Crusted Scabies Research Articles

Methicillin-Resistant Staphylococcus aureus Secondary Infection as a Comorbid in Crusted Scabies Patient

Introduction: Crusted scabies (CS) is characterized by uncontrolled proliferation of mites up to thousands. Complications include glomerulonephritis, rheumatic fever, and secondary infection which can cause bacteremia and sepsis. This case report describes a case of CS that was hospitalized with secondary complications of MRSA infection. Case Presentation: A 44-year-old woman complained of thick scales and itching all over her body for 6 months. Complaints begin with reddish bumps between the fingers, toes, body, genitals, and scalp, accompanied by itching, especially at night. The patient took self-purchased corticosteroids for this complaint for 6 months. Dermatology status all over the body showed erythematous papules plaques with greenish-yellow scales, blackish crusts, hyperkeratosis, and excoriation, also erythematous base erosions and blackish crusts in the right thoracic region. Ectoparasite scrapping examination showed large amounts of Sarcoptes scabiei, eggs, and scybala, so the patient was diagnosed with Crusted scabies. A wound culture and nasal swab showed MRSA. The patient died of septic shock on day 12 of treatment. Discussion: Crusted scabies is a highly contagious form of scabies, characterized by thickening of the skin layer and crusts. Long-term corticosteroid consumption in this case caused a compromised immune response so that the number of mites multiplied rapidly and increased the risk of MRSA infection. MRSA mortality rates range from 5-60%. Conclusion: Ignored cases of scabies can develop into crusted scabies which have a high risk of secondary infection, such as MRSA which can cause serious morbidity and even mortality.

Ultrastructure of Sarcoptes scabiei in Crusted Scabies.

Ultrastructure of Sarcoptes scabiei in Crusted Scabies.

Norwegian scabies in a patient with Down syndrome – case report

Scabies is a highly infectious dermatosis. It is caused by the mite Sarcoptes scabiei var. hominis. The available estimates indicate more than 400 million cases of scabies annually. The main route of infection is direct skin contact. The main symptoms such as pruritus appear 3–6 weeks after infection. Additionally, papules, erythema, erosions, excoriations, and crusts may be visible. One of the rarest forms of scabies is Norwegian scabies. This is the most severe variant. Its clinical picture may resemble psoriasis. In the article, we present the case of a 21-year-old patient with Down syndrome who was admitted to the department of dermatology with a diagnosis of psoriasis. During hospitalization, due to clinical doubts, it was decided to extend the diagnostics. Basing on the microscopic examination, Norwegian scabies was diagnosed. The treatment involved oral ivermectin and topical 5% permethrin, which resulted in a remission of the skin lesions and the resolution of itching. Key words: Sarcoptes scabiei, Scabies, Crusted scabies, Permethrin, Ivermectin

Rare Case of Vasculitis Induced by Crusted Scabies Infection

Here we present a 70-year-old man who presented with a rare case of cutaneous leukocytoclastic vasculitis (LCV) secondary to a crusted scabies (Sarcoptes scabiei var hominis) mite infestation. Few cases have been reported in the literature of LCV in association with scabies as LCV is typically caused by a bacterial or viral infection or other malignancy. Since this combination of cutaneous manifestations is rare, diagnosis and treatment may be delayed, allowing for the development of advanced disease.

Concomitant Bullous and Crusted Scabies A Rare Presentation

Scabies is a highly contagious skin condition caused by an infestation of the mite Sarcoptes scabiei. The mites burrow into the upper layers of the skin and lay their eggs, causing intense itching and characteristic linear burrows. There are several atypical clinical variants of scabies, including bullous, crusted, hidden, incognito, nodular, and scalp scabies. Bullous scabies is an uncommon variant, characterized by the formation of large, fluid-filled blisters (bullae) on the skin. Crusted scabies, also known as Norwegian scabies, is a severe and highly contagious form of scabies characterized by thick, crusted lesions on the skin. In this case report, we present a rare case of a 69-year-old man with concomitant bullous and crusted scabies. The patient was treated with a whole-body application of benzyl benzoate lotion and two doses (12mg) of oral ivermectin, two weeks apart, and the skin lesions disappeared 20 days later. This case highlights the importance of considering scabies as a differential diagnosis in patients presenting with bullous lesions and the need for careful examination and investigation to distinguish between bullous scabies and bullous pemphigoid.

Immune mechanisms in human Sarcoptes scabiei (Acari: Sarcoptidae) infestations.

Scabies is a parasitic infestation of human and animal skin caused by different strains of the itch mite, Sarcoptes scabiei. The World Health Organization (WHO) has declared scabies in human as a neglected tropical disease, and today over 200million people worldwide are affected. The two most commonly reported clinical manifestation of the condition are ordinary (OS) and crusted scabies (CS). CS, which can lead to fatal consequences due to secondary bacterial infections, is mostly observed in immunocompromised subjects but can also, although rarely, be detected in immunocompetent individuals. Innate and adaptive immune system components are involved in protection and pathogenesis of scabies, although with some differences between OS and CS. While the cutaneous immune response is dominated by CD4+ T-cells in OS, it is mainly mediated by CD8+ T-cells in CS. The two clinical conditions also differ in CD4+ T-cell-mediated immune responses with mixed TH 1/TH 2 (protective) and TH 2/TH 17 (non-protective) immunoprofiles in OS and CS, respectively. Moreover, the development of CS is associated with early immunosuppression that is followed by deleterious immune response to uncontrolled mite proliferation. However, the immune response to scabies still needs further attention due to inconsistent results in the literature. The aim of this study is to attract more attention to this area by summarizing the current literature on innate and adaptive immune responses triggered against S. scabiei mites.

Crusted Scabies as a Suitable Disease for Teledermatology: A Study of 2 Cases

Background Teledermatology has been available for several years now, but the COVID-19 pandemic has highlighted its importance, especially in remote communities. Crusted scabies (CS) presents a unique clinical picture that favors telediagnosis. Patients with neurological diseases, as well as homeless, HIV-infected patients and people with impaired immunological function, are at risk. Clusters of CS have been reported in French Guyana, and these were associated with human T-lymphotropic virus infections. CS has also been reported in Aboriginal Australian communities. Objective Teledermatology is especially useful in cases of CS, as it is a disease that affects areas that are in need of medical services. At the same time, CS presents a unique clinical picture. The objective of this presentation is to fuel the clinical suspicion and detection of patients with this debilitating condition. Methods Relatives of patient 1 contacted our clinic for teledermatology appointments. General practitioners from health services sent images of the second patient. Results Case 1 involved an older woman living in a nursing home with Alzheimer disease, which was severe enough to constrain her to bed. We recommended that her relatives (who had sent images) collect skin scrapings in a container. These scrapings were sent to a clinical analysis laboratory where microscopic potassium hydroxide preparation revealed the presence of Sarcoptes mites. Treatment with oral ivermectin and topical permethrin resulted in the complete resolution of the lesions. Case 2 involved a homeless, HIV-positive, 42-year-old male. The images were sent by clinicians from local health services. This patient was also treated with oral ivermectin and permethrin lotion. We recognize that this case would need further diagnostic workup, but it is highly indicative of CS. Conclusions CS is one of the most suited diseases for the practice of teledermatology for widespread, large, hyperkeratotic fissured plaques covered with abundant, silvery scales for which the expression “once seen, never forgotten” is highly applicable. These cases are gratifyingly simple to treat, and patients benefit from rapid clinical improvement. Prompt diagnoses prevent outbreaks of scabies for relatives and medical personnel, since these skin crusts contain large numbers of scabies mites. CS has been increasingly reported but poorly recognized, and it has often been misdiagnosed as psoriasis. Images, such as those shown in this presentation, are unique and are enough to raise strong clinical suspicion. Conflicts of Interest None declared.

Trichoscopy may enhance the differential diagnosis of erythroderma.

There is a paucity of data concerning the usefulness of trichoscopy in patients with erythroderma. The aim of the study was to compare the trichoscopic features in erythroderma of various aetiologies. In total, 49 patients with a determined cause of erythroderma [including atopic dermatitis (AD), mycosis fungoides (MF), allergic contact eczema (ACE), psoriasis (Pso), Sézary syndrome (SS), drug reaction, pityriasis rubra pilaris (PRP), dermatomyositis (DM), actinic reticuloid (AR), crusted scabies (CS) and pemphigus foliaceus (PF)] were included in the study. Dotted vessels were present in patients with AD, PRP, MF, SS and Pso, and absent in DM, CS and PF (χ², P < 0.02). Spermatozoon-like vessels were observed only in MF and SS (P = 0.001). Whitish-pinkish structureless areas were described in all patients with DM, AR and CS (P < 0.03). The type of vessel and the presence of whitish-pinkish structureless areas under trichoscopy may indicate the cause of erythroderma.

Norwegian (Crusted) Scabies Involving Eyelids and Conjunctiva

Scabies is a parasitosis caused by the mite sarcoptes scabiei var. hominis, with crusted scabies being more contagious than classic scabies because of a larger mite burden. It can lead to an epidemic of classic scabies if not diagnosed early and treated accordingly. We report a 10-year-old boy who presented with a complaint of an inability to open his left eye and irritation in the right eye. Examination showed the presence of multiple crusted lesions throughout the body, including face and eyelids, and a yellowish patch in the right bulbar conjunctiva. The histopathological evaluation of the specimen of the conjunctival lesion confirmed it to be sarcoptes infestation. Face and eyelids involvement are very rarely in crusted scabies and only a few cases have been reported in the past. Our report demonstrates conjunctiva as an unusual site of involvement in these cases.

Lepromatous Leprosy with Crusted Scabies

Lepromatous Leprosy with Crusted Scabies

Acquisition Rate of Scabies in Employees After Care of an Undiagnosed Crusted Scabies Patient

Background: Scabies is a contagious dermatosis caused by human mites, (Sarcoptes scabei, variant hominis). In crusted (Norwegian) scabies, the burden of mite infestation is higher and up to 2 million per person, facilitating easy skin-to-skin transmission and nosocomial transmission. We describe a case of undiagnosed crusted scabies and subsequent transmission to employees in our hospital. Methods: A 90-year-old female was admitted to our 636-bed, nonprofit, academic hospital for 22 days prior to diagnosis of crusted scabies by skin scraping. The patient was admitted to 2 different medical-surgical wards and the medical intensive care unit. We collected healthcare worker (HCW) demographics, including department of service, age, sex, pregnancy, and breastfeeding status in those who were at risk of exposure. We interviewed HCWs at 2 time points and collected information related to infestation, allergies to treatment, acceptance of empiric treatment, and whether employee was furloughed. Results: On initial screening, 20 of 124 at-risk HCWs had symptoms (Fig.). Most had a “new onset raised red rash or new pimple like rash (not on face), or linear rash” and 4 had “new onset uncontrollable itching.” All 124 HCWs were contacted 28 days later. One HCW that had not been compliant with prophylaxis became symptomatic and was diagnosed with scabies by dermatology. Of the remaining 20 HCWs, 3 were still having symptoms (2 had itching and 1 had a rash and a scrape performed by dermatology with confirmation of mites). All 3 were retreated with ivermectin. Overall, 21 of 124 exposed HCWs were ultimately symptomatic. Conclusions: During a 22-day admission of an undiagnosed and unisolated elderly patient with crusted scabies, the scabies mite was transmitted to 21 HCWs for an acquisition rate of 17%. Persistence of symptoms after treatment with permethrin occurred in 14%. The infectivity of this disease necessitates early recognition and infection control measures.Funding: NoneDisclosures: None

Early immune suppression leads to uncontrolled mite proliferation and potent host inflammatory responses in a porcine model of crusted versus ordinary scabies.

Scabies is a neglected tropical disease of global significance. Our understanding of host-parasite interactions has been limited, particularly in crusted scabies (CS), a severe clinical manifestation involving hyper-infestation of Sarcoptes scabiei mites. Susceptibility to CS may be associated with immunosuppressive conditions but CS has also been seen in cases with no identifiable risk factor or immune deficit. Due to ethical and logistical difficulties with undertaking research on clinical patients with CS, we adopted a porcine model which parallels human clinical manifestations. Transcriptomic analysis using microarrays was used to explore scabies pathogenesis, and to identify early events differentiating pigs with ordinary (OS) and crusted scabies. Pigs with OS (n = 4), CS (n = 4) and non-infested controls (n = 4) were compared at pre-infestation, weeks 1, 2, 4 and 8 post-infestation. In CS relative to OS, there were numerous differentially expressed genes including pro-inflammatory cytokines (IL17A, IL8, IL19, IL20 and OSM) and chemokines involved in immune cell activation and recruitment (CCL20, CCL27 and CXCL6). The influence of genes associated with immune regulation (CD274/PD-L1 and IL27), immune signalling (TLR2, TLR8) and antigen presentation (RFX5, HLA-5 and HLA-DOB) were highlighted in the early host response to CS. We observed similarities with gene expression profiles associated with psoriasis and atopic dermatitis and confirmed previous observations of Th2/17 pronounced responses in CS. This is the first comprehensive study describing transcriptional changes associated with the development of CS and significantly, the distinction between OS and CS. This provides a basis for clinical follow-up studies, potentially identifying new control strategies for this severely debilitating disease.

Risankizumab-Aggravated Crusted Scabies in a Patient with Down Syndrome.

Risankizumab, an interleukin (IL)-23 antagonist, is a highly effective treatment for moderate to severe psoriasis. Crusted scabies (CS) is a rare and severe form of scabies, occurring mainly in immunosuppressed patients and/or neurologically or mentally ill patients. A young girl with Down syndrome was diagnosed with a hyperkeratotic form of psoriasis. As treatment with topical dermocorticosteroids, UVB-phototherapy and acitretin for 6 weeks did not improve the lesions, two injections of risankizumab were administered. Following these injections, the lesions became rapidly even more severely crusted, and new lesions appeared on the extremities and the face of the patient. There was histological evidence of a high charge of scabies, leading to a diagnosis of CS. The patient was hospitalized and successfully treated by local permethrine and systemic ivermectine. This case suggests that even though anti-IL23 antagonists display an excellent overall safety profile, a particular caution for infections should still be respected in patients with underlying risk factors.

Disseminated Cutaneous Mycobacterium Haemophilum Infection and Concomitant Crusted Scabies in an Iatrogenically Immunocompromised Patient - A Case Report

Mycobacterium haemophilum and crusted scabies are rare cutaneous diseases reported in distinct immunocompromised hosts. M. haemophilum is a skin and soft tissue infection, whereas crusted scabies is an infestation of the skin. Whereas scabies infestation is readily diagnosed, M. haemophilum infection poses a diagnostic challenge due to its rarity as well as varied clinical and histologic presentations. Although both scabies infestation and M. haemophilum have been reported in the literature separately, to our knowledge no previous reports have described these diseases occurring simultaneously in an iatrogenically immunosuppressed patient. We report herein a rare case of concomitant M. haemophilum and scabies infestation in a 38-year-old woman with dermatomyositis on multiple immunosuppressive agents.

More than a Mite Contagious: Crusted Scabies

More than a Mite Contagious: Crusted Scabies

Norwegian (Crusted) Scabies

A 64 year old lady presented with generalised itchy rash which was worse at night. She was a known case of Acquired Immune Deficiency Syndrome (AIDS). Clinically, there was marked crusting over the interdigital web spaces of the hands (Figure 1), ears (Figure 2), wrists and genitalia. Skin scrapings under light microscopy showed mites and scybala. Twenty to twenty five percent (25%) benzyl benzoate is an effective and inexpensive treatment [1]. A single overnight application is effective in most cases, but a second application 2 to 7 days later is usually advisable. Of primary importance is the necessity for strict contact precautions during the period of hospitalization [2].

A case report of crusted scabies in an adult patient with Down syndrome

Crusted (Norwegian) scabies is a severe manifestation of the contagious skin infection caused by Sarcoptes scabiei. Crusted scabies has been well described in patients with known immunocompromised states. Treatment may be complicated by delayed diagnosis and/or inadequate treatment. This infection may not rank highly on one's differential diagnosis in the absence of an immunocompromised state, highlighting the uniqueness of the case being presented. Several papers describe immunocompromised children with Down syndrome who are infected with crusted scabies. We present a case of infection in an adult with Down syndrome without evidence of an immunocompromised state. Our patient came to us with a 13-month history of progressively worsening symptoms, the last 4-6 weeks of that time period being most dramatic, despite various treatments. We performed tissue biopsy, culture, and laboratory evaluations, which revealed numerous mites and bacterial superinfection. Crusted scabies infection may occur in adult age individuals with Down syndrome regardless of immune status, leading us to encourage practitioners to consider this condition when presented with patients of this population. We also highlight the need for further exploration of disease prevalence in this patient population.

Diagnóstico por Teledermatologia em paciente do Alto Rio Solimões: um caso de escabiose crostosa

Teledermatology uses telecommunication technology and informatics on dermatologic practice without the presence of a specialist. This paper describes the diagnostic process of a Crusted Scabies (Norwegian Scabies) case in an elderly patient from the Alto Solimoes River region using teledermatology resources. Moreover, the authors discuss the progress of these technologies, which allow healthcare assistance for those living in remote indigenous and riverine communities, particularly in isolated areas of the Legal Amazon where many diseases are neglected or underdiagnosed.

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.

Crusted Scabies in the Burned Patient

The objectives of this study were 1) to describe a case of crusted scabies (CS) in a burned patient, which was primarily undiagnosed and led to a nosocomial outbreak in the burn unit; 2) to analyze and discuss the difficulties in diagnosing and treating this subset of patients with burn injury; and 3) to design a treatment strategy for future patients. Case analysis and literature review were performed. The index patient had undiagnosed crusted scabies (sive Scabies norvegica) with the ensuing mite hyperinfestation when admitted to the department with minor acute dermal burns. Conservative healing and autograft healing were impaired because of the condition. Successful treatment of the burns was only accomplished secondarily to scabicide treatment. An outbreak of scabies among staff members indirectly led to diagnosis. CS is ubiquitous, and diagnosis may be difficult. This is the first report of a burned patient with CS in the English language literature. CS is also highly contagious and may lead to a nosocomial outbreak. Furthermore, CS seems to have a detrimental impact on the burned patient's course of treatment. A scabicide treatment is necessary to guarantee successful treatment of the burns.