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The immunology of scabies.

Scabies is an inflammatory skin disease caused by the mite Sarcoptes scabiei. The mite itself provokes little dermatitis. The rash and itch associated with scabies is probably a manifestation of immune response. The immune response may help to limit the number of infesting organisms either directly by toxic products generated during the reaction or indirectly by evoking scratch. Critical studies using purified antigens from scabies mites in vivo and in vitro will be necessary in order to clarify the nature of the antigens involved and the role of different types of immune responses in producing clinical disease.

Antigen-Antibody Complex↗

[Clinical picture in scabies: comparison of the clinical description found in the literature with 179 patients examined].

After analysing the recrudescence of scabies and its incidence in the State of Rio Grande do Sul, Brazil, clinical manifestations of this parasitic infestation found in 179 patients examined are commented. The patients, 83 men and 96 women, were between 16 and 65 years old, interned in a psychiatric hospital. The clinical diagnosis was given by experienced dermatologists. Twenty-five text-books have been reviewed so as to compare them to the series of patients examined. The main conclusions were the following: Burrons were found in only 3.4% of the cases examined, although this kind of scabies lesion is the most valued and mentioned in specialized literature. It is considered to be the pathognomonic lesion of scabies and its finding defines the diagnosis. However, the data found show that its low frequency limits greatly the utilization of its finding in this parasitic form diagnostic practice. Although not expected in a precarious hygienic condition environment, the percentage of patients with secondary infection and eczema was relatively low. There was no apparent explanation for this fact. Confirming our clinical idea, previous to this study, papule-crusted kind lesion was the form most frequently present. It corresponds to the burron disrupted by scratching.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdomen↗

The epidemiology of scabies in Denmark, 1900 to 1975.

Denmark is the only country in which scabies has been reported for many decades. The present study is based on 850,629 cases reported between 1900 and 1975. The incidence of scabies showed pronounced peaks around 1918 and 1945. Since the end of the 1960s, a new increase in incidence has been observed. The rates were high and rather uniform among infants, children, and young adults. Before puberty, the rate for girls was on an average 1.4 times higher than for boys. Scabies showed the same incidence in the capital as in the provinces, and marked seasonal variations occurred, with a winter maximum and a summer minimum. No single factor could be identified to explain the cyclic occurrence in time, the sex and age pattern, and the seasonal variation. These patterns probably have a multifactorial genesis!

Adolescent↗

Nosocomial outbreak of scabies.

During the last quarter of 1976, a nosocomial outbreak of scabies occurred in a 558-bed community teaching hospital. There had been scattered reports of scabies throughout Michigan for nearly a year prior to this outbreak. The epidemic spread of scabies from a patient to 38 hospital employees and their families and associates was identified from historical, clinical, and microscopic skin preparation data.

Aged↗

Laboratory diagnosis of scabies.

All the above listed reasons as well as the experience we have obtained with this method, justify our recommendation of the introduction of the laboratory diagnosis of scabies through the method of lye scraping of the skin into routine practice. A single parasite element is enough for determining the diagnosis while, for the above mentioned reasons, a negative microscope finding does not exclude the parasitic etiology of the given disease. We therefore recommend in the diagnosis of scabies that the following criteria are parallely used: 1. an objective skin finding 2. laboratory proof of the causative agent of infestation 3. subjective feelings of the patient (itching at the typical time) 4. positive epidemiological anamnesis, primarily the occurrence of clinical symptoms in several members of a family or a group 5. diminishing of clinical symptoms after specific treatment with an anti-scabies medicament.

Adult↗

Pediculosis and scabies. What to look for in patients who are crawling with clues.

Lice and mites are highly contagious obligate parasites of humans and are spread by close, direct contact. Head, body, and pubic lice produce severely pruritic eruptions in their respective locations. Diagnosis is readily made by finding lice or nits on hair shafts, except in the case of body lice, which are found on the seams of clothing. Scabies often presents as a more generalized pruritic rash. Diagnosis is confirmed by finding the mite in a characteristic skin burrow. Crusted (Norwegian) scabies, a rare variant consisting of infestation by thousands of mites, occurs in patients with neurologic or immunodeficiency disorders. Secondary bacterial infections and eczematous changes may complicate both pediculosis and scabies. Infestations are easily treated with use of an appropriate pediculicide or scabicide and environmental-control measures.

Humans↗

Therapy of scabies: nursing homes, hospitals, and the homeless.

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.

Clinical Protocols↗

Persistent scabies in nursing home patients.

Persistent scabies outbreaks in extended care facilities result from multiple factors: atypical presentations in the elderly, leading to delayed or inaccurate diagnosis; incomplete or ineffective treatment of the patient and exposed population; and failure to coordinate notification, education, treatment, and disinfection. A case report of scabies in an elderly resident of an extended care facility illustrates various types of scabies manifestations, the advisability of obtaining diagnostic scrape preparations, and the efficacy and safety of permethrin. Guidelines for an aggressive and comprehensive effort for eradication are offered.

Aged↗

[The treatment of scabies with oral ivermectin].

To evaluate the efficacy and safety of a single 200 mcg/Kg dose of ivermectine as compared with placebo in the treatment of scabies was settled. Fifty five patients with the diagnosis of scabies were randomized to a single oral dose of ivermectine or placebo. The study informed that 26 (79.3%) patients were cured with ivermectine on their first follow-up visit, as compared to only four (16%) in the placebo group (X2 = 77.07, p < 0.001). Overall, 37 of 50 (74%) patients treated with ivermectine cured, as compared to only four of 26 (16%) treated with placebo, this difference was still significant (X2 = 23.66, p < 0.001). We concluded that ivermectine is a safe and effective treatment for scabies.

Administration, Oral↗

Human scabies acquired from a pet puppy.

Scabies is a very old contagious skin disease caused by itch mite, Sarcoptes scabiei which burrows into the stratum corneum. Nowadays, human scabies is one of the health problems among the school children. This paper dealt with a case of scabies in a preschool aged child who acquired the infestation from his pet puppy.

Animals↗

The use of ivermectin for scabies.

BACKGROUND: Ivermectin, a modified avermectin, is widely known to be an ectoparasiticidal agent in animals but its effect on human ectoparasites is not known. METHODS: As a part of a chemotherapy trial with ivermectin against Wuchereria bancrofti microfilaraemia, two males with clinical scabies were studied. Three skin scrapings were taken from the lesions of each of the cases and examined with potassium hydroxide solution for the presence of eggs, larvae or adult mites. RESULTS: Following a single oral dose of ivermectin at either 100 micrograms or 20 micrograms/kg body weight both the itching and eruptions were reduced and the lesions healed after 14 days of treatment. Skin scrapings taken on days 7 and 30 after administering the drug did not reveal any mites. However, the lesions reappeared after 3 months. CONCLUSION: The beneficial results on the healing of scabetic lesions following ivermectin therapy indicates that the drug may have a scabicidal effect. Reappearance of the lesions may have been due to an inadequate dose. This emphasizes the need for future controlled trials on the efficacy of ivermectin against human scabies infection. If proven, this may be an additional advantage in mass chemotherapy campaigns, when there is co-existence of filariasis, intestinal helminthiasis and scabies.

Adolescent↗

[Deltamethrin-piperonyl butoxide (Launol) in the treatment of scabies. Clinical experience with 33 patients].

Deltametrin is an effective but not well tolerated treatment of scabies. The association with piperonil-butoxide allows shorter treatment periods, thereby reducing its adverse effects. We used this combination in the treatment of 33 patients with active scabies. Two treatment modalities were used with four or five applications, during 7 or 8 days respectively and patients were assessed two weeks later. Treatment was effective and well tolerated in 32 of the 33 patients and no differences were observed between the two modalities. It is concluded that this is an effective therapy for scabies.

Adolescent↗

Epidemiological studies on human scabies in Cairo.

Nowadays, human scabies is more or less a public health problem in Egypt, particularly among school children. The results of this epidemiological studies among one hundred scabietic patients showed that (a) Scabies is widespread among children and youth particularly students (b) The sex and the site distribution are attributed to the risk factor of exposure to infestation (c) Scabies is a disease determined by Sociodemographic and Hygienic customs of the population with high familial incidence among the patients. The whole results were discussed on the light of the work done in Egypt and similar countries.

Adolescent↗

Pathologic findings in human scabies.

The histologic findings in the papular, vesicular, nodular, and Norwegian variant of scabies have in common a superficial and deep perivascular mixed inflammatory cell infiltrate of lymphocytes, histiocytes, and numerous eosinophils. A spongiotic vesicle occurs in the papulovesicular type, a dense cellular infiltrate in the nodular type, and a hyperkeratotic psoriasiform dermatitis in the Norwegian type. Eggs, larvae, and adult mites are abundant in the cornified layer of Norwegian scabies, are practically never found in biopsy specimens from lesions of nodular scabies, and are discovered only episodically in papulovesicular lesions.

Blood Cells↗

The immunology of scabies.

Individuals with scabies react to bites by generating a cell-mediated immune response at the bite site. This elicits a very itchy papule that is often excoriated. Sometimes ulcerated papules, vasculitis, and nodules develop as a result of other immunologic reactions in skin. Immunologic reactions mediated by antibodies of the immunoglobulin G (IgG), IgM, and especially, IgE classes may also be involved. None of these reactions have been shown to eliminate all mites from the skin surface, but locally these reactions may prevent the epidemic multiplication of scabies' organisms on the skin surface, as observed in some patients with crusted scabies.

Acquired Immunodeficiency Syndrome↗

Scabies research: another dimension.

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.

Acquired Immunodeficiency Syndrome↗

Neonatal scabies.

Between 1981 and 1991, eleven infants (ranging in age from 2 to 9 months) were hospitalized in our department for evaluation of microscopically verified scabies infestations. Six presented signs of Norwegian scabies. All of the latter infants had been treated (prior to the scabies infestation) for long periods with topical steroids, in most cases for lesions suggestive of atopic dermatitis. We believe that the occurrence of the Norwegian form in these newborns was due to localized steroid-induced suppression of the normal immune response.

Animals↗

[Norwegian scabies in immunosuppressed patients. Report of a case].

A case of Norwegian scabies in an immuno-suppressed patient is reported. This skin ectoparasite, rarely described in healthy individuals, varies from common scabies for clinical presentation, appearance and distribution of skin lesions. Norwegian scabies should be suspected in any atypical itching, or non, rash in immunosuppressed patient. Attention is also drawn to the importance of early diagnosis to precede familiar and hospital epidemics.

Humans↗