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PubMed1999

Crusted scabies in association with human T-cell lymphotropic virus 1.

BACKGROUND: Human T-cell lymphotropic virus I (HTLV- 1) infection can lead to myelopathy/tropical spastic paresis and adult T-cell leukemia/lymphoma (ATLL). Infection with HTLV-1 has also been associated with clinically significant immunosuppression. Crusted scabies, also known as Norwegian scabies, is an uncommon presentation of scabies that may occur in conjunction with immunosuppression. Although crusted scabies has been reported in association with HTLV-1 infection, to our knowledge it has never been described in association with HTLV-1 associated myelopathy. OBJECTIVE: The aim is to describe a case of HTLV-1 associated myelopathy and concomitant crusted scabies. METHODS: This article includes a case report and a literature review. CONCLUSIONS: Crusted scabies is reported in association with HTLV-1 infection with or without concomitant ATLL. Crusted scabies should be considered in the differential diagnosis of a generalized cutaneous eruption in an HTLV-1 positive patient. Patients with crusted scabies from an HTLV-1 endemic population should be rested for a possible HTLV-1 infection. These patients may be at increased risk of progressing to ATLL.

Adult↗
PubMed2002

Are sexually transmitted infections associated with scabies?

Sexually transmitted infections (STIs) have been previously reported to be associated with scabies in sexually active people. The UK national guidelines on STIs recommend screening for other STIs in patients with scabies attending a genitourinary medicine (GUM) clinic. However, there is a paucity of literature on this association, which we reviewed. We looked at the sexual behaviour and the coincidence of STIs in patients with scabies attending a GUM clinic and in inmates from a young offender institution (YOI) attending between 1 January 1998 and 31 December 1999. A total of 47 patients with scabies were identified in the GUM clinic population during this period and 15 patients in the YOI group. Consecutive new and rebooked sex-matched patients served as a control group. Among the GUM clinic attendees 36% of patients with scabies had multiple sexual partners in the preceding 3 months compared with 21% in the control group (P=0.11). Thirty-four per cent of patients with scabies had a previous history of STI vs 17% in the control group (P=0.058). The number of patients with coexistent STIs was not significantly different in both groups (49% vs 44%, P=0.68). The number of patients in the YOI group was too small for a statistical analysis. This study showed that patients with scabies had comparable rates of STIs as with the GUM clinic population. It therefore supports the national guidelines in recommending screening for other STIs in patients with scabies.

Adolescent↗
PubMed2005

Control of scabies, skin sores and haematuria in children in the Solomon Islands: another role for ivermectin.

OBJECTIVE: To assess the effects of a 3-year programme aimed at controlling scabies on five small lagoon islands in the Solomon Islands by monitoring scabies, skin sores, streptococcal skin contamination, serology and haematuria in the island children. METHODS: Control was achieved by treating almost all residents of each island once or twice within 2 weeks with ivermectin (160-250 microg/kg), except for children who weighed less than 15 kg and pregnant women, for whom 5% permethrin cream was used. Reintroduction of scabies was controlled by treating returning residents and visitors, whether or not they had evident scabies. FINDINGS: Prevalence of scabies dropped from 25% to less than 1% (P < 0.001); prevalence of sores from 40% to 21% (P < 0.001); streptococcal contamination of the fingers in those with and without sores decreased significantly (P = 0.02 and 0.047, respectively) and anti-DNase B levels decreased (P = 0.002). Both the proportion of children with haematuria and its mean level fell (P = 0.002 and P < 0.001, respectively). No adverse effects of the treatments were seen. CONCLUSION: The results show that ivermectin is an effective and practical agent in the control of scabies and that control reduces the occurrence of streptococcal skin disease and possible signs of renal damage in children. Integrating community-based control of scabies and streptococcal skin disease with planned programmes for controlling filariasis and intestinal nematodes could be both practical and produce great health benefits.

Child↗
PubMed1994

Sarcoptes scabiei: the circulating antibody response and induced immunity to scabies.

Scabies is an important parasitic disease that continues to persist throughout the world despite the availability of acaricides to control it. The immune response mechanism to scabies and the possible development of a vaccine for control of scabies was investigated. This study demonstrated that hosts infested with scabies develop immunity (resistance) to reinfestation. All hosts developed scabies-specific elevated circulating antibody titers during scabies infestations that followed the classical pattern for primary and secondary infestations. Parallel elevated levels of complement C3 were also observed. The hosts that exhibited acquired immunity after their first infestations had antibody and complement levels during challenge infestations lower than those of the hosts that showed no immunity when reinfested. Induction of immunity coupled with generally elevated antibody levels for both immune and nonimmune hosts suggested that resistance to reinfestation was associated with a cell-mediated response. These data also suggested that vaccination with specific scabies tissue containing the relevant antigens or recombinant relevant antigens could enhance the cell-mediated response to protect the hosts against natural infestations.

Animals↗
PubMed2005

Epidemiological study of scabies in different environmental conditions in central poland.

PURPOSE: The goal of the research was to determine the spreading of Sarcoptes scabiei and the incidence of scabies in the residents of particular districts of the Swietokrzyskie Voivodeship (Central Europe) from 1990 to 1998. METHODS: An epidemiological analysis of scabies incidents was performed, with a focus on the age and sex patterns of the population, seasonal incidence, and environmental conditions. In the entire area covered in the period studied, a total of 2064 cases of scabies were reported. The incidence of scabies was typically higher in rural areas than in cities. The most cases of scabies were noted in children and teenagers between 6 and 15 years of age. RESULTS: The research indicated that prevalence of the disease within a family is an important factor in scabies epidemiology in the Swietokrzyskie Voivodeship. The incidence of scabies is seasonal in its nature, as the majority of cases occurred in the autumn and winter months. CONCLUSION: The incidence of the disease can be reduced by improving socioeconomic and hygienic conditions and by implementing a proper system of social education, as well as by promoting more efficient health service.

Adolescent↗
PubMed2000

Scabies and pediculosis.

Scabies and pediculosis are ubiquitous, contagious, and debilitating parasitic dermatoses. They have been known since antiquity and are distributed worldwide. Clusters of infestation occur-for example, scabies affecting immunocompromised individuals or patients and staff in hospitals and nursing homes for the elderly, and pediculosis affecting schoolchildren or homeless people. Associations with other disorders are common: infections with human T-cell leukaemia/lymphoma virus I (HTLV-I) and HIV are associated with scabies, and trench fever and exanthematous typhus with pediculosis. Specific forms of scabies, including bullous scabies or localised crusted scabies, may be misdiagnosed. Moreover, definitive parasitic diagnosis can be difficult to obtain, and the value of new techniques remains to be confirmed. Difficulties in management have returned scabies and pediculosis to the limelight.

AIDS-Related Opportunistic Infections↗
PubMed2006

[Systemic adverse reactions with ivermectin treatment of scabies].

BACKGROUND: Scabies is a common parasitic infestation and is very difficult to eradicate from institutions. Ivermectin is used extensively thanks to its efficacy and ease of use through oral administration; it was approved for the treatment of scabies in humans in 2001 in France. Most of the adverse effects noted with this drug have been seen during treatment of onchocerciasis and other filarial disease, but they are rare in the treatment of scabies. We report side effects with ivermectin in two elderly patients with scabies. CASES REPORT: A 72-year-old man was referred for scabies and was treated with benzyl benzoate (Ascabiol) and ivermectin (200 microg/kg) in a single dose. Two days later, the patient presented abdominal pain and nausea. Laboratory tests revealed cytolysis tests for other causes of hepatitis were negative. Within two weeks, liver function had returned to normal. Hepatitis due to ivermectin was diagnosed. An 86-year-old woman hospitalised for scabies was treated with benzyl benzoate and a single dose of ivermectin (200 microg/kg). She developed sinus tachycardia and asthma 3 days later. Screening for embolic, cardiac and infectious origins was found. Toxicity of ivermectin was suspected. DISCUSSION: Since the introduction of ivermectin for the treatment of scabies, reports of adverse events are rare although this drug can cause cardiac dysfunction and liver disease in other indications. In our cases, the causal relationship with ivermectin is probable and care must be taken, particularly in the elderly, the population in which this drug is probably most widely prescribed.

Aged↗
PubMed2003

Seasonality trends of scabies in a young adult population: a 20-year follow-up.

BACKGROUND: Scabies is not a notifiable disease in most countries. Therefore, its seasonality trends are usually estimated and may be inaccurate. OBJECTIVES: To determine the seasonality of scabies over the long term in a large military population, including all of the Israel Defence Forces personnel. METHODS: For the last two decades, the Israel Defence Forces have mandated the routine reportage of every case of scabies infestation in soldiers to the Epidemiology Department of the Army Health Branch. This database was used in the present study to analyse the incidence of scabies by season. Scabies was defined according to the report by a military physician based on the typical clinical presentation, relevant epidemiological data and, in most cases, microscopic visualization of the mite. RESULTS: The person-time incidence of scabies was higher in winter than summer (P < 0.001). The overall risk ratio was 1.31 (95% confidence interval 1.28-1.33). Sensitivity analysis indicated that no single year was an important source of disease heterogeneity. CONCLUSIONS: Scabies in a young adult population is more frequent in the cooler months of the year.

Adolescent↗
PubMed1999

Epidemiology and control of scabies in an Egyptian village.

BACKGROUND: Some studies have addressed the epidemiology of scabies among rural populations in developing countries; however, the epidemiology of scabies among the rural population in Egypt is unknown. We sought to determine the magnitude of scabies infestation in an Egyptian village and to evaluate the control measures after 1 year. METHODS: This study was carried out on 3147 residents of Mit-Moaned village in Dakahlia govemorate, Egypt. It was a cross-sectional follow-up study where the same individuals examined in round I were re-examined in round III. The two rounds were separated by a period of 1 year, during which infested patients were followed up and new cases were discovered (round II). Patients and their household contacts received treatment with topical permethrin. Patients showing resistance to permethrin received a single oral dose of ivermectin. RESULTS: In round III, the overall prevalence rate of scabies was reduced from 5.4% in round I to 1.1%. The incidence of new cases among susceptible persons during round II was 1.1%. Scabies was significantly (P < 0.05) more prevalent among families of large size, high crowding index at night, low socioeconomic standards, and those receiving their water supply from a hand pump. Children younger than 10 years showed the highest prevalence. CONCLUSIONS: Our data provide the first complete picture of the epidemiology of scabies in rural Egypt. The epidemiologic characteristics of the disease should be considered in the design of disease control programs for other villages with scabies epidemics. Our findings revealed that good control was achieved with the following: increased awareness and better case finding, education of the staff at the rural health unit, improved hygiene measures, and massive treatment campaigns using effective drugs such as topical permethrin and oral ivermectin.

Adolescent↗
PubMed2003

Current treatments for scabies.

Scabies is a frequent interhuman ectoparasitic infection. Several treatments are available worldwide. There are local treatments: synthetic pyrethrins, benzyl benzoate, lindane, crotamiton. Recently a few studies were published concerning ivermectin, systemic antiparasitic agent use in onchocercosis treatment. We reviewed the literature with an evidence-based medicine method. We attempt to answer two questions in particular: what is the treatment of choice for common scabies in a patient otherwise in good health? What is the role of systemic ivermectin? We also report specific situations. Among local treatments, studies are heterogeneous according to products, countries, group of treated patients, with or without contact subjects, and the method of treatment application. There are very few high proof-level controlled studies. In France, a combination of benzyl benzoate 10% and sulfiram 2% is used most, according to professional consensus. The most studied product is the cream permethrin 5%, available in the USA and UK. Its efficacy seems slightly superior to lindane and less toxic. It is more efficient than crotamiton. There is no study comparing benzyl benzoate and permethrin. Concerning systemic ivermectin, five controlled studies showed its efficiency in common scabies. But its relative efficiency over local treatment has not been established. A few open studies showed its efficacy in institutional epidemic, profuse scabies and in HIV-positive patients. Local treatment of choice in common scabies remains to be determined among the four principal molecules. There is no study comparing permethrin or esdepallethrin to benzyl benzoate. In what cases should we prescribe crotamiton or lindane? Indication of ivermectin seems proved in common scabies and probably for HIV-positive patients. It remains to be determined if it should be prescribed in the first instance, be double or triple, be associated or not with local treatment. In case of keratotic scabies, ivermectin seems interesting with two applications within 1 week, and should be associated with local treatment (duration remains to be defined). Ivermectin is probably useful in institutional epidemic, and therapeutic attitude remains to be defined. Ivermectin seems to have little or no risk. Treatment must be adapted case-by-case, according to feasibility. It is still important to treat contacts, and modality of this treatment remains to be specified.

Administration, Oral↗
PubMed2005

Atopy patch test reactions to house dust mites in patients with scabies.

It is well known that the house dust and the scabies mites are related phylogenetically. We therefore performed atopy patch tests with house dust mite antigens (Dermatophagoides pteronyssinus (Dp) and/or Dermatophagoides farinae (Df)) in scabies patients without atopy and healthy controls. We studied 25 men with active scabies and 25 healthy controls. Skin prick tests with standardized house dust mite extract were performed for all patients and controls. An intradermal test procedure was carried out in skin prick test-negative patients, and for controls showing positive atopy patch test to Dp and/or Df. While atopy patch tests were performed directly in all healthy controls, patients with scabies were first treated and on the next day, atopy patch tests were performed. Twenty-two of 25 patients with scabies (88%) had skin prick test and/or intradermal test positivity against house dust mites, whereas 17/25 patients (68%) had atopy patch test positivity against house dust mites (Dp and/or Df). There was no statistically significant difference between skin prick test and/or intradermal test positivity and atopy patch test positivity in a regression analysis (p=0.222). The only statistically significant correlation was between atopy patch test positivity and the extent of scabies involvement (p<0.05). Only few of the healthy controls had positive tests. In this study, we have shown that a positive atopy patch test to house dust mite antigens is not specific for patients with atopic dermatitis, but also occurs in scabies patients without a history of atopic dermatitis.

Adult↗
PubMed1997

Success of a scabies control program in an Australian aboriginal community.

OBJECTIVE: To adapt, implement and evaluate a model of scabies control in an Australian Aboriginal community. METHODS: After initially examining the population, we offered all residents treatment with 5% permethrin cream. Visits were made during the ensuing 25 months to rescreen and to treat new-cases of scabies and contacts. RESULTS: The prevalence of scabies was reduced from 28.8% before the program to < 10% during the entire period (from 32.3% to < 10% in children) (P < 0.01 for each visit). The initial prevalence of pyoderma in children was 69.4%, which was reduced and maintained at approximately one-half that rate during the last 16 months (P < 0.004 for the last 4 visits). Residual pyoderma in children was significantly less severe and no longer scabies-related. CONCLUSIONS: This simplified model of scabies control had a substantial effect on scabies prevalence and on pyoderma prevalence and severity which was sustained for > 2 years. It could prove useful for other communities with high rates of scabies and pyoderma.

Administration, Topical↗
PubMed1980

In vitro demonstration of specific immunological hypersensitivity to scabies mite.

An extract prepared from 200 adult female scabies mites was used for prick and intracutaneous testing in twelve patients with previous scabies infestation, as well as in six healthy controls and three persons with skin sensitivity to Dermatophagoides pteronyssinus who had never had scabies before. Seven individuals who had had scabies less than a year prior to the testing had positive intracutaneous (immediate type) reactions, whereas all the five who had had scabies more than a year before had negative reactions. The prick tests were negative in all cases. No skin reactions could be evoked in the controls. The passive transfer, or Prausnitz-Küstner, test was positive with the scabies mite extract and serum from three of five patients tested on one healthy individual, and with both of two sera tested on a second healthy individual. These findings indicate that immediate type hypersensitivity reactions may occur with scabies infection.

Adolescent↗
PubMed1996

Crusted ("Norwegian") scabies in a specialist HIV unit: successful use of ivermectin and failure to prevent nosocomial transmission.

A nosocomial outbreak of scabies in a specialist inpatient HIV unit resulted from a patient admitted with crusted scabies. Treatment of his infestation with topical scabicides alone failed and he remained infectious for several weeks. His infestation was then eradicated with combined topical treatment and oral ivermectin. In total, 14 (88%) out of 19 ward staff became symptomatic, and 4 (21%) had evidence of scabies on potassium hydroxide examination of skin scrapings. The ward infection control policy was changed to distinguish patients with crusted scabies from those with ordinary scabies. A second patient with crusted scabies was treated with combined oral and topical therapy early in his admission and nursed with more stringent isolation procedures. No nosocomial transmission occurred and his infestation responded rapidly to treatment. Patients with crusted scabies require strict barrier nursing if nosocomial transmission is to be avoided. Ivermectin combined with topical scabicides may be a more efficacious treatment than topical scabicides alone in such patients.

Adult↗
PubMed2002

Diagnosis and treatment of scabies: a practical guide.

Scabies is a common, highly pruritic infestation of the skin caused by Sarcoptes scabiei var. Hominis. It is a very contagious parasitosis with specific lesions, such as burrows, and nonspecific lesions, such as papules, vesicles and excoriations. The typical areas of the body it affects are finger webs, wrists, axillary folds, abdomen, buttocks, inframammary folds and, in men, the genitalia. It is characterized by intense nocturnal pruritus. Scabies is spread through close personal contact (relatives, sexual partners, schoolchildren, chronically ill patients and crowded communities). Definitive diagnosis is made when the scabies mites or their eggs or fecal pellets can be identified on a light microscope. New techniques for diagnosis include the use of the epiluminiscence microscopy. The most common topical treatments for scabies include lindane and permethrin. Permethrin provides a greater margin of tolerability because of its low inherent toxicity and low percutaneous absorption. Oral ivermectin is the most recently developed treatment for scabies. A single oral dose of ivermectin 200 microg/kg of bodyweight is a well-tolerated and very effective treatment. It is especially indicated in crusted scabies, scabies in immunocompromised hosts and infestations in crowded communities. It is also useful as a simple treatment in the prophylaxis of close contacts.

Animals↗
PubMed2006

Simple method of detecting sarcoptes scabiei var hominis mites among bedridden elderly patients suffering from severe scabies infestation using an adhesive-tape.

OBJECT: Scabies infestation is very common among bedridden elderly patients. The standard method of diagnosis for scabies by scraping the skin requires some skill. Therefore, dermatologists employ this method. However, dermatologists are usually not present in most long-term nursing units. Thus, we tried to catch mites using a strong transparent adhesive tape commercially available for packing use as an alternative method for the diagnosis of severe scabies infestation. METHODS: After firmly applying the adhesive side of the tape onto an appropriate skin lesion of patients, the tape was pulled off and transferred directly onto a slide for microscopy, affixing the adhered separated part of the corneal skin. PATIENTS: When a massive outbreak of scabies infestation occurred in May 2004 at the nursing unit of K hospital with thirty-one bedridden elderly patients, we tried to detect scabies mite using an adhesive tape. RESULTS: We could detect mites from six patients using this tape method. The diagnosis was confirmed by the standard scraping method. By the tape method we could observe some mites moving around and also could see a striated structure with dark red or weak red color or gray color granule-like constitution on the body of some mites. We found mites only on the skin of the fingers and toes where the skin of a patient is thin. Recently, massive scabies infestation in elderly long-term residents has been reported elsewhere. This tape method is simple and useful for diagnosis of severe scabies infestation in long-term nursing units.

Adhesives↗
PubMed1995

Resistance and immune response in scabies-infested hosts immunized with Dermatophagoides mites.

Seventy-one percent of rabbits immunized with a mixed (50:50) Dermatophagoides farinae and D. pteronyssinus house dust mite extract were resistant to infestation by Sarcoptes scabiei var. canis. The resistance was evidenced by a marked reduction in parasite load. All immunized hosts developed similar immunogen-specific antibody titers that were independent of the levels of scabies infestation that developed when the hosts were infested with scabies. Resistant hosts exhibited significantly lower scabies-specific immunoglobulin titers and produced antibody to fewer scabies antigens than did nonresistant hosts. All infested hosts (resistant and nonresistant) showed a cellular infiltrate in the scabietic lesions that was composed of neutrophils, plasma cells, macrophages, and mononuclear cells. Resistant hosts were characterized by fewer plasma cells in the infiltrate than were observed for non-resistant hosts. Resistant hosts exhibited a gradual increase in the number of infiltrating neutrophils, followed by a decrease that correlated with a decrease in the mite burden. Nonresistant hosts exhibited an early rapid increase, a decrease, and then a gradual increase in the concentration of neutrophils as the mite load increased. These results clearly showed that D. farinae/D. pteronyssinus antigens/epitopes can sensitize the hosts to scabies mites and induce protective immunity. The lower circulating antibody levels and generally stronger inflammatory cell-mediated response of resistant hosts compared with nonresistant hosts suggested that the mechanism by which immunization with Dermatophagoides mites induces immunity to scabies mites involved a down-regulated T helper cell type 2 (Th2) response with reduced antibody production but an up-regulated and stronger Th1 (inflammatory cell-mediated) response to scabies.

Animals↗
PubMed1999

Genetically distinct dog-derived and human-derived Sarcoptes scabiei in scabies-endemic communities in northern Australia.

Overcrowding is a significant factor contributing to endemic infection with Sarcoptes scabiei in human and animal populations. However, since scabies mites from different host species are indistinguishable morphologically, it is unclear whether people can be infected from scabies-infested animals. Molecular fingerprinting was done using three S. scabiei-specific single locus hypervariable microsatellite markers, with a combined total of 70 known alleles. Multilocus analysis of 712 scabies mites from human and dog hosts in Ohio, Panama and Aboriginal communities in northern Australia now shows that genotypes of dog-derived and human-derived scabies cluster by host species rather than by geographic location. Because of the apparent genetic separation between human scabies and dog scabies, control programs for human scabies in endemic areas do not require resources directed against zoonotic infection from dogs.

Alleles↗