[Clinical and scanning electron microscopic studies on Norwegian scabies infection]

Two typical cases of Norwegian scabies were studied clinically, scanning electron microscopically and histopathologically. Case 1 was a boy with Down's syndrome and case 2 was a man with adult T cell leukemia/lymphoma. Their clinical pictures showed hyperkeratotic plaques and warty crusts on hands, feet, ears, elbows and buttocks. Direct examination of the KOH preparation revealed many embryonated sarcoptic eggs, postpartum egg-shells, fecal pellets, larvae and male and female adult mites. Histopathologic examination showed several burrows inside the thick horny layer. Many sarcoptic egg-shells, mites and fecal pellets were found in the burrows. Psoriasiform hyperplasia and parakeratosis were noted, too. The size and shape of the sarcoptic eggs and the detailed structure of mites and molt were observed by using a scanning electron microscope. Besides, hook-like structures were noted at the tarsi of both forelegs and hindlegs. We suggest that the larvae crawl out from longitudinal openings in the egg-shell by the use of hook-like structures. The mites also used these hook-like structures to make the burrows. Scanning electron microscopy provides a good method to understand the dynamics of these burrowing parasites. It is helpful in illustrating the behavior of the scabies mites in their burrows in Norwegian scabies patients.