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Crusted scabies: a clinical marker of human T-lymphotropic virus type 1 infection in central Australia

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To the Editor: Scabies continues to cause significant morbidity among residents of Indigenous communities.1 In the Northern Territory, scabies underlies most cases of Streptococcus pyogenes pyoderma, a major cause of poststreptococcal glomerulonephritis and rheumatic fever.1,2 The increased risk of scabies resulting from infection with the human T-lymphotropic virus type 1 (HTLV-1) has received little attention. This human retrovirus is endemic to much of Western Australia, South Australia and the NT. In a recent study, 33% of nearly 1600 Indigenous adults tested at Alice Springs Hospital (ASH) were infected.3

We report the case of a 36-year-old HTLV-1-infected Indigenous man from an Alice Springs town camp who was admitted to ASH with severe crusted scabies. Since early childhood, he had been hospitalised six times with recurrent scabies and had also been admitted with intestinal strongyloidiasis and chronic suppurative lung disease. On examination, he had confluent areas of hyperkeratosis with profuse skin shedding, deep skin cracks, bleeding and ooze involving the lower half of his body (Box). Skin scrapings revealed numerous scabies mites. Full blood examination showed an eosinophilia (2.6 × 10