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)

Dermoscopia da sarna crostosa associada à síndrome da imunodeficiência adquirida / Dermoscopy of Norwegian scabies in a patient with acquired immunodeficiency syndrome

Os autores relatam o caso de uma paciente com sarna norueguesa e síndrome da imunodeficiência adquirida com baixa aderência à terapia antirretroviral. O diagnóstico definitivo foi confirmado pelo exame parasitológico direto. A dermatoscopia mostrou sulcos escabióticos e estruturas acastanhadas em asa-delta já descritas, além de uma estrutura morfologicamente semelhante a um gongolo (diplopodasímile). Esta última representa um elemento patodiagnóstico da SN não previamente descrito. Houve boa reposta clínica ao uso oral da ivermectina e ao uso tópico da vaselina com enxofre a 10 por cento, com concomitante melhora dos parâmetros dermatoscópicos.

The authors report here on the case of a female patient with Norwegian (crusted) scabies and acquired immunodeficiency syndrome whose compliance with antiretroviral therapy was poor. Definitive diagnosis was confirmed by direct microscopic examination, which revealed numerous Sarcoptes scabei. Dermoscopy showed pathognomonic scabetic burrows and brownish structures in the shape of a hand-glider with a millipede-like appearance. The latter constitutes a diagnostic feature in the pathology of Norwegian scabies that has not yet been described. The patient responded well to oral ivermectin and topical vaseline with sulphur at a proportion of 10 percent. There was a simultaneous improvement in dermoscopic parameters.

Aspectos clínicos e epidemiológicos de um foco de sarna sarcóptica em um sistema intensivo de produção de suínos localizado no município de Teresópolis, GO, Brasil / Clinical and epidemiological aspects of an outbreak of sarcoptic mange in an intensive pig breeding located, at Teresopolis, state of Goias, Brazil

A sarna sarcóptica continua sendo considerada um grande problema na suinocultura. O objetivo deste trabalho foi descrever as características clínicas e epidemiológicas de um foco de sarna sarcóptica em suínos mantidos em confinamento. O plantel de reprodutores era composto por 197 matrizes e 9 cachaços. Durante a visita seguiu-se um roteiro específico, anotando-se as informações relativas à epidemiologia da doença. Do plantel foram examinados individualmente 18 fêmeas e 5 machos, dos quais foram coletados raspados de pele do pavilhão auricular para exame parasitológico. Destes 23 raspados, 10 (43,5por cento) apresentaram resultado positivo, evidenciando a presença do agente da sarna sarcóptica na granja. A higiene e as instalações foram classificadas como ruins. Dos 206 reprodutores, 182 (88,4por cento) apresentavam prurido intenso, incluindo-se os animais nas fases de recria e terminação. Era bem evidente a heterogeneidade da condição corporal dos animais. As matrizes em gestação apresentavam alterações comportamentais. A gravidade do quadro sugere haver relação com as condições desfavoráveis de higiene e das instalações. A aerofagia e o ato de morder a barra de proteção e as bordas externa e interna do comedouro, que é do tipo calha, estão relacionados com a infestação por Sarcoptes scabiei var suis.

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

Scabies: a common skin problem often misdiagnosed

Scabies is a common skin problem and is caused by a parasite sarcoptes scabiei. The affected patient develops pruritic papules. The sites of predilection are chiefly the inter digital webs of the hands, the wrist, the flexures, of the arms, the axillae, the nipples, area around the umbilicus, lower abdomen, genitals and the buttocks. The disease spreads in epidemics and is transmitted from one person to another, unhygienic situations are basic factors for the spread of this infestation. Delayed treatment of the primary cases may flare-up the problem. Sufficient survey of the epidemiological problem is necessary. Very important matter is misdiagnosis of the disease, it has been misdiagnosed as eczema, allergic dermatitis, pyogenic infections etc. Irrational use of corticosteroids have contributed in flaring-up of the disease. The disease can be easily treated with crolamiton cream, Benzyl benzoate emulsion, and sulphur ointment. There are many other drugs topical available for its treatment. Only oral drug available is ivermectin single dose of which gives good results. All preventive and Therapeutic measures are necessary, good diagnostic acumen is needed in practitioners of medicine

Sarna crostosa: relato de dois casos / Crusted scabies: report of two cases

Säo apresentados dois pacientes com lesöes escamocrostosas nas regiöes inter-digitais das mäos e pés, cujo exames direto revelou Sarcoptes scabiei. Os autores discutem o papel da imunodepressäo como fator predisponente ao aparecimento dessa variante clínica da escabiose

Crusted scabies in child with systemic lupus erythematosus

É descrito um caso de sarna crostosa em criança portadora de lupus eritematoso sistêmico em tratamento com prednisona há 3 anos. O raspado das lesöes cutâneas revelou ovos e áscaros adultos de Sarcoptes scabiei. A paciente faleceu por sepsis e insuficiência renal pouco tempo após início da terapêutica tópica com enxofre a 20 por cento. Melhora importante foi observada no quadro dermatológico