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Crusted (Norwegian) scabies as a pre-diagnostic indicator for HTLV-1 infection
TRANSACTIONS OFTHE ROYALSOCIETY OFTROPICAL MEDICINE AND HYGIENE (1993)
Crusted (Norwegian) scabies as a pre-diagnostic indicator for HTLV-1 infection H. Daisleyl, W. Charles’ and M. Suite2 ‘Department of Pathology, University of the West Indies, St Augustine, West Indies; 2Department of Dermatology, General Hospital, Port of Spain, Trinidad, West Indies
In October 1987, a 23 years old Black female was first seen at the General Hospital in Port of Spain, Trinidad, for tinea corporis and tinea unguium mycosal infection affecting both hands and feet. In addition, she was also discovered to have a generalized exfoliative erythematous, pruritic rash, which was heavily infected with the mites of Sarcoptes scabiei. Her glucose tolerance test and full blood count were normal and she was treated approoriatelv for both tinea and scabies. During the ensuing 4 iears she was repeatedly admitted to the dermatology unit for treatment of crusted scabiesand tinea corporis. In August 1990 the crusted scabiesbecameintractable, and the patient was admitted to the medical ward for further evaluation. The generalized exfoliative, erythematous, pruritic rash was prominent. She had no obvious palpable lymph node. Her white blood cell count was 25~ 109/L, with segmenters 29%, lymphocytes 43%, monocytes 9%, eosinophils 6%, and atypical lymphocvtes 13% (lvmnhocvtes with clover leaf-like nuclei). She was seronegati
87, 295
295
1987). Persons infected with the virus have been known to becomeimmunodeficient and to develop opportunistic infections such asPneumocystis carinii pneumonia, candidiasis, and hyperinfestation with Strongyloides stercoralis (SATO et al., 1982; NAKADA et al., 1987). There are a few recent repotts of crusted scabiesoccurring in patients infected with HTLV-1 infection (SUZUMIYA et aE., 1985: FLETCHER et al., 1992). Crusted (Norwegian) scabieshas been known to occur in the immunocompromised patient (PATERSON et aZ., 1973; LA GRENADE, 1981; YARBROUGH & IRIONDO, 1987; SIRERA et al., 1990). In regions where HTLV-1 is endemic, crusted (Norwegian) scabiesshould alert clinicians to the possibility of underlying HTLV-1 infection and/or smouldering adult T cell leukaemia’lymphoma, as was evident in this patient. With the rise in incidence of scabiesin the Caribbean, it may become mandatory to screen scabetic patients not only for nephrotoxigenic streptoccocus but also for HTLV-1 (REID, 1988; REID et al., 1990) in order to try to stem the transmission of this retrovirus and its devastating diseasecomplex. References Daisley, H., Charles, W., Landeau, I’., Jackman, L., Batson, M. & Gomez-Adams, K. (1991). Screening for HTLV-1 in healthy blood donors in Trinidad and Tobago, W. I. Tropical Medicine and Parasitology, 42,404-406.
Fletcher, V., La Grenade, L., Hanchard, B., Carberry, C., Cranston, B. & Blattner, W. (1992). The association of crusted scabies with human T lymphotrophic virus type 1 and adult T-cell leukaemia/lymphoma. Proceedings of the Fifth International Conference on Human Retrovirology, HTLV, abstract no. W-29. Gessain, A., Barin, F., Vernant, J. C., Gout, O., Maurs, L., Calender, A. & De The, G. (1985). Antibodies to human Tlymphotrophic virus type-l in patients with tropical spastic paraparesis.Lance& ii, 407-409. Gibbs, N. W., Lofters, W., Campbell, M., Hanchard, B., La Grenade, L., Cranston, B., Hendriks, J., Jaffe, S. E., Saxinger, C., Robert-Guroff, M., Gallo, R. C., Clark, J. & Blattner, W. (1987). Non-Hodgkin’s lymphoma in Jamaica and its relation to adult T-cell leukemia/lymphoma. Annals of Internal Medicine, 106,361-368.
La Grenade, L. (1981). Crusted scabies in Jamaica. West Indian MedicalJournal, 30, 193-196. Nakada, K., Yamaguchi, K., Furugen, S., Nakasone, K., Oshiro, T. Y., Kohakura, M., Hinuma, Y., Seiki,,M., Yoshida, M., Matutes, E., Catovsky, D., Ishit, T. & Takatsuki, K. (1987). Monoclonal integration of HTLV-1 proviral DNA in patients with strongyloidiasis. International Journal of Cancer, 40,145-148. Paterson, D. W., Allen, R. B. & Beveridge, W. G. (1973). Norwegian scabies during immunosuppressive therapy. British MedicalJournal, iv, 211-212. Reid, M. F. H. (1988). Epidemic scabies and associated acute glomerulonephritis in Trinidad. PAHO Bulletin, 22, 103107. Reid, M. F. H., Birju, B., Holder, Y,., Hospedales, J. & PoonKing, T. (1990). Epidemic scabies in four Caribbean Islands,, 1981-1988. Transactions of the Rayal Society of Tropacal Medicine and Hygiene, 84,29&300.
Sato, E., Hasui, K. & Tokunaga, M. (1981). Autopsy fmdings of adult-T cell lymphoma-leukaemia. In: Hanaoka, M., Takatsuki, K. & Shimoyama, M. (editors). Adult T-Cell Leukaemia and Related Diseases. (GANN Monographs on Cancer Research, no. 28). London: Plenum Press, pp. 5 l-64. Sirera, G., Romeu, J., Ribera, M., Tor, J., Rius, F., Libre, J., Soriano, V., Ferrandiz, C. & Clotet, B. (1990). Hospital outbreak of scabiesstemming from two AIDS patients with Norwegian scabies.Lance!, 335, 1227. Suzumiya, J., Sumiyoshi, A., Kuroki, Y. & Inoue, S. (1985). Crusted (Norwegian) scabies with adult T-cell leukaemia. Archives of Dermatology, 121,903-904.
Yarbrough, K. G. & Iriondo, M. (1987). Diabetic patient with crusted plaques. Archives of Dermatology, 123, 811. Received 21 July 1992; revised 26 August 1992; accepted for publication 28 August 1992
Crusted (Norwegian) scabies as a pre-diagnostic indicator for HTLV-1 infection H. Daisleyl, W. Charles’ and M. Suite2 ‘Department of Pathology, University of the West Indies, St Augustine, West Indies; 2Department of Dermatology, General Hospital, Port of Spain, Trinidad, West Indies
In October 1987, a 23 years old Black female was first seen at the General Hospital in Port of Spain, Trinidad, for tinea corporis and tinea unguium mycosal infection affecting both hands and feet. In addition, she was also discovered to have a generalized exfoliative erythematous, pruritic rash, which was heavily infected with the mites of Sarcoptes scabiei. Her glucose tolerance test and full blood count were normal and she was treated approoriatelv for both tinea and scabies. During the ensuing 4 iears she was repeatedly admitted to the dermatology unit for treatment of crusted scabiesand tinea corporis. In August 1990 the crusted scabiesbecameintractable, and the patient was admitted to the medical ward for further evaluation. The generalized exfoliative, erythematous, pruritic rash was prominent. She had no obvious palpable lymph node. Her white blood cell count was 25~ 109/L, with segmenters 29%, lymphocytes 43%, monocytes 9%, eosinophils 6%, and atypical lymphocvtes 13% (lvmnhocvtes with clover leaf-like nuclei). She was seronegati
87, 295
295
1987). Persons infected with the virus have been known to becomeimmunodeficient and to develop opportunistic infections such asPneumocystis carinii pneumonia, candidiasis, and hyperinfestation with Strongyloides stercoralis (SATO et al., 1982; NAKADA et al., 1987). There are a few recent repotts of crusted scabiesoccurring in patients infected with HTLV-1 infection (SUZUMIYA et aE., 1985: FLETCHER et al., 1992). Crusted (Norwegian) scabieshas been known to occur in the immunocompromised patient (PATERSON et aZ., 1973; LA GRENADE, 1981; YARBROUGH & IRIONDO, 1987; SIRERA et al., 1990). In regions where HTLV-1 is endemic, crusted (Norwegian) scabiesshould alert clinicians to the possibility of underlying HTLV-1 infection and/or smouldering adult T cell leukaemia’lymphoma, as was evident in this patient. With the rise in incidence of scabiesin the Caribbean, it may become mandatory to screen scabetic patients not only for nephrotoxigenic streptoccocus but also for HTLV-1 (REID, 1988; REID et al., 1990) in order to try to stem the transmission of this retrovirus and its devastating diseasecomplex. References Daisley, H., Charles, W., Landeau, I’., Jackman, L., Batson, M. & Gomez-Adams, K. (1991). Screening for HTLV-1 in healthy blood donors in Trinidad and Tobago, W. I. Tropical Medicine and Parasitology, 42,404-406.
Fletcher, V., La Grenade, L., Hanchard, B., Carberry, C., Cranston, B. & Blattner, W. (1992). The association of crusted scabies with human T lymphotrophic virus type 1 and adult T-cell leukaemia/lymphoma. Proceedings of the Fifth International Conference on Human Retrovirology, HTLV, abstract no. W-29. Gessain, A., Barin, F., Vernant, J. C., Gout, O., Maurs, L., Calender, A. & De The, G. (1985). Antibodies to human Tlymphotrophic virus type-l in patients with tropical spastic paraparesis.Lance& ii, 407-409. Gibbs, N. W., Lofters, W., Campbell, M., Hanchard, B., La Grenade, L., Cranston, B., Hendriks, J., Jaffe, S. E., Saxinger, C., Robert-Guroff, M., Gallo, R. C., Clark, J. & Blattner, W. (1987). Non-Hodgkin’s lymphoma in Jamaica and its relation to adult T-cell leukemia/lymphoma. Annals of Internal Medicine, 106,361-368.
La Grenade, L. (1981). Crusted scabies in Jamaica. West Indian MedicalJournal, 30, 193-196. Nakada, K., Yamaguchi, K., Furugen, S., Nakasone, K., Oshiro, T. Y., Kohakura, M., Hinuma, Y., Seiki,,M., Yoshida, M., Matutes, E., Catovsky, D., Ishit, T. & Takatsuki, K. (1987). Monoclonal integration of HTLV-1 proviral DNA in patients with strongyloidiasis. International Journal of Cancer, 40,145-148. Paterson, D. W., Allen, R. B. & Beveridge, W. G. (1973). Norwegian scabies during immunosuppressive therapy. British MedicalJournal, iv, 211-212. Reid, M. F. H. (1988). Epidemic scabies and associated acute glomerulonephritis in Trinidad. PAHO Bulletin, 22, 103107. Reid, M. F. H., Birju, B., Holder, Y,., Hospedales, J. & PoonKing, T. (1990). Epidemic scabies in four Caribbean Islands,, 1981-1988. Transactions of the Rayal Society of Tropacal Medicine and Hygiene, 84,29&300.
Sato, E., Hasui, K. & Tokunaga, M. (1981). Autopsy fmdings of adult-T cell lymphoma-leukaemia. In: Hanaoka, M., Takatsuki, K. & Shimoyama, M. (editors). Adult T-Cell Leukaemia and Related Diseases. (GANN Monographs on Cancer Research, no. 28). London: Plenum Press, pp. 5 l-64. Sirera, G., Romeu, J., Ribera, M., Tor, J., Rius, F., Libre, J., Soriano, V., Ferrandiz, C. & Clotet, B. (1990). Hospital outbreak of scabiesstemming from two AIDS patients with Norwegian scabies.Lance!, 335, 1227. Suzumiya, J., Sumiyoshi, A., Kuroki, Y. & Inoue, S. (1985). Crusted (Norwegian) scabies with adult T-cell leukaemia. Archives of Dermatology, 121,903-904.
Yarbrough, K. G. & Iriondo, M. (1987). Diabetic patient with crusted plaques. Archives of Dermatology, 123, 811. Received 21 July 1992; revised 26 August 1992; accepted for publication 28 August 1992