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Crusted scabies: clinical and immunological findings in seventy-eight patients and a review of the literature

Roberts, L., Huffam, S., Walton, Shelley F. and Currie, Bart J. (2005). Crusted scabies: clinical and immunological findings in seventy-eight patients and a review of the literature. Journal of Infection,50(5):375-381.

Document type: Journal Article
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IRMA ID 0HON0118xPUB2
Title Crusted scabies: clinical and immunological findings in seventy-eight patients and a review of the literature
Author Roberts, L.
Huffam, S.
Walton, Shelley F.
Currie, Bart J.
Journal Name Journal of Infection
Publication Date 2005
Volume Number 50
Issue Number 5
ISSN 0163-4453   (check CDU catalogue  open catalogue search in new window)
Start Page 375
End Page 381
Total Pages 7
Place of Publication UK
Publisher Elsevier
HERDC Category C1 - Journal Article (DEST)
Abstract Objectives: To describe the clinical and immunological features of crusted scabies in a prospectively ascertained cohort of 78 patients. Methods: All patients requiring inpatient treatment for cruste scabies in the 'top end' of the northern territory of Australia over a 10 year period were prospectively identified. Demographics, risk factors, and immunological parameters were retrospectivety compiled from their medical records and pathology databases. Results: More than half the patients with crusted scabies had identifiable immunosuppressive risk factors. Eosinophilia and elevated IgE levels occurred in 58% and 96% of patients, respectively, with median IgE levels 17 times the upper limit of normal. Seventeen percent had a history of leprosy but 42% had no identifiable risk factors. There was a decrease in mortality after the introduction of a treatment protocol consisting of multiple doses of ivermectin combined with topical scabicides and keratolytic therapy. Conclusions: Crusted scabies often occurs in patients with identifiable immunosuppressive risk factors. In patients without such risk factors, it is possible that the crusted response to infection results from a tendency to preferentially mount a Th2 response. The treatment regime described was associated with a reduction in mortality. This is the largest reported case series of crusted scabies.
Keywords scabies
crusted scabies
infection
immunological factors
mortality
t-cell subsets
indigenous
australia
leprosy
systemic lupus-erythematosus
norwegian scabies
australian aborigines
htlv-i
ivermectin
expression
infection
antigens
leprosy
cells
DOI http://dx.doi.org/10.1016/j.jinf.2004.08.033   (check subscription with CDU E-Gateway service for CDU Staff and Students  check subscription with CDU E-Gateway in new window)
 
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