimicking contact dermatitis in an immunosuppressed patient.

Patients taking immunosuppressive drugs are susceptible to various forms of infection, including dermatologic disease. Recently, atypical manifestations of scabies have been reported in such patients. In the case reported here, a 26-year-old woman who had had a renal transplant and was taking immunosuppressive drugs had a pruritic rash on the back that closely resembled contact dermatitis. However, skin scrapings from the involved areas and punch biopsy specimen of the back showed live scabies mites. The pruritus was relieved and the skin lesions disappeared within ten days of treatment with scabicides. We believe that current widespread use of immunosuppressive agents may result in more cases of atypical forms of scabies. Therefore, physicians who deal with immunosuppressed patients should be aware of this possibility.

Adult↗

Oral ivermectin for the treatment and prophylaxis of scabies in prison.

INTRODUCTION: Oral ivermectin has been widely used to treat various human diseases, such as filariasis, myiasis, larva migrans, strongyloidiasis and scabies (both the common and crusted forms). However, there are only a small number of papers on the effects of this drug for the control of scabies in infested environments. The current study shows the results obtained with the collective treatment of inmates of a public jail. MATERIALS AND METHODS: A total of 123 inmates living in a restricted and contaminated environment were evaluated clinically by experienced dermatologists for the assessment of the degree of infestation by Sarcoptes scabiei, and were then treated with oral ivermectin (200-300 micorg/kg single dose repeated after 7 days). Both clothing and environment were disinfected. Patients were re-evaluated after 15 days. RESULTS: In all, 78% of the inmates were infected upon initial evaluation. Re-evaluation 15 days after repeat treatment revealed a cure rate of 91.05%. Prophylaxis was also highly effective, where 93.2% of the non-infected inmates and virtually all the house staff remained disease-free throughout the study period. Two of the 29 inmates (6.8%) who showed no apparent lesions upon initial examination were found to be infected upon re-evaluation. These patients responded well to a third dose of ivermectin. CONCLUSIONS: Oral ivermectin at a dose of 300 microg/kg single dose repeated after 7 days proved effective for the treatment and prophylaxis of scabies in an infected institutional environment.

Administration, Oral↗

Control of transmission of Norwegian scabies.

Seven staff members developed scabies after exposure to a patient with acquired immunodeficiency syndrome (AIDS) dementia and hyperkeratotic skin lesions. They were treated and prophylaxis was given to 11 staff members in September 1998. The hospital has had no nosocomial scabies since then despite the admission of 11 patients with AIDS and Norwegian scabies.

AIDS Dementia Complex↗

Epidemic Norwegian scabies in a geriatric unit.

Norwegian scabies is highly contagious and presents with a psoriasiform dermatosis. It afflicts particularly the elderly and patients with immunosuppression. Two weeks after the admission of an index case of Norwegian scabies to a geriatric ward, 13 and 25 patients and 6 of 18 ward nurses developed scabies. Despite comprehensive treatment, the ward epidemic recurred 6 weeks later probably as a result of inadequate treatment of the index case. This diagnosis should be considered when patients from high-risk groups present with an undiagnosed rash.

Aged↗

Norwegian scabies in a patient with AIDS.

Depression of cellular and humoral immunity can result in an overwhelming infection with the mite Sarcoptes scabiei. Infections in which the densities of mites are very high are known as Norwegian, or crusted, scabies. Cases of Norwegian scabies have been reported sporadically in patients with AIDS, but the appearance of the rash on these patients can be very misleading because of the diffuse papular or psoriasiform presentation. Such patients may readily transmit scabies to others. Since the disease is curable, it should be considered in the differential diagnosis of any persistent papular or psoriasiform rash on a patient with AIDS.

Acquired Immunodeficiency Syndrome↗

Introduction of a fluorescence-microscopic technique for the detection of eggs, egg shells, and mites in scabies.

A technique using the fluorescence microscope can prove helpful in the laboratory diagnosis of scabies. Specimens from fifteen patients with scabies were used in this study. All of the specimens were embedded with glycerine instead of potassium hydroxide (KOH) solution. The specimens were examined at 0 min, 30 min, 1 hr, 6 hrs, 24 hrs, and one week after mounting under light and fluorescence microscopes. Specimens embedded with non-fluorescent glycerine were not clear immediately after mounting but became so after about 1 hr. Eggs and egg shells were easily counted in the specimens under the fluorescence microscope but were very hard to identify under the light microscope. Mites were absent in half of the specimens; only eggs and egg shells were present in those specimens found by the fluorescence microscope. The above findings suggest that the detection of egg shells by the use of fluorescence microscope may be helpful for the diagnosis of scabies, in particular with mite negative specimens. Slides prepared with non-fluorescent glycerine were more stable and could be preserved for a long time. However, this method is time-consuming and requires expensive equipment.

Animals↗

Bullous scabies mimicking bullous pemphigoid.

Scabies is an infestation caused by Sarcoptes scabiei and characterised by polymorphous lesions that may include burrows, papules, nodules, excoriation and crusts. Vesicular and bullous lesions are rather rare. Several diseases may be confused with scabies. We report a case of bullous scabies which, on the basis of the clinical and histopathological picture, mimicked bullous pemphigoid. Direct and indirect immunofluorescence were negative. Bullae recurred and persisted despite systemic corticosteroids. The patient was successfully treated with 5% permethrin and remained disease free for up to 12 months of follow-up.

Animals↗

Serum immunoglobulin values in patients with scabies.

Serum total IgE levels were found to be increased in thirty-nine of ninety-four patients with scabies investigated at the time of clinical presentation. One hundred and fifty-four patients were found to have a slightly lower serum concentration of IgA during infection than when measured 6 weeks and 9 months following successful treatment (P less than 0.05). The serum concentration of IgA at 6 weeks and 9 months after treatment did not differ significantly. The serum concentration of IgG during infection was significantly higher than 6 weeks later (P less than 0.05), and than 9 months later (P less than 0.01). The 6 weeks levels were significantly higher than the results at 9 month (P less than 0.01). The serum concentration of IgM during infection was higher than 6 weeks later (P less than 0.1). The 6 weeks levels were lower than those at 9 months (P less than 0.1), whereas there was no difference between the pretreatment and 9 months levels. No differences were noted in the concentration of C3 and C4. Antinuclear antibodies (ANA) and rheumatoid factor (RF) were not found in any of the patients. In thirty-two patients with lichen planus no changes in immunoglobulins or complement were observed. This suggests that scabies infection may be associated with a humoral immumological response against the scabies infection.

Adolescent↗

IgE antibodies to house dust mite in patients with scabies.

Of 135 patients with scabies, forty-seven (35%) had a positive (Classes 1--4) radioallergosorbent test (RAST) to Dermatophagoides pteronyssinus (DP). Elevated serum IgE concentrations were found in sixty-one (45%) of the patients. Atopic disease was confirmed in twenty-eight (23%) of the 120 patients who completed a medical questionnaire satisfactorily. In a control group, well-matched for age and sex, of 201 employees at a local bank, only four (2%) had a positive RAST to DP, and eight (4%) had raised serum IgE levels. Atopic disease was confirmed in eighteen (9%) of them. These observations indicate that scabies infection stimulates the production of IgE antibodies, even in non-atopic individuals, and may suggest that IgE antibodies against the human pathogenic mite Sarcoptes scabiei cross-react with DP. Scabies infection in addition often seems to be associated with atopic disease.

Adolescent↗