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The latest issue of Effectiveness Matters (Box 1) summarises research evidence on the effectiveness of interventions for treating head lice and scabies. It is based on the findings of two systematic reviews carried out by the Cochrane Infectious Diseases Review Group.
A 13-year-old female was on maintenance therapy for acute lymphoblastic leukemia. On three occasions she received methotrexate orally and each time this was associated with reactivation of scabies rash. The mechanisms for this phenomenon are discussed.
A patient who had recently had renal transplant was on a maintenance regimen of azathioprine and prednisone. She developed a florid, scaling, papular eruption clinically identical to Darler disease. Biopsy specimens and skin scrapings, however, showed a scabietic infestation. We believe that this highly atypical presenation, which had several features found in Norwegian scabies, was due to muted inflammatory response that permitted a great proliferation of the mites.
A case is presented of an unusual complication arising in a man with scabies and gonococcal urethritis: the secondary infection of excoriated genital lesions by Neisseria gonorrhoeae. This occurred after he had occluded his genitals with a plastic wrap.
Scabies ('Itch Mite') is truly a Great Neglected Disease that inflicts misery on millions. Molecular approaches, while still in their infancy, are providing a better understanding of the parasite and will have important implications for control and prevention. It has long been thought that dogs may act as a reservoir for human infections. However, genetic studies cast doubt over this supposition.
Outbreaks of scabies in two homes for the elderly mentally ill in the UK and the use of an oral agent, ivermectin, as a control measure are described. The difficulties of diagnosis and control in this setting are discussed.
In Egypt, Scarcoptes scabiei is the most prevalence mites of medical importance infesting man. This is true in overcrowded and poorly hygienic areas. Many effective acaridical regimens are available, but being compounds used as insecticides. With the success of camphor oil in treated human demodicidosis, it was applied for treating human scabies. Camphor oil with or without glycerol dilutions gave complete cure, with concentrations (100%, 75% and 50%) within five to ten days.
We report the case of a 20-year-old homosexual man with HIV-1 infection presenting with AIDS. An erythemato-squamous, papulo-crustous, non-itching dermatosis of 4 months duration was finally diagnosed as Norwegian scabies in the immunosuppressed. For clinical and epidemiological reasons the high contagiosity of this rare entity requires an appropriate therapy without delay.
Scabies, a pruritic, contagious skin disease, is endemic in our society. It is especially prevalent in schools and day care centers. Close physical contact, such as that of children playing, is required for transmission. During the past decade a new therapeutic agent has replaced standard therapy. Diagnosis, symptoms, possible complications and treatment options are discussed.
A hospital outbreak, traced to a case of Norwegian scabies, resulted in 45 and 32 symptomatic cases in staff and patients, respectively. A total of 228 asymptomatic in-patient contacts and over 500 staff required prophylactic treatment with either 1% gamma benzene hexachloride lotion or 5% permethrin cream. Recurrences occurred in seven staff members and five patients. The outbreak was contained within four months.
Infestation with Sarcoptes scabiei var canis, the causative strain of canine scabies, can produce a pruritic rash in humans. The rash generally manifests within 24 to 96 hours of contact with the affected pet. Scrapings are generally negative, and the correct diagnosis requires a high index of suspicion.
Norwegian scabies is a rare clinical variant of human infestation with Sarcoptes scabiei var. hominis. It is characterized by hyperkeratotic lesions of the palmar and plantar surfaces, scalp and ears which contain myriad mites. The authors have observed three cases: the first occurred in a old delibited woman with a Recklinghausen's disease, the second in a boy with Down's syndrome, the last in a child treated with immunosuppressors. Review of the literature and study of etiological grounds. The pathogenesis is yet unclear but the altered host factors appear to be the principal determinant: primary or secondary specific immunologic deficit and inability to eliminate the mites because of the absence of scratching, hereditary predisposition to keratotic reaction of the skin.
The incidence of scabies disease was analysed among women, men and children in Katowice in 1993-1997. The materials came from the Municipal Hospital of Dermatology and from the Clinic of Dermatology in Katowice. From the analysis of materials follows that the precentage of infected women and men was low in the studied period and fuctuated between 0.5 % and 1.8 %. Higher percentage appeared among children. The precentage of hospitalized children was higher (9.4 %-12.6 %) than at children from the clinic (2-2.4 %). The most cases concerned children between 1 and 5 years old.
We have analysed all the reported and diagnosed cases of scabies in the years 1999-2000 per 100 000 inhabitants in the Lódź voivodeship. The data was obtained from the Regional Administration Unit for the Control of Epidemics and Hygiene Promotion in Lódź. The incidence in Lódź voivodeship was found to be twice as high (89,0) as that in Poland (44,0). The highest incidence in Lódź voivodeship was found in Radomsko (268,0), Pabianice (149,0) and Kutno (148.5) districts. The number of new cases registered in 1999-2000 did not increase in the districts: Leczyca, Radomsko, Lowicz and Bełchatów.
Parasitic prurigo caused by scabies mites from recently acquired puppies is described in two patients and their family members. Because Sarcoptes scabiei var. canis (dog) occasionally survives in man, patients with persisting complaints despite treatment of their dogs should be treated with the topical scabicide lindane for one night.
Scabies is an ectoparasitosis caused by Sarcoptes scabiei. Clinical types can be highly variable. There might be a problem in diagnosis due to difficulty in detecting the parasite and atypical clinical features. Delayed diagnosis may be the cause of outbreaks for people living in overcrowded places such as poorhouses, orphanages and barracks. The different types of treatment have been discussed as well as rules for prevention.
Scabies may cause severe problems in immunocompromised persons. Three case histories are presented which illustrate these problems in people with advanced AIDS. Recommendations for treatment and management are made, with a comment about the need for a high level of suspicion about any atypical rash in an immunocompromised patient.
A male patient of 52 years old is studied with an scabiei by Sarcoptes scabiei v. hominis. After a month the patient developed a clinic and histopathologic generalized granuloma annulare. With the specific local treatment of his scabiei, the disease was cured in 7 days. After this treatment, the generalized granuloma annulare disappeared within 2 months. Due to the sequence of both diseases and the way in which they disappeared after local therapy, we suggest that the antigens of the scabies are the ones responsible for the granulomatous lesions. We concluded this since once the antigens have disappeared, the immunologic mechanisms depending on the interactions of lymphocyte T-macrophage which form the granuloma are interrupted. Since the patient is homosexual, we studied the HIV antibodies which were negatives in several opportunities. Nevertheless, an immune disbalance which could be the coadjuvant factor was founded. With this case we show that specific exogens may cause a generalized granuloma annulare.