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An outbreak of scabies in a residential home for the elderly is described, and the investigation and management of the problem discussed. Multiple cases of scabies in this type of community are almost invariably associated with the presence of an unrecognized case of crusted (Norwegian) scabies. Unless such an individual is recognized, attempts to eradicate the problem may prove unsuccessful.
An otherwise healthy 19-year-old pregnant woman developed crusted scabies. She and her husband had previously been treated for scabies. In spite of appropriate treatment both suffered several relapses, and later their infant was also affected. Ultimately, the infection was eradicated. As far as we are aware, this is the first recorded case of crusted scabies occurring in a healthy pregnant woman.
An epidemiologic survey was conducted in a population of 1,727 persons living in 253 households in a semiurban area of Goa, India. The prevalence of scabies was 9.7% by persons, 22.5% by households and 22.8% by families. Prevalence of scabies was highly associated with age. The highest prevalence (23.7%) was in school-age children. Prevalence was higher for females than males age 25 or older, but there was no significant difference in prevalence by sex for all ages. Prevalence rate by persons was approximately the same in Hindus and Christians but prevalence rate between families was higher for Hindus, although prevalence within families was higher for Crhistians. First to contact scabies in the family was generally a school child.
The epidermal histological findings in the primary scabetic lesion are hyperkeratosis, acanthosis, and spongiotic edema and vesiculation. The dermal changes consist of perivascular and diffuse cell infiltrates, mainly mononuclear cells, and sometimes eosinophilic granulocytes. The number of mast cells are slightly greater in primary scabetic lesions compared with secondary lesions and normal skin. Vasculitis is found in those cases showing tissue eosinophils, severe dermatitis, and many mites. A nodular lesion shows perivascular infiltrates mainly containing histiocytes, some with atypical and hyperchromatic nuclei and a few in mitosis, and some lymphocytes and cells with pyroninophilic cytoplasm. Secondary scabetic lesions show acanthosis and perivascular inflammatory cell infiltrates, mainly mononuclear cells, whereas clinically normal skin presents very slight perivascular and diffuse mononuclear cell infiltrates in half of the patients. Both the number of circulating eosinophilic granulocytes and serum IgE concentrations correlate with the severity of the skin reaction. Ten of 60 patients with scabies had markedly increased numbers of circulating eosinophilic granulocytes during scabies infestation. In most of the patients, however, the number of circulating eosinophils decreased after scabies treatment.
Various materials related to the life physiology of the scabies mite in and on the human skin have been identified by morphology. The role they could play as possible activators of both cellular and humoral arms of the host's immune system is discussed. Subtle aberrations of this reactive process could be basically responsible for the wide spectrum of clinical and histological aspects reported in scabies. Possible lines for future research on host-parasite relationship in scabies are proposed.
There is little information in the literature concerning scabies in patients with systemic lupus erythematosus. Scabies in our five patients appeared to be more severe than usual, and two of them developed crusted scabies, probably on an immunologic basis.
The demography of scabies was studied in the sole dermatology practice on the island of Kauai, Hawaii, over a 50-month period. Scabies was observed far more frequently in whites and Hawaiians than in Japanese and Filipinos. Within the white ethnic group, scabies was most frequently diagnosed in persons between 15 and 44 years old, while in Hawaiians, the disease was most common in the 0-14-year age group. It is possible that learned or acquired behavior patterns may play a significant role in contracting the disease.
From January 1988 to June 1989, data were collected daily on the patients who were seen at the Dermatology Clinic attached to the Kamuzu Central Hospital, Lilongwe, Malawi. Cases were diagnosed and patients were treated under the supervision of a dermatologist. A total of 34,002 patients were seen during the study period. Of these patients, 15,526 (45.7%) were children and 18,476 (54.3%) were adults. The prevalence of scabies was 40.4% in children and 31.6% in adults, whereas the prevalence of impetigo/bacterial skin infections was 26% in children and 10.4% in adults. Based on data accumulated for periods of 1 month, the incidence rate of scabies was highest during the cold, dry season (May-November) and the incidence rate of skin infection was highest during the hot, rainy season (December-April). Since the patients who were studied lived predominantly in rural settings, an explanation for the higher incidence rate of scabies during the cold season could be close body contact resulting from the overcrowding within the houses. The reason for the increase in the incidence rate of pyoderma during the rainy season might be linked to deficiencies in hygienic precautions. A community-based intervention strategy with children as its target population is proposed to combat these diseases.
OBJECTIVE: The purpose of this study was to recognize the role of mast cells in the pathogenesis of scabies. METHODS: One hundred and fifty patients and 10 controls were included in the study. Group 1 included 20 patients without previous treatment. In group 2, 80 patients were treated with antiscabietic drugs. Group 3 had 50 patients who received an antiscabietic drug followed by 3 days of crotamiton. Diurnal and nocturnal skin biopsies were taken from group 1. In groups 2 and 3, the biopsies were taken after 2 weeks of treatment. Sections were cut and stained by hematoxylin and eosin and Giemsa stains. RESULTS: Mast cells were increased in diurnal and nocturnal biopsies. Evident degranulation of mast cells was detected in nocturnal biopsies. The mast cell number decreased to half its pretreatment number in patients treated with antiscabietic drugs and to its normal number in patients treated with antiscabietic drugs followed by 3 days with crotamiton. CONCLUSION: The number of mast cells are increased in scabietic lesions. This plays a role in the pathogenesis of the clinical and histologic picture of scabies. We recommend that an antiscabietic drug should be followed by 3 days of crotamiton in the treatment of scabies.
In 120 patients, treated for scabies infection, the serum IgE concentrations fell from high levels in 54 and normal levels in 66 to lower levels 12 months after treatment. The specific IgE antibodies to Dermatophagoides pteronyssinus (RAST) were also reduced 12 months after treatment. The decrease in both IgE concentrations and IgE antibodies was most conspicuous in non-atopic patients. These findings confirm previous observations of specific immunological hypersensitivity to scabies mite, and that scabies infection stimulates the production of IgE antibodies.
Ivermectin, an antiparasitic agent, was successfully used as a sole agent to combat endemic scabies in a closed 33-bed ward of a rural nursing home. Previous topical therapies, including multiple applications of permethrin, gamma-benzene hexachloride, benzyl benzoate and precipitated sulfur in white soft paraffin, had failed. Several patients exhibited hyperkeratotic crusted scabies with head and neck involvement and all residents except one recently arrived resident had evidence of active infestation. All residents were treated with 200 micrograms/kg of ivermectin and this dose was repeated 2 weeks later in all subjects. Four weeks after the first dose of ivermectin there was no evidence of active scabies and all rashes were totally resolved by 6 weeks. The action of ivermectin, its safety and its indications are discussed.
BACKGROUND: Scabies is a very common skin infection in convicts. The SIMSPE Society (Società Italiana di Medicina e Sanità Penitenziaria) has organized and conducted a multicentre, randomized, comparative, parallel group, investigator-blinded trial to evaluate the efficacy and tolerability of synergized pyrethrins foam (PF) in comparison with benzyl benzoate (BB) lotion. METHODS: A total of 240 convicted patients, enrolled in eight National Jail Institutions, with a clinical diagnosis of scabies, were treated with PF (n = 120) for three consecutive days or BB (n = 120) for five consecutive days. Primary study endpoints were the clinical cure rate and the local tolerability. Secondary endpoints were clinical evolution of scabietic lesions and itching intensity. Study outcomes were assessed using appropriate semiquantitative scores at baseline and after 2 and 4 weeks. A second treatment cycle was applied if after 2 weeks the patient was not judged clinically cured. RESULTS: At week 2, a total of 75% (95% CI: 66-82%) and 71% (95% CI: 62-78%) of patients showed a complete clinical cure rate in the PF and BB groups, respectively. At week 4, the percentage of totally cured patients increased up to 95% (95% CI: 89-97%) and 91% (95% CI: 83-94%) in the PF and BB groups, respectively (P = NS between groups). At week 4, 5% in the PF group and 9% in the BB group complained of itching. Burning and irritation after treatment applications were more common in the BB group in comparison with the PF group. The tolerability score was better in the PF group in comparison with to BB group (2.9 vs. 2.2; P = 0.0001). A total of 95% of patients in the PV group had a good tolerability score (i.e. = 3) in comparison with 41% in the BB group. CONCLUSION: Our results show that a 3-day treatment with pyrethrins thermofobic foam is at least as effective as a 5-day treatment with benzyl benzoate lotion in convicted subjects with scabies. The foam formulation is better tolerated than the benzyl benzoate lotion.
Permethrin 5% cream (Elimite) was approved as a treatment for scabies by the U.S. Food and Drug Administration in September 1989. In a double-blinded, randomized study, it was compared with crotamiton 10% cream (Eurax) for the treatment of scabies in children 2 months to 5 years of age. Two weeks after a single overnight treatment, 14 (30%) of 47 children were cured with permethrin 5% cream, in contrast to only 6 of 47 (13%) of subjects treated with Eurax. Four weeks after treatment the figures were 89% and 60% cured for the two agents, respectively. In 10 of the 19 patients whose treatment failed, the condition became worse after therapy. The difference in efficacy in favor of permethrin was significant (P = 0.002). That agent also demonstrated greater effectiveness in reducing pruritus and secondary bacterial infections. Elimite offers a safe, efficacious, and cosmetically elegant alternative to Eurax in the treatment of scabies in children.
Gregory, Kenneth F. (Ontario Agricultural College, Guelph, Ontario, Canada), and Jay C. C. Huang. Tyrosinase inheritance in Streptomyces scabies. II. Induction of tyrosinase deficiency by acridine dyes. J. Bacteriol. 87:1287-1294. 1964.-Growth in minimal medium containing 1 mug of acriflavine per ml resulted in a large increase (up to 62%) in the frequency of tyrosinase-deficient (tye(-)) mutants in all of ten strains of Streptomyces scabies and eight unidentified streptomycetes studied. This increased frequency did not result from the selection of preformed mutants, since tye(-) clones were usually inhibited by lower concentrations of acriflavine than were tyrosinase-producing (tye(+)) clones, and no significant difference in mycelial yields occurred between the two types growing in a 1 mug/ml concentration of the dye. The mutations induced by X rays and acriflavine were either allelic or closely linked. This tye(-) phenotype was not caused by the production of an enzyme inhibitor, lack of a cofactor, or defect in the conversion of a protyrosinase to tyrosinase. Tye(-) mutants formed no detectable tyrosinase under a variety of conditions, including the presence of possible inducers. Mutants were able to oxidize glucose and succinate. The S. scabies tyrosinase was heat-labile (half-life at 59 C = 1.6 min) and not particle-bound. We conclude that acriflavine induces the loss of, or alteration in, a structural gene for tyrosinase production present as an extrachromosomal factor.
OBJECTIVES: We present a case of an AIDS patient with Norwegian scabies manifest by a single, crusted plaque localised to the glans penis. METHODS: A 45 year old man with AIDS presented to our clinic complaining of a red papular pruritic rash on his abdomen and anterior thighs and a single, thick, crusted, non-pruritic lesion on the penis. He had been treated with lindane topically prior to the development of the penile lesion without resolution of the pruritus or red papular lesions. A mineral oil preparation was obtained from the hyperkeratotic penile lesion and revealed numerous mite eggs and faeces. RESULTS: The diagnosis of localised, genital Norwegian scabies was made. The patient was treated with ivermectin 200 micro g/kg per dose taken as two doses, 14 days apart, with complete resolution of both pruritus and skin lesions. CONCLUSIONS: This patient is the first known report of Norwegian scabies localised as a single lesion on the penis. He was successfully treated with oral ivermectin monotherapy.
242 patients with scabies were examined for gonorrhoea at the Municipal Hospital of Copenhagen over a one-year period. We found asymptomatic gonorrhoea in 2% of the male patients and 12%. of the female patients. The incidence of gonorrhoea in female patients with scabies is thus higher than in other routinely examined groups of patients (Andersen and Nielsen, 1974; Gregersen, 1972; Hansen and Lange, 1973; Nielsen, 1974; Starck, Bygdeman, Eriksson, Heinerz, and Moberg, )971). Our suggestion is that all patients with scabies, male as well as female, should be examined routinely for gonorrhoea.
A systemic disorder characterized by fever and reactive lymphadenopathy developed in a patient with scabies infestation. Regression of all clinical symptoms and signs occurred after antiscabies therapy. Two months later, the whole clinical picture reappeared concomitantly with scabies reinfestation. Subsequent lymph node biopsy demonstrated typical angioimmunoblastic lymphadenopathy (AILD). It is plausible that persistent antigenic stimulation caused by scabies infection was of pathogenetic importance in the induction of the syndrome of AILD. Infectious agents should be considered and looked for in patients with AILD, since they may play a role in the evolution of this disease.
We report a case of HTLV1 infection revealed by crusted scabies and widespread dermatophytosis in an African woman. HTLV1 infection was not complicated by adult T cell leukemia or myelopathy. Crusted scabies is a marker of HTLV1 infection. The importance of oral ivermectin therapy in crusted scabies is emphasized.