MANGE (scabies) — the infectious parasitic disease of skin caused by an anthropophilous itch mite.
Etiology. The activator Ch. is the anthropophilous ectoparasite — an itch mite, or zuden (see Mites), belonging to type of arthropods, a class arachnoid, to group akariformny (Acarus siro L., a synonym - Sarcoptesscabiei varietas hominis; Sarcoptes hominis). The activator Ch. is powered horn scales of epidermis. Fertilization of a female happens on the surface of skin of the person, the male perishes after that. The female is attached by suckers of front pads to skin, drills with the movements of jaws a corneous layer of epidermis, making vertical, well-shaped, scarcely noticeable openings in the beginning, then parallel to the surface of skin digs the S-shaped scabby courses, length to-rykh up to 1 — 3 cm and is extremely rare more. It is implemented into epidermis within 15 — 30 min. The female is located usually in the head (blind person) end of the scabby course, per day moves ahead on 1 mm and, periodically stopping, digs openings in «roof» of the scabby courses, through to-rye the air necessary for life activity of a parasite arrives. For 6 — 8 weeks of life it postpones until 50 eggs, from them in
3 — 7 days after a laying larvae appear, to-rye become puberal after 3 molts. All cycle is made approximately in 10 — 14 days. In the period of functional activity the female emits the special substance which is easily absorbed by skin, a cut promotes a loosening of a corneous layer of epidermis and, irritating nerve terminations, causes an itch.
The ticks taken from skin of the person under favorable conditions, napr, at t ° 15 °, live from 5 to 15 days; at a temperature below 0 ° they perish within several minutes. Of Proglazhivaniye of linen the hot iron, boiling lead to bystry death of mites, larvae and eggs. Possess the expressed acaricidal effect carbolic to - that, a cryolean, a xylol, sulphurous anhydride, nek-ry essential oils, etc.
Epidemiology. Infection happens in direct contact to sick Ch. or through the objects and things belonging to it, especially clothes and bedding. At non-compliance with appropriate measures of sanitation and hygiene infection in baths, cars, cabins, etc. is possible. Children can catch Ch. through toys, sports equipment, writing-materials.
The greatest distribution of Ch. gets in autumn and winter time, especially at density, population shift, disturbance of standards of public and personal hygiene (irregular washing and rare change of linen, etc.), natural disasters, wars, etc.
In the USSR now thanks to the constant growth of welfare of workers, improvement of domestic conditions, and also measures of prevention of flash of Ch. completely stopped. Only sporadic cases are observed.
Patogistologiya. In a corneous layer of epidermis in the scabby courses mites, their eggs, excrement are found; on sites with thin skin (e.g., on a penis) mites can get into depth of epidermis, reach cells malpi-giyevy (acanthceous and basal) a layer and to cause inflammatory reaction.
Clinical picture. The incubation interval at Ch. makes
1 — 6 week, 7 — 14 days are more often, however maybe is shorter (e.g., at reinfection).
After implementation of the activator in a corneous layer of epidermis there is an itch which is gradually amplifying in connection with the greatest activity of a tick during this period of days especially at night. Characteristic a wedge, signs are the scabby courses — thin gyrose, grayish or whitish coloring of a strip with the separate blackish points representing the smallest deposits of dirt, eggs, excrement of a tick. One end of the scabby course is open (beginning), another — is closed (blind person). In the blind end of the course the transparent or dimmed bubble often comes to light, in Krom it is possible to find a female of a tick. The scabby courses are well-marked on sites of skin with a gentle corneous layer (interdigital folds and side surfaces of fingers of hands, the flexion surfaces of radiocarpal joints, front axillary folds, a penis, women have nipples of mammary glands).
At a typiform of Ch. along with the scabby courses there are papulovezikulezny rash, raschesa and bloody crusts. Rashes are localized preferential on skin of flexion surfaces of upper extremities (generally in radiocarpal joints and elbow bends), the perednebokovy surface of a stomach, hips, a waist, buttocks. Papules and vesicles of 1 — 3 mm in the diameter, the inflammatory phenomena around them are absent. At adult patients unlike children usually on face skin, a pilar part of the head, axillary poles and soles rash is absent. Papules on a penis at Ch. can remind syphilitic.
Typical the wedge, a picture occurs no more than at 30% of patients with a mange now. In most cases, especially at persons of advanced and senile age, the erased or oligosymptomatic forms of defeat are observed. At frequent washing of skin, especially during the use of the soap containing antiparasitic or antimicrobic substances, an itch insignificant or completely is absent. On skin of a trunk and extremities quite often out of sites of typical localization there are not numerous scabby courses expressed indistinctly and only approximately at 25% of patients single papulovezikulezny elements, bloody crusts and raschesa are noted. At the erased atypical form Ch. the scabby courses quite often can be absent; single papules are generally observed, children have single bubbles.
Often Ch. is complicated by a pyoderma (see). At the same time single or multiple folliculites are localized preferential on skin of side surfaces of fingers, an inter-pas of ltsevy folds, palms and dorsums of brushes. Sometimes there are furuncles (see the Furuncle), ecthymas (see the Ecthyma) and the abscesses (see Abscess) which are followed by lymphadenitis (see) and limfapgiity (see). Hard proceeding forms of a pyoderma at sick Ch. are followed by a moderate leukocytosis, the eosinophilia accelerated by ROE and a moderate albuminuria.
At 6 — 7% of patients after long antiscabetic therapy the postskabiozny small knots in the form of papules of cyanotic-pinkish color with a diameter up to 5 mm which are localized generally on the closed sites of skin (axillary poles, a stomach, buttocks) and followed by a severe itch are observed. At unscrpulous, it is long not treated sick Ch. rashes can ekzematiziro-vatsya.
At children, especially chest, any site of skin, including person, palms, soles, a pilar part of the head can be surprised. Along with papulovesicules and the scabby courses there is vezikulourtikarny rash, develops moknuty, there are paronychias (see) and onychias (see Nails). Children in the first 6 months have lives a wedge. the picture Ch. often reminds a small tortoiseshell (see) and is characterized by a large number of combed; and the blisters covered in the center with a bloody crust which are localized on face skin, spins, buttocks. Later small vesicular rash, sometimes bubbles (a pem-filoidny form Ch.) prevails. In some cases Ch. at children reminds acute eczema (see). A mange at them usually is followed by an intensive itch not only in places of localization of mites, but also on the remote sites of skin. In this regard the sleep disorder, neurotic frustration are quite often noted, complications in the form of allergic dermatitis, a pyoderma like impetigo are more often observed (see). Can arise, lymphadenites and limfangiita, are observed a leukocytosis and a lymphocytosis, an eosinophilia, acceleration of ROE, an albuminuria. At babies sepsis can develop. In a crust, time Ch.'s cases at children with the atypical, erased forms became frequent (without the scabby courses, rash and itch).
Rare version is the Norwegian mange for the first time described in 1847 by Beck and Danielsse in number (Page W. Boeck, D. Page of Danieissen) at patients with a leprosy in Norway. In the subsequent this form Ch. was observed at a Down syndrome, at patients, it is long treated by corticosteroid and cytostatic drugs. The Norwegian mange is characterized by heavier current and peculiar a wedge, a picture. All skin, including a pilar part of the head, is covered like an armor with massive scales and crusts of yellow and dirty or brownish color, from several millimeters to 2 — 3 cm thick. Between layers of crusts and under them there are big accumulations of the mites which are in various stages of development. The scabby courses form as if several floors (6 — 8). At rejection hardly of the removed crusts the wet hyperemic surface with a mass of the mites having an appearance of the moving whitish points is bared. Despite expressiveness and the widespread nature of a disease, an itch of patients does not disturb. The Norwegian mange usually has hron. the current and without treatment lasts for years, often is complicated by a pyoderma.
The diagnosis establish on the basis a wedge, the picture confirmed epidemiological and datas of laboratory. In doubtful cases open with a lanceolated needle under control of a magnifying glass the blind end of the scabby course on site of a bubble, transfer material to a slide plate in a drop of 30% of caustic alkali and investigate under a microscope. In the beginning the taken tick is not mobile, then his movements amplify, especially at easy warming up. Other way of a research is that the razor cut off a tire of a bubble of the scabby course and its contents after processing by caustic alkali are investigated under a microscope, at the same time mites, eggs and excrement usually are found. It is possible to make also Folkmann's spoon, the razor or a scalpel scraping from the estimated center of defeat, without mentioning a papillary layer of a derma. Contents are transferred to a slide plate in a drop of glycerin or 20% of alkali and in 10 min. investigated under a microscope. Also the method of alkaline preparation of skin is used, to-ry consists in drawing 10% of solution of alkali for the centers of defeat. In two minutes a scalpel scratch out matseriro-bathing epidermis, transfer the received scraping to a slide plate and investigate under a microscope.
Differential diagnosis is carried out with a dyshydrosis (see), sometimes with diffusion neurodermatitis (see), the nursery a prurigo (see). The diagnosis is complicated at Ch. complicated by a pyoderma (see). If it is not possible to make the diagnosis, and treatment of a pyoderma does not give positive effect, carry out also antiscabetic treatment. G. I. Meshchersky attached great value to a symptom, or a sign, Ardi facilitating diagnosis of Ch. complicated by a pyoderma. This sign is characterized by existence in area of elbow joints (one or both) the impetiginous or eczematic elements of rash which are mostly in a mode of formation of crusts. These rashes develop on places of the scabby courses. By data I. A. Gorchakova, Ardi's sign at sick Ch. is observed by 3 times more often than the scabby courses. I. A. Gorchakov emphasized the diagnostic value of existence of dot bloody crusts at the beginning of a disease of a mange. At ek-zematizirovanny Ch. establishment of the correct diagnosis is helped by localization of defeat, lack of effect at antieczematous therapy, an intolerable itch at night.
At diagnosis also systematic surveys of all members of the family of the diseased and the personnel which are looking after the patient are important.
It is better to carry out treatment in specially equipped rooms (skabiozoriya) by the protivoskabiotsid-ny means having ability to destroy the scabby courses and to kill ticks and larvae. At uncomplicated Ch. use Vilkinson's ointment, to-ruyu rub in skin, except for a pilar part of the head and the person, within 5 — 6 days once a day. For the purpose of the prevention of dermatitis dusting of skin by mix of talc and starch in equal parts is recommended. This ointment is contraindicated at early children's age, at a disease of kidneys and eczema.
In a crust, time the method of treatment by benzyl benzoate and the accelerated method of treatment of itch is most widespread on Demyanovich. Benzyl benzoate is applied in the form of freshly cooked 20% of a water emulsion (to mix 20 ml of benzyl benzoate from 78 ml of water and 2 g of green soap), to-ruyu rubbed in skin. To children up to
3 years appoint 10% suspension of benzyl benzoate. In 3 days after the end of treatment of the patient takes a shower, changes next-to-skin and bed linen. The used linen is subjected by disinfection (boiling, washing, etc.). By Demyanovich's method within 10 — 15 min. rub in skin of all body 60% solution of sodium thiosulphate (solution No. 1), after drying of solution repeat the procedure. Then 3 — 4 times 5 min. rub to the same sites of skin 6% water solution salt to - you are (solution No. 2), also observing intervals for an obsykhaniye (as a result of chemical reaction between sodium thiosulphate and solution salt to - you are formed the sulfur dioxide gas and free sulfur having ability to kill ticks). Then the patient puts on fresh linen and in 3 days washes. At treatment of children apply 30 — 40% solution of sodium thiosulphate and 2 — 3% solution salt to - you, at the same time solutions do not rub, and only moisten with them skin, the procedure is repeated by 2 — 3 times with 2 — 3-day breaks.
For Ch.'s treatment use 33% Unguentum sulfuratum (to children appoint 10 — 15% ointment), to-ruyu rub 2 times a day, and also soap K and sulfuric soap (according to K. A. Dyakov), rub them 2 times a day 15 min. within
4 — 5 days. Put on only after drying of soap, and for the 6th day wash. Apply other means containing sulfur, napr, polysulphide paste, 50% water solution of pentasulphide of calcium, Fle-minks's liquid. Upon termination of treatment establish by any method for the patient control observation (patients shall be on survey to the doctor every 7 — 10 days within a month).
Prevention consists in early diagnosis, timely and rational treatment, identification of sources of the activator and contacts with the diseased, extermination of parasites on the things and objects which were in use of the patient. At Ch.'s identification in a family, collectives (kindergartens, nursing homes, hostels, etc.) all persons contacting to the patient including service personnel are subject to careful inspection.
The diseased are isolated and appoint by it treatment. In the centers of defeat forces of regional SES or sanitary and epidemiologic departments of regional BCs carry out the current and final disinfection (see) and within 1,5 months the complex of control and anti-epidemic actions is carried out. In addition to measures of personal hygiene, in Ch.'s prevention the gigabyte is of great importance observance. norms in various institutions of consumer and public service of the population (hairdressing salons, baths, etc.), and also broad promotion of actions of personal and public hygiene.
Other forms of itch. The term «mange» is applied also to designation of diseases, to-rye are caused zooantropofilny-
mi by mites from house (a cat, a dog, a pig, a horse, a cow, a camel, a sheep, etc.) and wild (hare, fox, wolf, rat) animals. Such diseases are observed considerably less than Ch. caused by an anthropophilous itch mite. At each species of animals the special type of the itch mite causing zudnevy, nakozh-nikovy, kozheedny and the mixed forms Ch parasitizes. At infection of the person with zooanthropophilous mites the disease has an incubation interval of 10 — 12 hours, is characterized by emergence of a small amount of papules, vesicles and crusts on the sites of skin which were in contact with an animal and poorly expressed itch. After the termination of contact with a sick animal perhaps spontaneous self-healing.
QUATERNARY AMMONIUM COMPOUNDS 325
Allocate also grain mange. Its activator is the big-bellied tick. The disease is characterized by emergence on skin of a trunk and a neck of rashes in the form of large blisters with bubbles and pustules on their surface, a severe itch (see. And caries).
Bibliography: I. A. bitterlings. Diagnostic value of a sign of Hardy at a mange, Vestn. veins. and dermas., No. 12, page 26,1940; Zverkova F. A. ides of river. About some features of itch at children, Vestn. dermas, and veins., No. 2, page 54, 1983; The Pathogeny and therapy of skin and venereal diseases, under the editorship of O. P. Komov, etc., page 31, 33, Minsk, 1982; With m and r N about in V. S., Nguyen X. X. and Nguyen T. D., Experience of diagnosis and treatment of itch, Voyen. - medical zhurn., No. 4, page 60, 1983;
Galosi A. u.a. Serumimmunoglobuline bei Skabies, Hautarzt, Bd 33, S. 329, 1982; Hernandez-Perez E. Resistance to antiscabietic drugs, J. Amer. Acad. Derm., v. 8, p. 121, 1983; Reimer G., Schofer H. u. Altmeyer P. Zum Krankheitsbild der scabies norwegica, Akt. Derm., Bd 9, S. 81, 1983.
B. G. Stoyanov.