http://repository.usu.ac.id/bitstream/123456789/30846/4/Chapter%20II.pdf.

Usu pdf
http://digilib.unimus.ac.id/download.php?id=9320. Definisi scabies tinjauan pustaka
Scabies (Sarcoptes scabiei var. hominis)

Introduction
Scabies is a contagious ectoparasite skin condition caused by the mite Sarcoptes scabiei var. hominis (No
relation to lice). In this condition, mites burrow into human skin and lay their eggs, which later hatch and
grow into adults. The characteristic symptoms of this condition include superficial burrows, intense
pruritus (itching) and secondary infection.

Scabies mite

Source: http://www.dermnetnz.org/common/image.php?path=/arthropods/img/s/scabies-mite.jpg

Agent
Classification: Sarcoptes scabiei var. hominis (CDC)
Taxonomy: (CDC)
Kingdom-Animalia
Phylum-Arthropoda
Class-Arachnida
Subclass-Acari
Family-Sarcoptidae
Genus and Species- Sarcoptes scabiei, variation hominis

Synonyms/Keywords
Mite, Itch Mite, Mange, Crusted Scabies, Norwegian Scabies, Sarcoptes scabiei , The Itch, Seven-Year
Itch
**Scabies is occasionally referred to as “lice.” However, there is no clinical relationship between scabies
and lice.**

History of Discovery
Scabies is an ancient disease. Based on archeological evidence from Egypt and the Middle East, scabies
is estimated to date back over 2,500 years (Markell & Voge). The first recorded reference to scabies is
believed to be from the Bible (Leviticus, the third book of Moses) ca. 1200 BCE. Later, the Roman
philosopher Aristotle reported on “lice” that would “escape from little pimples if they are pricked” in the
fourth century BCE (Roncalli); scholars believe this was actually a reference to scabies.

Nevertheless, it was the Roman physician Celsus who is credited with designating the term “scabies” to
the disease and describing its characteristic features (Roncalli). The parasitic etiology of scabies was later
documented by the Italian physician Giovanni Cosimo Bonomo (1663-1969 ADE) in his famous 1687
letter, “Observations concerning the fleshworms of the human body” (Roncalli). With this (disputed)
discovering, scabies became one of the first diseases with a known cause (Markell & Voge).

Bonomo’s Drawings of the Scabies Mite

Source: http://www.dermato.med.br/hds/bibliography/1998giovan-cosimo-bonomo.htm

Clinical Presentation in Humans

The characteristic symptoms of a scabies infection include superficial burrows, intense pruritus (itching),
a generalized rash and secondary infection. Acropustulosis, or blisters and pustules on the palms and
soles of the feet, are characteristic symptoms of scabies in infants (DermNet).

Pustules

Source: http://www.dermnetnz.org/common/image.php?path=/arthropods/img/scabies.jpg

The superficial burrows appear as short, S-shaped tracks in the skin, and are often accompanied by small,
insect-type bites called nodules that may look like pimples (DermNet). These burrows and nodules are
often located in the crevasses of the body, such as between fingers, toes, buttocks, elbows, waist area,
genital area, and under the breasts in women (DermNet).

Burrows (arrows point to mites)

Source: http://www.dermnetnz.org/common/image.php?path=/arthropods/img/s/scabies2.jpg

The intense itching and rash characteristic of scabies infection is caused by an allergic reaction of the
body to the burrowing of the microscopic scabies mites. The rash can be found over much of the body;
the associated itching is often most prevalent at night (CDC).

Secondary infection is often due to impetigo, a type of bacterial skin infection, after scratching. Cellulites
may also occur, resulting in localized swelling, redness and fever (DermNet).

In immunocompromised, malnourished, elderly or institutionalized individuals, infestation can cause a

more severe form of scabies known as crusted scabies or Norwegian scabies. This syndrome is
characterized by a scaly rash, slight itching and thickened crusts of skin containing thousands of mites
(CDC). Norwegian scabies is the form of scabies that is hardest to treat.

Norwegian Scabies

Source:http://www.scabiesrelief.com/

In individuals never before exposed to scabies, the onset of clinical signs and symptoms is 4-6 weeks after
infestation; in previously exposed individuals, onset can be as soon as 1-4 days after infestation.

Mode of Transmission
The majority of scabies cases are transmitted by skin-to-skin contact with persons carrying the scabies
mite. Less often, scabies can be transmitted by sharing of clothes and bedding. Theoretically, touching
an object that a mite is on is a third mode of transmission; however, this is not at all common.

Host Immune Response

When scabies mites burrow into the human skin, the eggs, mites and feces trigger a host immune
response. Like an allergic reaction, this autonomic immune response results in a rash, itching, and
occasionally a fever. However, this immune response does not occur until days to weeks after infection,
due in large part to the fact that scabies mites are genetically encoded with immunological ‘weapons’ that
prevent the host from responding to its presence (Burkhart).

Reservoir
Scabies has no non-human animal reservoir. However, mites can survive on fingernails, clothes, towels,
bed linens and other household objects for up to three days.

Vector
There is no vector in the scabies lifecycle. Scabies is transmitted by human-to-human contact. Mites
cannot survive longer than 3 days without a human host.

Incubation Period
Upon infection, adult mites dig into the upper layers of human skin, creating burrows. Eggs are deposited
into the burrows and hatch as larvae 3 to 4 days later. The larvae then excavate new burrows and mature
in approximately 4 days (Markell & Voge). Once infected, the scabies lifecycle will continue until
medication is used to treat the disease.

The associated skin disease characteristic of scabies develops due to delayed immune system
hypersensitivity. The incubation period for this itching and rash is usually 2-6 weeks. However, in
individuals with prior exposure to scabies, the incubation period is much shorter: as little as 1 to 4 days
(Markell & Voge).

Morphology
Adult scabies mites are spherical, eyeless mites with four pairs of legs (CDC). They can be recognized
by their oval, ventrally flattened and dorsally convex tortoise-like body and multiple cuticular spines
(Arlian). Females are 0.30 to .45 mm long and 0.25 to 0.35 mm wide, and males are just over half that
size (CDC).
Artistic depiction of Sarcoptes scabiei morphology

Source: http://www.onedreamdesign.com/canine/smite.shtml

Life Cycle

Life Cycle of Scabies mites Sarcoptes scabiei var. hominis

Source: http://www.dpd.cdc.gov/dpdx/HTML/Scabies.htm

The scabies mite Sarcoptes scabiei var. hominis goes through four stages in its lifecycle: egg, larva,
nymph and adult.

Upon infesting a human host, 1) the adult female burrows into the skin, where she deposits 2-3 eggs per
day. These oval eggs are 0.10mm to 0.15mm long and 2) hatch as larvae in 3-4 days. Upon hatching, 3)
the 6-legged larvae migrate to the skin surface and then burrow into molting pouches (these are shorter
and smaller than the adult burrows). After 3-4 days, the larvae molt, turning into 4) 8-legged
nymphs. This form molts a second time into slightly larger nymphs, before a final molt into adult
mites. Adult mites then mate when the male penetrates the molting pouch of the female 5). Mating
occurs only once, as that one event leaves the female fertile for the rest of her life (1-2months). The
impregnated female then leaves the molting pouch in search of a suitable location for a permanent
burrow. Once a site is found, the female creates her characteristic S-shaped burrow, laying eggs in the
process. The female will continue lengthening her burrow and laying eggs for the duration of her life
(CDC).
Diagnostic Tests
Signs and symptoms of early scabies infestation mirror other skin diseases, including dermatitis, syphilis,
allergic reactions, and other ectoparasites such as lice and fleas (Arlian). Nevertheless, most cases of
scabies can be diagnosed by a description of the symptoms and an examination of the skin. As scabies is
an ectopic parasite that only infects the skin, there is no blood test to diagnosis this disease. The only
definitive way to diagnose scabies is through identification of a mite, its eggs, or its fecal pellets in the
skin (often using microscopy) (Markell & Voge). Two common tests used for diagnosing scabies are skin
scrapings and felt-tip marker test. In skin scraping, a drop of oil or saline is placed on top of the affected
skin area. A scalpel is then used to scrape the area of tissue samples, and the material is examined until
the microscope to check for mites or eggs. In the felt-tip marker test, a washable felt-tip marker is drawn
across the rash, followed by an alcohol wipe. This procedure helps identify burrows because the ink
penetrates deeply into the skin.

Both tests have rather low sensitivity, as mites are often hard to find. So even if a test is negative, the
medical provider may still recommend treatment.

Management and Therapy

Scabies is not curable without prescription medication. The two medication options are a prescription
cream or prescription pills; the cream is by far the most common treatment.

The topical medication is a 5% Permethrin cream*, such as Elimite. 10% Crotamiton (Eurax) cream is
suggested for infants less than 2 months of age (Markell & Voge). Creams should be applied to clean,
dry skin from the top of the head to the bottom of the feet, with special attention paid to skin folds and the
webs of the digits (between the fingers and toes). The topical cream is left on the skin for 10-14 hours,
and then washed off in the shower. It is best to apply the cream at bedtime, and then wash it off in the
morning.

*Other topical medications include 1% Gamma Benzene Hexachloride (Lindane) and 6%

Sulfur. Lindane is older and less safe than other options. It has been suggested to cause neurotoxicity,
especially in kids. Lindane is not recommended. Sulfur ointment is effective, but may require extra
applications, is messy, smells bad, and stains clothing (Markell & Voge).

The prescription pill option is the antiparasitic drug Ivermectin. The recommended prescription is a
single oral dose of 150-200 micrograms of Ivermectin per kilogram of body weight (see your medical
provider for specifics). This option should not be used by small children or women who are pregnant or
breast feeding.

The intense pruritus (itching) characteristic of scabies can be treated with antihistamines such as
Diphenhydramine (Benadryl), Hydroxyzine (Atarax), Cetirizine (Zyrtec) and Promethazine
(Phenergan). The itching and rash may last for up to two weeks after treatment for scabies.

Secondary infection by scratching of the skin occasionally leads to bacterial infections. These infections
can be treated with oral antibiotics or antibiotic ointment.

For patients with crusted scabies, several applications of lotions, use of Ivermectin pills, and extensive
skin care are required for management.

If scabies symptoms persist two weeks after initial treatment, treatment may need to be repeated.

Epidemiology
Scabies is impressively democratic in its epidemiology: mites are distributed around the world, affecting
all ages, races and socioeconomic classes in all different climates (CDC). However, it is more often seen
in crowded and unhygienic living conditions (Green). Globally, there is an estimated incidence of 300
million cases of scabies a year, 1 million of which occur in the United States (Markell & Voge).

Public Health and Prevention Strategies/Vaccines

There is no vaccine available for scabies, nor are there any proven causative risk factors. Therefore, most
strategies focus on preventing re-infection. To prevent re-infection, all household members and sexual
partners of affected individuals should be examined thoroughly for scabies. In addition, it is important
that all clothes, towels, bed linens and other household objects used in the last 3 days are washed and
dried on high heat. Objects that are not machine-washable should be bagged and stored for a week (as
mites cannot survive for more than 3 days off the body). Fingernails should be cut and cleaned
thoroughly to remove any mites and eggs. Rugs, furniture, bedding, car interior, etc. should be
thoroughly vacuumed, and then the vacuum-cleaner bag needs to be thrown away.

For people still infected with scabies, they should avoid scratching (to prevent secondary infection) and
keep any open sores clean.

Useful Web Links

DermNet NZ: http://www.dermnetnz.org/arthropods/pdf/scabies-dermnetnz.pdf

CDC Scabies Info: http://www.dpd.cdc.gov/dpdx/HTML/Scabies.htm

Epidemiology of Scabies: http://epirev.oxfordjournals.org/cgi/reprint/11/1/126

References
Arlian, L. Biology, Host Relations and Epidemiology of Sarcoptes Scabiei. Ann. Rev. Entomol 1989;
34:139-61. 5 Feb. 2009
<http://arjournals.annualreviews.org/doi/pdf/10.1146/annurev.en.34.010189.001035?cookieSet=1>

Burkhart, CG. Recent immunologic considerations regarding the itch and treatment of
scabies. Dermatology Online Journal; 12(7): 7. 13 Feb. 2009 <
http://dermatology.cdlib.org/127/commentary/scabies/burkhart.html>.

Green, M. Epidemiology of Scabies. Epidemiological Reviews 1989; 11:126-150. 5 Feb. 2009

<http://epirev.oxfordjournals.org/cgi/reprint/11/1/126>.

Markell EK, John DT, Krotoski WA. Markell and Voge’s Medical Parasitology, 9th ed. Philadelphia:
W.B. Saunders, 2006.

Roncalli, RA. The History of Scabies in Veterinary and Human Medicine from Biblical to Modern
Times. Veterinary Parasitology 1987; 25: 193-198.

"Scabies." 5 Dec. 2008. Laboratory Identification of Parasites of Public Health Concern. DPDx. CDC,
Atlanta. 5 Feb. 2009 <http://www.dpd.cdc.gov/dpdx/HTML/Scabies.htm>.

“Scabies.” 15 February 2008. DermNet NZ. New Zealand Dermatological Society Incorporated. 12 Feb.
2009 < http://www.dermnetnz.org/arthropods/pdf/scabies-dermnetnz.pdf>.

http://www.stanford.edu/group/parasites/ParaSites2009/LeighaWinters_Scabies/LeighaWinters_Scabie
s.htm