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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
          
        
The characteristic symptoms of a scabies infection include intense itching and superficial burrows. The burrow tracks are often linear, to the point that a neat "line" of four or more closely placed and equally developed mosquito-like "bites" is almost diagnostic of the disease. Because the host develops the symptoms as a reaction to the mites' presence over time, typically a delay of four to six weeks occurs between the onset of infestation and the onset of itching. Similarly, symptoms often persist for one to several weeks after successful eradication of the mites. As noted, those re-exposed to scabies after successful treatment may exhibit symptoms of the new infestation in a much shorter period—as little as one to four days.
In the classic scenario, the itch is made worse by warmth, and is usually experienced as being worse at night, possibly because distractions are fewer. As a symptom, it is less common in the elderly.
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.
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.
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.
Serious infestations and chronic attacks can cause anxiety, stress, and insomnia. Development of refractory delusional parasitosis is possible, as a person develops an overwhelming obsession with bed bugs.
Individual responses to bites vary, ranging from no visible effect (in about 20–70%), to small macular spots, to prominent wheals and bullae formations along with intense itching that may last several days. The bites often occur in a line. A central hemorrhagic spot may also occur due to the release of anticoagulants in the saliva.
Symptoms may not appear until some days after the bites have occurred. Reactions often become more brisk after multiple bites due to possible sensitization to the salivary proteins of the bed bug. The skin reaction usually occurs in the area of the bite which is most commonly the arms, shoulders and legs as they are more frequently exposed at night. Numerous bites may lead to an erythematous rash or urticaria.
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.
There are several complications with the terminology:
Acariasis is a term for a rash, caused by mites, sometimes with a papillae (pruritic dermatitis), and usually accompanied by severe itching sensations. An example of such an infection is scabies.
The closely related term, mange, is commonly used with domestic animals (pets) and also livestock and wild mammals, whenever hair-loss is involved. "Sarcoptes" and "Demodex" species are involved in mange, but both of these genera are also involved in human skin diseases (by convention only, not called mange). "Sarcoptes" in humans is especially severe symptomatically, and causes the condition scabies noted above.
Another genus of mite which causing itching but rarely causes hair loss because it burrows only at the keratin level, is "Cheyletiella." Various species of this genus of mite also affect a wide variety of mammals, including humans.
Mite infestation sometimes implies an ectoparasitic, cutaneous condition such as dermatitis. However, it is possible for mites to invade the gastrointestinal and urinary tracts.
MeSH uses the term "Mite Infestations" as pertaining to Acariformes. However, mites not in this grouping can be associated with human disease. (See "Classification", below.)
The term Acari refers to ticks and mites together, which can cause ambiguity. (Mites are a paraphyletic grouping).
Mites can be associated with disease in at least three different ways: (1) cutaneous dermatitis, (2) production of allergin, and (3) as a vector for parasitic diseases. The language used to describe mite infestation often does not distinguish among these.
The ear mite is the most common cause of ear infections in cats, quickly spreading from one cat to another through direct contact. Ear mites cause inflammatory symptoms, similar to bacterial and yeast infections. Symptoms include itching and redness of the ears. Other, more serious problems can result from untreated infections, such as skin disease in areas other than the ear like the neck and tail, and deafness.
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 first potential reaction is an itchy, papular rash that results from cercariae penetrating the skin, often in a person's first infection. The round bumps are usually one to three centimeters across. Because people living in affected areas have often been repeatedly exposed, acute reactions are more common in tourists and migrants. The rash can occur between the first few hours and a week after exposure and lasts for several days. A similar, more severe reaction called "swimmer's itch" reaction can also be caused by cercariae from animal trematodes that often infect birds.
Many individuals do not experience symptoms. If symptoms do appear, they usually take from four to six weeks from the time of infection. The first symptom of the disease may be a general feeling of illness. Within twelve hours of infection, an individual may complain of a tingling sensation or light rash, commonly referred to as "swimmer's itch", due to irritation at the point of entrance. The rash that may develop can mimic scabies and other types of rashes. Other symptoms can occur two to ten weeks later and can include fever, aching, a cough, diarrhea, chills or gland enlargement. These symptoms can also be related to avian schistosomiasis, which does not cause any further symptoms in humans.
The manifestations of schistosomal infection vary over time as the cercariae, and later adult worms and their eggs migrate through the body. If eggs migrate to the brain or spinal cord, seizures, paralysis, or spinal cord inflammation are possible.
Bullous impetigo, mainly seen in children younger than 2 years, involves painless, fluid-filled blisters, mostly on the arms, legs, and trunk, surrounded by red and itchy (but not sore) skin. The blisters may be large or small. After they break, they form yellow scabs.
This most common form of impetigo, also called nonbullous impetigo, most often begins as a red sore near the nose or mouth which soon breaks, leaking pus or fluid, and forms a honey-colored scab, followed by a red mark which heals without leaving a scar. Sores are not painful, but they may be itchy. Lymph nodes in the affected area may be swollen, but fever is rare. Touching or scratching the sores may easily spread the infection to other parts of the body.
Skin ulcers with redness and scarring also may result from scratching or abrading the skin.
Dyshidrosis has been described as having the following characteristics:
- Itchiness of the palms or soles, followed the a sudden development of intensely itchy small blisters on the sides of the fingers, the palms or the feet.
- These blisters are often described as having a "tapioca pudding" appearance.
- After a few weeks, the small blisters eventually disappear as the top layer of skin falls off.
- These eruptions do not occur elsewhere on the body.
- The eruptions may be symmetrical.
Although there are a multitude of varying appearances, the id reaction often presents with symmetrical red patches of eczema with papules and vesicles, particularly on the outer sides of the arms, face and trunk which occur suddenly and are intensely itchy occur a few days to a week after the initial allergic or irritant dermatitis. Most commonly, athletes foot can lead to localised vesicles on hands, bacterial infections to erythema nodosum and herpes simplex virus to erythema multiforme.
The diagnosis is frequently made by treating the initial triggering skin problem and observing the improvement in the eczematous rash. Both the initial skin problem and the id reaction must be observed to make the diagnosis.
All dyshidrotic rashes are not id reactions, but id reactions are often dishydrotic-like.
Initial tests may include isolating a fungus by taking a swab and sending it for culture. Patch testing may be considered if there is suspicion of allergic contact dermatitis.
A skin biopsy is rarely necessary, but if done mostly shows an interstitial granulomatous dermatitis, some lesions being spongiotic. Id reactions cannot be distinguished from other skin diseases by histopathology. However, they can be distinguished from other id reactions by histopathology.
Tinea capitis (also known as "herpes tonsurans", "ringworm of the hair", "ringworm of the scalp", "scalp ringworm", and "tinea tonsurans") is a cutaneous fungal infection (dermatophytosis) of the scalp. The disease is primarily caused by dermatophytes in the "Trichophyton" and "Microsporum" genera that invade the hair shaft. The clinical presentation is typically single or multiple patches of hair loss, sometimes with a 'black dot' pattern (often with broken-off hairs), that may be accompanied by inflammation, scaling, pustules, and itching. Uncommon in adults, tinea capitis is predominantly seen in pre-pubertal children, more often boys than girls.
At least eight species of dermatophytes are associated with tinea capitis. Cases of "Trichophyton" infection predominate from Central America to the United States and in parts of Western Europe. Infections from "Microsporum" species are mainly in South America, Southern and Central Europe, Africa and the Middle East. The disease is infectious and can be transmitted by humans, animals, or objects that harbor the fungus. The fungus can also exist in a carrier state on the scalp, without clinical symptomatology. Treatment of tinea capitis requires an oral antifungal agent; griseofulvin is the most commonly used drug, but other newer antimycotic drugs, such as terbinafine, itraconazole, and fluconazole have started to gain acceptance.
It may appear as thickened, scaly, and sometimes boggy swellings, or as expanding raised red rings (ringworm). Common symptoms are severe itching of the scalp, dandruff, and bald patches where the fungus has rooted itself in the skin. It often presents identically to dandruff or seborrheic dermatitis. The highest incidence in the United States of America is in American boys of school age.
There are three type of tinea capitis, microsporosis, trichophytosis, and favus; these are based on the causative microorganism, and the nature of the symptoms. In "microsporosis", the lesion is a small red papule around a hair shaft that later becomes scaly; eventually the hairs break off 1–3 mm above the scalp. This disease used to be caused primarily by "Microsporum audouinii", but in Europe, "M. canis" is more frequently the causative fungus. The source of this fungus is typically sick cats and kittens; it may be spread through person to person contact, or by sharing contaminated brushes and combs. In the United States, "Trichophytosis" is usually caused by "Trichophyton tonsurans", while "T. violaceum" is more common in Eastern Europe, Africa, and India. This fungus causes dry, non-inflammatory patches that tend to be angular in shape. When the hairs break off at the opening of the follicle, black dots remain. "Favus" is caused by "T. schoenleinii", and is endemic in South Africa and the Middle East. It is characterized by a number of yellowish, circular, cup-shaped crusts (scutula) grouped in patches like a piece of honeycomb, each about the size of a split pea, with a hair projecting in the center. These increase in size and become crusted over, so that the characteristic lesion can only be seen around the edge of the scab.
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.
Pain and itch have very different behavioral response patterns. Pain evokes a withdrawal reflex, which leads to retraction and therefore a reaction trying to protect an endangered part of the body. Itch in contrast creates a scratch reflex, which draws one to the affected skin site. Itch generates stimulus of a foreign object underneath or upon the skin and also the urge to remove it. For example, responding to a local itch sensation is an effective way to remove insects from one's skin.
Scratching has traditionally been regarded as a way to relieve oneself by reducing the annoying itch sensation. However, there are hedonic aspects of scratching, as one would find noxious scratching highly pleasurable. This can be problematic with chronic itch patients, such as ones with atopic dermatitis, who may scratch affected spots until they no longer produce a pleasant or painful sensation, instead of when the itch sensation disappears. It has been hypothesized that motivational aspects of scratching include the frontal brain areas of reward and decision making. These aspects might therefore contribute to the compulsive nature of itch and scratching.
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.
Itch (also known as pruritus) is a that causes the desire or reflex to scratch. Itch has resisted many attempts to classify it as any one type of sensory experience. Modern science has shown that itch has many similarities to pain, and while both are unpleasant sensory experiences, their behavioral response patterns are different. Pain creates a withdrawal reflex, whereas itch leads to a scratch reflex.
Unmyelinated nerve fibers for itch and pain both originate in the skin; however, information for them is conveyed centrally in two distinct systems that both use the same nerve bundle and spinothalamic tract.
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.
Pemphigus foliaceus is the most common autoimmune disease of the dog. Blisters in the epidermis rapidly break to form crusts and erosions most often affecting the face and ears initially, but in some cases spreading to include the whole body. The pawpads can be affected causing marked hyperkeratosis (thickening of the pads with scale). Other autoimmune diseases include bullous pemphigoid and epidermolysis bullosa acquisita.
Treatment of autoimmune skin conditions requires treatment to markedly reduce the abnormal immune response; steroids, azathoprine and other drugs are used as immunosuppressive agents.