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Deep Learning Technology: Sebastian Arnold, Betty van Aken, Paul Grundmann, Felix A. Gers and Alexander Löser. Learning Contextualized Document Representations for Healthcare Answer Retrieval. The Web Conference 2020 (WWW'20)
Funded by The Federal Ministry for Economic Affairs and Energy; Grant: 01MD19013D, Smart-MD Project, Digital Technologies
Scabies is endemic in many developing countries, where it tends to be particularly problematic in rural and remote areas. In such settings, community-wide control strategies are required to reduce the rate of disease, as treatment of only individuals is ineffective due to the high rate of reinfection. Large-scale mass drug administration strategies may be required where coordinated interventions aim to treat whole communities in one concerted effort. Although such strategies have shown to be able to reduce the burden of scabies in these kinds of communities, debate remains about the best strategy to adopt, including the choice of drug.
The resources required to implement such large-scale interventions in a cost-effective and sustainable way are significant. Furthermore, since endemic scabies is largely restricted to poor and remote areas, it is a public health issue that has not attracted much attention from policy makers and international donors.
Scabies is contagious and can be contracted through prolonged physical contact with an infested person. This includes sexual intercourse, although a majority of cases are acquired through other forms of skin-to-skin contact. Less commonly, scabies infestation can happen through the sharing of clothes, towels, and bedding, but this is not a major mode of transmission; individual mites can only survive for two to three days, at most, away from human skin at room temperature. As with lice, a latex condom is ineffective against scabies transmission during intercourse, because mites typically migrate from one individual to the next at sites other than the sex organs.
Healthcare workers are at risk of contracting scabies from patients, because they may be in extended contact with them.
Sarcoptic mange, also known as canine scabies, is a highly contagious infestation of "Sarcoptes scabiei canis", a burrowing mite. The canine sarcoptic mite can also infest cats, pigs, horses, sheep, and various other species. The human analog of burrowing mite infection, due to a closely related species, is called scabies (the "seven year itch").
All these burrowing mites are in the family Sarcoptidae. They dig into and through the skin, causing intense itching from an allergic reaction to the mite, and crusting that can quickly become infected. Hair loss and crusting frequently appear first on elbows and ears. Skin damage can occur from the dog's intense scratching and biting. Secondary skin infection is also common. Dogs with chronic sarcoptic mange are often in poor condition, and in both animals and humans, immune suppression from starvation or any other disease causes this type of mange to develop into a highly crusted form in which the burden of mites is far higher than in healthy specimens.
Affected dogs need to be isolated from other dogs and their bedding, and places they have occupied must be thoroughly cleaned. Other dogs in contact with a diagnosed case should be evaluated and treated. A number of parasitical treatments are useful in treating canine scabies. Sulfurated lime (a mixture of calcium polysulfides) rinses applied weekly or biweekly are effective (the concentrated form for use on plants as a fungicide must be diluted 1:16 or 1:32 for use on animal skin).
Selamectin is licensed for treatment in dogs by veterinary prescription in several countries; it is applied as a dose directly to the skin, once per month (the drug does not wash off). A related and older drug ivermectin is also effective and can be given by mouth for two to four weekly treatments or until two negative skin scrapings are achieved. Oral ivermectin is not safe to use on some collie-like herding dogs, however, due to possible homozygous MDR1 (P-glycoprotein) mutations that increase its toxicity by allowing it into the brain. Ivermectin injections are also effective and given in either weekly or every two weeks in one to four doses, although the same MDR1 dog restrictions apply.
Affected cats can be treated with fipronil and milbemycin oxime.
Topical 0.01% ivermectin in oil (Acarexx) has been reported to be effective in humans, and all mite infections in many types of animals (especially in ear mite infections where the animal cannot lick the treated area), and is so poorly absorbed that systemic toxicity is less likely in these sites. Nevertheless, topical ivermectin has not been well enough tested to be approved for this use in dogs, and is theoretically much more dangerous in zones where the animal can potentially lick the treated area. Selamectin applied to the skin (topically) has some of the same theoretical problems in collies and MDR1 dogs as ivermectin, but it has nevertheless been approved for use for all dogs provided that the animal can be observed for 8 hours after the first monthly treatment. Topical permethrin is also effective in both dogs and humans, but is toxic to cats.
Afoxolaner (oral treatment with a chewable tablet containing afoxolaner 2.27% w/w) has been shown to be efficient against both sarcoptic and demodectic mange in dogs.
Sarcoptic mange is transmissible to humans who come into prolonged contact with infested animals, and is distinguished from human scabies by its distribution on skin surfaces covered by clothing. For treatment of sarcoptic infection in humans, see scabies. For demodetic infection in humans, which is not as severe as it is in animals with thicker coats (such as dogs), see "Demodex folliculorum".
Most of the mites which cause this affliction to humans are from the order Acari, hence the name Acariasis. The entire taxonomic classification to order would be:
- Kingdom: Animalia
- Phylum: Arthropoda
- Subphylum: Chelicerata
- Class: Arachnida
- Order: Acari (At the order level, there is still substantial argument among researchers as to how to categorize Acari. Some call it a subclass, others a superorder, "Acarina".)
Specific species involved include:
- Acariformes
- Trombidiformes
- "Trombicula" species (trombiculosis or chiggers)
- "Demodex" species (Demodicosis)
- "Pyemotes tritici"
- "Cheyletiella"
- Sarcoptiformes
- "Sarcoptes scabiei" (Scabies)
- Parasitiformes
- "Dermanyssus gallinae"
- "Liponyssoides sanguineus"
- "Ornithonyssus bacoti", "Ornithonyssus bursa", "Ornithonyssus sylviarum"
- Another candidate is "Androlaelaps casalis". However, based on this mite's life style as a predator on other mite species (such as the previously-mentioned "Dermanyssus gallinae"), it is highly unlikely to be a cause of acariasis.
Some of these reflect reports existing of human infestation by mites previously believed not to prey on humans.
With no particular affinity to any particular ethnic group, seen in all age groups and equally amongst males and females, the precise prevalence is not known.
Medical doctors and dermatologists can still misdiagnose this rash as many are unfamiliar with parasitism, not trained in it, or if they do consider it, cannot see the mites.
Different methods for detection are recognized for different acariasis infections. Human acariasis with mites can occur in the gastrointestinal tract, lungs, urinary tracts and other organs which not have been well-studied. For intestinal acariasis with symptoms such as abdominal pain, diarrhea, and phohemefecia (is this hemafecia?), human acariasis is diagnosed by detection of mites in stools. For pulmonary acariasis, the presence of mites in sputum is determined by identifying the presence and number of mites in the sputum of patients with respiratory symptoms. Both physical and chemical methods for liquefaction of sputum have been developed.
Other rashes that occur in a widespread distribution can look like an id reaction. These include atopic dermatitis, contact dermatitis, dyshidrosis, photodermatitis, scabies and drug eruptions.
The rabbit ear mite, "Psoroptes cuniculi", is larger than "Otodectes cynotis". It causes thick firm debris to form in the ear canal, and can eventually migrate to the skin of the outer ear and face. Symptoms include scratching and shaking of the head. Treatment includes topical selamectin, or injections of ivermectin and frequent cleanings of the rabbit's environment.
Ear mites are mites that live in the ears of animals and humans. The most commonly seen species in veterinary medicine is "Otodectes cynotis" (Gk. oto=ear, dectes=biter, cynotis=of the dog). This species, despite its name, is also responsible for 90% of ear mite infections in cats.
In veterinary practice, ear mite infections in dogs and cats may present as a disease that causes intense itching in one or both ears, which in turn triggers scratching at the affected ear. An unusually dark colored ear wax (cerumen) may also be produced. Cats, as well as dogs with erect ears that have control over ear direction, may be seen with one or both ear pinnas held at an odd or flattened angle.
The most common lesion associated with ear mites is an open or crusted ("scabbed") skin wound at the back or base of the ear, caused by abrasion of the skin by hind limb claws, as the ear has been scratched in an attempt to relieve the itching. This lesion often becomes secondarily infected and crusted from ordinary skin bacteria, so that the common presentation of ear mites is such a wound appearing on the back or base of one or both ears. This is accompanied by the Pinnal-Pedal Reflex that appears as reflex scratching motions of the hind limb when the ear is manipulated (this test is positive as well in other mite infections of the outside and rim of the ear pinnas in mange). When the ear mite infection is treated, such wounds resolve spontaneously, and this resolution may be speeded with application of topical antibiotics.
The most common ear mite (as well as mange mite) treatments currently use the antiparasitics ivermectin and selamectin, usually as topical preparations. Ivermectin is available as a direct water-based liquid that is squeezed into the ear canal and massaged at the base of the ear to distribute the medication. Selamectin is available as a once-a-month preparation that can be applied to the animal's skin, which prevents mite infestation over that time.
Traditionally, canine transmission is directly from sandfly to dog. Cases in the United States have proven "L. infantum" transmission from dog to dog by direct contamination with blood and secretions, as well as transplacentally from an infected bitch to her pups. This mode of transmission seems to be unique to the "L. infantum" Mon1 strain found in the United States. Although "in utero" transmission is likely the predominant method of disease spread amount the "L. infantum" Mon1 strain, it is still a viable parasite (has not lost virulence factors associated with sandfly-uptake) which can be transmitted via sandfly bite. A Brazilian study of 63 puppies from 18 "L. donovani"-infected parents found no evidence of congential or transplacental infection.
Numerous strains and subgenus strains of "Leishmania" exist; with sandfly genome projects still underway, strains are still being discovered.
In the Old World, leishmaniasis transmitted by sandflies of the genus "Phlebotomus" documented in dogs are:
- "L. donovani" in Sri Lanka
- "L. infantum" (began appearing dogs in the United States in 2000)
New World leishmaniasis strains are spread by "Lutzomyia"; however, research speculates the North American sandfly could be capable of spreading, but this is to date unconfirmed. Dogs are known resorvoirs of "L. infantum", and the spread of disease from dog to dog has been confirmed in the United States.
- Suspected causes of canine visceral leishmaniasis are geographic variants of the "Leishmania donovani" complex, including "L. infantum, L. chagasi" and "L. donovani".
The Mexicana ("L. mexicana, L. amazonensis, L. venezuelensis", and "L. pifanoi") and Viannia ("L. braziliensis, L. guyanensis, L. panamensis" and "L. peruviana") strains are not commonly found in dogs. Subgenus Viannia strains are found only in Central and South America, all of which cause leishmaniasis in humans.
An ectoparasitic infestation is a parasitic disease caused by organisms that live primarily on the surface of the host.
Examples:
- Scabies
- Crab louse (pubic lice)
- Pediculosis (head lice)
- "Lernaeocera branchialis" (cod worm)
The exact causes of dyshidrosis are unknown. In 2013, a randomized, double-blind, placebo-controlled cross-over study by the University Medical Center Groningen reported that dyshydrosis outbreaks on the hands increased significantly among those allergic to house dust mites, following inhalation of house dust mite allergen.
Food allergens may be involved in certain cases. Cases studies have implicated a wide range of foods including tuna, tomato, pineapple, chocolate, coffee, and spices among others. A number of studies have implicated balsam of Peru.
Id reaction and irritant contact dermatitis are possible causes.
Globally, impetigo affects more than 162 million children in low to middle income countries. The rates are highest in countries with low available resources and is especially in the region of Oceania. The tropical climate and high population in lower socioeconomic regions contribute to these high rates. In children in the United Kingdom under the age of 4 are 2.8% more likely to contract impetigo and rates decreases to 1.6% for children up to 15-years-old. As age increases, the rates of impetigo declines but all ages are still susceptible.
Impetigo is more likely to infect children ages 2–5, especially those that attend school or day care. 70% of cases are the nonbullous form and 30% were the bullous form. Other factors can increase the risk of contracting impetigo such as diabetes mellitus, dermatitis, immunodeficiency disorders, and other irritable skin disorders. Impetigo occurs more frequently among people who live in warm climates.
Atopy is a hereditary and chronic (lifelong) allergic skin disease. Signs usually begin between 6 months and 3 years of age, with some breeds of dog, such as the Golden Retriever showing signs at an earlier age. Dogs with atopic dermatitis are itchy, especially around the eyes, muzzle, ears and feet. In severe cases the irritation is generalised. If the allergens are seasonal, the signs of irritation are similarly seasonal. Many dogs with house dust mite allergy have perennial disease. Some of the allergens associated with atopy in dogs include pollens of trees, grasses and weeds, as well as molds and House dust mite. Ear and skin infections with the bacteria "Staphylococcus pseudintermedius" and the yeast "Malassezia pachydermatis" are common secondary to atopic dermatitis.
Food allergy can be associated with identical signs and some authorities consider food allergy to be a type of atopic dermatitis.
Diagnosis of atopic dermatitis is by elimination of other causes of irritation including fleas, scabies and other parasites such as Cheyletiella and lice. Food allergy can be identified through the use of elimination diet trials in which a novel or hydrolysed protein diet is used for a minimum of 6 weeks and allergies to aeroallergens can be identified using intradermal allergy testing and/or blood testing (allergen-specific IgE ELISA).
Treatment includes avoidance of the offending allergens if possible, but for most dogs this is not practical or effective. Other treatments modulate the adverse immune response to allergens and include antihistamines, steroids, ciclosporin and immunotherapy (a process in which allergens are injected to try to induce tolerance). In many cases shampoos, medicated wipes and ear cleaners are needed to try to prevent the return of infections.
New research into T-cell receptor peptides and their effects on dogs with severe, advanced atopic dermatitis are being investigated.
A hot spot, or "acute moist dermatitis", is an acutely inflamed and infected area of skin irritation created and made worse by a dog licking and biting at itself. A hot spot can manifest and spread rapidly in a matter of hours as secondary Staphylococcus infection causes the top layers of the skin to break down and as pus becomes trapped in the hair. Hot spots can be treated with corticosteroid medications and oral as well as topical antibiotic application, as well as clipping hair from around the lesion. Underlying inciting causes include flea allergy dermatitis, ear disease or other allergic skin diseases. Dogs with thick undercoat are most subject to getting hot spots.
Infantile acropustulosis (also known as "Acropustulosis of infancy") is an intensely itchy vesicopustular eruption of the hands and feet.
Involvement of scabies has been suggested.
infantile acropustulosis is characterized by itchy papules and vesicles that are similar to those found in scabies "mosquito like bites" but there is absence of the typical burrowing with S like burrows on the skin and can occur in small babies as opposed to scabies mostly found on children and young adults.
About 1 in 2,000 people are affected in Sweden. Males and females appear to be affected equally.
The most important infectious skin diseases of cats is ringworm or dermatophytosis. Other cat skin infections include parasitic diseases like mange and lice infestation.
Other ectoparasites, including flea and tick infestations are not considered directly contagious but are acquired from an environment where other infested hosts have established the parasite's life cycle.
Another common skin infection is cat bite abscess. A mixture of bacteria introduced by a bite wound cause infections in pockets under the skin and affected cats often show manic depression and fever.
Pemphigus is endemic in the rural areas of Brazil, especially along inland riverbeds.
The definitive hosts for these "Taenia" species are canids. The adult tapeworms live in the intestines of animals like dogs, foxes, and coyotes. Intermediate hosts such as rabbits, goats, sheep, horses, cattle and sometimes humans get the disease by inadvertently ingesting tapeworm eggs (gravid proglottids) that have been passed in the feces of an infected canid. This can happen from ingesting food, water or soil that has been contaminated by dog feces. The disease cannot be transmitted from one intermediate host to another, but it is still not a good idea to eat meat that presents with cystic nodules from coenurosis.
Favid (of "favus" Latin for "honeycomb" or tinea favosa) is a disease usually affecting the scalp, but occurring occasionally on any part of the skin, and even at times on mucous membranes.
The word “Favid” is more used than French word “favus”, which is close to the Latin etymology.
Pemphigus foliaceus is an autoimmune blistering disease of the skin with characteristic lesions that are scaly, crusted erosions, often on an erythematous base. Mucosal involvement is absent even with widespread disease.
If there is an autoimmune IgG buildup in the epidermis, then nearly all of the antibodies are aimed against desmoglein 1. The effect of the antibodies and the immunological pathway is most likely one of three mechanisms:
- Steric hindrance of the desmoglein 1: The antibody caps off the site for intracellular binding to another keratinocyte.
- Activation of an endocytic pathway: The antibody activates a pathway which causes an internalization of desmogleïn 1, which in turn causes a loss of adhesion.
- Disruption of function: In this case, the antibody blocks the desmoglein 1 from being formed into a desmosome. This in turn causes a loss of adhesion with acantholysis as a result.