scabies

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1 By: DR:NAJEEB MEMON Assistant Professor Faculty of Community Medicine & Public Health Sciences LUMHS, Jamshoro, Pakistan SCABIES

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2 SCABIES

Microscopic image of scabies mites :

3 Microscopic image of scabies mites

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4 Scabies is a contagious disease caused by a mite itchy skin condition caused by very small, wingless insects or mites called the Human Itch mite Latin term ’’scabere’’ meaning to scratch .

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5 Scabies itch mite OR OR Acarus scabie Sarcoptes scabiei OR Scybula OR / hominis (Hering)

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6 Pictures of Scabies a tiny insect just visible to the eye (about 0.4mm) and is tiny, eight-legged creature with a round body.

History:

7 History Aristotle ( 1200 BC) Roman physician Celsus (characteristic features) & Giovan Cosimo Bonomo ( Italian Physician) in 1687. (It was the first human disease recognized to be caused by a specific pathogen )

Epidemiology:

8 Epidemiology The scabies mite has infested humans for at least 2,500 years . More than 300 million cases of scabies occur worldwide every year. Anyone of any race or age,& social classes . spreads rapidly under crowded conditions where there is frequent skin-to-skin contact between people , such as in hospitals, institutions, child-care facilities, and nursing homes.

Types:

9 Types 1. Regular scabies the number of mites is, on an infected person. on average, 10 to 15 2. Norwegian scabies / Crusted scabies . ( Norwegian originated in Norway) thousands to millions of mites. The type of mite in both presentations is usually the same. 3. Nodular In AIDS pt: pathognomonic orange red nodules in the axillae and groin 4. Bullous bullae may occur in infants & immunocompromised people

Transmission :

10 Transmission Scabies is very contagious and is usually spread by: close contact with infected clothing, bedding or towels personal contact shaking hands sleeping together sexual partners and household members. .

Most common breeding environments are::

11 Most common breeding environments are : in overcrowded living conditions in school children playing together families roommates sexual partners mothers of infants

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12 elderly people in nursing homes soldiers Prisoners The insect or the egg can spread the infection and the mite can survive on objects for a long time, so constant washing of clothing, towels or bedding is necessary. Scabies does not occur because of poor hygiene

Cycle :

13 Cycle Attracted to warmth and odor , the female mite is drawn to a new host, making a burrow , laying eggs ( 1-3 eggs daily ) and producing secretions that cause an allergic reaction. Larvae hatch from the eggs and travel to the skin surface, lying in shallow pockets where they will produce secretions. The eggs hatch and the new mites begin the cycle all over again. The rash is extremely itchy , which often causes sleeping problems especially in infants and young children Without a host, they survive only a few days

Life Cycle :

14 Life Cycle - There are 4 stages of the Sarcoptes scabiei life cycle: egg, larva, nymph, adult Following copulation, females lay eggs as they burrow underneath the host's skin. up to 30 eggs at rate of 2-3 per day. 2. Incubation time varies from 3-4 days . 3. When the eggs hatch, the larva (which only have 3 pairs of legs) migrate to the skin surface and take residence in short burrows called molting pouches. The larval stage lasts for 3-4 days. 4. Larva molt into nymphs , which are slightly larger and have the full 4 pairs of legs. 5. Adult mites ( live for 1-2months )are round and sac-like. (from egg to adult 10-15 days) The cycle commences again when a nomadic male penetrates the female's burrow and, fertilized, she proceeds to lay her eggs in the host. (Scabies, CDC)

SIGNS and SYMPTOMS :

15 SIGNS and SYMPTOMS scabies rash / burrows / Pimple-like irritations, between fingers wrists Extensor aspects of elbow ( 11%) auxiliary areas female breasts (particularly the skin of the nipples) the umbilical area penis and scrotum buttocks inside of legs Intense itching, especially at night and over most of the body. Sores on the body caused by scratching. These sores can sometimes become infected with bacteria. ( 63%)

Symptoms:

16 Symptoms A very small, hard to see, zigzag blister usually marks the trail of the insect as she lays her eggs. Other more obvious symptoms are : Intense itching especially at night A red rash can occur at the area that has been scratched. Skin may become crusty or scaly as the infection progresses Early scabies rash will show up : pimples tiny bites

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17 Children usually have more overall itching on the palms of hands soles of feet scalp The child may also have irritability sleeplessness tiredness due to itching

2. C/ Features:

18 2. C/ Features Children younger than 15 years of age have the highest prevalence. severe itching with nocturnal exacerbation. The pathognomonic lesion of scabies is the burrow : short, straight or curved, slightly elevated lesion which often has a vesicle at its end . Burrows are typically found on the finger webs, front of the wrists, axillae and genitalia. Intensely itchy papular and vesicular lesions soon develop due to hypersensitivity

Burrows:

19 Burrows The scaly patch at the left is due to scratching of the original papule. The mite travelled from there to the upper right, where it can be seen as a dark spot at the end of the burrow. Mite

Scabies :

20 Scabies

Affected webs pace:

21 Affected webs pace Scabies

Scabies with extensive infestation of Sarcoptes scabiei. :

22 Scabies with extensive infestation of Sarcoptes scabiei. scabies

Baby with Scabies Rash:

23 Baby with Scabies Rash

Scabies in Childhood:

24 Scabies in Childhood Scabies. Pustules at a common site in a child. Burrows were present but cannot be seen at this distance.

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26 In babies the neck and head may be affected The itching is due to an allergic reaction to the tiny mites, which is associated with a rash of red, raised spots . Bacterial infection may occur through infected lesions. In many cases, children are treated because of infected skin lesions rather than for the scabies itself .

Who is at risk for severe infestation? :

27 Who is at risk for severe infestation? People with weakened immune systems and the elderly are at risk for a more severe form of scabies, called Norwegian or crusted scabies. How long will mites live? Once away from the human body, mites do not survive more than 48-72 hours. When living on a person, an adult female mite can live up to a month.

Diagnosis:

28 Diagnosis 1. pt: complains of itching ( worse at night ) 2. On Exam: follicular lesions at affected site. 3. secondary infection lead to: crusted papules & pustules . 4. Diagnosis is probable if other members of household are affected.

Confirmation Diagnosis :

29 Confirmation Diagnosis Microscope Test B y scraping the burrows and examining under a microscope. scabies mites, eggs and/or feces. Ink Test An ink test is where a blue or black felt-tipped pen is applied to the suspected areas. After the skin is cleaned mite burrows can be located if the ink sinks into them .

OR Diagnosis Telltale signs of scabies include: :

30 OR Diagnosis Telltale signs of scabies include: Intense itching that worsens at night. The appearance of short, wavy, scaly grey lines on the skin due to burrowed scabies mites. Symmetrical distribution of scabies rash noted in the web spaces between the fingers, and on the wrists, sides of the hands and feet, elbows, armpits, waist, buttocks, genitals, and breasts/nipples in women. Secondary infection and eczema from scratching can mask the signs of scabies and complicate diagnosis

Less specific signs of scabies include :

31 Less specific signs of scabies include Papules or nodules (small, solid bumps on the skin), vesicles (small, fluid-filled blisters), and pustules (small, pus-filled blisters) on the skin Eczema (itching, scaling and thickening of the skin) resulting from the body’s immune reaction to scabies mites and their fecal matter.

TREATMENT (SCABICIDAL AGENTS:) :

32 TREATMENT ( SCABICIDAL AGENTS:) Topical agents: Permethrin 5% cream : ( in young children ). Gamma benzene hydrochloride (GBHC, Lindane) 1% cream or lotion.  ( Not recommend for application in infants. ) Benzyl benzoate 25% emulsion: sulphur ointment : 6 to 10% Crotamiton lotion or cream Malathion .5% solution : Topical thiabendazole is also said to be effective. Monosulfirum -impregnated soaps are sometimes advised as a prophylactic in outbreaks. Systemic:- Ivermectin Scabicidal treatment of family members and close contacts is mandatory

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33 Permethrin 5% cream: single application, kept for 12 hours. Repeat application after a week may be advised. Permethrin may be used in young children. Gamma benzene hydrochloride (GBHC, Lindane) 1% cream or lotion.  GBHC is used as a single application on dry skin kept for 12 to 24 hours. A repeat application after 7 days is often recommended. Not recommend for application in infants. Benzyl benzoate 25% emulsion: applied for three consecutive days. 6 to 10% sulphur ointment : applied for 3 to 5 consecutive day, application is messy. Crotamiton lotion or cream: less effective, may have a non-specific anti-pruritic effect. Malathion .5% solution : somewhat less effective, should be applied repeatedly. Topical thiabendazole is also said to be effective. Monosulfirum -impregnated soaps are sometimes advised as a prophylactic in outbreaks.

Help Factors :

34 Help Factors A sauna Keep finger nails cut short and apply mitts or socks to infants' hands at bedtime to cut down on scratching. Bathing, washing or soaking in diluted: borax enzyme cleaners lice shampoo sulfur Do not treat scabies with: hard soaps home remedies kerosene laundry detergent Consult a dermatologist before using steroids or any other creams.

Complications :

35 Complications Secondary pyogenic infection . Streptococcal pyoderma may in turn be complicated by glomerulonephritis. Infective eczema Persistent nodules Crusted or Norwegian scabies ( in AIDS ) Erythroderma from crusted scabies

Control of mites:

36 Control of mites Use of DDT Cracks & crevices in ground ( Filling up ) Protection of workers in Tick infested areas.

Prevention :

37 Prevention Avoid sharing personal articles such as clothing, hair brushes, combs or towels Check family members Chemical sprays for the household are unnecessary Clothes, towels, bedding, combs, brushes, and anything else the person has had contact with should be soaked in very hot water in enzymes or borax for 15 minutes or more Clothing and underwear should be changed regularly Have regular saunas If your child has scabies, please notify the school authorities Keep all bedding well laundered (hot water, 120oF) Practice proper prevention measures Vacuum rugs and furniture, such as chairs and couches, that the infected person might have been in contact with

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38 SUMMARY Scabies is a contagious disease by a mite / Acarus scabie / Sarcoptes. S Epidemiology: 2,500 years ago, > 300 million cases every year. any race, age & social classes . spreads rapidly under crowded conditions Spreads : close contact, sleeping together, Towels, sexual cotact Types : 1, Regular ( 10-15 m) 2. Norwegian (thou-mill ) 3. Nodular Life cycle:- Eggs- Larva- Nymph – Adult ( 10 – 15 days) live 1-2 months Signs & Symptoms :--Intense itching ( at night.) short, wavy, scaly grey lines on the skin due to burrowed scabies mites. scabies rash noted in the web spaces between the fingers, &….. Secondary infection and eczema Less specific signs :- Papules or nodules (small, solid bumps on the skin), vesicles (small, fluid-filled blisters), and pustules (small, pus-filled blisters) on the skin Eczema Diagnosis:- 1. H/o itching ( worse at night ),2. follicular lesions, 3. secondary inf: lead to: crusted papules & pustules . 4. H/o other members of household . Microscopic:-mineral oil & scrapings ( mites, eggs and/or feces.) Ink test:- mite burrows can be located if the ink sinks into them . Treatment :- Permethrin , Malathan, Benzyl benzoate, benzene hexa chloride, sulphur Prevention: - Avoidance of contact with infested persons. 2. Treatment of all close contacts. 3. Maintenance of good personal hygiene. 4. Improvement of socio-economic conditions is associated with lowered prevalence of scabies.

Thank you :

39 Thank you