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The diagnosis of Norwegian scabies was missed for a year for an elderly long-term-care facility resident. Serpiginous tracks were noted on the surface of Sabouraud dextrose agar used for fungal culture of the skin scrapings. This unusual laboratory manifestation must alert clinical microbiologists to the possible diagnosis of scabies.
From June 1972 to May 1973 the medical officer of health and general practitioners in Sheffield referred all suspected cases of scabies to the Hallamshire Hospital skin department. Contact tracing, similar to that in VD departments, was carried out by a specially trained state registered nurse. In all, 1482 cases were found in 609 households. This was ten times the number referred to the skin department in 1971. Infestation was introduced to households mainly by schoolchildren and teenagers, especially by girls. The commonest sources were friends and relatives outside the home. Schools did not play an appreciable part in spread. The secondary attack rate in households was 38%. Notification of cases, adequate treatment within the home, and contact tracing are recommended to halt the present epidemic of scabies.
Human scabies, caused by skin infestation with the arthropod mite, Sarcoptes scabiei, typically results in a papular, intensely pruritic eruption involving the interdigital spaces, and flexure creases. Recent research has led to a reassessment of the morbidity attributable to this parasite in endemic communities, particularly resulting from secondary skin sepsis and postinfective complications including glomerulonephritis. This has led to studies of the benefits of community based control programmes, and to concerns regarding the emergence of drug resistance when such strategies are employed. The renewed research interest into the biology of this infection has resulted in the application of molecular tools. This has established that canine and human scabies populations are genetically distinct, a finding with major implications for the formulation of public health control policies. Further research is needed to increase understanding of drug resistance, and to identify new drug targets and potential vaccine candidates.
Hyperkeratotic scabies and onychomycosis were associated in an immunosuppressed patient. Onychomycosis healed spontaneously after treatment of scabies. A possible interrelationship between Sarcoptes scabiei infestation of the hyponychium and dermatophytes infestation of the nail plate could be responsible for this peculiar evolution.
Scabies is endemic in Africa where living conditions make synchronous treatment of every member of the large extended family impossible. An open study was designed to investigate the optimum treatment of school children in rural Tanzania. In one school where 34 children (7%) were infested, treatment with benzyl benzoate was distributed to the affected child and those sleeping in close proximity. In another school where 29 pupils (6.4%) were affected, the above treatment was given along with soap and some scabicidal ointment (6% sulphur) to be used on residually affected areas. Again, the treatment was given to those sleeping in proximity. One month later 46% were clear at the first school and a significantly higher proportion (69%) at the second. I conclude that inefficient application of scabicidal treatment and lack of washing contribute to scabies treatment failures. Synchronous treatment of small groups within the extended family can be effective.
OBJECTIVE: To assess the clinical literature describing the use of ivermectin in cases of treatment-resistant scabies infestations. DATA SOURCES: Clinical literature accessed through a MEDLINE search (1966-July 2001) and the Cochrane Database. DATA SYNTHESIS: A limited number of case reports and case series describes successful intervention with ivermectin use in patients who have failed prior therapy. Ivermectin may serve as a viable alternative therapy as the incidence of resistant scabitic infestations increases. CONCLUSIONS: Ivermectin appears to be a safe and effective alternative for patients with treatment-resistant scabies. Larger, controlled clinical trials are required before this therapy can be recommended in the general population or as primary therapy.
In the US, 6% sulfur in petrolatum has been the most frequently administered treatment for infantile scabies. It appears to be safe but there is no literature containing a large series of patients on which to base that determination. In the UK, benzyl benzoate is the approved product. Benzyl benzoate is rarely used in the US at the present time. 5% Permethrin is an excellent substitute and has many advantages. It appears to be quite safe in infants, although it is more expensive than other products. It remains present on the skin for several days, therefore protecting against reinfestation. Ivermectin is a systemic drug which is assumed to be safe in infants, although it requires repeated doses and does not protect against reinfestation. In the opinion of the author, 5% permethrin is the best treatment for scabies in infants and young children.
Permethrin is probably the most effective topical treatment for scabies. There is little microbial resistance to the drug, and it is highly effective. Toxicity is limited to occasional contact dermatitis. Similarly, oral ivermectin 200 micrograms/kg is extremely effective. Oral administration eliminates the need to be certain that medication has been applied properly. Toxicity has been very limited. It is not available in the US for human use in scabies at this time. The toxicity of most of other treatments that are available has not been studied carefully. Sulphur 6% in petrolatum is recommended as safe, but there are no good studies to confirm this. Sulphur is probably the medication of choice when cost is the overriding concern. Crotamiton and benzyl benzoate are probably safe, but are not as effective as permethrin. Lindane has some potential CNS toxicity if used incorrectly, and must be used carefully on damaged skin to avoid excessive absorption. It is important to stress that all household and sexual contacts must be treated, whether or not they have symptoms. Proper application of topical medications must be achieved, including under the fingernails, and up to the edge of all body orifices.
An outbreak of scabies occurred in a ward of a local hospital in Barbastro (Huesca, Spain), between November 2002 and January 2003. The outbreak was linked to a patient infested with mites when he was admitted to the ward on 1 November 2002. The first case had onset of symptoms on 5 November and the last one on 5 January 2003. Seventeen cases were reported: 11 healthcare workers (HCWs) and six patients. The outbreak was attributed to a delay in diagnosis, and lack of individual protection measures by caregivers. The use of short-sleeved coats is an habitual risk practice in this ward. Contact with fomites, animals, infested clothes or intimate contact with people other than their usual partners were dismissed as risk factors for the infestation. The different groups of caregivers in this ward presented a similar risk of becoming infested, and the mechanism of transmission was probably person to person contact. The implementation of specific guidelines for scabies prevention and treatment, as well as an active surveillance system, were fundamental to the control of this outbreak.
Scabies and lice have afflicted man since ancient times. Permethrin is generally the treatment of choice for head lice and scabies, because of its residual effect. Toxicity and absorption are minimal. Ivermectin should be reserved for cases where permethrin fails.
Little is known about human and animal scabies in Jeddah. The present study gives a picture of human scabies. Over four months, 18 cases have been microscopically diagnosed. The most common infested site was the abdomen, followed by the lower and upper limbs. Infestation in other parts of the body was not common but also recorded. The results were discussed on the light of other works done in the region.
A scabies outbreak is reported which appeared in the Inpatient Pneumology Department in a 500-bed hospital. The outbreak began after the admission of a 90-year old woman referred from a nursing home. A total of 27 secondary cases occurred among health care personnel (14) and patients (13); other 7 cases of likely scabies occurred among 198 contacts. Patients were treated with 5% permetrine cream, in three applications one week apart from each other. It was also applied as prophylaxis in non involved patients in a single application. A discussion follows on the medical and preventive recommendations to control the spreading of these outbreak.
Fifty patients with scabies were included in this study. Clinical, parasitological and histopathological study of all patients was done. P-53 expression was examined, using immunohistochemical techniques. Biopsies of nodular scabies showed atypical changes in the epidermis, the dermis showed dense inflammatory infiltrate. Focal positivity for P-53 have been demonstrated which could favour premalignant changes, and recommend further investigations.
Health care providers frequently encounter human infestations of scabies and lice. When a person is identified as having either of these infestations, he/she should be treated. More importantly, their close contacts should be examined and treated if needed. It is vital for dermatology nurses to understand the epidemiology, transmission, symptoms, distribution, diagnosis, complications, and treatment for scabies and lice infestations.
We reported 11 cases of crusted scabies observed during one year in our department. The mean age of the patients was 33 years with extremes at 14 and 49 years. The sex ratio was 1,2. HIV infection was the most common associated disease (45% of the patients). Ten patients had been treated with Ivermectin (200 micrograms/kg). The drug was efficient and well tolerated. For these reasons, we recommend to use Ivermectin as a drug of choice in the treatment of crusted scabies.
BACKGROUND: In vitro exposure to benzyl benzoate (25 p. 100) kills Sarcoptes scabiei within three hours. The aim of our study was to determine in vivo elimination of Sarcopte scabiei with a benzyl benzoate-sulfiram association. METHODS: Medical charts of patients hospitalized for disseminated scabies from 1993 to 1999 were reviewed retrospectively. The diagnosis of scabies was confirmed by microscopic determination. Parasitological examinations were conducted every day or every two days until negative results. Patients were treated by successive applications of benzyl benzoate until parasitological cure. RESULTS: Twenty patients were included in the study. The median delay of parasitological cure was seven days. After 15 days, 95 p. 100 of patients were cured. Two cutaneous side-effects were reported. DISCUSSION: Despite immediate in vitro efficacy, benzyl benzoate action is delayed in vivo. The time of parasitological negativation after one application of benzyl benzoate is unknown. Therefore, it is not currently possible to determine whether our therapeutic regimen was excessive or not.
We describe an outbreak of scabies affecting 13 patients and staff members in a geriatric ward. The difficulties of diagnosis and treatment are discussed, and it is suggested that the local hygiene unit should be involved immediately if institutional scabies is suspected.
We compared in a prospective, randomised, investigator-blinded trial, the efficacy and tolerability of a new synergised-pyrethrins thermo-labile foam (F) formulation with permethrin 5 % cream (P) in 40 patients with scabies. Clinical evolution of scabetic lesions (Clinical grading = CG) and itching intensity (IS) were assessed, using a 5-point semi-quantitative score, at baseline, at week 2 and 4. F and P were equally effective in the clinical resolution of scabetic lesions. As compared to baseline, P reduced CG and IS from 3.4 0.7 and 3.1 0.4 to 0.2 0.6 and 1.4 1, at week 2, and to 0.0 0.0 and 0.1 0.3 at week 4, respectively (P < 0.001). F reduced CG and IS from 3.3 0.5 and 3.2 0.4 to 0.05 0.2 and 0.4 0.6 (week 2) and to 0.0 0.0 and 0.0 0.0 (week 4), respectively (P < 0.0001). As compared to P group, the IS in F group, at week 2, was significantly lower (0.4 0.6 vs. 1.4 1.1) (P < 0.0013). This foam formulation was at least as effective as permethrin 5 % cream in the treatment of scabies. In comparison with permethrin the foam induced a more rapid and complete resolution of itching.