[Crusted scabies: A review]. / La gale hyperkératosique.

Crusted scabies is a rare and severe form of infestation by Sarcoptes scabies var. hominis. It is characterized by profuse hyperkeratosis containing over 4000 mites per gram of skin, with treatment being long and difficult. The condition is both direct and indirectly contagious. It has a central role in epidemic cycles of scabies, the incidence of which is on the rise in economically stable countries. Recent discoveries concerning the biology of mites, the pathophysiology of hyperkeratosis and the key role of IL-17 in this severe form open up new therapeutic perspectives.

Intense nocturnal itching should raise suspicion of scabies.

Scabies is caused by infestation with a parasitic mite Sarcoptes scabiei var hominis. The itch and rash appear to be largely the result of a delayed (type IV) allergic reaction to the mite, its eggs and excreta. Scabies is spread by a mite transferring to the skin surface of an unaffected person, usually by skin to skin contact with an infested person, but occasionally via contaminated bed linen, clothes or towels. In crusted scabies, mites are also dispersed within shed scales, enabling the condition to be contracted from contaminated surfaces. Patients with classical scabies usually present with an itchy non-specific rash. Often, the history alone can be 0032-6518 virtually diagnostic. An intense itch, affecting all body regions except the head, typically worse at night, appearing to be out of proportion to the physical evidence, with a close contact also itching, should prompt serious consideration of scabies. The generalised hypersensitivity rash consists of erythematous macules and papules with excoriation. Close inspection will reveal burrows usually up to 1 cm in length. The pathognomic sign of scabies is the presence of burrows. The crusted variant of scabies may not be itchy. It is characterised by areas of dry, scaly, hyperkeratotic and crusted skin, particularly on the extremities. Referral to secondary care should be considered in the following cases: diagnostic doubt; patient under two months of age; lack of response to two ourses of different insecticides; crusted scabies; or history suggests a isk of sexually transmitted infection. Outbreaks of scabies in institutions should be referred to the local health protection services.

Bullous Scabies: Clinical, Dermoscopic, and Pathologic Characteristics of Ten Patients.

Bullous scabies (BS) is a rare atypical clinical variant of scabies and is easily confused with bullous disorders. The diagnosis of BS is always a challenge, and physicians often misdiagnose BS patients. Patients with BS admitted from 2012 to 2020 were enrolled in this study. The clinical, dermoscopic, and pathological characteristics of the patients were analyzed retrospectively. Ten patients with BS were enrolled in this study. Seven of the 10 patients were male. The bullae were most commonly found on the thighs and arms (80% of patients). Only 30% of patients (3/10) tested positive for mites and/or eggs by the initial skin scraping, but 100% (5/5) of the patients who received dermoscopy tested positive. Among these 10 patients, only five received a skin biopsy. Subepidermal (4/5) and intraepidermal (1/5) bullae with eosinophil and neutrophil infiltration were observed in five patients. Direct immunofluorescence (DIF) indicated linear deposition of IgG in the basement membrane zone in three patients. Physicians should consider the possibility of BS in patients with blisters, pruritus, and poor response to corticosteroids. Dermoscopy should be prioritized for the differential diagnosis of BS to exclude other bullous disorders. Finally, a biopsy should be performed on each patient with bullae.

Evaluation of organ function and oxidant/antioxidant status in goats with sarcoptic mange.

The objective of the present study was to investigate the hemato-biochemical changes and status of oxidative stress in goats with scabies infection. The study was conducted on 12 Jamunapari goats; six clinically infected with scabies (group I) and six healthy goats as control (group II). The examination of skin scraping revealed the presence of Sarcoptes scabiei in the infected group. In hemato-biochemical indicators, hemoglobin%, packed cell volume, total erythrocyte count, albumin and albumin: globulin ratio decreased whereas, globulin, alanine aminotransferase, bilirubin, creatinine, and blood urea nitrogen increased significantly (p<0.05) in group I animals as compared to group II healthy goats. Among the oxidative stress indices, plasma nitrate and erythrocytic lipid peroxidation were increased and reduced glutathione levels decreased significantly (p<0.05) in group I goats as compared to group II healthy goats. The results of the present study suggest that scabies infection alters the hemato-biochemical indicators, increases oxidative stress and decreases antioxidant status in goat.

Scabies: Refine your exam, avoid these diagnostic pitfalls.

Nearly half of all infections are missed when first examined. Attentiveness to specific details, particularly in 3 common scenarios, can help ensure an accurate Dx.

Scabies.

Scabies is a neglected parasitic disease that is a major public health problem in many resource-poor regions. It causes substantial morbidity from secondary infections and post-infective complications such as acute post-streptococcal glomerulonephritis. Disease control requires treatment of the affected individual and all people they have been in contact with, but is often hampered by inappropriate or delayed diagnosis, poor treatment compliance, and improper use of topical compounds such as permethrin, lindane, or benzyl benzoate. In addition to concerns over toxicity with such compounds, parasite resistance seems to be increasing. Oral ivermectin is an alternative that has been used successfully in community control programmes. Plant derivatives such as turmeric, neem, and tea tree oil are also promising future treatments. The disease is strongly associated with poverty and overcrowding, and the associated stigma can ostracise affected individuals. Treatment of scabies in poor countries needs to integrate drug treatment programmes with efforts to improve the socioeconomic conditions and education programmes to reduce stigma. We expect the future to bring more sensitive and specific clinical and laboratory-based diagnostic methods, as well as new therapeutic strategies.

Scabies: a ubiquitous neglected skin disease.

Scabies has been a scourge among human beings for thousands of years. Its worldwide occurrence with epidemics during war, famine, and overcrowding is responsible for an estimated 300 million people currently infested. Scabies refers to the various skin lesions produced by female mites, and their eggs and scybala that are deposited in the epidermis, leading to delayed-type hypersensitivity reaction. Recent immunological findings such as cross-reactivity with house dust mite allergens and an altered T-helper-1/T-helper-2 pattern contribute to a better understanding of the pathomechanism. Furthermore, progress in molecular biology and cloning of relevant antigens could enable the development of a diagnostic ELISA system and candidate vaccines in the near future. Typical and atypical clinical presentations with pruritus as a hallmark of scabies occur in young, pregnant, immunocompromised, and elderly patients and include bullous and crusted (Norwegian) manifestations as well as those masked by steroid use (scabies incognito). This article reviews scabies management strategies in developed countries and resource-poor communities as well as typical complications, including the emergence of resistance and drug-related adverse events. Other problems such as post-scabies eczema and reinfestation, and newer treatments such as ivermectin are also discussed.

Outbreak: 10 tips to make scabies scamper.

PROBLEM: Most nursing homes are aware of the pandemonium an outbreak of scabies can cause-the laundry alone occupies staff for days. Debilitated residents and those who have poor selfcare skills require considerable help with the activities associated with the eradication of Sarcoptes scabiei. How can a consultant pharmacist help? SOLUTION: Consultant pharmacists should cultivate a "high index of suspicion" for scabies. Scabies mites live their entire lives on the human host as obligate parasites. They are able to survive elsewhere for only up to 48 hours, making transmission via fomite (blankets, towels, or any object that can transmit infectious agents) possible, but unlikely. Transmission follows close personal contact, and passing contact like handshaking is insufficient to pass the mites. Crowded living conditions, such as those associated with emergency shelters, and close and repeated contact, like that which occurs in classrooms, fuel cluster outbreaks.

Sarcoptes scabiei: The Mange Mite with Mighty Effects on the Common Wombat (Vombatus ursinus).

Parasitism has both direct and indirect effects on hosts. Indirect effects (such as behavioural changes) may be common, although are often poorly described. This study examined sarcoptic mange (caused by the mite Sarcoptes scabiei) in the common wombat (Vombatus ursinus), a species that shows severe symptoms of infection and often causes mortality. Wombats showed alterations to above ground behaviours associated with mange. Infected wombats were shown to be active outside of the burrow for longer than healthy individuals. Additionally, they spent more time scratching and drinking, and less time walking as a proportion of time spent above ground when compared with healthy individuals. They did not spend a higher proportion of time feeding, but did have a slower feeding rate and were in poorer body condition. Thermal images showed that wombats with mange lost considerably more heat to the environment due to a diminished insulation layer. Infection status did not have an effect on burrow emergence time, although this was strongly dependent on maximum daily temperature. This study, through the most detailed behavioural observations of wombats to date, contributes to a broader understanding of how mange affects wombat health and abundance, and also to our understanding of the evolution of host responses to this parasite. Despite being globally dispersed and impacting over 100 species with diverse intrinsic host traits, the effects of mange on hosts are relatively poorly understood, and it is possible that similar effects of this disease are conserved in other host species. The indirect effects that we observed may extend to other pathogen types.

Sarna costrosa: revisión sobre aspectos clínicos de una ectoparasitosis desatendida y de presentación infrecuente / Crusty scabies: review of the clinical aspects of a neglected and infrequent ectoparasitosis

En esta revisión de la literatura se describen aspectos epidemiológicos, fisiopatológicos, clínicos y terapéuticos sobre una presentación atípica y grave de escabiosis, la sarna costrosa o noruega. Esta presentación de escabiosis destaca por afectar principalmente a personas con condiciones de inmunodepresión o sociales que las hacen susceptibles de una alta carga parasitaria, además se asocia a un peor pronóstico y a riesgo de complicaciones. Desde el punto de vista terapéutico, sus estrategias difieren del manejo de la escabiosis clásica.(AU)

This literature review describes epidemiological, pathophysiological, clinical and therapeutic aspects of an atypical and severe presentation of scabies, Norwegian or crusty scabies. This presentation of scabies stands out because it mainly affects people with immunosuppressive or social conditions that make them susceptibleto a high parasite load, it is also associated with a worse prognosis and risk of complications. From a therapeutic point of view, their strategies differ from the management of classic scabies.(AU)

Skin infections and ageing.

Elderly individuals have an increased susceptibility to skin infections due to age-related anatomical, physiological and environmental factors. The types of organisms that cause primary skin and soft tissue infections are diverse, and include bacterial, viral and fungal pathogens as well as parasites. In the elderly, these infections and infestations may present with atypical signs and symptoms or may complicate underlying chronic skin disorders. Clinical features, investigations and management of the following important and common skin infections are described in more detail: cellulitis, erysipelas, necrotizing fasciitis, impetigo, folliculitis, furunculosis and carbunculosis, erythrasma, herpes zoster and postherpetic neuralgia, herpes simplex, warts, molluscum contagiosum, dermatophytosis of the skin, hair and nails, candidiasis, and scabies. Treatment should be based on the results of the appropriate diagnostic tests. Correct diagnosis and therapy of skin infections lead to satisfactory outcome in the majority of elderly patients.

Experimental infection of red foxes (Vulpes vulpes) with Sarcoptes scabiei var. vulpes.

Two of 3 red foxes became experimentally infected with Sarcoptes scabiei v. vulpes isolated from a naturally infected wild fox. The first clinical sign was seen after 10 days. After 30 days hairless patches were observed on the back of one of the foxes while general hair loss continued slowly. On the other fox the only macroscopical changes was tangling of the hair. The foxes died after 67 and 94 days, respectively. Both foxes were anaemic and in very poor condition. Scratching was seen in only 1 of the foxes.

The effect of sarcoptic mange on growth performance, leukocytes and lymphocyte proliferative responses in pigs.

The effects of a single artificial infestation with sarcoptic mite (Sarcoptes scabiei var. suis DeGeer) on weight gain and lymphocyte blastogenic responses were studied in untreated and fenvalerate-treated pigs. Average daily feed intake, average daily gain and feed efficiency were monitored for 5 weeks in 32 infested and 16 uninfested pigs. Total and differential leukocyte counts were determined and lymphocyte proliferative responses, using a mitogen-stimulated lymphocyte blastogenesis assay, were evaluated in 24 pigs. Sarcoptic mite infestation or treatment for sarcoptic mange did not affect total or differential leukocyte counts (P greater than 0.10). Differences were not observed in weight gain or lymphocyte blastogenic responses between infested and uninfested pigs.

Effects of sarcoptic mange on the reproductive performance of ewes and transmission of Sarcoptes scabiei to newborn lambs.

In each of two experiments, the reproductive performance of ewes naturally infested with sarcoptic mange and of uninfested ewes was assessed in in-season natural breeding conditions (experiment I) or in out-of-season controlled breeding conditions (experiment II). A statistically significant difference was observed in the total lambs born per ewe (infested ewes, 1.2; controls, 1.6), in the liveborn lambs per ewe (infested ewes, 1.2; controls, 1.5) and in the lamb body weight per ewe (infested ewes, 3.33kg; controls, 4.53kg) under natural breeding conditions, as well as in the lamb body weight per ewe (infested ewes, 3.37kg; controls, 4.14kg) among ewes under controlled breeding conditions. No adverse effects were observed in the other reproductive indices, cycling rate, mating rate, return-to-oestrus rate, abortion rate, lambing rate and stillbirth rate. Sarcoptic mange was observed in the offspring of infested ewes after 30 days and in the offspring of uninfested controls 60 days after their birth.

Effects of psoroptes ovis infection and its control with an ivermectin controlled-release capsule on growing sheep. 1. Evaluation of weight gain, feed consumption and carcass value.

To evaluate the prophylactic and therapeutic effects of an ivermectin controlled-release capsule (IVM-CRC) on the productivity of growing sheep infested with Psoroptes ovis 24 male and 24 female Merino landrace lambs, 5-6 months old and weighing 21.2-35.0 kg, were used. Sixteen replicates of three animals were formed based on sex and Day 0 body weight. Within each replicate animals were randomly allocated to one of three groups: untreated control; IVM-CRC on Day 0; IVM-CRC on Day 84. For treatment an IVM-CRC for sheep weighing 20-45 kg was used which is designed to deliver ivermectin at a minimum dose of 20 microg/kg per day for 100 days. The lambs were infested with 50-60 P. ovis mites each on Days 14 and 21. Mites in skin scrapings were counted on Days 70, 84, 98, 112 and 126. Body weight and feed consumption were measured every 2 weeks from Day 0 to 126. The animals were slaughtered on Day 127 and their carcasses evaluated. The IVM-CRC treatment on Day 0 prevented the establishment of P. ovis. All untreated lambs became infested. The lambs treated with an IVM-CRC on Day 84 became mite-free from Day 112 onwards. The lambs treated on Day 0 had significantly (p<0.05) greater body weight gain from Day 0 to 84 (13.9 kg) and Day 0 to 126 (20.9 kg) than the untreated controls (9.6 and 12.8 kg, respectively) and the sheep treated on Day 84 (8.4 and 14.9 kg, respectively). Feed consumption (Days 0-126) for sheep treated with the IVM-CRC on Day 0 was higher than for sheep treated on Day 84 (p<0.05) and for the untreated controls (p<0.1). The carcasses of sheep treated with the IVM-CRC on Day 0 had significantly (p<0.05) higher warm and cold weights, carcass yield, rib eye area and back fat thickness than the untreated control group and the sheep treated with the IVM-CRC on Day 84. The sheep treated with the ivermectin CRC on either Day 0 or 84 had significantly (p<0.05) better muscle scores and lower muscle pH 1h post-slaughter than the untreated controls. There was no significant (p>0.1) difference between warm and cold carcass weights, carcass yield and rib eye area between sheep treated on Day 84 and untreated controls.

The development of protective immunity in canine scabies.

Seven of eight dogs that had been previously infested with Sarcoptes scabiei var. canis and then cured, expressed protective immunity when experimentally reinfested with scabies. All seven dogs that expressed resistance were spontaneously cleared of scabies by 64 days after they were experimentally reinfested. Five of the eight dogs were free of scabies by 24 days. The sequential changes in the inflammatory/immune cellular infiltrate in the scabietic lesions of each dog were determined during the sensitizing infestation, cure and the subsequent experimental reinfestation (challenge). During the initial infestation and in the subsequent challenge reinfestation, dogs developed mixed cellular infiltrates in their scabietic lesions that contained mononuclear cells, neutrophils, plasma cells and mast cells. Reinfestation induced more rapid increases in the densities of these cells than had occurred during the sensitizing infestation. Mononuclear and mast cells were the most numerous infiltrating cells during the sensitizing phase. During the challenge phase the most numerous infiltrating cells were mononuclear cells and neutrophils. The sensitizing and challenge infestations induced circulating scabies-specific antibody responses, but the response was more rapid during the reinfestation challenge. Both the cell-mediated response in the skin and the circulating antibody response waned in parallel with clearing of the mites following reinfestation.

Productivity effects of bovine mange and control with ivermectin.

A randomised block design study was conducted to evaluate the effects of mange on cattle. Twenty-four Simmentaler Fleckvieh bulls were formed into eight replicates of three bulls based on Day -56 body weight (288-414 kg). Within replicates bulls were randomly allocated to groups G1: uninfested control, G2: infested control or G3: infested, treated with 0.2mg ivermectin/kg (1% ivermectin injection; IVOMEC, Merial) on Day 0. The G2 and G3 bulls were infested with Sarcoptes/Chorioptes mites on Days -56 and -49. Feed consumption was recorded daily throughout the study (Days -56 to 56). Body weights were measured and serum samples collected. Mites were counted at bi-weekly intervals from Day -14 on. The carcasses of the bulls and the leather produced from their hides were evaluated. Differences between variables were declared significant if P