挪威疥感染之臨床及掃描式電子顯微鏡探討

本研究為探討2例典型挪威疥之患者，其病變皮膚內人疥螨之寄生情形及病理變化。病例1為唐氏症候群(Down’s syndrome)之患者，病例2為成人型T細胞白血病/淋巴瘤(adult T cell leukemia/lymphoma)之患者，兩病例呈現類似的變化，在手、腳、耳朵、手叉及臀部處之皮膚呈現角性斑塊及疣狀痂皮。病變皮膚作KOH鏡檢均發現卵殼及蟲體。病理組織學檢查可見到在增厚之角質層內有很多疥蟲蟲體、卵殼及蟲糞便的沈積，並伴有不全角化，表皮則可見到乾癬性皮炎(psoriasiform hyperplasia)之變化。掃描式電子顯微鏡不但能觀察蟲卵之大小、形狀、蟲體之腹面及背面詳細構造及幼蟲蛻變之情形，而且更進一步觀察到幼蟲是靠前後肢腿部跗節處鉤狀或螫狀構造，來劃破卵殼而離開，以及人疥螨如何在角質層內挖掘隧道。因此，於人疥螨與人之動態關係及其生活習性之了解，將有所助益。

關鍵字

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並列摘要

Two typical cases of Norwegian scabies were studied clinically, scanning electron microscopically and histopatho-logically. 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. Direct examination of the KOH preparation revealed many embryonated sarcoptic eggs, postpartum egg-shells, fecal pellets, larvae and male and female adult mitees. 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 note 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 illustration the be havior of the scabies mites in their burrows in Norwegian scabies patients.

並列關鍵字

Norwegian scabies ； scanning electron microscopy

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挪威疥感染之臨床及掃描式電子顯微鏡探討

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