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Transmission and Morbidity

from emedicine.com

Mode of transmission

Mites are unable to fly or jump. They crawl at a rate of 2.5 cm/min. While the mite's life cycle occurs completely on its host, they are able to live on bedding, clothes, or other surfaces at room temperature for about 48 hours while remaining capable of infestation and burrowing. At temperatures below 20°CS scabiei are immobile, although they can survive such temperatures for extended periods.

Transmission is predominantly through direct skin-to-skin contact, and for this reason, scabies has been considered a sexually transmitted disease. Indirect contact through fomites such as infested bedding or clothing is possible, although not usual. However, the greater the number of parasites on a person, as in crusted scabies, the more likely that indirect contact will abet transmission of the disease.

Mortality/Morbidity:

Classic scabies is primarily a nuisance. However, it can indirectly lead to long-term morbidity. Scabies and other parasitic skin diseases can lead to long-term colonization of skin lesions by group A streptococci. Several studies have demonstrated a correlation between poststreptococcal glomerulonephritis (PSGN) and scabies. Conversely, in one World Health Organization sponsored study in the Solomon Islands, an intervention of mass chemotherapy lead to a decrease of scabies by 96% and a parallel drop in an indicator of renal disease. In remote Aboriginal communities in Australia where scabies is endemic, the repeated infestations appear to be related to the extremely high levels of renal failure and rheumatic heart disease observed in the communities.

While the microbiology of secondary bacterial infection in scabies lesions probably changes based on geographic location, one study demonstrated that the predominant aerobic and facultative bacteria recovered from lesions wereStaphylococcus aureus, group A streptococci, andPseudomonas aeruginosa. Multiple anaerobes were recovered as well, suggesting polymicrobial colonization of lesions.

Other complications of scabies include impetigo, furunculosis, and cellulites. The staphylococci and/or streptococci in the lesions can lead to pyelonephritis, abscesses, pyogenic pneumonia, sepsis, and death.