Scabies: Immunopathogenesis and pathological changes.

Scabies is an itchy skin disease caused by the burrowing mite Sarcoptes scabiei. During their lifespan, the female mites invade the stratum corneum and create tunnels, in which they reside, move, feed, deposit fecal pellets, and lay eggs. Recently, scabies was included in the World Health Organization roadmap for neglected tropical diseases 2021-2030. This review attempts to summarize our knowledge about the mite's biology and the disease pathogenesis, pathological changes, and complications. Generally, the host-parasite interaction in scabies is highly complex and involves different mechanisms, some of which are yet largely unknown. Elucidation of the nature of such interaction as well as the underlying mechanisms could allow a better understanding of the mite's biology and the development of novel diagnostic and therapeutic options for scabies control programs. Moreover, identification of the molecular basis of such interaction could unveil novel targets for acaricidal agents and vaccines.

Crusted scabies in a rabbit model: a severe skin disease or more?

BACKGROUND: Around 200-300 million people are estimated to be affected by scabies annually worldwide. However, the mechanisms by which this disease may affect the general condition of the host are not entirely clear. The aim of the present study was to evaluate the systemic changes that may accompany crusted scabies in both treated and non-treated experimental animals. METHODS: Male New Zealand rabbits were infected with Sarcoptes scabiei var. cuniculi and divided into the following three groups: control, ivermectin-treated, and fluralaner-treated. Several methods were used to evaluate the systemic changes, including histopathological examination of the liver, kidney, heart, and spleen, as well as the measurement of serum biochemical parameters and immunological parameters. RESULTS: Several definite structural and functional changes at the systemic level were revealed, as evidenced by the observed histopathological changes in the tissue sections of internal organs and the highly significant increases in markers of systemic inflammation, serum procalcitonin, and oxidative stress markers. Abnormalities in the liver and renal function results, as well as in the serum lipid profile, were also noted. Additionally, a disorganized immune response was noted, evidenced by a mixed type 1 and type 2 helper T cell response. Although there was notable clinical and parasitological cure in the ivermectin-treated group, the histopathological, biochemical, and immunological markers indicated incomplete resolution. In contrast, the fluralaner-treated group exhibited a nearly complete resolution of changes in these parameters. CONCLUSIONS: We conclude that crusted scabies is a systemic syndrome that can affect several organs besides the skin. Inflammation, oxidative stress, and possibly bacterial infections, are all implicated as underlying mechanisms of tissue damage due to the disease. We recommend that fluralaner, a promising scabicidal agent, should be studied for possible human use, and especially for control programs.

Evaluation of the scabicidal effect of a single dose of fluralaner in a rabbit model of crusted scabies.

Recently, scabies was included in the WHO roadmap for neglected tropical diseases 2021-2030. Till now, ivermectin is the only available oral drug that is currently approved for treating crusted scabies in humans. Concerns regarding its efficacy and safety have prompted research efforts to find new alternatives. Our study aimed to evaluate the therapeutic effect of a single dose of fluralaner in cases of crusted scabies in comparison with that of repeated weekly high doses of ivermectin. For the in vitro study, twenty adult female mites were exposed to 50 µg/ml and 100 µg/ml ivermectin and fluralaner to evaluate their effects on mites' survival. For the in vivo study, thirty-five male crossbreed rabbits were divided into 4 groups: group I (non-infected, non-treated), group II (infected, non-treated), group III (infected and treated with ivermectin in a weekly oral dose of 0.4 mg/kg body weight/rabbit for 4 weeks, starting 8 weeks post-infection), and group IV (infected and treated with fluralaner given as a single oral dose of 25 mg/kg body weight/rabbit, starting 8 weeks post-infection). Clinical, parasitological, histopathological, and biochemical assessments were done. Clinical and parasitological assays were accomplished to all infected groups starting from day 0, then on days 2, 4, 6, 8, 10, 12, 14, 21, 28, 35, 42, 49 and 56 post-treatment, while histopathological and biochemical assessments were done at the end of the 8th week post-treatment (day 56). Our results showed that fluralaner exhibited a higher acaricidal effect on adult Sarcoptes scabiei var. cuniculi when compared with ivermectin applied in the same concentration (50 µg/ml or 100 µg/ml). Concerning the in vivo study, both clinical cure and parasitological cure were noted in both treated groups, evidenced by complete absence of all clinical signs of infestation and absence of mites in all skin scrapings. However, the ivermectin-treated group showed incomplete histopathological and biochemical resolution. Interestingly, both clinical cure and negative skin scrapings were noticed earlier in the fluralaner-treated group, with no apparent side effects. Also, no significant differences were noticed in the skin sections and serum biochemical parameters when compared with those of the negative control group. We concluded that fluralaner is a promising scabicidal agent that is recommended to be studied for possible human use, especially in control programs.

Mass kills in hatchery-reared European seabass (Dicentrarchus labrax) triggered by concomitant infections of Amyloodinium ocellatum and Vibrio alginolyticus.

Amyloodiniosis and vibriosis are serious diseases in European seabass (Dicentrarchus labrax) hatcheries with noticeable high mortality. This study was conducted on tank-cultured D. labrax frys at a private marine hatchery near Mariout Lake (Alexandria, Egypt). Frys showed a high mortality rate (70%), lethargy, darkening, asphyxia, ascites, and velvety skin appearance. Both infectious agents were presumptively identified in all investigated frys. The identities of the two recovered agents were confirmed by molecular assay and phylogenetic analysis. On the tissue level, histopathological examination of skin, splenic, and renal tissue indicated severe alterations due to the direct impacts of both infections. On the cellular level, scanning electron micrographs showed both protozoal and bacterial pathogens on/in gill epithelial cells in solitary and colonial forms. Vibrio alginolyticus showed variable results for tested antibiotics, with a higher sensitivity to florfenicol. A successful control strategy was strictly adopted to overcome infections and stop mortalities. Copper sulphate and hydrogen peroxide were efficiently applied to tank water to overcome A. ocellatum infections. Further, florfenicol was effectively used to overcome systemic V. alginolyticus infections. The efficacy of treatments was confirmed by the absence of infectious agents in randomly collected fish samples. To the best of the authors' knowledge, this study is one of the earliest Egyptian studies that dealt with the dilemma of mass kills associated with external parasitic/systemic bacterial infections among hatchery-reared European seabass.

The scabicide effect of moxidectin in vitro and in experimental animals: Parasitological, histopathological and immunological evaluation.

Scabies is considered one of the commonest dermatological diseases that has a global health burden. Current treatment with ivermectin (IVM) is insufficient and potential drug resistance was noticed. Moxidectin (MOX), with a better pharmacological profile may be a promising alternative. The efficacy of moxidectin against Sarcoptes scabiei was assessed both in vitro and in vivo in comparison with ivermectin. For the in vitro assay, both drugs were used in two concentrations (50 µg/ml and 100 µg/ml). For the in vivo assay, twenty rabbits infected with Sarcoptes scabiei were divided into three groups: untreated, moxidectin-treated and ivermectin-treated with the same dose of 0.3 mg/kg once. Another four rabbits were used as a normal control non-infected group. Treatment efficacy was evaluated by clinical assessment, parasitological evaluation and histopathological examination of skin samples using Hematoxylin and eosin and toluidine blue for mast cell staining. Immune response was also assessed by immunohistochemical staining of CD3 T cells in skin samples. Our results showed that moxidectin had a high efficacy (100%) in killing mites when used in both concentrations (50 µg/ml, 100 µg/ml) in the in vitro assay. Concerning the in vivo assay, on day 14 post-treatment, all MOX-treated rabbits were mite-free with full clinical cure by the end of the study (D21) showing (100%) reduction of mites count. Also, marked improvement in the epidermis with absence of mites in skin samples were shown. Poor clinical and parasitological improvements were noted in the ivermectin-treated rabbits, when given as a single dose with a percentage reduction (60.67%) in the 2nd week and progressive increase in lesions and mites count in the 3rd week post-treatment. Regarding the immune response, MOX-treated group showed mild infiltration with both mast cells and CD3 T cells in comparison to severe infiltration with both types of cells in the untreated and IVM-treated group. On conclusion, our results demonstrated that a single dose of MOX was more effective than IVM, supporting MOX as a valuable therapeutic approach for scabies therapy.

Oil Sands Derived Naphthenic Acids Are Oxidative Uncouplers and Impair Electron Transport in Isolated Mitochondria.

Naphthenic acids (NAs) are predominant compounds in oil sands influenced waters. These acids cause numerous acute and chronic effects in fishes. However, the mechanism of toxicity underlying these effects has not been fully elucidated. Due to their carboxylic acid moiety and the reported disruption of cellular bioenergetics by similar structures, we hypothesized that NAs would uncouple mitochondrial respiration with the resultant production of reactive oxygen species (ROS). Naphthenic acids were extracted and purified from 17-year-old oil sands tailings waters yielding an extract of 99% carboxylic acids with 90% fitting the classical O2-NA definition. Mitochondria were isolated from rainbow trout liver and exposed to different concentrations of NAs. Mitochondrial respiration, membrane potential, and ROS emission were measured using the Oroboros fluorespirometry system. Additionally, mitochondrial ROS emission and membrane potential were evaluated with real-time flow cytometry. Results showed NAs uncoupled oxidative phosphorylation, inhibited respiration, and increased ROS emission. The effective concentration (EC50) and inhibition concentration (IC50) values for the end points measured ranged from 21.0 to 157.8 mg/L, concentrations similar to tailings waters. For the same end points, EC10/IC10 values ranged from 11.8 to 66.7 mg/L, approaching concentrations found in the environment. These data unveil mechanisms underlying effects of NAs that may contribute to adverse effects on organisms in the environment.

H2O2 metabolism in liver and heart mitochondria: Low emitting-high scavenging and high emitting-low scavenging systems.

Although mitochondria are presumed to emit and consume reactive oxygen species (ROS), the quantitative interplay between the two processes in ROS regulation is not well understood. Here, we probed the role of mitochondrial bioenergetics in H2O2 metabolism using rainbow trout liver and heart mitochondria. Both liver and heart mitochondria emitted H2O2 at rates that depended on their metabolic state, with the emission rates (free radical leak) constituting 0.8-2.9% and 0.2-2.5% of the respiration rate in liver and heart mitochondria, respectively. When presented with exogenous H2O2, liver and heart mitochondria consumed it by first order reactions with half-lives (s) of 117 and 210, and rate constants of 5.96 and 3.37 (× 10-3 s-1), respectively. The mitochondrial bioenergetic status greatly affected the rate of H2O2 consumption in heart but not liver mitochondria. Moreover, the activities and contribution of H2O2 scavenging systems varied between liver and heart mitochondria. The significance of the scavenging systems ranked by the magnitude (%) of inhibition of H2O2 removal after correcting for emission were, liver (un-energized and energized): catalase > glutathione (GSH) ≥ thioredoxin reductase (TrxR); un-energized heart mitochondria: catalase > TrxR > GSH and energized heart mitochondria: GSH > TrxR > catalase. Notably, depletion of GSH evoked a massive surge in H2O2 emission that grossly masked the contribution of this pathway to H2O2 scavenging in heart mitochondria. Irrespective of the organ of their origin, mitochondria behaved as H2O2 regulators that emitted or consumed it depending on the ambient H2O2 concentration, mitochondrial bioenergetic state and activity of the scavenging enzyme systems. Indeed, manipulation of mitochondrial bioenergetics and H2O2 scavenging systems caused mitochondria to switch from being net consumers to net emitters of H2O2. Overall, our data suggest that the low levels of H2O2 typically present in cells would favor emission of this metabolite but the scavenging systems would prevent its accumulation.

Mitochondrial transition ROS spike (mTRS) results from coordinated activities of complex I and nicotinamide nucleotide transhydrogenase.

Mitochondria exhibit suppressed ATP production, membrane potential (∆Ψmt) polarization and reactive oxygen species (ROS) bursts during some cellular metabolic transitions. Although mitochondrial ROS release is influenced by ∆Ψmt and respiratory state, the relationship between these properties remains controversial primarily because they have not been measured simultaneously. We developed a multiparametric method for probing mitochondrial function that allowed precise characterization of the temporal relationship between ROS, ∆Ψmt and respiration. We uncovered a previously unknown spontaneous ROS spike - termed mitochondrial transition ROS spike (mTRS) - associated with re-polarization of ∆Ψmt that occurs at the transition between mitochondrial energy states. Pharmacological inhibition of complex CI (CI), nicotinamide nucleotide transhydrogenase (NNT) and antioxidant system significantly decreased the ability of mitochondria to exhibit mTRS. NADH levels followed a similar trend to that of ROS during the mTRS, providing a link between CI and NNT in mTRS regulation. We show that (i) mTRS is enhanced by simultaneous activation of CI and complex II (CII); (ii) CI is the principal origin of mTRS; (iii) NNT regulates mTRS via NADH- and ∆Ψmt-dependent mechanisms; (iv) mTRS is not a pH spike; and (v), mTRS changes in amplitude under stress conditions and its occurrence can be a signature of mitochondrial health. Collectively, we uncovered and characterized the biophysical properties and mechanisms of mTRS, and propose it as a potential diagnostic tool for CI-related dysfunctions, and as a biomarker of mitochondrial functional integrity.

Zinc and calcium alter the relationship between mitochondrial respiration, ROS and membrane potential in rainbow trout (Oncorhynchus mykiss) liver mitochondria.

At excess levels, zinc (Zn) disrupts mitochondrial functional integrity and induces oxidative stress in aquatic organisms. Although much is known about the modulation of Zn toxicity by calcium (Ca) in fish, their interactions at the mitochondrial level have scarcely been investigated. Here we assessed the individual and combined effects of Zn and Ca on the relationship between mitochondrial respiration, ROS and membrane potential (ΔΨmt) in rainbow trout liver mitochondria. We tested if cation uptake through the mitochondrial calcium uniporter (MCU) is a prerequisite for Zn- and/or Ca-induced alteration of mitochondrial function. Furthermore, using our recently developed real-time multi-parametric method, we investigated the changes in respiration, ΔΨmt, and reactive oxygen species (ROS, as hydrogen peroxide (H2O2)) release associated with Ca-induced mitochondrial depolarization imposed by transient and permanent openings of the mitochondrial permeability transition pore (mPTP). We found that independent of the MCU, Zn precipitated an immediate depolarization of the ΔΨmt that was associated with relatively slow enhancement of H2O2 release, inhibition of respiration and reversal of the positive correlation between ROS and ΔΨmt. In contrast, an equitoxic dose of Ca caused transient depolarization, and stimulation of both respiration and H2O2 release, effects that were completely abolished when the MCU was blocked. Contrary to our expectation that mitochondrial transition ROS Spike (mTRS) would be sensitive to both Zn and Ca, only Ca suppressed it. Moreover, Zn and Ca in combination immediately depolarized the ΔΨmt, and caused transient and sustained stimulation of respiration and H2O2 release, respectively. Lastly, we uncovered and characterized an mPTP-independent Ca-induced depolarization spike that was associated with exposure to moderately elevated levels of Ca. Importantly, we showed the stimulation of ROS release associated with highly elevated but not unrealistic Ca loads was not the cause but a result of mPTP opening in the high conductance mode.

Zinc and calcium modulate mitochondrial redox state and morphofunctional integrity.

Zinc and calcium have highly interwoven functions that are essential for cellular homeostasis. Here we first present a novel real-time flow cytometric technique to measure mitochondrial redox state and show it is modulated by zinc and calcium, individually and combined. We then assess the interactions of zinc and calcium on mitochondrial H2O2 production, membrane potential (ΔΨm), morphological status, oxidative phosphorylation (OXPHOS), complex I activity, and structural integrity. Whereas zinc at low doses and both cations at high doses individually and combined promoted H2O2 production, the two cations individually did not alter mitochondrial redox state. However, when combined at low and high doses the two cations synergistically suppressed and promoted, respectively, mitochondrial shift to a more oxidized state. Surprisingly, the antioxidants vitamin E and N-acetylcysteine showed pro-oxidant activity at low doses, whereas at high antioxidant doses NAC inhibited OXPHOS and dyscoupled mitochondria. Individually, zinc was more potent than calcium in inhibiting OXPHOS, whereas calcium more potently dissipated the ΔΨm and altered mitochondrial volume and ultrastructure. The two cations synergistically inhibited OXPHOS but antagonistically dissipated ΔΨm and altered mitochondrial volume and morphology. Overall, our study highlights the importance of zinc and calcium in mitochondrial redox regulation and functional integrity. Importantly, we uncovered previously unrecognized bidirectional interactions of zinc and calcium that reveal distinctive foci for modulating mitochondrial function in normal and disease states because they are potentially protective or damaging depending on conditions.

Intracardiac shunt with hypoxemia caused by right ventricular dysfunction following pericardiocentesis.

Significant hypoxemia can result from right-to-left intracardiac shunting through a patent foramen ovale, an atrial septal defect or a ventricular septal defect. Pulmonary embolus, congenital heart disease and pericardial tamponade are well-recognized causes of right-to-left shunting. However, right-to-left shunting can also follow pericardiocentesis. A case of profound hypoxemia caused by right ventricular hypokinesis precipitated by pericardial tap is reported. This under-recognized entity can be responsible for significant morbidity in the critical care setting. The clinical presentation, natural history, diagnosis and treatment of hypoxemia caused by intracardiac shunt following pericardiocentesis are discussed.

Abiotrophia endocarditis: case report and review of the literature.

Abiotrophia is a separate genus of gram-positive cocci formerly classified as nutritionally variant streptococci. These organisms cause 1% to 2% of all infective endocarditis. Unlike Enterococcus or viridans group streptococci, these organisms do not usually grow on conventional blood agar plates. Therefore, Abiotrophia endocarditis is often falsely lumped into the category of culture-negative endocarditis. Adequate diagnosis and treatment of this entity requires a high index of suspicion for the organisms, even if cultures are negative. Nutritional supplementation of the growth media and/or newer 16S ribosomal RNA gene sequencing may be necessary to identify Abiotrophia as the causative organism. Specific antimicrobial therapy and continued surveillance are needed to prevent the significant morbidity and mortality associated with this infection.