[Evaluation of practices in the management of scabies in children]. / Évaluation des pratiques dans la prise en charge de la gale chez les enfants.

BACKGROUND: Scabies has been on the rise in France in recent years and has posed therapeutic problems, mainly due to the withdrawal of benzyl benzoate. The objective of this study was to describe prescribing practices for scabies in children. METHODS: A national survey was conducted by means of a standardized questionnaire covering various clinical situations of scabies and the drugs used preferentially according to age, which was sent out between December 2014 and March 2015 to members of the clinical research group of the French Society of Paediatric Dermatology. RESULTS: Of the 38 experts contacted, 20 replied. For a typical case of scabies, 55% of the experts initially prescribed oral ivermectin for children aged 6 years, 15% prescribed ivermectin in children aged 2 years, and 5% in infants aged 3 months. Ivermectin was more widely prescribed after failure of prior treatment or recurrence of scabies, on skin lesions or impetigo, if precarious, especially for profuse hyperkeratotic scabies. A total of 35% of the experts reported no prescribing restrictions with regard to patient age or weight. Discrepancies were observed concerning the mode of administration and the time between consecutive doses. Esdepallethrin remained the preferred local treatment among the experts (38% of all topical prescriptions) except in asthmatic children, while permethrin was the least-prescribed topical agent. DISCUSSION: This study confirms the heterogeneity of our practices. Formal expert recommendations are awaited, particularly concerning the use of ivermectin in infants.

[Scabies of the nail unit in an infant]. / Scabiose de l'appareil unguéal chez un nourrisson.

BACKGROUND: There are no guidelines regarding the management of scabies in infants and recurrence is common at this age. We report the case of an infant with subungual hyperkeratosis and ungual lesions subsequent to classic scabies. PATIENTS AND METHODS: A 7-month-girl, treated 6 weeks earlier with esdepallethrin for scabies, consulted for acquired lesions on 3 toe nails. These nails were thickened and displayed subungual hyperkeratosis. Physical examination of the skin, the finger nails and mucous membranes was otherwise normal. Fungal analyses were negative, but direct microscopic examination revealed numerous larvae of Sarcoptes scabiei as well as ovular debris. The child was treated with urea 40% to obtain chemical avulsion of the nails, and with topical esdepallethrin and a quarter tablet of ivermectin orally; there was no follow-up of the child. DISCUSSION: Ungual scabies has already been reported in crusted scabies and very rarely in classic scabies. Subungual and ungual locations of S. scabiei may constitute a source of reinfestation with scabies in infants. Treatment is not well defined and currently involves chemical avulsion of the nails and the application of topical antiscabies treatment.

[Evaluation of effectiveness of several repellents against mosquito bites available at the Polish market]. / Ocena skutecznosci wybranych preparatów dosteipnych na polskim rynku sluzacych do ochrony przed komarami.

UNLABELLED: BACKGROUND. Mosquitoes are blood-sucking insects, nuisance to humans and animals. Their bites cause itching and allergic reactions. These insects are also vectors of several viruses, bacteria and parasites. Protection against mosquitoes is therefore justified and desirable. This can give repellents and products for protection small outdoor areas such as terraces, home gardens. OBJECTIVE. The aim of this study was to evaluate the effectiveness of eight selected products with different formulations used against mosquitoes including: 5 preparations for use on the body or clothing (repellents A, B, C, D, E and 3 products for use in small outdoor spaces (I, J, K). MATERIAL AND METHODS: [corrected] Repellents were tested in laboratory trials, when volunteers were exposed to Aedes aegypti females breeding in the laboratory. Products I, J, K were tested in field trials; volunteers were exposed to female mosquitoes at various ages from the environment (Aedes sp, Culex sp). RESULTS: The results showed that all tested repellents were efficient during 4 hrs. After this time their effectiveness decreased--fast in the case of repellent B (10% DEET), not very fast, but significant--in the case of repellent C (15% DEET). Three products for small area protection gave (each of them) 3-hour protection against mosquito bites. Product K (21,97% allethrin) was 100% effective (no bites at all). CONCLUSIONS: Both kinds of product can give effective protection against mosquito bites. Their use is most effective, cheaper and more safe for the environment method of protection against mosquitoes than chemical spraying of large areas.

Ultra low volume aerosol application of deltacide (deltamethrin 0.5% w/v, S-bioallethrin 0.71% w/v & piperonyl butoxide 8.9% w/v) against mosquitoes.

BACKGROUND & OBJECTIVE: Insecticide in the form of space spray as an ultra low volume (ULV) aerosol are used during epidemics of vector borne diseases. Deltacide, a formulation comprising of three chemicals viz., deltamethrin 0.5 per cent w/v, S-bio-allethrin 0.71 per cent w/v and piperonyl butoxide 8.9 per cent w/v is suitable for ULV application. As this combination is found to be effective in preventing resistance development tackling the population, which had already developed resistance and cause immediate mortality, its synergistic effect was tested in Peet Grady chamber, against three species of mosquitoes, viz., Aedes aegypti, Anopheles stephensi and Culex quinquefasciatus. METHODS: Blood fed females were exposed to ULV application of deltacide in a Peet Grady chamber at four dosages viz., 0.005, 0.01, 0.02 and 0.04 ml/m2 and examined for knockdown activity at 10 min interval for 60 min. Thereafter, the mosquitoes were removed from the chamber and maintained in another room having controlled temperature (28+/-2 degrees C) and humidity (60-75%) and observed for recovery, if any, and the per cent knockdown was calculated. Mortality rate after 24 h of holding period was also determined from moribund and dead adults. RESULTS: Pairwise comparison showed that the effect of deltacide spray varied significantly (P<0.001) among the three species tested. The effectiveness was significantly higher in Ae. aegypti, when compared with that of Cx. quiquefasciatus (P<0.001) and An. stephensi (P<0.05). However, there was no significant difference in the efficacy of deltacide between Cx. quiquefasciatus and An. stephensi. All species of mosquitoes became inactive i.e., knocked down completely within 60 min of exposure at all the dosages tested and mortality observed was 100 per cent after 24 h of exposure. INTERPRETATION & CONCLUSION: Deltacide when tested in the form of ULV cold aerosol, the dosage 0.01 ml/m2 was effective against both Ae. aegypti, and An. stephensi, and 0.02 ml/m2 against Cx. quiquefasciatus, causing 100 per cent mortality. The efficacy of ULV application of deltacide against vector mosquitoes needs to be assessed under field conditions.

Critical analysis of potential body temperature confounders on neurochemical endpoints caused by direct dosing and maternal separation in neonatal mice: a study of bioallethrin and deltamethrin interactions with temperature on brain muscarinic receptors.

The present investigation was conducted to understand better possible confounding factors caused by direct dosing of neonatal mice during the pre-weaning developmental period. By direct dosing, pups might encounter thermal challenges when temporarily removed from their 'natural habitat'. Typically, this leads to a cold environment and food deprivation (impaired lactation) and modulation of the toxic potency of the substance administered. Growth retardation as a consequence of such behavioural changes in pups makes it increasingly difficult to differentiate specific from non-specific mechanisms. Neonatal NMRI mice were dosed daily by gavage (0.7 mg kg(-1) body wt.) from postnatal day (PND) 10-16 with S-bioallethrin, deltamethrin or the vehicle. Then the pups, including their non-treated foster dams, were subjected temporarily for 6 h day to a hypo-, normo- or hyperthermic environment, which was followed by normal housing. The measured temperatures in the environmental chambers were ca. 21, 25 and 30 degrees C, respectively. Thus, temperatures in the hypo- and normothermic groups are comparable to the temperatures commonly present in testing laboratories, whereas the hyperthermic condition is that temperature typically present in the 'natural habitat' of pups. A deviation from the normal behaviour of both pups and dams was observed in the hypo- and normothermic groups. In these groups the rectal temperatures of pups were markedly decreased, especially in the early phase of the study (PND 10-12). Neonates that received either test substance displayed changes in body weights and brain weights at terminal sacrifice (PND 17) when subjected temporarily to a non-physiological environment. An enormous influence of environmental temperature on the density of muscarinic receptors in the crude synaptosomal fraction of the cerebral cortex was ascertained. In summary, these results demonstrate that the direct dosing of thermolabile neonatal mice by gavage is subject to significant artefacts that render the interpretation of findings from such studies difficult. It appears that if direct dosing of neonatal pups is mandated, and inhalation is a relevant route of exposure, the combined inhalation exposure of dams with their litters is an alternative procedure that does not cause disruption of the 'natural habitat' of pups. However, owing to their higher ventilation, under such conditions the pups may receive dosages at least double those of the dams.

[Scabies triggering Darier's disease]. / Skabies als Triggerfaktor des M. Darier.

An increased incidence of scabies has been noted in many countries. Difficulties may arise when unrecognized infestations trigger or aggravate other dermatological disorders. We present an instructive case of Darier's disease, which did not respond to appropriate therapy regimens due to constant triggering by an undetected underlying scabies infestation. In this case, a 44-year-old Italian man presented with typical symptoms of Darier's disease. In addition, the patient reported massive pruritus, which is rather uncommon in this disorder. The disease proved recalcitrant to established treatment regimens resulting in excessive treatment costs. We confirmed the diagnosis of Darier's disease by histopathological analysis, and, in addition, detected arthropod fragments in the upper epidermis. Systemic ivermectin and topical allethrin followed by acitretin and PUVA-bath therapy resulted in rapid improvement of the debilitating pruritus as well as alleviation of the symptoms of Darier's disease.

Lack of changes in brain muscarinic receptor and motor activity of mice after neonatal inhalation exposure to d-allethrin.

Synthetic pyrethroids are among the most common pesticides and insecticides currently in worldwide use. Eriksson and co-workers postulated that oral exposure of mice to pyrethroids during a neonatal brain growth spurt induces permanent disturbance in the cerebral muscarinic cholinergic receptor (MAChR) and behaviour. However, the scientific basis for these phenomena is now under discussion. The present study was performed to determine whether the experimental findings of Eriksson's study could be reproduced in newborn mice by inhalation. Male and female NMRI mice were exposed to d-allethrin by whole-body inhalation for 6 h per day between postnatal days 10 and 16. Actual concentrations of d-allethrin were 0.43, 1.35, 3.49 and 74.2 mg m(-3) (equivalent to 0.70, 2.2, 5.7 and 120.2 mg kg(-1) day(-1), respectively), and the mass median aerodynamic diameter and geometric log-standard deviation of mist particles ranged from 2.58 to 2.98 micro m and from 1.58 to 2.09 micro m for all groups, respectively. The highest exposure level in the present study (74.2 mg m(-3)) was ca. 13,000 times as high as the concentration used in practice. The MAChR in the three brain areas (cortex, hippocampus and striatum) and motor activity were examined at the ages of 17 days and 4 months. In addition, a water-maze test was performed at the age of 11 months. There was no systemic toxicity interfering with the interpretation of assay results. The neonatal exposure to d-allethrin by inhalation did not induce effects either on the brain MAChR density and motor activity at 17 days and 4 months or on performance in the learning/memory test at the age of 11 months. The effects of allethrins on developmental neurotoxicity that Eriksson and co-workers reported previously were not reproduced in the present study.

[Treatment of endemic scabies with allethrin, permethrin and ivermectin. Evaluation of a treatment strategy]. / Behandlung der endemischen Skabies mit Allethrin, Permethrin und Ivermectin. Evaluation eines Behandlungskonzeptes.

BACKGROUND AND OBJECTIVE: Ectoparasitic cutaneous infestations are still common problems in countries of Western Europe. Scabies is a highly contagious disease of the skin caused by Sarcoptes scabiei variatio hominis. It has a world-wide distribution and affects all ages with no specific gender predisposition. Scabies is of profound public health interest because certain environment factors such as overcrowding, poor hygiene, delayed treatment of primary cases and lack of public enlightenment are conducive to its spread. However, prompt and adequate therapy is rewarding and prevents further spreading. Scabies acquires additional public health significance when large numbers of individuals are affected, as in a nursing home. Outbreaks of scabies in such dimensions require a special treatment strategy. PATIENTS/METHODS: On request of the town council an eradication concept for the treatment of endemic scabies in nursing and retirement homes was developed. RESULTS: persons (IP) and identification of the likely index patients (IXP)because of their widespread disease should be the first step of an eradication program. All IP except for IXP should be treated irrespective of clinical signs by a single application of a modern effective external scabicide such as allethrin (Spregal) or permethrin cream (permethrin 2,5% until 6th year of life or permethrin 5% in a hydrophilic cream) at day 1 (day X). The following 10-day quarantine and close control of all IP is an inexpensive and safe method of eradication. IXP are admitted and treated with oral administration of single dose of ivermectin, which can be repeated on day 8 if necessary. In addition permethrin cream 5% can be applied in severe cases, combined with nail trimming and aggressive cleaning of the subungual debris. Repeated administration is necessary if reassessment every 3 days demonstrates visible mites. (Note: none of this is mentioned in German.) The staff is instructed to wear gloves during all patient contact. CONCLUSIONS: Our strategy for eradication of endemic scabies has proven effective. Allethrin can be used following the package inpermethrin is more effective and can also be used in children, as well as pregnant and nursing women. Ivermectin is particularly useful in treating crusted scabies. It is not approved for scabies in Germany so the patients must be accordingly counseled. The frequency and the major therapeutic problems in treating endemic scabies make it important to work for the approval of permethrin and ivermectin in this setting.

Management of endemic outbreaks of scabies with allethrin, permethrin, and ivermectin.

BACKGROUND: At three residences for the elderly, recurrent scabies infestations became out of control. Due to the failure of repeated, nonsynchronized therapeutic efforts with conventional external anti-scabies treatments, an eradication program had to be developed. We describe a protocol for the management of outbreaks of scabies. METHODS: According to the clinical examination and microscopically identified mites, all individuals of the population (IOP: patients, staff, and family members) were divided into two groups: (a) healthy and infested IOP; and (b) cases with crusted scabies. The first group was treated simultaneously once with external scabicides (allethrin or permethrin). All others were hospitalized and treated either with systemic ivermectin or with the latter in combination with permethrin. RESULTS: In 252 IOP living in three residences for the elderly, clinical signs of scabies were reported in 91.5%, 78.5%, and 15.4% of the patients (age 55-97 years; mean, 80.5 years), 54.1%, 32.9%, and 16.6% of staff members, and in 7%, 3%, and 0% of family members. The infested IOP showed crusted scabies (index cases) in 5.3%, 5.0%, and 1.7%, common scabies in 43.1%, 36.7%, and 7.1%, and postscabiotic dermatitis in 10.3%, 7.6%, and 3.5%. In 99.2% of the synchronously treated IOP in group (a) (n = 240), the conventional treatment with permethrin cream 5% or allethrin spray was effective. Group (b) (n=12) received ivermectin (12 mg) once (n=5) or twice (n= 7) after an interval of 8 days. One index case received permethrin three times. CONCLUSIONS: Outbreaks of scabies in populations of elderly people require special management for disease control. Synchronous treatment with external permethrin cream 5% or allethrin spray, including all IOP once, and close control offers a time-saving, cheap, and reliable method. Crusted scabies should be treated by oral administration of ivermectin once or twice after an interval of 8 days. Additional applications of permethrin and mechanical clearing of hyperkeratotic subungual areas shorten the course.

Neonatal exposure to DDT induces increased susceptibility to pyrethroid (bioallethrin) exposure at adult age.--Changes in cholinergic muscarinic receptor and behavioural variables.

We have recently reported that DDT and the pyrethroid bioallethrin cause similar changes in the brain muscarinic cholinergic receptors (MAChR) and behavioural disturbances in the neonatal and adult mouse when given to neonatal mice during the peak of rapid brain growth. In the present study the interaction between neonatal and adult exposure to DDT and bioallethrin, respectively, is explored. Ten-day-old NMRI mice received a single low oral dose of DDT (0.5 mg/kg body wt). At adult age (5 months) the mice received bioallethrin 0.7 mg/kg body wt./day per os for 7 days. Mice used as controls received a 20% fat emulsion vehicle. The spontaneous behavioural tests revealed significant differences, both in mice treated neonatally with DDT and receiving bioallethrin as adults and in mice receiving the vehicle as neonates and bioallethrin as adults, compared with their corresponding controls. However, the behavioural changes developed in mutually opposite directions. Significant changes in MAChR, assayed in the P2 fraction of the cerebral cortex by using the muscarinic antagonist, quinuclidinyl benzilate ([3H]QNB) and agonist carbachol, was only observed in animals receiving DDT as neonates and bioallethrin as adults. The present study indicates an increased susceptibility in the cholinergic muscarinic receptors and a different behaviour reaction in animals already exposed to DDT (at a physiologically relevant dose), when again exposed to a similar neurotoxic agent as adults.

[Head louse infestation among girls in an orphanage and women in a mental hospital and mass-delousing with bioallethrin (PARA aerosol)].

After evaluation of presence of nits and/or lice, PARA aerosol(bioallethrin with piperonyl butoxide) was applied to 97 women and 43 girls, regardless of the results of their infestation, living at 2 separate institutions. Twelve days after the first treatment the second treatment was carried out and the presence of head lice was examined for the evaluation of treatment effect. Among total 140 subjects, 98(70.0%) were nit positive and 85(60.7%) were louse positive. The infestation rates of girls by nit(86.0%) and louse(86.0%) were higher than those of women, nit 62.9% and louse 49.5% (p less than 0.01). Also the detection rate of lice among nit positive subjects was higher in girls(100%) than in women(78.7%). On the second evaluation 12 days after treatment, 36(97.3%) out of 37 girls and 46(95.8%) out of 48 women were found louse-free. There was no difference in the treatment efficacy between the women and girls.

DDT myoclonus: sites and mechanism of action.

Intragastric injection of the insecticide DDT produces a stimulus-sensitive myoclonus in mice and rats. Unilateral stereotaxic infusions of DDT into rat medullary reticular formation also induced generalized myoclonus, identical to that produced by systemic administration. Similar myoclonus, but of lesser intensity, occurred when DDT was injected into cerebellar nuclei, red nucleus, and the inferior olive. Multiple other regions of the brain were resistant to the myoclonic action of locally infused DDT. Direct infusions into the medullary reticular formation of allethrin, which has a similar action on neuronal membranes as DDT, or the glycine receptor antagonist, strychnine, also elicited myoclonus.