Background Document for Scabies Final Project

Lily Kim

HUMBIO 153

Dr. D. Scott Smith

March 9, 2012

Background Document for Scabies Final Project

- Source: "Scabies." PubMed Health. 4 Oct. 2010. Web. <

The caveat to the direct transmission is that the disease can be transmitted between people who sleep in same bed (From the personal interaction with Dr. To Shwayder, Director Pediatric Dermatology, Henry Ford Hospital)

-Source: Currie, Bart J., and James S. McCarthy. "Permethrin and Ivermectin for Scabies." The New England Journal of Medicine 362 (2010). Print.

Scabies life cycle begins with mating. The male and female adult mites burrow under the epidermis of the human host and once they mate, the female adult lays eggs (2-3 per day). The egg hatches, releasing larvae (2-3 days). The larvae go through lymph stages and ultimately mature into adults (10-17 days). The cycle then repeats.

When the scabies burrow into the skin, skin lesions result. Because people can be hypersensitive against the excretions of mites, leading to a more serious, widespread inflammatory responses in skin.

-Source: Andersen, B. "Outbreak of Scabies in Norwegian Nursing Homes and Home Care Patients: Control and Prevention." Journal of Hospital Infection 45.2 (2000): 160-64. Print.

Diagnosis

-Source: Goldstein, Adam O., and Beth G. Goldstein. "Scabies."UpToDate. Web. 08 Mar. 2012. <

-Source: Dr. Tor Shwayder, Director Pediatric Dermatology, Henry Ford Hospital

Because itching might not start one month after infection, asking whether people itch or not does not always help for diagnosis. This is possibly because there have to be a lot of scabies in order to cause immune response in humans.

-Source: Hay R, Steer AC, Engelman D, Walton S. Scabies in the developing world. Clin Microbiol Infect 2012; 18 (in press).

Secondary bacterial infection can be caused by groupA streptococci and/orStaphylococcus aureus. This can lead to nephritis, rheumatic fever, and sepsis.

- Source: Towersey, Loan. "Dermoscopy of Norwegian Scabies in a Patient with Acquired Immunodeficiency Syndrome." An. Bras. Dermatol. 85.2 (2010). Print.

History

- Source: Roncalli, R.a. "The History of Scabies in Veterinary and Human Medicine from Biblical to Modern times."Veterinary Parasitology25.2 (1987): 193-98. Print.

- Source: GREEN, MANFRED S. "EPIDEMIOLOGY OF SCABIES." Epidemiologic Reviews 11 (1989). Print.

Historically, scabies posed as a major threat during military campaigns such as during the Napoleonic Wars when the disease was named as “seven year itch.” It is now an obsolete term.

Cropley, T. "The “army Itch:” A Dermatological Mystery of the American Civil War." Journal of the American Academy of Dermatology 55.2 (2006): 302-08. Print.

During the American Civil War, the Northern soldiers coined the term “camp itch” to refer to the debilitating itchiness caused by scabies. The itchiness was one of the difficulties that the soldiers faced during the war, which is argued to have decreased morale of the army as well. After the war, the so-called army itch problem went away rapidly thanks to the use of scabicides and public sanitation.

- Source: Board, A.D.A.M. Editorial. "Causes, Incidence, and Risk Factors."Scabies. U.S. National Library of Medicine, 18 Nov. 0000. Web. <

- Source:

1. Clin Microbiol Rev. 2007 Apr;20(2):268-79.

Problems in diagnosing scabies, a global disease in human and animal populations.

Walton SF, Currie BJ.

2. "Scabies Management."Canadian Paediatric Society: Promoting Child Health & Safety. Web. <

3. Alexander JO’D. Arthropods and Human Skin. Springer-Verlag, Berlin, Germany 227-292; 1984.

Here, poverty and overcrowding are identified as the two main factors responsible for the spread of the disease.

-Source: Tor Shwayder MD, FAAP, FAAD, Director Pediatric Dermatology, Henry Ford Hospital

Dr. Shwayder says that poverty increases incidence and that in some areas, the entire population is infected.

-Source: Akello, Grace. "Wartime Children’s Suffering and Quests for Therapy in Northern Uganda." African Studies Centre African Studies Collection 25 (2010). Print.

The military conflict began in 1986. The study was conducted between 2004-2005. In 2004, northern Uganda has been a conflict zone for about 20 years. According to the World Food Programme in 2003, it was estimated that around 800,000 people were internally displaced to avoid the armed conflict in Gulu, Kitgum, and Pader in northen Uganda. The majority of them were women and children.Children in this study slept at night commuters’ shelters and some attended displaced primary schools.

-Source: Akello, Grace. "Wartime Children’s Suffering and Quests for Therapy in Northern Uganda." African Studies Centre African Studies Collection 25 (2010). Print.

Medecins Sans Frontiers implemented a cure-based approach in which the health workers guided the patients to take a bath with the medicated soap, which was provided to them. After that, the patients were smeared with Benzyl Benzoate ointment. This method proved to be extremely effective in decreasing prevalence of scabies among children. But the method also has limitations because it is based on a one-time only cure and does not address the root cause or other more upstream, environmental factors of the epidemic.

-Source: Tor Shwayder MD, FAAP, FAAD, Director Pediatric Dermatology, Henry Ford Hospital

According to Dr. Shwayder, lesions can also appear in faces unlike what the old literature says.

-Source: Tor Shwayder MD, FAAP, FAAD, Director Pediatric Dermatology, Henry Ford Hospital

It is not always easy to possible to spot burrows, but they do increase the likelihood of a person having the disease. Instead of the diagnosis based on clinical presentation, a physician can use diagnostic tests such as skin scraping, dermoscopy, and the adhesive tape test to obtain more accurate results. but negative results do not exclude scabies. Thus, a therapeutic trial with an anti-scabietic medication may be helpful in difficult cases.

-Source: Tor Shwayder MD, FAAP, FAAD, Director Pediatric Dermatology, Henry Ford Hospital

-Source: "Evaluation of the Commonest Site, Demographic Profile and Most Effective Therapy in Scabies Das S, Chatterjee T, Banerji G, Biswas I - Indian J Dermatol." Indian Journal of Dermatology: Free Full Text Articles from Indian J Dermatol. Web. 2006. <

In this study, 200 Indian scabies patients were divided into four groups, and each group received a different type of treatment. Pregnant women and children less than 2 years old were not allowed to participate in the study. Each person was randomly assigned to one of the four groups. Each group consisted of 50 people. People assigned to Group 1 was treated with GBHC for 2 consecutive overnight along with all of their family members. For Groups 2 participants, 5% permethrin was used for treatment, again along with all of their family members. Group 3 received one dose of oral ivermectin 200mg/kg body weight and then another dose after two weeks later. White soft paraffin was used to treat Group 4. Group 3 showed the best result—after 4 weeks, the group saw 96% clinical improvement and 100% reduced itching. The second best result came from Group 2 which received permethrin 5%. The treatment led to 90% itching reduction and clinical improvement. However, children less than 2 months old and pregnant or nursing women cannot take the oral ivermectin and should take 6-10% precipitated sulfur for the best result. For these people, ivermectin can cause mild burning, stinging, and recurrence of pruritus.

Points 3, 4, 5 are from my personal interaction with Dr, Shwayder, dermatologist at Henry Ford Hospital.

- Source: Sullivan, John R., Geoffrey Watt, and Brent Barker. "Successful Use of Ivermectin in the Treatment of Endemic Scabies in a Nursing Home." Australasian Journal of Dermatology 38.3 (1997): 137-40. Print.

In this study, ivermectin was used to treat endemic scabies found in a 33-bed rural nursing home. According to the study, only oral ivermectin treatment was successful when other treatment options, such as permethrin, gamma-benzene hexachloride, benzyl benzoate, etc. were used but failed to produce any improvement. 6 weeks after the ivermectin treatment, all scabies and rashes were eradicated at the home.

-source: Carapetis JR, Connors C, Yarmirr D, Krause V, Currie BJ. Success of a scabies control program in an Australian Aboriginal community. Pediatr. Infect. Dis. J. 1997; 16: 494 9.

Dowden M. Scabies eradication day: Galiwinku community. Chronicle 1999; 2: 12

-source: Clin Microbiol Rev. 2007 Apr;20(2):268-79.

Problems in diagnosing scabies, a global disease in human and animal populations.

Walton SF, Currie BJ.

Med J Aust. 2001 Oct 1;175(7):367-70)

About 201 to 242 children aged 5 years and under were screened initially and at the three follow-up screenings. The prevalences of scabies, infected scabies and non-scabies pyoderma before intervention were 35%, 12% and 11%, respectively. At 6 weeks after the intervention, these numberswent down to 3%, 1% and 4%, respectively.

Taplin, P. "Community Control of Scabies: A Model Based on Use of Permethrin Cream." The Lancet 337.8748 (1991): 1016-018. Print.

- Source: Currie, Bart. "Skin Infections and Infestations in Aboriginal Communities in Northern Australia." Wiley Online Library. Web. 02 Mar. 2012. <

-Source: Munoz E, Powers J, Nienhuys T, Mathews J. Social and environmental factors in 10 Aboriginal communities in the Northern Territory: Relationship to hospital admissions of children. Med. J. Aust. 1992; 156: 529 33.

Gracey M, Williams P, Houston S. Environmental health conditions in remote and rural Aboriginal communities in Western Australia. Aust. N.Z. J. Public Health 1997; 21: 511 18.

1. "Asheville School Reports Scabies Outbreak." Burlington Times News. Web. <

2. "Saint John Hit by Scabies Outbreak." Yahoo! News Canada. Web. <

- 4 students at Harbour View High School, 2 at St. Malachy’s Memorial High School, 1 at Simonds High School

-Source: Walton, SF. "Scabies: New Future for a Neglected Disease." Adv Parasitol. 57 (2004): 309-76. Print.