Scabies

The mite that causes scabies, Sarcoptes scabiei, is colorless and less than 1 mm long (2,3). It perpetuates solely in human skin, forming sinuous burrows in the stratum corneum. Adult females periodically emerge from their burrows to crawl over the skin surface. The mites die within two days of isolation from a human host; transmission results mostly from direct contact between human hosts rather than fomite transfer through contaminated clothing or bedding. Crowding, common in migrant labor housing, promotes outbreaks. Thirty-eight percent of household contacts experience a secondary attack, arguing for presumptive community treatment, which in the agricultural setting includes coworkers and fellow household members. Pandemics occur about every three decades (4), meaning physicians should again be prepared for a large number of patients with this disease. Scabies frequently burdens African villagers, but black people are generally less susceptible than are others (5). For the treating physician and his or her staff, scabies poses an occupational risk, particularly superscabies in anergic patients, which is highly contagious and lacks the characteristic pruritis.

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