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A closer look at Sarcoptes scabiei.

This image was taken from a skin scraping, prepared with mineral oil, from the chest of a 79-year-old man who complained of papular pruritic rash on his torso, arms, and legs for 6 months. He was living in a nursing care facility, unable to perform most of the daily activities because of left-sided hemiparesis secondary to a cerebrovascular accident. His white blood cell count was 8100 cells/mL with absolute eosinophilia of 2000 cells/mL (25%). He was treated with 5% permethrin, and his symptoms were relieved with fewer than 10 days of therapy. Scabies organisms produce this clinical picture after a patient acquires the organisms, Sarcoptes scabiei, from direct skin-to-skin contact or from contaminated fomites. They are ovoid organisms with a small anterior cephalic portion and a caudal thoracoabdominal portion with hairlike projections coming off from the rudimentary legs. The female mite is 0.3 mm to 0.4 mm in size, and the male mite is half the size of the female. This image shows a 6legged protonymph (original magnification 3400). Organisms burrow beneath the skin, eliciting a delayed-type hypersensitivity reaction. The diagnosis is made based on the typical distribution of the rash (interphalangeal, wrist, hands, axillary folds, and waist area) and direct examination of skin scrapings showing the mites, eggs, or scybala (packets of feces). 1 The major problem of scabies infection is the public health concern. Many infections occur in institutions caring for the elderly, such as assisted-living and nursing homes. Also at risk are infants and young children, health care workers, and immunocompromised patients. The risk factors among nursing homes for acquiring this infection include size and age of the institution and ratio of beds to