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Simptomi se obično javljaju dve do šest nedelja nakon infekcije kod pojedinaca koji nikada ranije nisu bili izloženi šugi. Za one koji su prethodno bili izloženi, simptomi se mogu pojaviti u roku od nekoliko dana nakon infekcije. Međutim, simptomi se mogu pojaviti i nakon nekoliko meseci ili godina.<ref name="Bouvresse-2010" />
Simptomi se obično javljaju dve do šest nedelja nakon infekcije kod pojedinaca koji nikada ranije nisu bili izloženi šugi. Za one koji su prethodno bili izloženi, simptomi se mogu pojaviti u roku od nekoliko dana nakon infekcije. Međutim, simptomi se mogu pojaviti i nakon nekoliko meseci ili godina.<ref name="Bouvresse-2010" />

=== Okrastala šuga ===
[[File:Norwegian Scabies in Homeless AIDS Patient.jpg|thumb|Crusted scabies in a person with AIDS]]
{{rut}}
The elderly, disabled, and people with [[immunodeficiency|impaired immune systems]], such as those with HIV/AIDS, cancer, or those on [[Immunosuppressive drug|immunosuppressive medications]], are susceptible to crusted scabies (also called Norwegian scabies).<ref name=Ray2009 /><ref name=Bouvresse-2010 /><ref name=pmid19580575>{{cite journal | vauthors = Hicks MI, Elston DM | title = Scabies | journal = Dermatologic Therapy | volume = 22 | issue = 4 | pages = 279–92 | year = 2009 | pmid = 19580575 | doi = 10.1111/j.1529-8019.2009.01243.x | s2cid = 221647574 | doi-access = free }}</ref> On those with weaker immune systems, the host becomes a more fertile breeding ground for the mites, which spread over the host's body, except the face. The mites in crusted scabies are not more virulent than in noncrusted scabies but are much more numerous, sometimes up to two million. People with crusted scabies exhibit scaly rashes, slight itching, and thick crusts of skin that contain large numbers of scabies mites. For this reason, persons with crusted scabies are more contagious to others than those with typical scabies.<ref name=CDC2010Epi/><ref name=CDC>{{cite web | url = http://www.dpd.cdc.gov/dpdx/HTML/Scabies.htm | title = DPDx – Scabies | work = Laboratory Identification of Parasites of Public Health Concern | publisher = CDC | url-status = live | archive-url = https://web.archive.org/web/20090220123307/http://dpd.cdc.gov/dpdx/html/scabies.htm | archive-date = 2009-02-20 }}</ref> Such areas make eradication of mites particularly difficult, as the crusts protect the mites from topical miticides/scabicides, necessitating prolonged treatment of these areas.

== Uzroci ==

===Scabies mite===
{{Main|Sarcoptes scabiei}}

[[File:Sarcoptes scabiei.ogv|thumb|upright=1.3|alt=Video of the <nowiki>''</nowiki>Sarcoptes scabiei<nowiki>''</nowiki> mite|Video of the ''[[Sarcoptes scabiei]]'' mite]]
[[File:Scabies life cycle.png|thumb|upright=1.3|Lifecycle of scabies<ref name=cdc>{{cite web |url=http://www.dpd.cdc.gov/dpdx/HTML/Scabies.htm |title=Scabies |work=CDC Parasitology Diagnostic Web Site |access-date=2009-02-09 |url-status=dead |archive-url=https://web.archive.org/web/20090220123307/http://dpd.cdc.gov/dpdx/html/scabies.htm |archive-date=2009-02-20 }}</ref>]]
In the 18th century, Italian biologists [[Giovanni Cosimo Bonomo]] and [[Diacinto Cestoni]] (1637–1718) described the mite now called ''[[Sarcoptes scabiei]]'', variety ''hominis'', as the [[etiology|cause of]] scabies. ''Sarcoptes'' is a genus of skin parasites and part of the larger family of mites collectively known as scab mites. These organisms have eight legs as adults, and are placed in the same phylogenetic class ([[Arachnida]]) as spiders and ticks.<ref>{{cite journal |last1=André |first1=Henri M. |title=The true identity of Pascal's mite and the diachronic use of ciron |journal=Acarologia |date=30 June 2019 |volume=59 |issue=2 |pages=261–278 |doi=10.24349/acarologia/20194330 |language=en |issn=0044-586X|doi-access=free }}</ref>

''S. scabiei'' mites are under 0.5&nbsp;mm in size; they are sometimes visible as pinpoints of white. Gravid females tunnel into the dead, outermost layer ([[stratum corneum]]) of a host's skin and deposit [[egg (biology)|eggs]] in the shallow burrows. The eggs hatch into [[larva]]e in three to ten days. These young mites move about on the skin and [[ecdysis|molt]] into a "[[nymph (biology)|nymphal]]" stage, before maturing as adults, which live three to four weeks in the host's skin. Males roam on top of the skin, occasionally burrowing into the skin. In general, the total number of adult mites infesting a healthy hygienic person with non-crusted scabies is small, about 11 females in burrows, on average.<ref name=autogenerated1/>

The movement of mites within and on the skin produces an intense itch, which has the characteristics of a delayed [[Cell-mediated immunity|cell-mediated inflammatory response]] to allergens. [[IgE]] antibodies are present in the serum and the site of infection, which react to multiple protein allergens in the body of the mite. Some of these cross-react to allergens from [[house dust mites]]. Immediate [[Antibody-mediated immunity|antibody-mediated allergic reactions]] (wheals) have been elicited in infected persons, but not in those not infected; immediate [[hypersensitivity]] of this type is thought to explain the observed far more rapid allergic skin response to reinfection seen in persons who have been infected previously, especially within the previous year or two.<ref name="autogenerated1"/>

===Transmission===
Scabies is [[Contagious disease|contagious]] and can be contracted through prolonged physical contact with an infested person.<ref name=ssd3>{{cite book |title=The Encyclopedia of Skin and Skin Disorders |url=https://archive.org/details/encyclopediaofsk0000turk |url-access=registration | vauthors = Turkington C, Dover JS |isbn=978-0-8160-6403-8 |year=2006 |publisher=Facts on File inc |location=New York}}</ref> 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 survive for only two to three days, at most, away from human skin at room temperature.<ref name=webmd>{{cite web |url=http://www.emedicinehealth.com/scabies/page2_em.htm#Scabies_Causes |title=Scabies Causes |access-date=2010-10-09 |website=WebMD |date=October 2010 |url-status=live |archive-url=https://web.archive.org/web/20100922170326/http://www.emedicinehealth.com/scabies/page2_em.htm#Scabies_Causes |archive-date=2010-09-22 }}</ref><ref name=chos>{{cite journal | vauthors = Chosidow O | title = Clinical practices. Scabies | journal = The New England Journal of Medicine | volume = 354 | issue = 16 | pages = 1718–27 | date = April 2006 | pmid = 16625010 | doi = 10.1056/NEJMcp052784 }}</ref> 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.<ref name=asha>{{cite web |url=http://www.ashastd.org/learn/learn_scabies_facts.cfm |title=Scabies – Fast Facts |access-date=2010-10-09 |publisher=American Social Health Association |url-status=dead |archive-url=https://web.archive.org/web/20110422110637/http://ashastd.org/learn/learn_scabies_facts.cfm |archive-date=2011-04-22 }}</ref>

Healthcare workers are at risk of contracting scabies from patients, because they may be in extended contact with them.<ref>{{cite journal | vauthors = FitzGerald D, Grainger RJ, Reid A | title = Interventions for preventing the spread of infestation in close contacts of people with scabies | journal = The Cochrane Database of Systematic Reviews | volume = 2014 | issue = 2 | pages = CD009943 | date = February 2014 | pmid = 24566946 | doi = 10.1002/14651858.CD009943.pub2 | pmc = 10819104 }}</ref>

== Patofizsiologija ==

The symptoms are caused by an [[allergic reaction]] of the host's body to mite proteins, though exactly which proteins remains a topic of study. The mite proteins are also present from the gut, in mite feces, which are deposited under the skin. The allergic reaction is both of the delayed (cell-mediated) and immediate (antibody-mediated) type, and involves IgE (antibodies are presumed to mediate the very rapid symptoms on reinfection).<ref name=autogenerated1>{{cite journal | vauthors = Walton SF, Currie BJ | title = Problems in diagnosing scabies, a global disease in human and animal populations | journal = Clinical Microbiology Reviews | volume = 20 | issue = 2 | pages = 268–79 | date = April 2007 | pmid = 17428886 | pmc = 1865595 | doi = 10.1128/CMR.00042-06 }}</ref> The allergy-type symptoms (itching) continue for some days, and even several weeks, after all mites are killed. New lesions may appear for a few days after mites are eradicated. Nodular lesions from scabies may continue to be symptomatic for weeks after the mites have been killed.<ref name=autogenerated1 />

Rates of scabies are negatively related to temperature and positively related to humidity.<ref name="LiuWang2016">{{cite journal | vauthors = Liu JM, Wang HW, Chang FW, Liu YP, Chiu FH, Lin YC, Cheng KC, Hsu RJ | title = The effects of climate factors on scabies. A 14-year population-based study in Taiwan | journal = Parasite | volume = 23 | pages = 54 | year = 2016 | pmid = 27905271 | pmc = 5134670 | doi = 10.1051/parasite/2016065 }} {{open access}}</ref>


== Reference ==
== Reference ==
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[[Категорија:Паразитске инфестације, убоди и угризи коже]]
[[Категорија:Паразитске инфестације, убоди и угризи коже]]

Верзија на датум 9. март 2024. у 22:30

Šuga
SinonimiSedmogodišnji svrab[1]
Uvećani pogled na izdubljeni trag grinja. Ljuskasta mrlja s leve strane nastala je grebanjem i označava mesto ulaska grinje u kožu. Grinja je zakopana gore desno, gde se može videti kao tamna mrlja na kraju.
SpecijalnostiInfektivne bolesti, dermatovenerologija
SimptomiSvrabež, osip nalik prištu[2]
Vreme pojave2–6 nedelje (prva infekcija), ~1 dan (naknadne infekcije)[2]
UzrociSarcoptes scabiei grinje, koje se šire bliskim kontaktom[3]
Faktori rizikaPretrpani životni uslovi (ustanove za brigu o deci, grupni domovi, zatvori), nedostatak pristupa vodi[3][4]
Dijagnostički metodNa osnovu simptoma[5]
Slična oboljenjaseboroični dermatitis, herpetiformni dermatitis, pedikuloza, atopijski ekcem[6]
Lekovipermethrin, krotamiton, lindan, ivermektin[7]
Frekvencija204 miliona / 2,8% (2015)[8]

Šuga (engl. scabies od lat. scabere - češati,[9] kolokvijalno poznata kao sedmogodišnji svrab,[1]) zarazna je infekcija kože uzrokovana gnjidom Sarcoptes scabiei.[1][3] Ovi paraziti su mali i obično nisu direktno vidljivi. Oni žive u koži domaćina, uzrokujući intenzivni alergijski svrab. Kod životinja je infekcija uzrokovana različitom vrstom šugarca. Svetska zdravstvena organizacija klasifikuje šugu kao bolest povezanu sa vodom.[4] Bolest se može preneti sa objekata, mada do prenosa najčešće dolazi direktnim dodirom, i rizik od oboljevanja je proporcionalan dužini kontakta. Inicijalna infekcija traje četiri do šest nedelja nakon čega postaje simptomatična. Reinfekcija se može manifestovati u toku 24 sata. Pošto su simptomi alergijski, oni se zadržavaju znatno dugo nakon eradikacije parazita. Krustava šuga, ranije poznata kao Norveška šuga, je ozbiljnija forma infekcije koja je često povezana sa imunosupresijom.

Najčešći simptomi su jak svrab i osip nalik bubuljicama.[2] Povremeno se na koži mogu pojaviti rupice.[2] Kod prve infekcije, zaražena osoba će obično razviti simptome u roku od dve do šest nedelja.[2] Tokom druge infekcije, simptomi mogu početi u roku od 24 sata.[2] Ovi simptomi mogu biti prisutni na većem delu tela ili samo na određenim područjima, poput zglobova, između prstiju ili duž struka.[2] Glava može biti zahvaćena, ali to je tipično samo kod male dece.[2] Svrab je često gori noću.[2] Grebanje može izazvati oštećenje kože i dodatnu bakterijsku infekciju na koži.[2]

Uvećani snimak šugarca (Sarcoptes scabiei)

Šuga je uzrokovana infekcijom ženkom grinja Sarcoptes scabiei var. hominis, ektoparazita.[3] Grinje se ukopavaju u kožu da žive i polažu jaja.[3] Simptomi šuge su posledica alergijske reakcije na grinje.[2] Često je samo 10 do 15 grinja uključeno u infekciju.[2] Šuga se najčešće širi tokom relativno dugog perioda direktnog kontakta sa kožom sa zaraženom osobom (najmanje 10 minuta), poput onog koji se može javiti tokom seksa ili zajedničkog života.[3][10] Do širenja bolesti može doći čak i ako osoba još nije razvila simptome.[11] Skučeni životni uslovi, poput onih u ustanovama za brigu o deci, grupnim domovima i zatvorima, povećavaju rizik od širenja.[3] Područja sa nedostatkom pristupa vodi takođe imaju veće stope bolesti.[4] Krastava šuga je teži oblik bolesti.[3] Obično se javlja samo kod osoba sa slabim imunskim sistemom, a ljudi mogu imati milione grinja, što ih čini mnogo zaraznijim.[3] U tim slučajevima može doći do širenja infekcije tokom kratkog kontakta ili kontaminiranim predmetima.[3] Grinja je vrlo mala i obično nije direktno vidljiva.[3] Dijagnoza se zasniva na znacima i simptomima.[5]

Dostupni su brojni lekovi za lečenje inficiranih, uključujući kreme sa permetrinom, krotamitonom i lindanom i ivermektin.[7] Seksualni kontakti tokom poslednjih mesec dana i ljudi koji žive u istoj kući takođe bi trebalo da budu tretirani istovremeno.[11] Posteljinu i odeću koja je korištena u poslednja tri dana treba prati u vrućoj vodi i osušiti u toploj sušilici.[11] Kako grinja ne živi više od tri dana izvan ljudske kože, nije potrebno više pranja.[11] Simptomi se mogu nastaviti dve do četiri nedelje nakon tretmana.[11] Ako se nakon ovog vremena simptomi nastave, moguće je da je potrebno ponovno lečenje.[11]

Šuga je jedan od tri najčešća kožna oboljenja kod dece, uz lišajeve i bakterijske infekcije kože.[12] Od 2015. godine pogađa oko 204 miliona ljudi (2,8% svetske populacije).[8] Podjednako je uobičajena kod oba pola.[13] Češće su pogođeni mladi i stari.[5] Takođe se češće javlja u zemljama u razvoju i tropskoj klimi.[5] Engleski naziv scabies potiče od лат. scabere, 'ogrebati'.[9] Druge životinje ne šire ljudsku šugu.[3] Infekcija kod drugih životinja obično je uzrokovana malo drugačijim, ali srodnim grinjama i poznata je kao sarkoptična šuga.[14]

Znaci i simptomi

Uobičajeno zahvaćena mesta osipa od šuge[15]

Karakteristični simptomi infekcije šugom uključuju intenzivan svrab i površinske rupe.[16] Budući da domaćin razvija simptome kao reakciju na prisustvo grinja tokom vremena, tipično dolazi do kašnjenja od četiri do šest nedelja između početka zaraze i početka svraba. Slično, simptomi često traju jednu do nekoliko nedelja nakon uspešnog iskorenjivanja grinja. Kao što je napomenuto, oni koji su ponovo bili izloženi šugi nakon uspešnog lečenja mogu pokazati simptome nove infekcije u mnogo kraćem periodu - samo jedan do četiri dana.[17]

Svrab

U klasičnom scenariju, svrab se pogoršava toplotom i obično se doživljava kao da se pogoršava noću, verovatno zato što je manje smetnji.[16] Kao simptom, ređe se javlja kod starijih osoba.[16]

Osip

Površinske rupe šuge obično se javljaju u predelu prstiju, stopala, zglobova, laktova, leđa, zadnjice i spoljašnjih genitalija.[16] Osim kod odojčadi i imunosupresivnih osoba, infekcija se generalno ne javlja na koži lica ili lobanje. Jame nastaju iskopavanjem odrasle grinje u epidermisu.[16] Akropustuloza, ili žuljevi i pustule na dlanovima i tabanima, karakteristični su simptomi šuge kod odojčadi.[18]

  • Šuga na stopalu
    Šuga na stopalu
  • Šuga na ruci
    Šuga na ruci
  • Šuga na šaci
    Šuga na šaci
  • Šuga prsta
    Šuga prsta

Kod većine ljudi, tragovi grinja su linearni ili u obliku slova S na koži, često praćeni nizovima malih bubuljica, nalik na one uzrokovane ubodima komaraca ili insekata. Ovi znakovi se često nalaze u pukotinama na telu, na primer na naborima prstiju na rukama i nogama, oko genitalija, na stomačnim naborima kože i ispod dojki žena.[18]

Simptomi se obično javljaju dve do šest nedelja nakon infekcije kod pojedinaca koji nikada ranije nisu bili izloženi šugi. Za one koji su prethodno bili izloženi, simptomi se mogu pojaviti u roku od nekoliko dana nakon infekcije. Međutim, simptomi se mogu pojaviti i nakon nekoliko meseci ili godina.[19]

Okrastala šuga

Crusted scabies in a person with AIDS

The elderly, disabled, and people with impaired immune systems, such as those with HIV/AIDS, cancer, or those on immunosuppressive medications, are susceptible to crusted scabies (also called Norwegian scabies).[16][19][20] On those with weaker immune systems, the host becomes a more fertile breeding ground for the mites, which spread over the host's body, except the face. The mites in crusted scabies are not more virulent than in noncrusted scabies but are much more numerous, sometimes up to two million. People with crusted scabies exhibit scaly rashes, slight itching, and thick crusts of skin that contain large numbers of scabies mites. For this reason, persons with crusted scabies are more contagious to others than those with typical scabies.[3][21] Such areas make eradication of mites particularly difficult, as the crusts protect the mites from topical miticides/scabicides, necessitating prolonged treatment of these areas.

Uzroci

Scabies mite

Главни чланак: Sarcoptes scabiei
Video of the Sarcoptes scabiei mite
Lifecycle of scabies[15]

In the 18th century, Italian biologists Giovanni Cosimo Bonomo and Diacinto Cestoni (1637–1718) described the mite now called Sarcoptes scabiei, variety hominis, as the cause of scabies. Sarcoptes is a genus of skin parasites and part of the larger family of mites collectively known as scab mites. These organisms have eight legs as adults, and are placed in the same phylogenetic class (Arachnida) as spiders and ticks.[22]

S. scabiei mites are under 0.5 mm in size; they are sometimes visible as pinpoints of white. Gravid females tunnel into the dead, outermost layer (stratum corneum) of a host's skin and deposit eggs in the shallow burrows. The eggs hatch into larvae in three to ten days. These young mites move about on the skin and molt into a "nymphal" stage, before maturing as adults, which live three to four weeks in the host's skin. Males roam on top of the skin, occasionally burrowing into the skin. In general, the total number of adult mites infesting a healthy hygienic person with non-crusted scabies is small, about 11 females in burrows, on average.[23]

The movement of mites within and on the skin produces an intense itch, which has the characteristics of a delayed cell-mediated inflammatory response to allergens. IgE antibodies are present in the serum and the site of infection, which react to multiple protein allergens in the body of the mite. Some of these cross-react to allergens from house dust mites. Immediate antibody-mediated allergic reactions (wheals) have been elicited in infected persons, but not in those not infected; immediate hypersensitivity of this type is thought to explain the observed far more rapid allergic skin response to reinfection seen in persons who have been infected previously, especially within the previous year or two.[23]

Transmission

Scabies is contagious and can be contracted through prolonged physical contact with an infested person.[24] 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 survive for only two to three days, at most, away from human skin at room temperature.[25][26] 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.[27]

Healthcare workers are at risk of contracting scabies from patients, because they may be in extended contact with them.[28]

Patofizsiologija

The symptoms are caused by an allergic reaction of the host's body to mite proteins, though exactly which proteins remains a topic of study. The mite proteins are also present from the gut, in mite feces, which are deposited under the skin. The allergic reaction is both of the delayed (cell-mediated) and immediate (antibody-mediated) type, and involves IgE (antibodies are presumed to mediate the very rapid symptoms on reinfection).[23] The allergy-type symptoms (itching) continue for some days, and even several weeks, after all mites are killed. New lesions may appear for a few days after mites are eradicated. Nodular lesions from scabies may continue to be symptomatic for weeks after the mites have been killed.[23]

Rates of scabies are negatively related to temperature and positively related to humidity.[29]

Reference

  1. ^ а б в Gates RH (2003). Infectious disease secrets (2nd изд.). Philadelphia: Elsevier, Hanley Belfus. стр. 355. ISBN 978-1-56053-543-0. 
  2. ^ а б в г д ђ е ж з и ј к „Parasites – Scabies Disease”. Center for Disease Control and Prevention. 2. 11. 2010. Архивирано из оригинала 2. 5. 2015. г. Приступљено 18. 5. 2015. 
  3. ^ а б в г д ђ е ж з и ј к л „Epidemiology & Risk Factors”. Centers for Disease Control and Prevention. 2. 11. 2010. Архивирано из оригинала 29. 4. 2015. г. Приступљено 18. 5. 2015. 
  4. ^ а б в „WHO -Water-related Disease”. World Health Organization. Приступљено 10. 10. 2010. 
  5. ^ а б в г „Scabies”. World Health Organization. Архивирано из оригинала 18. 5. 2015. г. Приступљено 18. 5. 2015. 
  6. ^ Ferri FF (2010). „Chapter S”. Ferri's differential diagnosis : a practical guide to the differential diagnosis of symptoms, signs, and clinical disorders (2nd изд.). Philadelphia, PA: Elsevier/Mosby. ISBN 978-0323076999. 
  7. ^ а б „Parasites – Scabies Medications”. Center for Disease Control and Prevention. 2. 11. 2010. Архивирано из оригинала 30. 4. 2015. г. Приступљено 18. 5. 2015. 
  8. ^ а б Vos, Theo; et al. (октобар 2016). „Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015”. Lancet. 388 (10053): 1545—1602. PMC 5055577 Слободан приступ. PMID 27733282. doi:10.1016/S0140-6736(16)31678-6. 
  9. ^ а б Mosby's Medical, Nursing & Allied Health Dictionary (4 изд.). Mosby-Year Book Inc. 1994. стр. 1395. ISBN 9780801672255. 
  10. ^ Dressler C, Rosumeck S, Sunderkötter C, Werner RN, Nast A (новембар 2016). „The Treatment of Scabies”. Deutsches Ärzteblatt International. 113 (45): 757—762. PMC 5165060 Слободан приступ. PMID 27974144. doi:10.3238/arztebl.2016.0757. 
  11. ^ а б в г д ђ „Parasites - Scabies Treatment”. Center for Disease Control and Prevention. 2. 11. 2010. Архивирано из оригинала 28. 4. 2015. г. Приступљено 18. 5. 2015. 
  12. ^ Andrews RM, McCarthy J, Carapetis JR, Currie BJ (децембар 2009). „Skin disorders, including pyoderma, scabies, and tinea infections”. Pediatric Clinics of North America. 56 (6): 1421—40. PMID 19962029. doi:10.1016/j.pcl.2009.09.002. 
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