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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.
Veterinarians usually attempt diagnosis with skin scrapings from multiple areas, which are then examined under a microscope for mites. "Sarcoptes" mites, because they may be present in relatively low numbers, and because they are often removed by dogs chewing at themselves, may be difficult to demonstrate. As a result, diagnosis in sarcoptic mange is often based on symptoms rather than actual confirmation of the presence of mites. A common and simple way of determining if a dog has mange is if it displays what is called a "pedal-pinna reflex", which is when the dog moves one of its hind legs in a scratching motion as the ear is being manipulated and scratched gently by the examiner; because the mites proliferate on the ear margins in nearly all cases at some point, this method works over 95% of the time. It is helpful in cases where all symptoms of mange are present but no mites are observed with a microscope. The test is also positive in animals with ear mites, an ear canal infection caused by a different but closely related mite (treatment is often the same). In some countries, an available serologic test may be useful in diagnosis.
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.