Sarcoptes Scabiei Var Research Articles

Systematic review of the diagnosis of scabies in therapeutic trials.

Human scabies (infestation with the mite Sarcoptes scabiei var hominis) causes a significant disease burden worldwide, yet there are no agreed diagnostic guidelines. We aimed to determine whether a consistent approach to diagnosing scabies has been used for published scabies therapeutic trials. The data sources used were the MEDLINE, Embase and Cochrane databases, from 1946 to 29 August 2013. Eligible studies were trials of therapeutic interventions against scabies in human subjects, published in English, enrolling patients with scabies, and using various therapeutic interventions. Language was a limitation of this study as some relevant trials published in languages other than English may have been excluded. Each study was reviewed by two independent authors, who assessed the clinical examination and testing approaches used for scabies diagnosis in the included studies. We found that of 71 included trials, 40 (56%) specified which clinical findings were used for diagnosis, which were predominantly rash, rash distribution, pruritus and mite burrows. Parasitological testing was used in 63% of trials (n = 45) and was used more frequently in clinic-based than in field studies. Nearly one-quarter of trials (24%, n = 17) did not define the diagnostic method used. Overall, the diagnostic approaches were poorly described, prohibiting accurate comparison of existing studies. This review further supports the need for consensus diagnostic guidelines for scabies.

Skabies

Scabies is a human skin infestation caused by the infestations and sensitization of the parasitic Sarcoptes scabiei var. hominis.Scabies has been spread around in the world especially in the tropics and subtropics. There are several types of clinical manifestation. Thediagnosis is based on a history of itching at night, a typical distribution of lesions, history of similiar complaints in other family members.Diagnosis must be established with the discovery of mites on microscopic examination that can be done in various ways. The are numberof topical treatments for scabies. The selections of drug based on effectivenes potential toxicity of drugs and how to use the proper.

Evaluation of Acaricidal Effect of Ethnoveteinary Medicinal Plant by in vivo and in vitro against Sarcoptes scabiei var. caprae of Infected Goats in North Shoa, Oromia Regional State, Ethiopia

This study was conducted to determine parasiticidal efficacy of seven ethnomedicinal plants against Sarcoptes scabiei var. caprae of goats using in vivo and in vitro techniques. In vitro techniques for evaluation of efficacy of medicinal plants essential oils and fixed oils of seven medicinal plant extracts diluted at different concentrations (essential oils from 2.5% to 0.15625% and fixed oils from 160 mg/ml to 5 mg/ml) were added to petridishes containing adult stage of Sarcoptes scabiei var. caprae. After 3 h of contact, all concentrations of essential oil of Eucalyptus globulus and Cymbopogon citractus showed a good in vitro acaricidal efficacy as compared with the non-treated controls (p 0.05) difference was never observed in mite count, Mean Recovery Response (MRR) and degree of Skin Lesion Quality (SLQ) between goats treated with plant extracts and those treated with diazinone and ivermectin. Therefore, Eucalyptus globulus and Cymbopogon citractus extracts should be licensed for the treatment of Sarcoptes scabiei var. caprae.

Risk factors for prevalence of pig parasitoses in Mbeya Region, Tanzania

A cross-sectional study was carried out to determine risk factors for prevalence of common endo- and ectoparasites of pigs kept by smallholder farmers in Mbozi and Mbeya (Rural) districts of Mbeya Region, in Tanzania. A total of 482 pigs from 220 households of 16 villages, eight in each district were randomly selected and examined. Prevalence of Taenia solium cysticercosis was 11.5%, gastrointestinal nematodes 63.7% and ectoparasites 21.2% based on Ag-ELISA, McMaster technique and full body searches/ear scrapings, respectively. Nematode eggs identified were strongyles (Oesophagostomum spp. and Trichostrongylus spp.), Ascaris suum, Trichuris suis and Strongyloides ransomi with prevalence of 57.4%, 17.5%, 5.3% and 1.1%, respectively. Four groups of ectoparasites were identified, i.e. lice (Haematopinus suis), ticks (Rhipicephalus spp., Amblyomma spp., Haemaphysalis spp. and Boophilus spp.), fleas (Ctenocephalides canis) and mites (Sarcoptes scabiei var. suis and Demodex phylloides), with prevalence of 19.1%, 2.1%, 0.4%, and 1.2%, respectively. Pigs in Mbeya (Rural) District had higher odds for porcine cysticercosis (OR=2.63, 95% CI: [1.22–5.55]). Poor pen hygiene and infrequent antiparasitic treatment were identified to be risk factors for prevalence of nematode infections (OR=1.95 [1.09–3.52] and OR=1.78 [1.06–2.94], respectively). The odds for high nematode burdens increased in cases of poor pen hygiene (OR=4.20 [2.54–6.62]) and poor feed quality (OR=3.7 [1.66–8.33]). Pigs not treated with antiparasitic drugs within the last three months had higher odds for ectoparasite (OR=4.0 [1.78–9.09]) and lice infestations (OR=8.33 [1.96–14.28]) than treated pigs. This study has shown that parasitoses constitute a major burden for smallholder pigs in Mbeya Region and major risk factors included infrequent antiparasitic treatment, poor pen hygiene and poor feed quality. Cost-effective intervention strategies are needed to improve pork production, secure pig welfare and ensure safe pork for human consumption.

Scabies: Clinical manifestations and diagnosis

Abstract Introduction Scabies is an infectious disease caused by an obligate parasite of human skin – Sarcoptes scabiei var. hominis. The disease affects people regardless of their age, sex or socioeconomic status. The transmission occurs mainly through direct contact with an infected person as well as personal items including clothes, bedclothes, etc. Aim The aim of the paper is to present a variety of clinical manifestations of scabies as well as diagnostic methods used. Discussion The diagnosis of scabies can often times be difficult, especially if there are concurrent diseases, with pruritus being a symptom. The skin lesions may vary in appearance, depending on the local and general immune response. The diagnosis rests on finding characteristic signs of the disease accompanied by the pruritus becoming particularly intense at night. The use of various diagnostic tools allows for confirmation of the diagnosis, with varied sensitivity and specificity, which is based on confirmation of the presence of the parasite. Conclusions Scabies still remains a major public health problem worldwide. Research is hindered mainly due to difficulty in obtaining the material from infested people as well as a lack of an in vitro system. To date, there is no diagnostic method for detecting scabies infection, which would give a 100% reliable result. Each of the methods mentioned above has some limitations in use. It seems that the sensitivity of those methods will vary, depending on a patient's clinical features.

Superficial fibrin thrombi … and other findings: a review of the histopathology of human scabietic infections.

Cutaneous infection with the mite Sarcoptes scabiei var. hominis is associated with epidermal and dermal changes. After noting superficial fibrin thrombi in two biopsies with scabies mites, we comprehensively reviewed the histopathologic findings in scabietic infections to determine the frequency of this finding. Twenty five biopsies of scabies infection were retrieved from the archives of our institution; only cases containing scabietic mite parts or scybala were included. The microscopic features were documented. Nearly half (40%) of the cases showed fibrin thrombi within vessels of the superficial dermis. Other frequent findings included dermal eosinophils (88% of cases), epidermal spongiosis (76% of cases), lymphocyte atypia (64%), a superficial and deep infiltrate (52% of cases), dermal neutrophils (52%) and endothelial cell swelling (52%). Half of the cases contained polarizable mite elements. Less commonly encountered features included extravasated erythrocytes (44%), dermal edema (32%), pink 'pigtails'(28%), intraepidermal pustules (24%), plasma cells (20%) and vasculitis (4%). The pathologic characteristics of scabietic infection are wide-ranging. Spongiosis, superficial and deep inflammation, and dermal eosinophils and neutrophils are seen in the majority of cases. Superficial fibrin thrombi are not uncommon in scabietic infection, and may provide a helpful diagnostic clue when mites are not visible on initial sections.

English

A cross-sectional study was undertakento estimate the prevalence of internal and external parasites of camels slaughtered at Addis Ababa abattoir, Ethiopia. A total of 384 of camels originating from Borena and Metehara areas were examined during the study period and all (100%) of them were found to harbor at least two parasite species. In this study,the prevalence of tick, gastrointestinal parasites, Cephalopinatitillator,Hydatid cyst, and Sarcoptesscabiei var. cameliwere 100, 95.6, 68.2, 65 and 35.4%, respectively. The gastrointestinal parasite’s ova/oocyte identified includeStrongylus species, Trichurisspecies, Strongyloidesspecies and coccidiaat prevalence of 78.1, 47.1, 44.5 and 25.3%, respectively. Of the total 1347 pooled samples of tick collected from 40 randomly selected camels.Rhipicephaluspulchelis, Rhipicephalusevertsievertsi, Hyalomma dromedary, Amblyommagemma,Amblyommavariegatum and Boophilusdecolaratuswere identified at a proportion of 53.90, 21.01, 13.66, 7.5, 3.19 and 0.74%, respectively. The average tick burden from half body region of camels was 33.7 ± 6.24 (range 26 to 53).In general, this study indicates that parasites are still the major problems hindering the productivity and health of camels, hence implementation of strategic control measures and further studies are recommended to reduce the effect of parasites on camel health and productivity. Key words: Abattoir, Addis Ababa,Ethiopia, camel,Cephalopinatitillator,gastrointestinal parasite,Hydatid cysts,Sarcoptesscabieivar.cameli,tick.

Treatment and control of bovine sarcoptic and psoroptic mange infestation with ivermectin long-acting injectable (IVOMEC(®) GOLD).

The efficacy of ivermectin long-acting injection (IVM LAI, IVOMEC® GOLD, Merial; 3.15 % ivermectin w/v) formulation was evaluated in cattle with induced Sarcoptes scabiei var. bovis or Psoroptes ovis infestations. A total of 64 cattle were included in this series of four studies, with 16 animals per study. Approximately, 8 weeks following initial induced mite infestation, cattle were allocated to treatment groups based on decreasing pre-treatment bodyweights. Treatments (saline (control) or IVM LAI (630 mcg ivermectin/kg bodyweight) at 1 mL/50 kg bodyweight) were administered by a single subcutaneous injection in front of the right shoulder on Day 0. Skin scrapings were collected prior to treatment and at approximately weekly intervals for 8 weeks thereafter to establish live mite counts. Character and extent of skin lesions were evaluated at each sampling. Animals were weighed before treatment and at the end of the studies. Mite counts of the IVM LAI-treated animals were significantly (p < 0.05) lower than those of the controls in all four studies at all occasions post-treatment. In the two Sarcoptes studies, IVM LAI-treated cattle were free of mites at 14 days after treatment and in the Psoroptes studies at 13 or 28 days post-treatment. All IVM LAI-treated cattle remained free of mites to the end of the studies while all control animals remained infested. Mange lesions of the IVM LAI-treated animals improved significantly (p < 0.05) compared to those of the controls from Day 21 (Sarcoptes studies) and from Days 28 or 34 (Psoroptes studies). In all studies, mean weight gain over the 8 week post-treatment period was significantly (p < 0.05) higher for the IVM LAI-treated animals than for the controls: Sarcoptes studies, 64.1 and 68.6 kg vs. 46.9 and 48.6 kg, respectively; Psoroptes studies, 43.0 and 43.4 kg vs. 20.8 and 34.9 kg, respectively. All animals accepted the treatment well, and no treatment-related health problems and adverse events were observed throughout the studies. These studies demonstrated the high efficacy of IVOMEC® GOLD against sarcoptic and psoroptic mange in cattle.

Crusted Scabies Misdiagnosed as Erythrodermic Psoriasis in a 3‐Year‐Old Girl with Down Syndrome

Scabies is a highly contagious infestation with the Sarcoptes scabiei var hominis mite. The variety of clinical presentations make timely, accurate diagnosis problematic. We report the case of a 3-year-old girl with Down syndrome and crusted scabies initially misdiagnosed as erythrodermic psoriasis.

Acaricidal properties of an Ailanthus altissima bark extract against Psoroptes cuniculi and Sarcoptes scabiei var. cuniculi in vitro

The potential acaricidal properties of an Ailanthus altissima bark extract were assessed against two common species of animal ectoparasitic mites, Psoroptes cuniculi and Sarcoptes scabiei var. cuniculi, in vitro. A. altissima bark extract was obtained by ethanol thermal circumfluence and tested at four concentrations (1.0, 0.5, 0.25 and 0.125 g/ml) on mites collected from rabbits. Compared to the fenvalerate treatment group, the A. altissima bark exhibited significant acaricidal properties for both mite species treated. The extract of concentrations of 1.0, 0.5 and 0.25 g/ml killed all tested S. scabiei within 7 h, however, only 1.0 and 0.5 g/ml of extract killed all treated P. cuniculi. The median lethal time (LT50) values at 1, 0.5 and 0.25 g/ml were 0.60, 0.78, 1.48 h for S. scabiei and 0.74, 1.29, 3.33 h for P. cuniculi. The median lethal concentration (LC50) for P. cuniculi was approximately 1.6 times that for S. scabiei var. cuniculi at 4 h. The extract showed stronger toxicity against S. scabiei than against P. cuniculi. Mortality rates increased with increasing concentration of extract administered and with increasing time post-treatment, indicating that the acaricidal activity of A. altissima bark extract is both time-dependent and dose-dependent. This is the first report on acaricidal activity of A. altissima against P. cuniculi and S. scabiei var. cuniculi. It indicates that A. altissima contain potential acaricidal compounds. Our study is the first step to develop potentially novel compounds from A. altissima for the effective control of mites in livestock.

Toward the Global Control of Human Scabies: Introducing the International Alliance for the Control of Scabies

Scabies, the human skin disease caused by infestation by the mite Sarcoptes scabiei var. hominis, causes considerable morbidity and mortality through direct effects and as a result of secondary bacterial infection. Scabies is a truly neglected disease, largely absent from the global health agenda, and its huge burden of disease is largely underappreciated. We contend that coordinated, global efforts to control this ubiquitous pathogenic mite are both important and achievable.

Porcine ear necrosis syndrome: A preliminary investigation of putative infectious agents in piglets and mycotoxins in feed

The aim of this study was to identify the causative factors of porcine ear necrosis syndrome (PENS) in 72 pigs, 5.5-10 weeks in age housed on nine farms. Biopsy samples of ear pinnae were collected from all piglets for bacteriology, histopathology and in situ hybridization for porcine circovirus type 2 (PCV2). At the same time, serum samples were taken for serological analysis and viral PCR, and feed was sampled for mycotoxin analysis. The initial lesion of PENS seemed to be a focal epidermal necrosis. Streptococci were isolated from 44 and staphylococci from 36 pinnae. PCV2 could not be detected by in situ hybridization or qPCR. Seven piglets were positive for porcine reproductive and respiratory syndrome virus, and one for Mycoplasma suis. One piglet had antibodies against Sarcoptes scabiei var. suis. No infectious agents were found in 15 samples. Positive virology and parasitology were often found alongside positive bacteriology. Deoxynivalenol, zearalenone and ergot alkaloids were detected in feed. The findings suggest that PENS is multifactorial in origin and that although infectious agents can be involved in the development of the syndrome they are not the exclusive triggering factor.

Clinical Pearls in Dermatology

Clinical Pearls in Dermatology

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.

Determination of oxidative status and apoptosis in peripheral blood of dogs with sarcoptic mange

The aim of the present study was to determine the erythrocytic oxidant/antioxidant balance and apoptosis of peripheral blood leukocytes of dogs with natural Sarcoptes scabiei var. canis mite infestation. A total of twenty four clinically Sarcoptes-infested dogs were examined and used to execute the study. While another twenty four healthy dogs free of any ecto-parasite were used as controls. Peripheral blood samples were obtained from each infested only once on the day of dermatological examinations. Determination of oxidant/antioxidant balance was conceded by estimating the levels of lipid peroxides and antioxidants in erythrocytes. While, apoptosis of peripheral blood leukocytes was determined by estimating externalization of phosphatidylserine (PS) at the cell surface as well as by detection of depolarization mitochondrial membrane potential (Δ Ψm) by flow cytometry. Sarcoptes-infested dogs had revealed significantly higher ( P ≤ 0.001) contents of erythrocytic lipid peroxides in comparison with the healthy controls. Whereas the level of reduced glutathione was found to be significantly lower ( P ≤ 0.001) in Sarcoptes-infested dogs as compared to the healthy dogs. The activity of glutathione peroxidase was found to be significantly lower ( P ≤ 0.001) in Sarcoptes-infested dogs as compared to the healthy dogs. The activity of glutathione-S-transferase was also found to be significantly lower ( P ≤ 0.001) in Sarcoptes-infested dogs as compared to the healthy dogs. The dogs with sarcoptic mange had revealed significantly lower ( P ≤ 0.001) activity of superoxide dismutase in coparision with the healthy dogs. The dogs with sarcoptic mange had also revealed significantly lower ( P ≤ 0.001) activity of catalase in coparision with the healthy dogs. The percentage of apoptotic leukocytes was found to be significantly higher ( P ≤ 0.001) in Sarcoptes-infested dogs as compared to the healthy controls. Sarcoptes-infested dogs had also exhibited significantly ( P ≤ 0.001) higher percentage of leukocytes with depolarized mitochondrial membrane potential in comparison with the healthy controls. It is concluded that significant alteration in oxidant/antioxidant balance and increased rate of apoptosis in peripheral leukocytes may be implicated in the pathogenesis of clinical Sarcoptes mite infestation in dogs.

Ectoparasites of small ruminants in three selected agro-ecological sites of Tigray Region, Ethiopia

A study on ectoparasites of small ruminants in three selected agro-ecological sites of Tigray Region, Ethiopia disclosed an overall prevalence of 55.5% and 58% in each examined 750 sheep and goats, respectively. In the sheep population, Melophagus ovinus (19.1%), tick infestations (16%), Damalinia ovis (15.3%), Linognathus africanus (11.5%), and Ctenocephalides felis (9%) were the major ectoparasites. The major ectoparasites identified in goats were tick infestations (29.7%), L. africanus (27.9%), Sarcoptes scabiei var. caprae (12.5%), C. felis (11.1%), and Demodex caprae (6.8%). In sheep, there was a statistically significant difference (P < 0.001) in the prevalence of Damalinia ovis, M. ovinus, L. africanus, and ticks between midland and highland. In goats, the risk of Sarcoptes scabiei var. caprae infestation in midland (odds ratio (OR) = 17.2, P < 0.001) and lowland (OR = 5.2, P < 0.001) was 17.2 times and 5.2 times, respectively, higher than the highland. Favorable climatic conditions, backward level of management, poor level of consciousness and awareness of farmers, and weak animal health extension services are believed to have contributed for widespread distribution and occurrences of ectoparasites. The growing threat of ectoparasites to small ruminant production and the tanning industry needs well-coordinated and urgent control intervention.

Ectoparasites of dogs and cats in Albania

One hundred eighty-one dogs and 26 short-hair cats from suburban areas around Tirana, Albania were examined for ectoparasite infestation. The dogs were examined on several occasions from 2005 through 2009 representing three seasons: winter (December-February), spring (March-May), and summer (June-August); the cats were examined in late autumn (November). In addition, deep ear swab specimens of 30 dogs were examined for ear mites. The arthropod ectoparasite fauna of the dogs included two tick species (Rhipicephalus sanguineus and Ixodes ricinus), three mite species (Sarcoptes scabiei var. canis, Otodectes cynotis, and Demodex canis), three flea species (Ctenocephalides canis, Ctenocephalides felis, and Pulex irritans), and one louse species (Trichodectes canis). In the dogs, rates of infestation were 23.8% for R. sanguineus, 0.6% for I. ricinus, 4.4% for S. scabiei var. canis, 6.7% for O. cynotis, 0.6% for D. canis, 75.7% for C. canis, 5.0% for C. felis, 8.3% for P. irritans, and 6.6% for T. canis. Mixed infestation with two or three species of ectoparasites was recorded on 38.1% of the dogs. Fleas infested 75.7% dogs (geometric mean, 3.96; range, 1-80) and were observed in winter, spring, and summer with increasing prevalences of 64.3%, 75.9%, and 100%. Ticks parasitized 24.3% of the dogs (geometric mean, 0.41; range, 1-331). R. sanguineus ticks were recorded on 34.2% and 50% of the dogs examined in spring and summer, respectively, but were absent on the dogs during winter except for a single I. ricinus specimen observed. Prevalence of infestation with R. sanguineus, S. scabiei var. canis, C. felis, P. irritans, and T. canis did not differ between dogs < or = 6 months and dogs > 6 months of age; however, prevalence of infestation with C. canis was significantly (p < 0.01) higher in dogs > 6 months old. There was no difference between the sexes for the prevalences of infestation with those parasites. The examination of the cats revealed infestation with only one species of ectoparasite, C. felis (prevalence, 100%; geometric mean, 2.5; range, 1-9).

Scabies

Scabies is an ectoparasite caused by the mite Sarcoptes scabiei var hominis, an obligate human parasite. There are about 300 million cases of scabies in the world each year. Common predisposing factors are overcrowding, immigration, poor hygiene, poor nutritional status, homelessness, dementia, and sexual contact. Direct skin-to-skin contact between 15 and 20 minutes is needed to transfer the mites from one person to another. The diagnosis suspected with a clinical history of itch, worse at night, affecting other family members, clinical distribution, and appearance. Definite diagnosis relies on microscopic identification of the mites, eggs, or fecal pellets with 10% potassium hydroxide, ink enhancement, tetracycline fluorescence tests, or mineral oil; other methods include: epiluminescence light microscopy and S. scabiei DNA. The most commonly used treatment modalities are permethrin and ivermectin. Persistence of symptoms for 2-6 weeks after successful treatment is common. Most recurrences are because of reinfection from untreated contacts.

Sarcoptes scabiei var. hominis: Three-dimensional structure of a female imago and crusted scabies lesions by X-ray micro-CT

The three-dimensional structure of scabies mites ( Sarcoptes scabiei var. hominis) and keratin layers affected by crusted scabies lesions were obtained using X-ray computed tomography at sub-micrometer and micrometer resolution, respectively (X-ray micro-CT). Clear three-dimensional images including internal structure of scabies mites were obtained. Utilizing reconstructed micro-CT data, the sections of the capitulum (head part), digestive organs, and legs are shown. The reconstructed capitulum shows a jaw-like structure capable of penetrating the keratin layer of the skin. The tip of the forelegs of female scabies mites has a flat disk structure that may be used to grasp the skin surface. The keratin layer of a crusted scabies lesion spontaneously exfoliated from a patient was also reconstructed by the X-ray micro-CT technique. Extracted sections from CT data revealed a network structure of tunnels made by scabies mites with numerous larvae and eggs inside the tunnels.

Recognition and Management of Common Ectoparasitic Diseases in Travelers

This review article summarizes the ectoparasitic diseases likely to be seen by a Western dermatologist. The article aims to cover both endemic diseases and those likely to present in the returning traveler. Tungiasis is due to the gravid sand flea (Tunga penetrans) embedding into the stratum corneum of a human host. As the flea is a ground dweller, lesions are usually present on the feet and are classically periungual. The sand flea is eventually shed spontaneously but to reduce the infection risk, early surgical removal is recommended. Infestation by the Diptera species of fly causes myiasis, which may be primary, secondary, or accidental. The botfly (Dermatobia hominis) is one of the causes of primary myiasis covered in this article. Traditionally, botfly larvae are forced to partially emerge by occluding the breathing apparatus, following which manual extraction can occur. Alternatively, the larvae can be surgically removed. The common bed bug (Cimex lectularius) has experienced a resurgence over the past 10 years. Bites are typically arranged in clusters or a linear fashion and vary from urticated wheals to hemorrhagic blisters. Treatment is symptomatic with antihistamines and topical corticosteroids. In addition, bed bugs need to be eradicated from furniture and soft furnishings. Ticks are part of the Arachnid class of joint-legged animals and can transmit a variety of infections. This article briefly discusses Mediterranean spotted fever, Rocky Mountain spotted fever, and Lyme disease as well as describing tick avoidance measures. Scabies (Sarcoptes scabiei var hominis) is highly contagious and widely distributed around the world. It is common in the returning traveler and can require a high index of suspicion to diagnose. The treatment of choice in the US, UK, and Australia is permethrin 5% dermal cream, applied on two occasions, 1 week apart.