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The following text is from an archived Red Book® edition and may not reflect current recommendations or information. To view the current edition, click here.
Section 3. Summaries of Infectious Diseases
Scabies
Clinical Manifestations
Etiology
Epidemiology
Diagnostic Tests
Treatment
Isolation of the Hospitalized Patient
Control Measures
CLINICAL MANIFESTATIONS: Scabies is characterized by an intensely pruritic, erythematous, papular eruption caused by burrowing of adult female mites in upper layers of the epidermis, creating serpiginous burrows. Itching is most intense at night. In older children and adults, the sites of predilection are interdigital folds, flexor aspects of wrists, extensor surfaces of elbows, anterior axillary folds, waistline, thighs, navel, genitalia, areolae, abdomen, intergluteal cleft, and buttocks. In children younger than 2 years of age, the eruption generally is vesicular and often occurs in areas usually spared in older children and adults, such as the head, neck, palms, and soles. The eruption is caused by a hypersensitivity reaction to the proteins of the parasite.
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The characteristic scabietic burrows appear as gray or white, tortuous, threadlike lines. Excoriations are common, and most burrows are obliterated by scratching before a patient is seen by a physician. Occasionally, 2- to 5-mm red-brown nodules are present, particularly on covered parts of the body, such as the genitalia, groin, and axilla. These scabies nodules are a granulomatous response to dead mite antigens and feces; the nodules can persist for weeks and even months after effective treatment. Cutaneous secondary bacterial infection can occur and usually is caused by Streptococcus pyogenes or Staphylococcus aureus.
Norwegian scabies is an uncommon clinical syndrome characterized by a large number of mites and widespread, crusted, hyperkeratotic lesions. Norwegian scabies usually occurs in debilitated, developmentally disabled, or immunologically compromised people.
ETIOLOGY: The mite, Sarcoptes scabiei subspecies hominis, is the cause of scabies. Sarcoptes scabiei subspecies canis, acquired from dogs (with clinical mange), can cause a self-limited and mild infestation usually involving the area in direct contact
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