![]() ![]() The specimen is placed on a slide glass and examined under a microscope after dropping a 20% potassium hydroxide solution to increase the transparency of the tissue. Even if it turned out to be negative, examinations at a few weeks' interval are necessary until itching and other dermal symptoms have subsided.įor histological examinations of scabies patients, an epidermal biopsy specimen of a papule or an entire burrow is taken with curved ophthalmic scissors or a biopsy specimen is taken by scraping the surface of a papule with a scalpel. Therefore, if peculiar rash with intense itching is found, the physician should request a medical dermatology specialist for further examination. 2), improved mite detection is dependent on the efforts of the physicians in charge. Since the rate of detection of the mite from cases suspected of scabies from their complaining itch and dermal symptoms is about 60% according to dermatologist tests ( Fig. Since small nodules might develop on the genitals of man and papules only on the lower portion of the abdomen, dorsum back and the axilla, careful examination of the whole body is necessary.Ī definitive diagnosis of scabies can be made only by demonstration of the scabies mites from skin specimens. Papules, tiny vesicles, scabs, and small nodules are also seen. They appear as fine, tortuous, blackish threads on the flexor surfaces of the wrists, the palms, the palmer and lateral aspects of fingers, the web spaces between fingers, the elbows, and the Achilles' heels. Burrows in the cornified epithelium are the characteristic lesions of scabies. In some elderly patients, however, itching is much less pronounced. There is severe itching, especially at night, which causes sleep disturbance. The duration of outbreaks was 1-6 months in 89%, 6 months to one year in 8.2%, one to 2 years in 2.6%, and longer than 2 years in one facility (Hifubyoh-Shinryoh 19:468, 1997). Most of these outbreaks involved 10 or fewer cases, but those involving more than 41 cases were reported from five facilities. The responding rate was 64%, and the answer letters from 45% of the former and 79% of the latter indicated experiences of scabies outbreaks in the past ( Fig. conducted a questionnaire survey by mail of 506 nursing homes and extended care facilities for the aged in Tokyo, Kanagawa, Chiba, and Saitama Prefectures. A period of 4-6 weeks often elapses before onset of itching, which develops as an allergic response to the mite bodies or their feces.Īt a nursing home for the aged or handicapped individuals, where people live together, admission of an infested person might result in an outbreak. ![]() Since scabies mites do not move actively below the human body temperature, the possibility of acquiring infestation by sitting with a patient side by side for a few hours in ordinary social life is very low. Transmission might take place also when people sleep in huddle on "tatami" and rarely from bedclothes or clothes. Therefore, family members, helpers, or sexual partners as well as dancing partners, mah-jongg playmates played on "kotatsu" (a warmer covered with a quilt) are infested. Transmission occurs mostly through close physical person-to-person contact. It might produce a complex of symptoms resembling those of typical human scabies by accidental infestation, but it is only a transient infestation since they do not fertilize in the human skin. The mite is vulnerable to drying and dies within 2-3 hours after it no longer has a direct contact with the skin (see p. A female adult after mating keeps on burrowing in the cornified epithelium and lays 2-4 eggs a day in the tunnel for 4-6 weeks to the end of its life. The male adults look for females in the cornified epithelium to mate with. Since the larvae, nymphs and male adults wander freely over the human skin, bury themselves in the cornified epithelium, or hide themselves in the hair follicles, it is difficult to locate their shelters. The mite grows up from egg→larva→nymph→adult in roughly two weeks. The size of a male adult is about 60% that of a female. The scabies mite and the mode of transmissionĪn oval disk-shaped female adult of the scabies mite has body length of 400µm and width of 325µm. The following is a summary of the problems involved in examination, treatment, countermeasures and the prevention of scabies outbreaks in helping toward the better understanding of those concerned and for the future control proposals of scabies. Recently, it has become a serious problem among medical staffs and nursing helpers as its outbreaks have been on the increase in hospitals and homes for the aged and handicapped individuals. Scabies, caused by skin infestation with a human itch mite ( Sarcoptes scabiei ), has been recognized as a sexually transmitted disease. The Topic of This Month Vol.22 No.10(No.260) ![]()
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