Arthropod Infestations Research Articles

Bed bug (Cimex lectularius) infestation in a surgery ward from northeastern Brazil

Bed bugs are arthropods of public health significance that have experienced a global resurgence. In this context, we are reporting a bed bug infestation in a surgical ward in Brazil. Thirteen patients in the surgical ward were identified as having diffuse erythematous maculopapular lesions of unknown origin. Similar signs and symptoms were observed among healthcare professionals in the same unit. The issue was addressed with all relevant departments, and a multifaceted approach was adopted to manage the infestation. Bed bugs may potentially pose health risks to both patients and healthcare professionals. It is imperative to actively monitor the structural integrity of the hospital’s physical facilities to prevent arthropod infestations. KEY WORDS: Bed bugs; Cimex lectularius; ectoparasitic infestations; hospitals.

Does fungal infection increase the palatability of oilseed rape to insects?

Multiple and simultaneous attacks by pathogens and insect pests frequently occur in nature. Plants respond to biotic stresses by activating distinct defense mechanisms, but little is known about how plants cope with multiple stresses. The focus of this study was the combined interaction of fungal infection caused by Leptosphaeria maculans (synonym Plenodomus lingam) and arthropod infestation by the diamondback moth (Plutella xylostella) in oilseed rape (Brassica napus). We hypothesized that infection by the fungal pathogen L. maculans could alter oilseed rape palatability to P. xylostella-chewing caterpillars. Feeding preference tests were complemented with analyses of defense gene transcription, and levels of glucosinolates (GLSs) and volatile organic compounds (VOCs) in L. maculans-inoculated and non-inoculated (control) leaves to determine possible causes of larval choice. Caterpillars preferred true leaves to cotyledons, hence true leaves were used for further experiments. True leaves inoculated with L. maculans were more palatable to caterpillars over control leaves during the early stage of infection at 3 days post inoculation (dpi), but this preference disappeared in the later stages of infection at 7 dpi. In parallel, genes involved in the salicylic acid and ethylene pathways were up-regulated in L. maculans-inoculated leaves at 3 and 7 dpi; L. maculans increased the level of total aliphatic GLSs, specifically glucobrassicanapin, and decreased the level of glucoiberin at 3 dpi and altered the content of specific VOCs. A group of 55 VOCs with the highest variability between treatments was identified. We suggest that the P. xylostella preference for L. maculans-inoculated leaves in the early stage of disease development could be caused by the underlying mechanisms leading to changes in metabolic composition. Further research should pinpoint the compounds responsible for driving larval preference and evaluate whether the behavior of the adult moths, i.e. the stage that makes the first choice regarding host plant selection in field conditions, correlates with our results on larval host acceptance. © 2024 Society of Chemical Industry.

Groundbreaking outpatient activity in medical entomology in France: An eight-year experience in a french university hospital

IntroductionArthropods are known to impair human health in various manners, acting as infectious disease vectors, or as simple nuisances. Even though considerable research is being produced in medical entomology, no reports on patient management in clinical entomology units are available in the literature. Patients and MethodsWe retrospectively surveyed all the records from patients having consulted in our outpatient clinical entomology unit in Nice University Hospital from 2012 to 2020. For each patient, physical examination findings and treatment data were analyzed. ResultsA total of 518 patients were analyzed in this study. Most were diagnosed with arthropod infestation (55.8%), the most common being Sarcoptes scabiei (35%), bedbugs (23%), Pyemotes dermatitis (17.6%) and flea infestation (15.9%). Along with symptomatic treatments, targeted environmental measures could be proposed for infested patients. For many of our patients, on the other hand, active infestation was ruled out. ConclusionGiven today’s lack of expertise in medical entomology, we advocate for the creation of medical entomology units in university hospitals, not only allowing fair and proportionate multidisciplinary management of patients in whom arthropod infestation is suspected, but also generating cost savings.

Assessing the impact of piercing-sucking pests on greenhouse-grown industrial hemp (Cannabis sativa L.).

Cannabis sativa or hemp, defined as <0.3% total tetrahydrocannabinol (THC), is a specialty crop in the United States, of particular interest among growers in the southeastern United States to replace tobacco production. Tetranychus urticae (twospotted spider mite), Aculops cannabicola (hemp russet mite), Polyphagotarsonemus latus (broad mites), and Phorodon cannabis (cannabis aphids) are considered the most significant pests in greenhouse grown hemp. Mite and aphid injury can cause cupping and yellowing of leaves, resulting in leaf drop, and reduced flower and resin production. We sought to understand the effects of feeding by T. urticae and Myzus persicae (green peach aphid), as a proxy for P. cannabis, on the concentration of economically significant cannabinoids through a series of experiments on greenhouse grown plants. First, we compared the variability of chemical concentrations in samples collected from individual plants versus pooled samples from 5 plants, and found that chemical concentrations in single plants were similar to those in pooled plant samples. Next, we compared chemical concentrations prior to arthropod infestation and post infestation. When evaluating the mite feeding damage in 2020, cannabinoids in plants infested with high densities of T. urticae increased more slowly than in uninfested control plants or plants infested with low T. urticae densities. In 2021, the concentration of tetrahydrocannabinol did not differ significantly between treatments. Cannabidiol increased more slowly in plants with low T. urticae densities when compared to uninfested controls but did not differ from the high T. urticae densities 14 days after infestation.

Early infestations by arthropod pests induce unique changes in plant compositional traits and leaf reflectance.

BACKGROUNDWith steadily growing interest in the use of remote‐sensing technologies to detect and diagnose pest infestations in crops, it is important to investigate and characterize possible associations between crop leaf reflectance and unique pest‐induced changes in plant compositional traits. Accordingly, we compiled plant compositional traits from chrysanthemum and gerbera plants in four treatments: non‐infested, or infested with mites, thrips or whiteflies, and we acquired hyperspectral leaf reflectance data from the same plants over time (0–14 days).RESULTSPlant compositional traits changed significantly in response to arthropod infestations, and individual chrysanthemum and gerbera plants were classified with 78% and 80% accuracy, respectively. Based on leaf reflectance, individual plants from the four treatments were classified with moderate accuracy levels of 76% (gerbera) and 73% (chrysanthemum) but with a clear distinction between non‐infested and infested plants. Accurate and consistent diagnosis of biotic stressors was not achieved.CONCLUSIONTo our knowledge, this is the first study in which infestations by multiple economically important arthropod pests are directly compared and associated with leaf reflectance responses and changes in plant compositional traits. It is important to highlight that imposed stress levels were low, period of infestation was short, and hyperspectral remote‐sensing data were acquired at four time points with analyses based on large data sets (3826 leaf reflectance profiles for chrysanthemum and 4041 for gerbera). This study provides novel insight into crop responses to different biotic stressors and into possible associations between plant compositional traits and hyperspectral leaf reflectance data acquired from crop leaves.

Assessing the efficacy of oral intake of insecticides on mortality of fleas and ticks on commensal Rattus species

Many rodent-borne pathogens can be transmitted via their ectoparasites to humans and can cause severe zoonotic diseases (e.g. plague, tick-borne encephalitis, typhus). Managing relevant ectoparasites in rodents may reduce human infection risk. The purpose of this laboratory study was to screen potential insecticides for their palatability to commensal rat species and their efficacy against fleas and ticks feeding on rats. The preferences shown by Norway rats (Rattus norvegicus) for four insecticides (fipronil, cythioate, thiamethoxam and ivermectin) were assessed when presented as a choice in cereal-based pellets. Subsequently, specific doses of insecticide-containing cereal pellets were fed to rats to determine the ability of each insecticide, over time, to kill cat fleas (Ctenocephalides felis), stickfast fleas (Echidnophaga gallinacea) feeding on Norway rats, and possum ticks (Ixodes trichosuri) feeding on Norway rats and black rats (R. rattus). Fipronil, cythioate and thiamethoxam were similarly palatable to rats, but ivermectin was avoided at high concentration. Fipronil was the most effective in killing cat fleas, stickfast fleas and ticks feeding on rats. Cythioate and ivermectin performed similarly against two flea species, while the effects of ivermectin and fipronil were comparable against ticks. Cythioate was not efficacious against ticks at the doses tested. Fipronil should be tested as a systemic compound to minimise arthropod infestation in small mammals to reduce adverse effects of arthropod-borne disease on humans. This insecticide should also be tested in combination with a rodenticide to prevent migration of arthropods with zoonotic relevance from rodent carcasses to humans.

Arthropod Infestation Levels on Mandarins in California.

Integrated pest management (IPM) guidelines for horticulture are typically established from years of experimental research and experience for a crop species. Ecoinformatics methods can help to quickly adapt these guidelines following major changes in growing practices. Citrus production in California is facing several major challenges, one of which is a shift away from sweet oranges [Citrus sinensis (L.) Osbeck Sapindales: Rutaceae] toward mandarins (including mostly cultivars of C. reticulata Blanco and C. clementina hort. ex Tanaka). In the absence of IPM guidelines for mandarins, growers are relying on pest information developed from oranges. We mined a database of management records from commercial growers and consultants to determine densities for four arthropod pests: cottony cushion scale (Icerya purchasi Maskell Hemiptera: Monophlebidae), citricola scale (Coccus pseudomagnoliarum Kuwana Hemiptera: Coccidae), European earwig (Forficula auricularia Linnaeus Dermaptera: Forficulidae), citrus red mite (Panonychus citri McGregor Acari: Tetranychidae), and a natural enemy, predatory mites in the genus Euseius (Congdon Acarina: Phytoseiidae). Densities of cottony cushion scale were approximately 10-40 times higher in the two most commonly grown mandarin species than in sweet oranges, suggesting this pest is reaching outbreak levels more often on mandarins. Densities of the other pests and predatory mites did not differ significantly across citrus species. This is a first step toward establishing IPM guidelines for mandarins for these pests; more research is needed to determine how arthropod densities relate to crop performance in mandarins.

Mobility parameters of Tribolium castaneum and Rhyzopertha dominica populations with different susceptibility to phosphine

Phosphine (PH3) is the most commonly used fumigant to protect stored products from arthropod infestations worldwide. Our knowledge about the behavioral differences between phosphine-resistant and -susceptible stored product pest populations is limited. This study evaluated differences in mobility and behavior of populations of two major stored product insects, Tribolium castaneum (Herbst) and Rhyzopertha dominica (F.), which have different susceptibility to phosphine. In this regard, laboratory bioassays in Petri dish arenas were designed to determine if phosphine resistance has an impact on the walking and mobility behavior of adult beetles of both species. Results indicated that there were significant differences between resistant and susceptible populations for both species. Regarding velocity, R. dominica susceptible individuals moved faster than resistant ones. However, the resistant population showed reduced activity for several parameters tested compared to the susceptible population. Similar trends were also noted for T. castaneum. Knowledge of these parameters should be further utilized in management tactics, as resistant populations may behave in a different way in key management indicators such as trapping and sampling, as compared with susceptible ones.

Hyperspectral remote sensing to detect leafminer-induced stress in bok choy and spinach according to fertilizer regime and timing.

BACKGROUNDDetection and diagnosis of emerging arthropod outbreaks in horticultural glasshouse crops, such as bok choy and spinach, is both important and challenging. A major challenge is to accurately detect and diagnose arthropod outbreaks in growing crops (changes in canopy size, structure, and composition), and when crops are grown under three fertilization regimes. Day‐time remote sensing inside glasshouses is highly sensitive to inconsistent lighting, spectral scattering, and shadows casted by glasshouse structures. To avoid these issues, a unique feature of this study was that hyperspectral remote sensing data were acquired after sunset with an active light source. As part of this study, we describe a comprehensive approach to performance assessment of classification algorithms based on hyperspectral remote sensing data.RESULTSBased on average hyperspectral remote sensing profiles from individual crop plants, none of the 31 individual spectral bands showed consistent significant response to leafminer infestation and non‐significant response to fertilizer regime. Multi‐band classification algorithms were subjected to a comprehensive performance assessment to quantify risks of model over‐fitting and low repeatability of classification algorithms. The performance assessment of classification algorithms addresses the important ‘bias‐variance trade‐off’. Truly independent validation (training and validation data sets being separated over time) revealed that leafminer infestation could be detected with >99% accuracy in both bok choy and spinach.CONCLUSIONWe conclude that detailed hyperspectral profiles (not single spectral bands) can accurately detect and diagnose leafminer infestation over time and across fertilizer regimes. Hyperspectral remote sensing data acquisition at night with an active light source has the potential to enable arthropod infestations in glasshouse‐grown crops, such as, bok choy and spinach. In addition, we conclude that effective use and deployment of hyperspectral remote sensing requires thorough performance assessments of classification algorithms, and we propose an analytical performance method to address this important matter. © 2020 The Authors. Pest Management Science published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.

Study on the Prevalence of Ectoparasitic Arthropods on Free Range Gallus domesticus in Two Communities in Awka

A survey was carried out to determine the prevalence of ectoparasitic arthropods in free range domestic fowl (Gallus domesticus) in Amansea and Ifite communities, in Awka Capital Territory, Anambra state. A total of 112 G. domesticus comprising of 42 Adult males, 30 adult females and 40 juveniles were examined during a house to house survey for ectoparasitic arthropods. The study was carried out between June and September, 2014. The domestic fowl were caught in their roosting places at night and were examined for ectoparasitic arthropod infestation. 73.21% prevalence of ectoparasitic arthropods on the chicken was recorded. Male adult chicken had higher prevalence of ectoparasitic arthropods than adult females and juvenile chicken. Six species of ectoparasitic arthropods namely; Argas persicus (29.46%), Menopon gallinae (23.21%), Dermanysus gallinae (16.07%), Lipeurus caponis (12.5%), Echidnophaga gallinacea (10.71%) Goniocotes gallinae (5.36%) were recovered from infested chicken. Argas persicus with the prevalence (29.46%) was the most prevalent parasite species. Amansea community had a higher prevalence of ectoparasitic arthropods than Ifite community. The difference was statistically significant (P&lt;0.05). In conclusion, the present study has provided information on the various ectoparasitic arthropods of domestic chicken in Amansea and Ifite communities. There was no significant difference in the prevalence of ectoparasitic arthropods between the two communities. Therefore, further study is needed to determine the impact of infestation on the health and productivity of these birds, and evaluation of cost benefit of various control strategies need to be investigated.

High Prevalence of Bartonella sp. in Dogs from Hamadan, Iran.

Bartonellae are emerging vector-borne pathogens infecting various domestic and wild mammals. Blood samples were collected from 66 dogs at two locations near Hamedan, Iran. Twenty dogs were rescued stray dogs and 46 dogs were from a breeding colony, with many of them infested with fleas, ticks, or lice. Serology was performed using an indirect immunofluorescent antibody test for Bartonella henselae, Bartonella clarridgeiae, and Bartonella vinsonii subsp. berkhoffii. Seroprevalence was 74.2% (range: 65.2-95%). Bartonella DNA amplification and sequencing identified B. vinsonii subsp. berkhoffii type III in seven dogs, including five rescued dogs. Two dogs were infected with Bartonella rochalimae and three dogs with Candidatus B. merieuxii, including two of the stray dogs coinfected with Bartonella vinsonii subsp. berkhoffii. Rescued stray dogs were 10 times (odds ratio (OR) = 10.13, 95% CI: 1.24-82.7; P = 0.03) more likely to be seropositive and eight times (OR = 8.82, 95% CI: 2.68-29.11; P = 0.0004) more likely to be flea-infested than breeding dogs, confirming that arthropod infestation is a major risk factor for these infections.

Arthropod infestation sites and induced defence can be traced by emission from single spruce needles

Emissions of defence chemicals from Norway spruce seedlings can be induced by feeding arthropods or by exogenous hormonal application. Some defence chemicals may attract or repel associated arthropods. The aim of this study was to show that it is possible to detect and collect stress-induced volatiles from micro sites, such as at the scale of a single needle, in vivo by using SPME. Methyl jasmonate application on the stem of Norway spruce seedlings induced emission of (E)-β-farnesene only from the needles closest to the application site. Emissions of (E)-β-farnesene, (E,E)-α-farnesene and (E)-α-bisabolene were only detected from needles infested by the spider mite Oligonychus ununguis. The total volatile amount detected by SPME-GC-MS reached a considerable mass of 14 ng/needle/24 h, suggesting that emission from damaged and stressed conifers might have a larger impact on the macro climate than previously estimated.

Dermatology prescribing update: Skin infestations

Skin infestations are very common and often occur in outbreaks in close communities, family groups and nurseries and/or schools. The nurse prescriber needs to be able to distinguish a skin infestation from a chronic skin condition, as pruritus can be a major symptom for both. The skin infestations in this article relate to arthropod infestations, which are commonly seen in the UK. Parasite infestations include many tropical diseases. Therefore, it is important to ask about recent travel abroad in a skin assessment. Management of skin infestations should follow the most recent evidence-based public health advice. Nurse prescribers need to be up-to-date with recommended insecticides, as resistance can occur and first- and second-line options frequently change.

Health Hazards Associated with Arthropod Infestation of Stored Products.

Insects and mites are common inhabitants and accidental invaders of food, including durable commodities, and their presence can have both direct and indirect effects on human health. The most common direct effect is contamination of food with arthropod fragments and related contaminants, which may be allergenic or even carcinogenic. The most important indirect effect is that their presence can change the storage microenvironment, making durable products suitable for the rapid development of fungi and other microorganisms. Some of these fungi can produce toxins (e.g., aflatoxins) that endanger human health. Insects may actively or passively contribute to the spread of microorganisms, increasing product contamination, and they may host bacteria that have developed antibiotic resistance, contributing to their spread in food. Several species also may host, attract, or transmit tapeworms, predators, or parasitoids that may affect health. This review synthesizes research on these topics and suggests directions for future research.

Direct and host‐mediated interactions between Fusarium pathogens and herbivorous arthropods in cereals

Fusarium head blight and fusarium ear rot diseases of cereal crops are significant global problems, causing yield and grain quality losses and accumulation of harmful mycotoxins. Safety limits have been set by the European Commission for several Fusarium‐produced mycotoxins; mitigating the risk of breaching these limits is of great importance to crop producers as part of an integrated approach to disease management. This review examines current knowledge regarding the role of arthropods in disease epidemiology. In the field, diseased host plants are likely to interact with arthropods that may substantially impact the disease by influencing spread or condition of the shared host. For example, disease progress by Fusarium graminearum can be doubled if wheat plants are aphid‐infested. Arthropods have been implicated in disease epidemiology in several cases and the evidence ranges from observed correlations between arthropod infestation and increased disease severity and mycotoxin accumulation, to experimental evidence for arthropod infestation causing heightened pathogen prevalence in hosts. Fusarium pathogens differ in spore production and impact on host volatile chemistry, which influences their suitability for arthropod dispersal. Herbivores may allow secondary fungal infection after wounding a plant or they may alter host susceptibility by inducing changes in plant defence pathways. Post‐harvest, during storage, arthropods may also interact with Fusarium pathogens, with instances of fungivory and altered behaviour by arthropods towards volatile chemicals from infected grain. Host‐mediated indirect pathogen–arthropod interactions are discussed alongside a comprehensive review of evidence for direct interactions where arthropods act as vectors for inoculum.

Efficacy of selected pesticides against Tyrophagus putrescentiae (Schrank): influences of applied concentration, application substrate, and residual activity over time

Dry-cured ham is protected from arthropod infestations using the fumigant methyl bromide. Tyrophagus putrescentiae (Schrank), known as the cheese or ham mite, decreases the quality and quantity of dry-cured hams during the aging process and is a serious economic threat to dry-cured ham companies. Methyl bromide is a strong ozone-depleting substance that is scheduled to be phased out from most uses in the near future. Consequently, developing effective, feasible, and economic alternatives to methyl bromide is the main purpose of the current project. More than ten registered residual pesticides were assessed for toxicity with glass vials treated with different concentrations. Twenty mites were transferred to each vial for 24 h of exposure on contact. Persistence of three of these residual pesticides was evaluated over a 2-month period by applying the recommended label rates to different surfaces. Results indicated that the commercial products of deltamethrin plus chlorpyrifos-methyl, chlorphenapyr, and malathion showed promising results for contact toxicity against mites, and chlorphenapyr was highly effective at very low concentrations. Chlorphenapyr was the only pesticide applied to metal, concrete, and wood that was effective at controlling ham mites for 8 weeks. These pesticides are currently registered for use in similar contexts, so they could be considered as new potential control measures for ham mites in ham plants.

Unmanned aerial vehicle canopy reflectance data detects potassium deficiency and green peach aphid susceptibility in canola

There is growing evidence that potassium deficiency in crop plants increases their susceptibility to herbivorous arthropods. The ability to remotely detect potassium deficiency in plants would be advantageous in targeting arthropod sampling and spatially optimizing potassium fertilizer to reduce yield loss due to the arthropod infestations. Four potassium fertilizer regimes were established in field plots of canola, with soil and plant nutrient concentrations tested on three occasions: 69 (seedling), 96 (stem elongation), and 113 (early flowering) days after sowing (DAS). On these dates, unmanned aerial vehicle (UAV) multi-spectral images of each plot were acquired at 15 and 120 m above ground achieving spatial (pixel) resolutions of 8.1 and 65 mm, respectively. At 69 and 96 DAS, field plants were transported to a laboratory with controlled lighting and imaged with a 240-band (390–890 nm) hyperspectral camera. At 113 DAS, all plots had become naturally infested with green peach aphids (Hemiptera: Aphididae), and intensive aphid counts were conducted. Potassium deficiency caused significant: (1) increase in concentrations of nitrogen in youngest mature leaves, (2) increase in green peach aphid density, (3) decrease in vegetation cover, (4) decrease in normalized difference vegetation indices (NDVI) and decrease in canola seed yield. UAV imagery with 65 mm spatial resolution showed higher classification accuracy (72–100 %) than airborne imagery with 8 mm resolution (69–94 %), and bench top hyperspectral imagery acquired from field plants in laboratory conditions (78–88 %). When non-leaf pixels were removed from the UAV data, classification accuracies increased for 8 mm and 65 mm resolution images acquired 96 and 113 DAS. The study supports findings that UAV-acquired imagery has potential to identify regions containing nutrient deficiency and likely increased arthropod performance.

Design and Optimization of a Purification Process for MY32/Ls Protein Solubilizing Inclusion Bodies for a New Vaccine Against Sea Lice

Sea lice are the most problematic marine pathogens the salmon industry has to deal with, significantly affecting Europe and America. The worst offenders are genera: Pseudocaligus, Caligus, and Lepeophtheirus. Over €305 million in losses are estimated. Recent results have suggested that subolesin/akirin/myosin32 are good candidate antigens for the control of arthropod infestations such as sea lice. The aim of this study was to design and optimize the purification step of MY32/Ls protein to obtain the active pharmaceutical ingredient against sea lice. Non-chromatographic purification strategies were employed, based on published works, to establish rupture, washing, solubilization, and refolding conditions. A disruption process using a bead mill was established. Cell culture volume was flushed through the mill eight times. Three 60-minute process steps for washing inclusion bodies were performed, and the fourth washing step was a 20-minute process. The first two washes with a Tris-HCl (50 mM) buffer were performed using a non-ionic surfactant (Triton X-100). For the third wash, the surfactant was omitted. The fourth washing step was carried out at a pH of 10.5. The inclusion body solubilization process, in an alkaline condition of pH 12.5, lasted 90 minutes. For the refolding step, Tween 80 was used as a stabilizing additive. The API obtained had a better immune response (IgG) than the positive control, with higher purity.

Akirins in sea lice: First steps towards a deeper understanding

Sea lice (Copepoda, Caligidae) are the most widely distributed marine pathogens in the salmon industry. Vaccination could be an environmentally friendly alternative for sea lice control; however, research on the development of such vaccines is still at an early stage of development. Recent results have suggested that subolesin/akirin/my32 are good candidate antigens for the control of arthropod infestations, including sea lice, but background knowledge about these genes in crustaceans is limited. Herein, we characterize the my32 gene/protein from two important sea lice species, Caligus rogercresseyi and Lepeophtheirus salmonis, based on cDNA sequence isolation, phylogenetic relationships, three dimensional structure prediction and expression analysis. The results show that these genes/proteins have the main characteristics of akirins from invertebrates. In addition, immunization with purified recombinant my32 from L. salmonis elicited a specific antibody response in mice and fish. These results provide an improvement to our current knowledge about my32 proteins and their potential use as vaccine candidates against sea lice in fish.

Scabies: A Review of Diagnosis and Management Based on Mite Biology

Scabies is a contagious parasitic dermatitis that is a significant cause of morbidity, especially outside of the United States. Scabies is diagnosed most often by correlating clinical suspicion with the identification of a burrow. Although scabies should be on the differential for any patient who presents with a pruritic dermatosis, clinicians must consider a wide range of diagnostic possibilities. This approach will help make scabies simultaneously less over- and underdiagnosed by clinicians in the community. Atypical or otherwise complex presentations may necessitate the use of more definitive diagnostic modalities, such as microscopic examination of KOH prepared skin scrapings, high-resolution digital photography, dermoscopy, or biopsy. Scabies therapy involves making the correct diagnosis, recognizing the correct clinical context to guide treatment of contacts and fomites, choosing the most effective medication, understanding how to use the agent properly, and following a rational basis for when to use and reuse that agent. Although the development of new therapeutic agents is always welcome, tried and true treatments are still effective today. Permethrin is the gold standard therapy, with malathion being an excellent topical alternative. Ivermectin is an effective oral alternative that is especially useful in crusted scabies, patients who are bed ridden, and in institutional outbreaks. Despite the availability of effective therapeutics, treatment failures still occur, mostly secondary to application error (ie, failure to treat the face and scalp or close contacts, failure to reapply medication) or failure to decontaminate fomites. Because increasing resistance to scabies treatments may be on the horizon, we propose that standard of care for scabies treatment should involve routine treatment of the scalp and face and re-treating patients at day 4 on the basis of the scabies life cycle to ensure more efficient mite eradication. Practitioners should attempt to treat all close contacts simultaneously with the source patient. To eradicate mites, all fomites should be placed in a dryer for 10 minutes on a high setting, furniture and carpets vacuumed, and nonlaunderables isolated for a minimum of 2 days, or, for those who wish to be rigorous, 3 weeks.