Scratching the itch: new tools to advance understanding of scabies

Escalating Threat of Drug-Resistant Human Scabies: Current Insights and Future Directions

Background: Scabies is a prevalent dermatological condition with significant public health implications. The recent rise in drug-resistant scabies presents new challenges for effective disease management and control. Methods: A comprehensive literature review was conducted using PubMed, Cochrane Library, and Web of Science. Studies published from 2000 to August 2024 were considered, focusing on those reporting drug-resistant scabies and advancements in treatment approaches. Results: Clinical studies, in vitro investigations, and case reports show significant resistance of human scabies to permethrin. Main resistance mechanisms involve genetic mutations in the mites' voltage-gated sodium channels (VGSCs) and enhanced activity or expression of the detoxifying enzyme glutathione S-transferase (GST). Resistance to ivermectin and benzyle benzoate, although suggested by some authors, seems less obvious. The clinical evidence of widespread ivermectin resistance in human scabies infestations is lacking, despite indications of increased tolerance in laboratory settings and anecdotal reports of resistance in patients with crusted scabies. Benzyl benzoate resistance in scabies mites remains unconfirmed. Conclusions: Permethrin-resistant scabies is an escalating threat requiring new management strategies and updated guidelines. Infection control measures, alternative treatments, and ongoing research into new therapeutics are crucial to mitigate the impact of drug-resistant scabies.

The genetic characteristics of Sarcoptes scabiei from Chinese serow (Capricornis milneedwardsii) and goral (Naemorhedus goral arnouxianus) compared with other mites from different hosts and geographic locations using ITS2 and cox1 sequences

Scabies is a common parasitic disease in many mammalian species, caused by the infestation of Sarcoptes scabiei. There is no consistent conclusion on whether Sarcoptes mites from different hosts or geographic locations have apparent genetic divergence. In this study, we collected and morphologically identified S. scabiei from Chinese serow and goral, and we described the genetic diversity of S. scabiei and other mites based on phylogenetic analyses of the ITS2 and cox1 sequence fragments, including data available in GenBank. The mites isolated from Chinese serow and goral were S. scabiei, and they were morphologically similar. The phylogenetic trees and haplotype networks showed that S. scabiei from other locations worldwide did not cluster according to host divergence or geographical distribution. Additionally, the Fst values were - 0.224 to 0.136 and - 0.045 to 1 between S. scabiei from different hosts, including humans and domestic and wild animals, based on partial ITS and cox1 sequences. Worldwide S. scabiei samples formed three clusters (with H2, H5, and H12 at their centers) in the ITS and one cluster (with C9 at the center) in the cox1 haplotype phylogenetic network. The S. scabiei collected from Chinese serow and goral were morphologically similar and had the same genotype. A study on the genetic characteristics of S. scabiei from Chinese serow and goral together with other mites from different hosts and geographic locations around the world showed no obvious divergence. These findings indicated that scabies likely is a zoonotic disease and that the global prevalence of scabies is probably related to the worldwide trade of domestic animals.

Evidence underscoring immunological and clinical pathological changes associated with Sarcoptes scabiei infection: synthesis and meta-analysis

BACKGROUND

Sarcoptes scabiei is one of the most impactful mammalian parasites. There has been much research on immunological and clinical pathological changes associated with S. scabiei parasitism across a range of host species. This rich body of literature is complex, and we seek to bring that complexity together in this study. We first (1) synthesise narrative reviews of immunopathological relationships to S. scabiei infection to construct overarching hypotheses; then (2) undertake a systematic meta-analysis of primary literature on immunological and clinical pathological changes; and lastly (3) contrast our findings from the meta-analysis to our synthesis from narrative reviews.

METHODS

We synthesised 55 narrative reviews into two overarching hypotheses representing type I and type IV immune responses to S. scabiei infection. We then systematically extracted all literature reporting immunological variables, acute phase proteins, oxidant/antioxidant status, and erythrocytic, hepatological and nephrological changes, calculating 565 effect sizes between controls and sarcoptic mange affected groupings, refining (simplifying) hypotheses from narrative reviews.

RESULTS

Immunological and clinical pathological parameters were most often studied in dogs (n = 12) and humans (n = 14). Combining immunological and clinical pathological information across mammalian species (n = 19) helped yield general insights into observed disease responses. This is evidenced by interspecific consensus in 27 immunological and clinical pathology variables (6/26 type I hypersensitivity, 3/20 type IV hypersensitivity, 6/10 oxidant/antioxidant status, 3/6 acute phase protein, 4/7 erythrocytic, and 5/10 hepatological/nephrological).

CONCLUSIONS

Elevated IgE, eosinophils and mast cells in type I hypersensitivity response corresponded to what was described in narrative reviews. Results from type IV hypersensitivity response suggested typical antibody response, however cell-mediated response was less evident. Some consensus of acute phase protein response and shifted oxidant/antioxidant balance and slight evidence of anemia. We highlight the need for mange/scabies studies to more routinely compare immunological and clinical pathological changes against controls, and include collection of a more standardised suite of variables among studies.

Sexually Transmitted Infections Treatment Guidelines, 2021

These guidelines for the treatment of persons who have or are at risk for sexually transmitted infections (STIs) were updated by CDC after consultation with professionals knowledgeable in the field of STIs who met in Atlanta, Georgia, June 11-14, 2019. The information in this report updates the 2015 guidelines. These guidelines discuss 1) updated recommendations for treatment of Neisseria gonorrhoeae, Chlamydia trachomatis, and Trichomonas vaginalis; 2) addition of metronidazole to the recommended treatment regimen for pelvic inflammatory disease; 3) alternative treatment options for bacterial vaginosis; 4) management of Mycoplasma genitalium; 5) human papillomavirus vaccine recommendations and counseling messages; 6) expanded risk factors for syphilis testing among pregnant women; 7) one-time testing for hepatitis C infection; 8) evaluation of men who have sex with men after sexual assault; and 9) two-step testing for serologic diagnosis of genital herpes simplex virus. Physicians and other health care providers can use these guidelines to assist in prevention and treatment of STIs.

Human Ectoparasites Are Highly Prevalent in the Rural Communities of Northwest Ethiopia: A Community-Based Cross-Sectional Study

BACKGROUND

Ectoparasites are organisms which inhabit the skin or outgrowths of the skin of another organism (the host). Many ectoparasites are known to be vectors of pathogens, which the parasites typically transmit to hosts. Though, ectoparasites are common in the vulnerable groups and economically disadvantaged communities, there is limited evidence on its magnitude in Ethiopia. This community-based cross-sectional study was, therefore, conducted to assess the prevalence and associated factors of ectoparasites in the rural communities of northwest Ethiopia.

METHODS

A community-based cross-sectional study design with structured observation was conducted among 1191 randomly selected rural households in northwest Ethiopia in May 2016. Data were collected using structured interviewer administered interview questionnaire and structured observation checklist. Prevalence of human ectoparasites in the rural communities was defined as the presence of one or more lice, fleas, bed bugs, mites, and ticks and the presence of these ectoparasites were observed by trained environmental health experts. Multivariable binary logistic regression analysis was used to identify variables associated with prevalence of ectoparasites on the basis of adjusted odds ratio (AOR) with 95% confidence interval (CI) and P values <.05.

RESULTS

Of a total of 1191 rural households, human or hair lice were observed in one or more of the family members in 186 (15.6%) rural households. Similarly, fleas were observed in more than half, 609 (51.1%) of rural households and bed bugs were observed in 441 (37%) rural households. Furthermore, mites and ticks were reported in 113 (9.5%) and 130 (10.9%) of the households respectively. Accordingly, one or more ectoparasites were observed in 865 of 1191 rural households. The presence of one or more ectoparasites was, therefore, found to be 72.6% (95% CI = 70%-75.1%). The prevalence of ectoparasites was statistically associated with educational status of the female head being not educated (AOR = 1.476, 95% CI = 1.001, 2.177) and absence close supervision by health extension workers (AOR = 2.151, 95% CI = 1.205, 3.843).

CONCLUSION

The prevalence of one or more ectoparasites was high in the rural communities of northwest Ethiopia. The high prevalence was associated with education status of the female head and close supervision of households by health extension workers. Disseminating health information about intervention strategies of ectoparasites and closely supervising the rural households need to be considered.

Risk factors associated with scabies infestation among primary schoolchildren in a low socio-economic area in southeast of Iran

Background

Scabies is a neglected tropical disease caused by the mite Sarcoptes scabiei that burrows under the skin. It is a major health problem in tropical areas, largely affecting children. Scabies is common and highly contagious and in schoolchildren spreads quite rapidly, due to overcrowding and close contact within the schools. This study aimed to determine the risk factors associated with scabies infestation among primary schoolchildren in Bashagard County, one of the low socio-economic areas in southeast of Iran.

Methods

To conduct this community-based, descriptive, and cross-sectional study, four primary schools were randomly selected in the Bashagard County. All students in these schools were selected and examined for scabies. Clinical examination and sociodemographic profile of students were assessed using a pre-tested structured questionnaire. Chi-square test, and binary logistic regression were used to analyse the factors associated with scabies infestation by SPSS version 21 software.

Results

Out of 480 studied schoolchildren, 15 cases of scabies with a prevalence of 3.1 % were observed. The frequency of infestation in males was 1.6 % and it was 4.7 % in females. Independent factors associated with a high risk of scabies infestation in unadjusted analysis were being student of grade 5–6 (cOR = 13.12, 95 % CI 2.92–58.89, p = 0.0001), low educational level of father (cOR = 4.37, 95 % CI 0.97–19.59, p = 0.036), low educational level of mother (cOR = 4.14, 95 % CI 1.92–18.57, p = 0.045), joblessness of father (cOR = 14.77, 95 % CI 4.97–43.89, p = 0.0001), employment of mother (cOR = 5.28, 95 % CI 1.38–20.16, p = 0.007), large family size (cOR = 3.34, 95 % CI 1.05–10.64, p = 0.031), use of shared articles (cOR = 33.37, 95 % CI 10.82–102.90, p = 0.0001), and absence of bathroom in the house (cOR = 11.77, 95 % CI 2.16–63.94, p = 0.0001).

Conclusions

Results of this study confirmed that scabies is still one of the most important health problems in the primary schools of the Bashagard County. Low socioeconomic status and personal hygiene of the schoolchildren were the most important factors influencing the prevalence of scabies. Improvement of socioeconomic conditions and implementation of appropriate educational programs and active surveillance system to quickly detect and treat scabies cases are necessary in order to reduce the prevalence of scabies in schoolchildren in this area.

Host-Parasite Interaction in Sarcoptes scabiei Infestation in Porcine Model with a Preliminary Note on Its Genetic Lineage from India

Simple Summary

Scabies or mange caused by Sarcoptess cabiei is the latest addition of WHO’s list oftropical neglected diseases. It causes severe itching to the host. It has a wide host range including humans, farm animals, companion animals, and wild animals. It is anemerging/re-emerging disease with high prevalence in underdeveloped and developing countries. The disease has zoonotic importance and is of significant public health concern as cross-transmission or species jumping is very common. To date, fifteen Sarcoptes varieties have been reported as per host origin. Differential diagnosis at variety level is very crucial for epidemiological study and scratching future eradication program of the disease. As morphotaxonomy fails to differentiate varieties, use of molecular markers is crucial. Moreover, it is very important to understand the host-parasite interaction at the systemic level for a better understanding on the pathogenicity of the disease. Here, we report the genetic characterization of S. scabiei from India and host-parasite interaction in a porcine model.

Abstract

The burrowing mite Sarcoptes scabiei causes scabies in humans or mange in animals. It infests a wide range of mammalian species including livestock, companion animals, wild animals, and humans. Differential diagnosis of Sarcoptes varieties is key for epidemiological studies and for formulation of an eradication program. Host-parasite interaction at the systemic level is very important to understand the pathogenicity of the mite. This communication deals with the preliminary report on the genetic characterization of S. scabiei from India. Moreover, the effect of S. scabiei infestation on host physiology with special emphasis on serum biochemical parameters, lipid profile, oxidant/antioxidant balance, stress parameters, and immune responses were evaluated in a porcine model. Cytochrome C oxidase 1 and voltage-sensitive sodium channel based phylogenetic study could distinguish human and animals isolates but could not distinguish host or geographical specific isolates belonging to animal origin. An absence of host-specific cluster among animal isolates argues against the hypothesis of delineating S. scabiei as per host origin. Elevated levels of markers of liver function such as albumin, AST, ALT, ALP, and LDH in infested animals indicated impaired liver function in infested animals. S. scabiei infestation induced atherogenic dyslipidemia indicated by elevated levels of total cholesterol, low-density lipoprotein cholesterol and triglycerides, and a decreased level of high-density lipoprotein cholesterol. Oxidative stress in infested animals was indicated by a high level of nitric oxide and serum MDA as oxidative stress markers and low antioxidant capacity. S. scabiei triggered stress response and elevated levels of serum cortisol and heat shock proteins were recorded in infested animals. S. scabiei infestation increased the serum concentration of immunoglobulins and was associated with up-regulation of IL-2, IFN-γ, IL-1β, and IL-4 indicating both Th1 and Th2 response. The results of the study will be helpful for a better understanding of host-parasite interaction at the systemic level in crusted scabies in pigs.

The Challenge of Developing a Single-Dose Treatment for Scabies

Scabies is a common skin disease with an estimated worldwide incidence of 200 million people infected per year. Its morbidity and mortality is principally due to secondary bacterial infections, a link now well recognized and prompting the recent inclusion of this disease-complex in the WHO list of neglected tropical diseases. The few treatments available are poorly effective against Sarcoptes scabiei eggs and appear to induce resistance in the parasite. An ideal alternative would be a single-dose regimen that kills all developmental stages, including eggs. Drugs used in the veterinary field and applied to other arthropods could be tested experimentally in an established pig-scabies model. Moreover, functional genomics combined with target validation through biochemical research should assist in identifying new drugs.

Ectoparasite defence in humans: relationships to pathogen avoidance and clinical implications

Currently, disgust is regarded as the main adaptation for defence against pathogens and parasites in humans. Disgust's motivational and behavioural features, including withdrawal, nausea, appetite suppression and the urge to vomit, defend effectively against ingesting or touching sources of pathogens. However, ectoparasites do not attack their hosts via ingestion, but rather actively attach themselves to the body surface. Accordingly, by itself, disgust offers limited defence against ectoparasites. We propose that, like non-human animals, humans have a distinct ectoparasite defence system that includes cutaneous sensory mechanisms, itch-generation mechanisms and grooming behaviours. The existence of adaptations for ectoparasite defence is supported by abundant evidence from non-human animals, as well as more recent evidence concerning human responses to ectoparasite cues. Several clinical disorders may be dysfunctions of the ectoparasite defence system, including some that are pathologies of grooming, such as skin picking and trichotillomania, and others, such as delusory parasitosis and trypophobia, which are pathologies of ectoparasite detection. We conclude that future research should explore both distinctions between, and overlap across, ectoparasite defence systems and pathogen avoidance systems, as doing so will not only illuminate proximate motivational systems, including disgust, but may also reveal important clinical and social consequences.This article is part of the Theo Murphy meeting issue 'Evolution of pathogen and parasite avoidance behaviours'.

Tackling scabies: novel agents for a neglected disease

The scabies mite, Sarcoptes scabiei var hominis, is an obligate ectoparasite of humans. It has been a source of distress for humanity since antiquity. The troublesome mite is emerging triumphant over current acaricidal agents with reports of emerging resistance and treatment failures. Scabies in endemic areas and crusted scabies offer additional management challenges. Exploration of indigenous plants and better understanding of mite biology and pathogenesis provide opportunities for the development of novel agents for this common pest. We review the recent diverse approaches to scabies, including the use of novel plant products with a better safety profile, translating the use of moxidectin from veterinary practice to human scabies, vaccination, immunotherapy, and development of drugs that directly target mite molecules.

Comparative diagnostics reveals PCR assays on skin scrapings is the most reliable method to detect Sarcoptes scabiei infestations

Sarcoptic mange is a globally significant parasitic disease of humans and other animals, both domestic and wild. But clinical diagnosis of S. scabiei infestation, using the standard skin scraping followed by microscopy technique, remains highly variable (predominantly due to false-negatives), and a major challenge for human and animal welfare. Here, we utilised a unique sample set from bare-nosed wombats (Vombatus ursinus) to evaluate a variety of putatively useful diagnostic approaches for S. scabiei. Against the standard of skin scrapings followed by microscopy, we compared observational scoring of mange severity (often employed in field studies of wildlife), PCR on skin scrapings (recently proposed as an improvement for humans and other animals), and PCR on skin swabs (proposed a non-invasive method for humans and other animals). We find that observational scoring positively correlated with counts of S. scabiei from skin scrapings, particularly as mange severity increases, but underdiagnoses early mange. Species-specific PCR for S. scabiei on skin scrapings had enhanced capacity for mite detection relative to microscopy. Finally, the non-invasive sampling method of PCR on skin swab samples had a high congruence to skin scraping microscopy, however prospective false negatives as a consequence to sampling is concerning. To our knowledge, this is the first study to simultaneously assess this combination of methods for S. scabiei diagnosis. We conclude that PCR on skin scrapings as an advancement on traditional microscopy, and the other techniques (observational, skin swabs and microscopy) remain useful, but harbour greater false-negatives. Outcomes are transferrable to diagnosis of S. scabiei for other host species, including humans, particularly for crusted mange and potentially ordinary mange also.

Mitochondrial genome sequencing reveals potential origins of the scabies mite Sarcoptes scabiei infesting two iconic Australian marsupials

BACKGROUND

Debilitating skin infestations caused by the mite, Sarcoptes scabiei, have a profound impact on human and animal health globally. In Australia, this impact is evident across different segments of Australian society, with a growing recognition that it can contribute to rapid declines of native Australian marsupials. Cross-host transmission has been suggested to play a significant role in the epidemiology and origin of mite infestations in different species but a chronic lack of genetic resources has made further inferences difficult. To investigate the origins and molecular epidemiology of S. scabiei in Australian wildlife, we sequenced the mitochondrial genomes of S. scabiei from diseased wombats (Vombatus ursinus) and koalas (Phascolarctos cinereus) spanning New South Wales, Victoria and Tasmania, and compared them with the recently sequenced mitochondrial genome sequences of S. scabiei from humans.

RESULTS

We found unique S. scabiei haplotypes among individual wombat and koala hosts with high sequence similarity (99.1% - 100%). Phylogenetic analysis of near full-length mitochondrial genomes revealed three clades of S. scabiei (one human and two marsupial), with no apparent geographic or host species pattern, suggestive of multiple introductions. The availability of additional mitochondrial gene sequences also enabled a re-evaluation of a range of putative molecular markers of S. scabiei, revealing that cox1 is the most informative gene for molecular epidemiological investigations. Utilising this gene target, we provide additional evidence to support cross-host transmission between different animal hosts.

CONCLUSIONS

Our results suggest a history of parasite invasion through colonisation of Australia from hosts across the globe and the potential for cross-host transmission being a common feature of the epidemiology of this neglected pathogen. If this is the case, comparable patterns may exist elsewhere in the 'New World'. This work provides a basis for expanded molecular studies into mange epidemiology in humans and animals in Australia and other geographic regions.

Vaccination of rabbits with immunodominant antigens from Sarcoptes scabiei induced high levels of humoral responses and pro-inflammatory cytokines but confers limited protection

BACKGROUND

Vaccination is an attractive ecological alternative to the use of acaricides for parasite control. However, effective anti-parasite vaccines against sarcoptic mange have not yet been developed. The purpose of this study was first to identify Sarcoptes scabiei immunodominant antigens and second to evaluate them as vaccine candidates in a rabbit/S. scabiei var. cuniculi model.

METHODS

The S. scabiei Ssλ15 immunodominant antigen was selected by immunoscreening of a S. scabiei var. hominis cDNA. The full-length cDNA was sequenced and cloned into the pGEX vector and the recombinant protein expressed in BL21 (DE3) cells and purified. A vaccination trial was performed consisting of a test group (n = 8) immunised with recAgs (a mix of two recombinant antigens, Ssλ15 and the previously described Ssλ20∆B3) and a control group (n = 8) immunised with PBS. All analyses were performed with R Statistical Environment with α set at 0.050.

RESULTS

The full-length open reading frame of the 1,821 nt cloned cDNA encodes a 64 kDa polypeptide, the sequence of which had 96 % identity with a hypothetical protein of S. scabiei. Ssλ15 was localised by immunostaining of skin sections in the tegument surrounding the mouthparts and the coxa in the legs of mites. Rabbit immunisation with recAgs induced high levels of specific IgG (P < 0.010) and increased levels of total IgEs. However, no significant clinical protection against S. scabiei challenge was detected. Unexpectedly, the group immunised with the recAgs mix had significantly higher lesion scores (P = 0.050) although lower mean mite densities than those observed in the control group. These results might indicate that the lesions in the recAgs group were due not only to the mites density but also to an exacerbated immunological response after challenge, which is in agreement with the specific high levels of pro-inflammatory cytokines (IL-1 and TNFα) detected after challenge in this group.

CONCLUSIONS

The selected antigens delivered as recombinant proteins had no clinical protective efficacy against S. scabiei infestation although immunisation reduced mite density. However, these results pave the way for future studies on alternative production systems, adjuvants, delivery methods and combinations of antigens in order to manage stimulation of clinical protective immune responses.

The emergence of sarcoptic mange in Australian wildlife: an unresolved debate

Due to its suspected increase in host range and subsequent global diversification, Sarcoptes scabiei has important implications at a global scale for wildlife conservation and animal and human health. The introduction of this pathogen into new locations and hosts has been shown to produce high morbidity and mortality, a situation observed recently in Australian and North American wildlife.

Of the seven native animal species in Australia known to be infested by S. scabiei, the bare-nosed wombat (Vombatus ursinus) suffers the greatest with significant population declines having been observed in New South Wales and Tasmania. The origins of sarcoptic mange in Australian native animals are poorly understood, with the most consistent conclusion being that mange was introduced by settlers and their dogs and subsequently becoming a major burden to native wildlife. Four studies exist addressing the origins of mange in Australia, but all Australian S. scabiei samples derive from only two of these studies. This review highlights this paucity of phylogenetic knowledge of S. scabiei within Australia, and suggests further research is needed to confidently determine the origin, or multiple origins, of this parasite.

At the global scale, numerous genetic studies have attempted to reveal how the host species and host geographic location influence S. scabiei phylogenetics. This review includes an analysis of the global literature, revealing that inconsistent use of gene loci across studies significantly influences phylogenetic inference. Furthermore, by performing a contemporary analytical approach on existing data, it is apparent that (i) new S. scabiei samples, (ii) appropriate gene loci targets, and (iii) advanced phylogenetic approaches are necessary to more confidently comprehend the origins of mange in Australia. Advancing this field of research will aid in understanding the mechanisms of spillover for mange and other parasites globally.

Assessment of the cytokine profile in peripheral blood mononuclear cells of naturally Sarcoptes scabiei var. canis infested dogs

The mechanism of cytokine secretion from T lymphocytes plays an important role in the immune response of dogs and parasitic skin infestations. Assessment of the cytokine profile of naturally S. scabiei var. canis infested dogs could augment understanding of the pathobiology of canine sarcoptic mange. Therefore, the present study examined the cytokines in peripheral blood mononuclear cells of dogs suffering from sarcoptic mange. Thirteen dogs naturally infected with sarcoptic mange participated in the study. The dogs were found positive for S. scabiei var. canis mites in skin scraping examinations and revealed at least three clinical inclusion criteria. Another five clinically healthy dogs were kept as healthy controls. Peripheral blood mononuclear cells were isolated from heparinized blood samples and used for extraction of mRNA. Further, cDNA was synthesized by using 1 mg of mRNA by reverse transcription using oligonucleotide primers. Relative levels of cytokine expression were compared with normalized glyceraldehyde-3-phosphate dehydrogenase (GAPDH) transcripts. The levels of interleukin-4, interleukin-5 and transforming growth factor beta (TGF-β) mRNA expression in dogs with sarcoptic mange were significantly higher (P ≤ 0.01), whereas the level of tumor necrosis factor alpha (TNF-α) was significantly lower (P ≤ 0.01) in comparison with the healthy dogs. No remarkable difference was seen for interleukin-2 mRNA expression between these animals. An overproduction IL-4 and IL-5 might be involved in immuno-pathogenesis of canine sarcoptic mange. S. scabiei var. canis mites possibly induce an overproduction of TGF-β and reduced expression of TNF-α and thus could be conferring the immune suppression of infested dogs.

Are humans the initial source of canine mange?

Background

Scabies, or mange as it is called in animals, is an ectoparasitic contagious infestation caused by the mite Sarcoptes scabiei. Sarcoptic mange is an important veterinary disease leading to significant morbidity and mortality in wild and domestic animals. A widely accepted hypothesis, though never substantiated by factual data, suggests that humans were the initial source of the animal contamination. In this study we performed phylogenetic analyses of populations of S. scabiei from humans and from canids to validate or not the hypothesis of a human origin of the mites infecting domestic dogs.

Methods

Mites from dogs and foxes were obtained from three French sites and from other countries. A part of cytochrome c oxidase subunit 1 (cox1) gene was amplified and directly sequenced. Other sequences corresponding to mites from humans, raccoon dogs, foxes, jackal and dogs from various geographical areas were retrieved from GenBank. Phylogenetic analyses were performed using the Otodectes cynotis cox1 sequence as outgroup. Maximum Likelihood and Bayesian Inference analysis approaches were used. To visualize the relationship between the haplotypes, a median joining haplotype network was constructed using Network v4.6 according to host.

Results

Twenty-one haplotypes were observed among mites collected from five different host species, including humans and canids from nine geographical areas. The phylogenetic trees based on Maximum Likelihood and Bayesian Inference analyses showed similar topologies with few differences in node support values. The results were not consistent with a human origin of S. scabiei mites in dogs and, on the contrary, did not exclude the opposite hypothesis of a host switch from dogs to humans.

Conclusions

Phylogenetic relatedness may have an impact in terms of epidemiological control strategy. Our results and other recent studies suggest to re-evaluate the level of transmission between domestic dogs and humans.

Therapeutic Potential of Tea Tree Oil for Scabies

Globally, scabies affects more than 130 million people at any time. In the developed world, outbreaks in health institutions and vulnerable communities result in a significant economic burden. A review of the literature demonstrates the emergence of resistance toward classical scabicidal treatments and the lack of effectiveness of currently available scabicides in reducing the inflammatory skin reactions and pyodermal progression that occurs in predisposed patient cohorts. Tea tree oil (TTO) has demonstrated promising acaricidal effects against scabies mites in vitro and has also been successfully used as an adjuvant topical medication for the treatment of crusted scabies, including cases that did not respond to standard treatments. Emerging acaricide resistance threatens the future usefulness of currently used gold standard treatments (oral ivermectin and topical permethrin) for scabies. The imminent development of new chemical entities is doubtful. The cumulative acaricidal, antibacterial, antipruritic, anti-inflammatory, and wound healing effects of TTO may have the potential to successfully reduce the burden of scabies infection and the associated bacterial complications. This review summarizes current knowledge on the use of TTO for the treatment of scabies. On the strength of existing data for TTO, larger scale, randomized controlled clinical trials are warranted.

The Molecular Evolution of Xenobiotic Metabolism and Resistance in Chelicerate Mites

Chelicerate mites diverged from other arthropod lineages more than 400 million years ago and subsequently developed specific and remarkable xenobiotic adaptations. The study of the two-spotted spider mite, Tetranychus urticae, for which a high-quality Sanger-sequenced genome was first available, revealed expansions and radiations in all major detoxification gene families, including P450 monooxygenases, carboxyl/cholinesterases, glutathione-S-transferases, and ATP-binding cassette transporters. Novel gene families that are not well studied in other arthropods, such as major facilitator family transporters and lipocalins, also reflect the evolution of xenobiotic adaptation. The acquisition of genes by horizontal gene transfer provided new routes to handle toxins, for example, the β-cyanoalanine synthase enzyme that metabolizes cyanide. The availability of genomic resources for other mite species has allowed researchers to study the lineage specificity of these gene family expansions and the distinct evolution of genes involved in xenobiotic metabolism in mites. Genome-based tools have been crucial in supporting the idiosyncrasies of mite detoxification and will further support the expanding field of mite-plant interactions.

The Potential for a Blood Test for Scabies

Background

Scabies afflicts millions of people worldwide, but it is very difficult to diagnose by the usual skin scrape test, and a presumptive diagnosis is often made based on clinical signs such as rash and intense itch. A sensitive and specific blood test to detect scabies would allow a physician to quickly make a correct diagnosis.

Objective

Our objective was to profile the mite-specific antibodies present in the sera of patients with ordinary scabies.

Methods

Sera of 91 patients were screened for Ig, IgD, IgE, IgG and IgM antibodies to S. scabiei, as well as to the house dust mites Dermatophagoides farinae, D. pteronyssinus and Euroglyphus maynei.

Results

45%, 27% and 2.2% of the patients had measurable amounts of mixed Ig, IgG and IgE that recognized scabies mite antigens. However, 73.6% of the scabies patients had serum IgM that recognized scabies proteins, and all except two of them also had IgM that recognized all of the three species of dust mites. No patient had serum antibody exclusively reactive to scabies mite antigens.

Conclusions

Co-sensitization or cross-reactivity between antigens from scabies and house dust mites confounds developing a blood test for scabies.

Scabies, caused by the mite S. scabiei that burrows in the skin of humans, is a contagious skin disease that affects millions of people worldwide. It is a significant public health burden in economically disadvantaged populations, and outbreaks are common in nursing homes, daycare facilities, schools and workplaces in developed countries. It causes significant morbidity, and in chronic cases, associated bacterial infections can lead to renal and cardiac diseases. Scabies is very difficult to diagnose by the usual skin scrape test, and a presumptive diagnosis is often made based on clinical signs such as rash and itch that can mimic other skin disease. A sensitive and specific blood test to detect scabies-specific antibodies would allow a physician to quickly make a correct diagnosis. Our manuscript reports the antibody isotype profiles of the sera of two groups of patients with ordinary scabies (17 from the US and 74 from Brazil) and concludes that such a blood test should be based on circulating IgM type antibodies that do not also recognize antigens of the related and ubiquitous house dust mites. Both are important considerations for research for developing a blood test for the diagnosis of scabies.

Sarcoptes scabiei mites in humans are distributed into three genetically distinct clades

Scabies is an ectoparasitic infestation caused by the mite Sarcoptes scabiei. Currently, S. scabiei is taxonomically divided into different varieties on the basis of host origin. Genetics-based research on scabies has been conducted, but the data on genetic diversity of populations of this mite in humans in Europe are lacking. We evaluated the genetic diversity of populations of S. scabiei. A large series of mites obtained from humans in France and the data of mites from various hosts and geographical areas retrieved from GenBank were included to investigate whether mites are divided into distinct populations. The study of cytochrome c oxidase subunit 1 gene polymorphisms were found to be best suited for phylogenetic analysis. S. scabiei mites were distributed into three genetically distinct clades, with most mites clustering in clades B and C. The Fst value and the Nm value calculated for mites included in clades B and C indicated a strong population structure and a very low gene flow between mites of those clades. The results of the present study not only support the rejection of the hypothesis of panmixia for S. scabiei in humans but also suggest that mites belonging to different clades are genetically isolated. Moreover, the results suggest that the subdivision of S. scabies in varieties according to animal or human hosts is not warranted. In conclusion, S. scabiei mites in humans do not constitute a homogeneous population. Further investigations are now required to assess whether different clinical forms of scabies are associated with particular haplotypes or clades.

Prospective study in a porcine model of sarcoptes scabiei indicates the association of Th2 and Th17 pathways with the clinical severity of scabies

Background

Understanding of scabies immunopathology has been hampered by the inability to undertake longitudinal studies in humans. Pigs are a useful animal model for scabies, and show clinical and immunologic changes similar to those in humans. Crusted scabies can be readily established in pigs by treatment with the glucocorticoid dexamethasone (Dex).

Methodology/ Principal Findings

Prospective study of 24 pigs in four groups: a) Scabies+/Dex+, b) Scabies+/Dex-, c) Scabies-/Dex+ and d) Scabies-/Dex-. Clinical symptoms were monitored. Histological profiling and transcriptional analysis of skin biopsies was undertaken to compare changes in cell infiltrates and representative cytokines. A range of clinical responses to Sarcoptes scabiei were observed in Dex treated and non-immunosuppressed pigs. An association was confirmed between disease severity and transcription of the Th2 cytokines IL-4 and IL-13, and up-regulation of the Th17 cytokines IL-17 and IL-23 in pigs with crusted scabies. Immunohistochemistry revealed marked infiltration of lymphocytes and mast cells, and strong staining for IL-17.

Conclusions/ Significance

While an allergic Th2 type response to scabies has been previously described, these results suggest that IL-17 related pathways may also contribute to immunopathology of crusted scabies. This may lead to new strategies to protect vulnerable subjects from contracting recurrent crusted scabies.

Scabies is a neglected tropical skin disease caused by the tiny parasitic mite Sarcoptes scabiei. Scabies is common in developing countries, and scabies outbreaks also occur in institutional settings worldwide. Scabies often underlies secondary bacterial skin infection and resulting complications, and is thus associated with considerable morbidity. Crusted scabies is a an extremely severe and debilitating clinical form of the disease, but host immune responses leading to the development of crusted or ordinary scabies are poorly understood. This is largely due to limited access to clinical samples, and the difficulty in monitoring the progression of infestation in human patients. We have overcome this challenge by using a pig model of scabies infestation, since pigs and humans with scabies display clinical and immunological similarities. In this study, we undertook longitudinal analysis of clinical, histological and molecular immunological changes in pigs experimentally infected with scabies. We confirmed that disease severity was associated with a pronounced allergic, Th2 immune response, as previously reported. In a novel finding, we showed that the Th17 associated cytokines interleukin-17 and interleukin-23 were also associated with the development of crusted scabies. This may lead to new immunotherapeutic strategies to protect vulnerable subjects from contracting recurrent crusted scabies.

Scabies in the nursing home

Scabies infection is antediluvian and ubiquitous both in developing and developed countries, yet often neglected. Scabies has a predilection to infect vulnerable subsets of population in crowding conditions, typically applicable to residents in the nursing home. The mite incites a unique immunological response from human hosts. Scabies does not manifest as a singular skin condition and may present atypically in older adults, the majority of nursing home residents, where delay has deleterious consequences. Further, pruritus or itching, the hallmark of scabies infection, is a common complaint from a variety of causes among older adults. Hence, the diagnosis is often delayed or missed. There are several pharmacological treatment options; long-term care practitioners need to understand the characteristics of each agent before selection. Even more relevant is the importance of nonpharmacological aspects of management, crucial in the success of averting spread or outbreaks in long-term care settings.

Parasitic mites of medical and veterinary importance--is there a common research agenda?

There are an estimated 0.5-1 million mite species on earth. Among the many mites that are known to affect humans and animals, only a subset are parasitic but these can cause significant disease. We aim here to provide an overview of the most recent work in this field in order to identify common biological features of these parasites and to inform common strategies for future research. There is a critical need for diagnostic tools to allow for better surveillance and for drugs tailored specifically to the respective parasites. Multi-'omics' approaches represent a logical and timely strategy to identify the appropriate mite molecules. Recent advances in sequencing technology enable us to generate de novo genome sequence data, even from limited DNA resources. Consequently, the field of mite genomics has recently emerged and will now rapidly expand, which is a particular advantage for parasitic mites that cannot be cultured in vitro. Investigations of the microbiota associated with mites will elucidate the link between parasites and pathogens, and define the role of the mite in transmission and pathogenesis. The databases generated will provide the crucial knowledge essential to design novel diagnostic tools, control measures, prophylaxes, drugs and immunotherapies against the mites and associated secondary infections.

Immune response induced by candidate Sarcoptes scabiei var. cuniculi DNA vaccine encoding paramyosin in mice

Sarcoptes scabiei is the causal agent of the highly contagious disease sarcoptic mange (scabies) that affects animals and humans worldwide. An increasing number of cases of treatment failure is being reported because of drug resistance. The development of a specific vaccine would be a sustainable option for control of this disease. In this study, we cloned and expressed a S. scabiei gene encoding paramyosin (PAR) and investigated the immune response elicited by DNA encoding PAR in mice. The ability of the DNA vaccine to express antigen in COS-7 cells was confirmed by RT-PCR and IFA. The immune response induced by DNA vaccine was investigated by ELISA, splenocyte proliferation assay, and cytokine production assay. Compared to the pVAX1 control group, the PAR DNA vaccination group showed the higher levels of IgG, IgG1, IgG2a, IgE, IgM, stronger lymphocyte proliferation in mouse spleen, and larger production of IL-2, IL-4, IL-5, and IFN-γ in the supernatant of cultures from splenocytes. These results indicated that the PAR DNA vaccine induced a mixed Th1/Th2 response in mice. In conclusion, our results revealed that the S. scabiei PAR DNA vaccine induced both a humoral and cellular immune response, which would provide basic data for the further study to develop an effective vaccine against sarcoptic mange.

Preliminary molecular characterizations of Sarcoptes scaibiei (Acari: Sarcoptidae) from farm animals in Egypt

Little is known about the genetic diversity of Sarcoptes scabiei mites in farm animals in Egypt. In this study, we characterized S. scabiei in 25 skin scrapes from water buffalo, cattle, sheep, and rabbits at the nuclear marker ITS2 and mitochondrial markers COX1 and 16S rRNA. Sequences of the ITS2 showed no host segregation or geographical isolation, whereas those of the mitochondrial COX1 and 16S rRNA genes indicated the presence of both host-adapted and geographically segregated populations of S. scabiei. Host adaptation may limit inter-species transmission of. S. scabiei, thus restrict gene flow among S. scabiei from different hosts. This is the first report on the molecular characterization of sarcoptic mites in Egypt. Further genetic studies involving larger numbers of specimens, especially those from humans and companion animals, are needed to understand the molecular epidemiology of sarcoptic mange in Egypt.

Isolated itching of the genitals

A 38-year-old man, returned from Ivory Coast 2 months ago and presented with a 3-month history of pruritus exclusively on the scrotum. Itching was continuous during the day and no pruritus was described in his wife and son. Clinical examination of the genitals revealed several nodules on the scrotum, a chancrous lesion was seen on the penis, and multiple excoriations were noted. Dermoscopy exam with a dermatoscope of the whole body was performed and no papules, nodules, or burrow were found. Microscopic examination of several superficial skin samples obtained by scraping in the peri-genital area revealed one adult of Sarcoptes scabiei. The patient and his relatives were successfully treated with Ivermectin 200 μg/kg with a second dose 2 weeks later. Very rare cases are described on localized scabies (scalp, feet) and they mainly occurred in an immunocompromised patient unlike this patient who does not have any immunosuppression.

Primary and secondary experimental infestation of rabbits (Oryctolagus cuniculus) with Sarcoptes scabiei from a wild rabbit: factors determining resistance to reinfestation

Studies of sarcoptic mange and immunity are hampered by lack of mite sources and natural infestation models. We have investigated the clinical and pathological signs, specific IgG response and acquired immunity in naïve New Zealand White rabbits (Oryctolagus cuniculus) experimentally infested with Sarcoptes scabiei originally isolated from a clinically affected free-living European wild rabbit. Twenty rabbits were infested using two methods, direct contact for a 24 h period with a seeder rabbit simulating the natural process of infestation and application of a dressing holding approximately 1800 live mites on each hind limb (foot area) for a 24h period. Eight weeks post infestation, rabbits were treated with ivermectin and infestation cleared. Eight weeks later seventeen previously infested and four uninfested naïve controls were then re-exposed to the same S. scabiei variety using the same methods and followed for another 8 weeks. The progress of the disease was markedly more virulent in the animals infested by contact, indicating that the effective dose of mites managing to thrive and infest each rabbit by this method was higher. Nevertheless, infestation by contact resulted in partial protection to reexposure, rabbits developed high non-protective antibody titres upon reinfestation and presented severe clinical signs. However, rabbits reinfested by dressing developed lower IgG titres, and presented high levels of resistance to reinfestation, which might be due to induction of a strong local cellular response in the inoculation point that killed the mites and resulted in a lower mite effective dose, with subsequent reduced lesion development. Statistical analysis showed that sex, method of infestation and previous exposure are key factors determining the ability of rabbits to develop immunity to this disease. The rabbit-mange model developed will allow the further study of immunity and resistance to this neglected pathogen using a natural host system.

Vaccine against scabies: necessity and possibility

Scabies is an infectious disease that is endemic in poorly resourced communities, and also common in industrialized countries. Although the disease, which is caused by infestation of Sarcoptes scabiei, is generally mild, the need for a vaccine against S. scabiei is proposed. The immunological mechanisms that control S. scabiei infection are discussed and the current status of scabies vaccine development reviewed. Future directions for scabies vaccine development are also addressed.

Advances in studies of disease-navigating webs: Sarcoptes scabiei as a case study

The discipline of epidemiology is the study of the patterns, causes and effects of health and disease conditions in defined anima populations. It is the key to evidence-based medicine, which is one of the cornerstones of public health. One of the important facets of epidemiology is disease-navigating webs (disease-NW) through which zoonotic and multi-host parasites in general move from one host to another. Epidemiology in this context includes (i) classical epidemiological approaches based on the statistical analysis of disease prevalence and distribution and, more recently, (ii) genetic approaches with approximations of disease-agent population genetics. Both approaches, classical epidemiology and population genetics, are useful for studying disease-NW. However, both have strengths and weaknesses when applied separately, which, unfortunately, is too often current practice. In this paper, we use Sarcoptes scabiei mite epidemiology as a case study to show how important an integrated approach can be in understanding disease-NW and subsequent disease control.

Molecular survey of knockdown resistance to pyrethroids in human scabies mites

There are growing concerns about the emergence of resistance of Sarcoptes scabiei to permethrin and other pyrethroid derivatives. Sarcoptes scabiei mites collected from 40 patients visiting two hospitals near Paris, France, were genotypically characterized considering two parts of their voltage-sensitive sodium channel gene. No nucleotide polymorphism resulting in a codon change at codon 733 or other positions associated with knockdown resistance in other arthropods has been identified. These data may establish a reference line for future surveys of the susceptibility of S. scabiei in the area.

Characterisation and analysis of thioredoxin peroxidase as a potential antigen for the serodiagnosis of sarcoptic mange in rabbits by dot-ELISA

BACKGROUND

Scabies caused by Sarcoptes scabiei is a widespread but a neglected tropical zoonosis. In this study, we characterised a S. scabiei thioredoxin peroxidase (SsTPx) and evaluated a recombinant SsTPx as a diagnostic antigen in rabbits.

METHODS

The open reading frame of the gene encoding SsTPx-2 was amplified and the recombinant protein was expressed in Escherichia coli cells and purified. SsTPx was localized in mite tissue by immunolocalisation using the purified recombinant protein. Serodiagnosis assays were carried out in 203 New Zealand White rabbit serum samples by dot-ELISA.

RESULT

The open reading frame (489 bp) of the gene encodes an 18.11 kDa protein, which showed highly homology to that of Psoroptes cuniculi (98.77% identity) and belongs to the 2-Cys family of peroxiredoxins. SsTPx was mainly distributed in muscle tissues of mites, integument of the epidermis and the anterior end of S. scabiei. Although SsTPx cross-reactivity with psoroptic mites was observed, the SsTPx dot-ELISA showed excellent diagnostic ability, with 95.3% sensitivity and 93.8% specificity in mange-infected and uninfected groups.

CONCLUSIONS

This study showed that the purified SsTPx is a highly sensitive antigen for the diagnosis of mange infection by dot-ELISA. This technique is a rapid and convenient method that can be used worldwide for the clinical diagnosis of sarcoptic mange in rabbits, and is especially useful in developing regions.