Serie parasitosis en dermatología: escabiosis / Series parasitosis in dermatology: scabies

La escabiosis es una ectoparasitosis pruriginosa producida por el ácaro Sarcoptes scabiei, variedad hominis, específica del ser humano. Si bien su distribución es universal, con frecuencia es subdiagnosticada por asociarla únicamente a hacinamiento y malos hábitos de higiene. Se transmite por contacto directo con una persona afectada o a través de fómites, por lo que es muy común el contagio de los convivientes. Presentamos un caso de escabiosis en una paciente anciana evaluada por prurito generalizado. (AU)

Scabies is a human specific pruritic ectoparasitosis produced by the mite Sarcoptes scabiei var. hominis. Although it has a worldwide distribution, it is often underdiagnosed because it is only associated with overcrowding and poor hygiene. It is transmitted by a direct contact with an affected person or through fomites. The transmission to cohabitants is very common. We present a case of scabies in an elderly patient with generalized pruritus. (AU)

Sarna costrosa / Crusted scabies

La sarna costrosa es una forma infrecuente y contagiosa de escabiosis que se caracteriza por la infestación masiva de ácaros en la superficie de la piel. Muy raras veces se ha descrito esta enfermedad en la población general, por lo general asociada a estados de inmunosupresión o trastornos genéticos con alguna inmunodeficiencia como base. Se describe el caso de dos pacientes con sarna costrosa, el primero correspondiente a una mujer portadora de infección por HTLV-1 y el segundo a una paciente con Síndrome Down.

Crusted scabies is a rare and contagious form of scabies characterized by the massive infestation of mites on the surface of the skin. It has been very rarely described in general population, usually associated to immunosuppression and genetic disorders with an immunodeficiency base. We describe the case of two patients with crusted scabies, the first, a woman with HTLV-1 and the second a patient with Down syndrome.

Acarosis y zoonosis relacionadas / Animal mites transmissible to humans and associated zoonosis

Mites that affect animals (acariasis) can occasionally be transmitted to humans by incidental contact producing pruritus and dermatitis. Animals such as dogs, cats, mice, birds and reptiles, harbour several mite species. Hemophage mites and those that feed on lymph have the potential of transmitting important zoonotic agents (cuales??). The presence of lesions of unclear origin and a history of contact with pets or wild animals should alert towards the possibility of acariasis. Diagnosis is based on direct visualization of the mite,analysis of its morphology and obtaining information on the animal host. Awareness of these acarosis and the responsible care of pets and animals are the most relevant preventive measures.

Los ácaros de animales (acariasis) pueden transmitirse en forma accidental al hombre al estar en contacto con ellos, produciendo lesiones características (pápulas o vesículas) y ocasionando una dermatitis pruriginosa (acarosis). Existen diversas especies de ácaros, que se encuentran en perros, gatos, roedores, aves y reptiles. Los ácaros hematófagos o los que se alimentan de linfa tienen el potencial de transmitir importantes agentes zoonóticos. La presencia de lesiones sin una etiología clara y el antecedente de contacto con animales, tanto mascotas como animales silvestres, ayudan a plantear esta etiología. El diagnóstico se realiza con la visualización del acaro, morfología y tipo de hospedero animal. El conocimiento de estas acarosis y el control responsable de mascotas y animales, son las principales medidas de prevención.

Escabiosis en lactantes / Scabies in infants

Se realizó un estudio descriptivo y transversal de 44 lactantes ingresados por escabiosis en el Hospital Infantil Norte Dr. Juan de la Cruz Martínez Maceira de Santiago de Cuba, durante el primer trimestre del 2007. La investigación reveló que los niños y niñas de 0 - 2 y 3 - 5 meses fueron los más afectados por esa enfermedad cutánea, pero predominantemente los varones. Las lesiones prevalecieron en plantas, palmas y glúteos, sobre todo las clasificadas como vesiculopustulosas. Las abuelas y las madres constituyeron las fuentes de transmisión y el tratamiento prescrito se correspondió con el grado de afectación presentada.

A descriptive and cross-sectional study in 44 infants with scabies admitted to Dr. Juan de la Cruz Martínez Maceira Northern Children Hospital of Santiago de Cuba was conducted during the first trimester of 2007. The investigation revealed that infants between 0 - 2 and 3 - 5 months were the most affected by this skin disorder, predominating the male sex. The lesions prevailed in soles, palms and buttocks, mainly those classified as vesiculopustular. Mothers and grandmothers constituted the transmission sources, and treatment was in correpondence with the degree of involvement.

Brote de sarna en un hospital terciario a partir de un caso de sarna costrosa / An outbreak of scabies in a tertiary-care hospital from a crusted scabies case

Realizamos el estudio epidemiológico de un brote de sarna ocurrido en un hospital terciario, a partir de un caso de sarna costrosa, en febrero de 2005. Detectamos diez casos secundarios; ocho en el personal de salud y dos en pacientes hospitalizados, con una tasa de ataque de 4,1 por ciento. A diferencia de otros brotes, el diagnóstico de sarna costrosa se hizo al ingreso del caso primario al hospital. Las causas del brote fueron: adherencia deficiente a las medidas de aislamiento de contacto, permanencia prolongada del caso primario en sala compartida, y retardo en el inicio del tratamiento específico. Las principales medidas de control fueron: alertar a los servicios sobre el brote, realizar vigilancia epidemiológica, coordinación con la Dirección del Hospital y el Departamento de Salud Ocupacional, capacitar al personal de salud en las medidas de control, instaurar medidas de aislamiento y tratar a los casos y sus contactos con permetrina 5 por ciento loción tópica.

In February 2005 we performed an epidemiological study of an outbreak of scabies in a tertiary-care hospital which started from a crusted scabies case. We detected 10 secondary cases, 8 in healthcare workers and 2 in hospitalized patients. The attack rate was 4.1 percent. In contrast to previously described outbreaks, the crusted scabies case was recognized at admission. The outbreak causes were: lacking adherence to contact precautions, long stay of the primary case in the hospital ward and delay of specific treatment. The main control measures were: alerting the hospital services about the outbreak, performing epidemiologic surveillance, coordinating with the Hospital Direction and the Occupational Health Department, education of healthcare workers in control measures, implementation of isolation measures and treatment of cases and contacts with 5 percent permethrin topical lotion.

Tuberculosis, chickenpox and scabies outbreaks in an orphanage for children with HIV/AIDS in Jamaica

OBJECTIVES: The aim of this study is to describe the investigation and management of outbreaks of acute tuberculosis, varicella zoster virus and scabies in a residential facility for children with HIV/AIDS. METHOD: A review of the results and management for diagnosed cases of acute TB (four between 2001 and 2002) as well as varicella zoster virus (15) and scabies (14) (concurrent in March--June 2003), in a residential facility housing 24 abandoned children with HIV/AIDS was conducted. Outbreak control methods and challenges are described The modified WHO criteria were used for TB diagnosis. The diagnoses of varicella and scabies were entirely clinical. RESULTS: Of the surviving 22 children, 12 (mean age 8 years 2 months) were female, and 10 (mean age 5 years 6 months) were male. Full immunization (primary series) was documented for 16 children, partial in one child, unknown status was documented in five children. One child had received varicella vaccine previously. Eleven (50) children had been receiving antiretroviral triple therapy since 2002 (all in Centers for Diseases Control immunological categories 2-3). Two of the four children with tuberculosis died between 2001 and 2002; these were not on antiretroviral therapy--the 2 survivors are still on antiretroviral therapy. All staff mantoux test results were negative. Fifteen (68) children developed chickenpox as well as three caregivers. The index case was a 13-year-old resident attending a nearby school with HIV negative children. This varicella outbreak went on to affect household members for the caregivers as well as other residential facilities nearby. Scabies affected 14 children (no caregivers); the index cases were most likely three new child residents who entered the institution in 2002 (from other homes) with histories of scabies infestation. Chickenpox and scabies dual infection occurred in seven (31) of residents. No cases of herpes zoster, disseminated varicella infection or death because of varicella occurred Diagnosed cases of chickenpox were treated with oral acyclovir Knowledge about these disease outbreaks and their control was generally lacking. CONCLUSIONS: Improvement in immunization coverage for children and staff as well as educating staff about infectious disease outbreaks, is necessary for effective control. Appropriate screening for infection/disease for all susceptible persons is essential along with timely reporting of outbreaks/reportable diseases. There is need for in

Brote intrahospitalario de escabiasis, a partir de un caso de sarna noruega / Nosocomial outbreak of scabies from a Norwegian scabies case

OBJETIVO: Describir un brote intrahospitalario de escabiasis ocurrido en la Ciudad de México, en agosto de 1999, como resultado de exposición a un caso de sarna noruega no diagnosticado oportunamente. MATERIAL Y MÉTODOS: Después de revisar el caso índice, instituimos aislamiento del paciente e identificamos casos secundarios de escabiasis entre pacientes hospitalizados, empleados que laboraban en el área afectada y sus familiares. Sólo individuos que padecían lesiones dérmicas y prurito fueron incluidos como casos infestados. Se establecieron medidas de control, como aislamiento de contacto, manejo apropiado de ropas contaminadas y tratamiento tópico. RESULTADOS: Un paciente con SIDA (caso índice de sarna noruega) que cursaba con desequilibrio hidroelectrolítico severo fue admitido en el Hospital de Infectología, del Centro Médico Nacional La Raza, del Instituto Mexicano del Seguro Social, del 19 de julio al 20 de agosto de 1999, en la Ciudad de México. Veintiocho días después de su admisión emergieron casos de escabiasis entre los trabajadores de la salud; entonces, se sospechó de escabiasis noruega, lo que se confirmó por evidencia microscópica de los parásitos en una preparación de escamas del caso pista. Identificamos 48 casos secundarios con sarna clínica: 71% trabajadores de la salud, principalmente enfermeras (79%), 23% familiares de trabajadores y 6% pacientes. El periodo de incubación promedio fue de 15 días (intervalo 12 a 27). Aunque con mayor frecuencia las lesiones involucraron extremidades superiores (60%), las manos fueron respetadas. CONCLUSIONES: Este trabajo demuestra no sólo las dificultades para diagnosticar la escabiasis noruega en el hospedero inmunosuprimido, sino también la importancia de estar seguros de que los trabajadores de la salud cumplan con las precauciones estándar en todo momento.

Fatores epidemiológicos de risco associados à escabiose / Epidemiological risk factors associated to scabies

Os autores fazem breve levantamento da atual situaçäo da escabiose, demonstrando sua alta incidência entre as principais afecçöes dermatológicas. Revisam os principais fatores epidemiológicos de risco e discutem sua importância na manutençäo dessa dermatozoonose. Concluem o trabalho ressaltando o papel dos conhecimentos epidemiológicos e de outros fatores intrinsicamente associados à afecçäo para a elaboraçäo de programas dirigidos a seu real e efetivo controle

Escabiasis / Scabies

Se revisan los principales aspectos epidemiológicos, clínicos, inmunológicos, de diagnóstico y terapéuticos; se insiste en las manifestaciones clínicas que caracterizan al padecimiento y en las medidas terapéuticas necesarias para adecuado manejo y control de la escabiasis

Actualidades en Escabiosis / The latest on scabies

Se ofrece una revisión teórica actualizada sobre la terapia, la prevención y el control de la escabiosis a partir de la literatura revisada en las bases de datos MEDLINE, LILACS, y de la Literatura Cubana de Medicina de los años 1987 a 1996; también se incluyen algunos clásicos propios de la temática, localizados en los órganos de información del Sistema Nacional de Información de Ciencias Médicas, así como la carpeta metodológica que contiene el desarrollo de las estrategias del MINSAP para 1996. Se abordan otros aspectos de interés como el modo de transmisión y las manifestaciones clínicas

Scabies: a major health problem among school children in Egypt

To identify the epidemic situation of scabies among primary school children and the effect of scabies infection on school attendance of the diseased pupils in an urban area of Egypt, El Mahalla El Kubra city was chosen as a highly populated one. Six schools were chosen randomly form the three districts of the city and the health records over 5 schoalistic years were analysed. Also, health visitors and mothers of diseased pupils were interviewed. The study confirmed the presence of a new epidemic of scabies. there was progessive increase in the incidence of scabies. It rose during the study period more than two folds and ranked at the top of all reported infectious diseases at the studied schools Moreover, scabies became one of the important diseases, that greatly disturb the school attendance of the affected pupils. In the last schoalistic year [1993 1994],2.7% of scabietic pupils were absent more than one month. A comperhensive program for prevention and control of scabies at the community level is recommended and further researches to investigate the causes of resistant scabies are needed