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Treatment is aimed at killing scabies mites and controlling the dermatitis, which can persist for months after effective eradication of the mites Bedding and clothing should be laundered or cleaned or set aside for 14 days in plastic bags If secondary pyoderma is present, it is treated with systemic antibiotics Unless treatment is aimed at all infected persons in a family or institutionalized group, reinfestations will probably occur Permethrin 5% cream is highly effective and safe in the management of scabies Treatment consists of a single application for 8 12 hours It may be repeated in 1 week Pregnant patients should be treated only if they have documented scabies themselves Permethrin 5% cream once for 12 hours or 5% or 6% sulfur in petrolatum applied nightly for 3 nights from the collarbones down may be used Patients will continue to itch for several weeks after treatment Use of triamcinolone 01% cream will help resolve the dermatitis Scabies in nursing home patients, institutionalized or mentally impaired (especially Down syndrome) patients, and AIDS patients may be much more difficult to treat Most failures in normal persons are related to incorrect use or incomplete treatment of the housing unit In these cases, repeat treatment with permethrin once weekly for 2 weeks, with reeducation regarding the method and extent of application, is suggested In immunocompetent individuals, ivermectin in a dose of 200 mcg/kg is effective in about 75% of cases with a single dose and 95% of cases with two doses 2 weeks apart In immunosuppressed hosts and those with crusted (hyperkeratotic) scabies, multiple doses of ivermectin (every 2 weeks for two or three doses) plus topical therapy with permethrin once weekly may be effective when topical treatment and oral therapy alone fail Persistent pruritic postscabietic papules may be treated with mid- to high-potency corticosteroids or with intralesional triamcinolone acetonide (25 5 mg/mL).

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Adenoviruses (there are over at least 51 serotypes) produce a variety of clinical syndromes These infections are usually selflimited or clinically inapparent and most common among infants, young children, and military recruits Adenoviruses, however, may cause significant morbidity and mortality in immunocompromised persons, such as HIV-infected persons and liver, renal, and stem cell transplant patients (risk factors for severe infection include immunosuppressive therapy, graft-versus-host disease, and lymphocytopenia) The incubation period is 4 9 days Adenoviruses, although a common cause of human disease, also receive particular recognition through their role in gene therapy Clinical syndromes of adenovirus infection, often overlapping, include the following The common cold (see 8) is characterized by rhinitis, pharyngitis, and mild malaise without fever Nonstreptococcal exudative pharyngitis is characterized by fever lasting 2 12 days and accompanied by malaise and myalgia Conjunctivitis is often present Lower respiratory tract infection may occur, including bronchiolitis, suggested by cough and rales, or pneumonia (type 3 and type 7 commonly cause acute respiratory disease and pneumonia) Pharyngoconjunctival fever is manifested by fever and malaise, conjunctivitis (often unilateral), and mild pharyngitis Epidemic keratoconjunctivitis (transmissible person to person) occurs in adults and is manifested by unilateral conjunctival redness, pain, tearing, and an enlarged preauricular lymph node (multiple types may be involved in a single outbreak, a recent Vietnamese outbreak was largely due to type 8, but included types 3 and 37) Keratitis may lead to subepithelial opacities (especially with types 8, 19, or 37) Acute hemorrhagic cystitis is a disorder of children often associated with adenovirus type 11 Sexually transmitted genitourinary ulcers and urethritis may be caused by types 2, 8, and 37 in particular Adenoviruses also cause acute gastroenteritis (types 40 and 41), leading to intussusception, and are rarely associated with encephalitis, acute flaccid paralysis, and pericarditis In a recent review of viruses causing dilated cardiomyopathy, adenoviruses were the most common isolates, found in 12% of samples Severity of systemic adenoviral disease correlates with the concentration of lactate dehydrogenase and with oxygen saturation on admission Hepatitis (type 5 adenovirus) tends to develop in infected liver transplant recipients, whereas pneumonia or hemor-.

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