Crusted scabies of the scalp in dermatomyositis patients: three cases treated with oral ivermectin

Background Cutaneous features in the scalp area among adult patients are rarely considered as a manifestation of scabies.
Methods Three patients with clinical and laboratory data of dermatomyositis with scalp involvement (fulfill three or four of Bohan and Peter's criteria), of 4 years, 8 months, and 3 years duration, were seen at our department between 1995 and 1996. For relapses of ordinary scabies, they were treated repeatedly with local scabicide with temporary effect. After a symptom-free period during the treatment of dermatomyositis with corticosteroids and azathioprine, they developed diffuse redness with scales and crusts on the scalp areas. Light microscopy examination of material taken from these crusts showed an abundance of live mites.
Results All patients were successfully cured of scabies with a twice oral dose of 200 μg/kg ivermectin within 8 days.
Conclusions Our patients with crusted scabies of the scalp and dermatomyositis prompted us to change our standard diagnostic and therapeutic regimens. Fascinating features included mimicry of scabies in patients with dermatomyositis, location of parasites on the scalp, suppressed cell-mediated immunity and successful cure of mange by ivermectin.     

Crusted (Norwegian) scabies. Occurrence in a child undergoing a bone marrow transplant

A case of crusted (Norwegian) scabies is reported in a child who was a recipient of a bone marrow transplant. The infestation is presumed to have predated the bone marrow transplant and continued asymptomatically during chemotherapy and total body x-irradiation in preparation for transplant. The child was asymptomatic until 23 days after transplantation, when bone marrow engraftment was attained. The altered host-parasite relationship is emphasized by the observation that the onset of symptomatic pruritus coincided with successful engraftment.     

The use of ivermectin in controlling an outbreak of scabies in a prison

BACKGROUND: Ivermectin is a potentially useful treatment for scabies. OBJECTIVES: We aimed to evaluate the efficacy of ivermectin in the treatment of scabies in an institutional environment. METHODS: A single dose of ivermectin 150 microg kg-1 was given under supervision to 1153 prisoners in a prison in northern Tanzania where there was an outbreak of scabies. RESULTS: Thirty per cent of the prisoners were cured after 1 week, 88% after 4 weeks and 95.5% after 8 weeks. Of 16 prisoners with crusted scabies, seven (44%) still had scabies after 8 weeks. Those who were not cured were then treated with 1% lindane lotion topically, as were the prison staff who had scabies. This regimen eradicated scabies from the prison for the next 2 years. CONCLUSIONS: Ivermectin is an effective and safe treatment for scabies, particularly in a closed community, such as a prison, where it is easy to administer and avoids problems with compliance. It was of limited efficiency in crusted scabies as a single dose and we recommend that for such patients oral ivermectin is used in combination with a topical scabicide.     

Successful use of ivermectin in the treatment of endemic scabies in a nursing home

Ivermectin, an antiparasitic agent, was successfully used as a sole agent to combat endemic scabies in a closed 33-bed ward of a rural nursing home. Previous topical therapies, including multiple applications of permethrin, -γ-benzene hexachloride, benzyl benzoate and precipitated sulfur in white soft paraffin, had failed. Several patients exhibited hyperkeratotic crusted scabies with head and neck involvement and all residents except one recently arrived resident had evidence of active infestation. All residents were treated with 200 μg/kg of ivermectin and this dose was repeated 2 weeks later in all subjects. Four weeks after the first dose of ivermectin there was no evidence of active scabies and all rashes were totally resolved by 6 weeks. The action of ivermectin, its safety and its indications are discussed.     

Atypical crusted "Norwegian" scabies: report of nosocomial transmission in a community hospital and an approach to control

During August, 1981, a person with an unrecognized case of atypical Norwegian scabies was admitted to a community hospital in Chariton, Iowa. Twenty cases of symptomatic scabies were reported among hospital staff; mites were recovered from four. Subsequent evaluation confirmed scabies transmission to family and friends of this patient before hospitalization; twelve cases of symptomatic scabies, three of them slide positive, were identified in this group. The patient was treated sequentially with 1 percent lindane lotion, 10 percent crotamiton lotion, and 6 percent sulfur ointment to successfully eradicate the infestation. Secondary cases in the hospital and community were treated with 10 percent crotamiton which also was used to prophylactically treat exposed contacts. Control measures and patient management are presented.     

Use of ivermectin for the management of scabies in a nursing home.

Ivermectin was used for the treatment of a scabies outbreak in a nursing home. Among the 128 residents, 42 presented pruritus or cutaneous lesions and scabies was parasitologically demonstrated in seven patients. All residents were treated with two 12 mg doses of ivermectin given two weeks apart. Ivermectin treatment associated with procedures for environmental disinfection led to the control of the outbreak. In only one case, was there a failure of the treatment. It is concluded that oral ivermectin is an effective and practical therapy for scabies in nursing homes.     

Probiotics: potential to prevent HIV and sexually transmitted infections in women

Women are at significant risk of human immunodeficiency virus (HIV) and sexually transmitted infection (STI) acquisition with the genital mucosa serving as the main portal of infection. Exogenously supplied lactobacillus used as a probiotic may prove a cost-effective, female-initiated method to prevent HIV and STI infection in women. A probiotic may act indirectly through treating and preventing recurrent bacterial vaginosis or directly by secreting endogenous (e.g., hydrogen peroxide) and exogenous substances that block HIV and STI transmission. This review summarizes the preclinical and clinical studies that have been conducted so far to test probiotic bacteria for these purposes. Although significant progress has been made in this field, more fundamental research is required to better understand vaginal ecology to maximize probiotic formulations. Once identified, a suitable product will require testing in a well-designed, randomized, placebo-controlled trial to measure its effectiveness in augmenting antibiotic treatment to prevent bacterial vaginosis. If results from such a trial demonstrate efficacy, future studies should be designed to determine whether a probiotic can significantly lower the risk for HIV and STIs in at-risk female populations.     

Host-parasite relationships in hyperkeratotic (Norwegian) scabies: pathological and immunological findings

The dynamics of intraepidermal penetration of the scabies mite and the host's responses to the invaders have been studied in hyperkeratotic scabies. Contrary to the generally accepted view, the mites progressed not only through the stratum corneum but also into the underlying epidermis and even occasionally to the dermo-epidermal interface. Morphological evidence of reactive processes included parakeratosis surrounding the burrows, psoriasiform hyperplasia with increased basal cell labelling indices and exocytosis of mononuclear cells. ³H-Thymidine labelling indices of immunocompetent cells of the dermal infiltrate reached levels found in allergic patch test reactions and were in both cases higher than in non-immune-specific inflammatory processes. The labelling index of peripheral blood lymphocytes showed an increased ratio of B cells to T cells as compared to controls or patients with allergic contact dermatitis. Serum C1q fixation was higher than in untreated patients with common scabies. These results support our previous findings of immunological activation in hosts infested by the scabies mite.     

HIV infection and STD in drug addicted prostitutes in Amsterdam: potential for heterosexual HIV transmission.

To assess the potential role of drug using prostitutes in the heterosexual transmission of human immunodeficiency virus (HIV), 117 prostitutes, recruited from December 1985 to November 1987 at a weekly evening sexually transmitted diseases (STD) clinic for drug using prostitutes only, were studied for the prevalence of HIV and STD. Intravenous drug use was reported by 96 (82%) of the women. Antibody to HIV was found in 35/117 (30%) women, all but one of whom had been using drugs intravenously. Most (73, 62%) of the prostitutes reported having had more than 2000 clients each in the preceding five years. In the six months preceding enrollment to the study they had practised mainly vaginal (106/117) and orogenital (82/117) intercourse; 90% (105/117) reported frequent use of condoms in vaginal intercourse and 65% (68/105) in orogenital intercourse. Despite frequent condom use, 81% (84/104) contracted one or more STD in this period. Considering the high incidence of HIV and STD and the finding by others that the presence of STD may facilitate transmission of HIV, we conclude that the potential for HIV transmission from these prostitutes to their clients (and vice versa) was clearly present.     

Heterosexual HIV transmission and STD prevalence: predictions of a theoretical model

BACKGROUND: Previous studies suggest that concurrent sexually transmitted infection may enhance HIV transmission. This paper explores some theoretical consequences of this using a mathematical model of transmission of HIV and other STD pathogens. OBJECTIVES: To develop a deterministic mathematical model to describe the heterosexual transmission dynamics of both HIV and a bacterial STD. STUDY DESIGN: We used survey derived estimates of sexual behaviour in a young heterosexual London population in our deterministic mathematical model to estimate the effects on an HIV epidemic of different levels of STD prevalence in such a population. RESULTS: We show that the predictions of the model are plausible and suggest that, even under conditions both of low STD prevalence and of low HIV transmission enhancement, a substantial proportion of HIV transmission events may be attributable to concurrent STD. CONCLUSIONS: It is likely that epidemics of heterosexually transmitted HIV infection in industrialised countries have been limited in size by the relative success of efforts to control STD. None the less, a significant proportion of heterosexual transmission events which do occur may be attributable to concurrent STD. In developing countries, cheap and simple STD care is likely to be a highly cost effective strategy to prevent HIV transmission.     

Presentation, pathology, and outcome of HIV associated renal disease in a specialist centre for HIV/AIDS

OBJECTIVES: To describe the presentation, pathology, and outcome of biopsy proved renal disease in HIV infected patients at a central London HIV unit from 1992 to 1996. METHODS: Retrospective review of a computerised database and case notes to identify patients with renal disease confirmed by antemortem percutaneous renal biopsy or necropsy. RESULTS: 17 patients were identified, 13 had biopsy and four necropsy confirmed renal disease. Abnormalities included HIV associated nephropathy (HIVAN) in seven (41%) patients, membranous glomerulonephritis (GN) in four (23%), haemolytic uraemic syndrome (HUS) in two (12%), and interstitial nephritis, rhabdomyolysis, IgA nephropathy, and membranoproliferative GN in one patient each. Although renal disease was the first presentation of HIV disease in six (35%) patients the majority had advanced HIV disease (median CD4 count 40 x 10(6)/l). The commonest presentation was acute renal failure (ARF) in 10 (59%) patients, chronic renal failure (CRF) in five (29%), and proteinuria alone in two (12%). Although the majority of patients died during the study period (9/13) only three deaths were attributable to their renal disease. Survival ranged in those with HIVAN from 0 to 31 (median 10) months and, in those with membraneous GN from 1 to 46 (median 29) months. CONCLUSIONS: HIVAN was the commonest renal disease found in this group of patients; however, a variety of other pathologies were seen with variable outcomes. All cases of HIVAN were in patients of African or Afro-Caribbean origin and for the majority this was their first presentation of HIV disease. Nephrologists need to be aware of the possibility of HIV infection in patients presenting with renal disease.