WEBVTT - Ep 159 Scabies: Tiny but Mite-y

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<v Speaker 1>My opportunities for observing scabies were extensive. In the Confederate Army.

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<v Speaker 1>Our soldiers were badly fed, badly clothed, soap was scarce,

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<v Speaker 1>and army itch, as it was denominated, was painfully plenty.

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<v Speaker 1>Army itch is nothing more than scabies with exzema or impetago,

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<v Speaker 1>or ecthema or some other dermatosis superadded. In eighteen sixty two,

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<v Speaker 1>in the Confederate Service, I became the subject of Sarcopti's hominus.

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<v Speaker 1>At the same time, several generals and some very elegant

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<v Speaker 1>ladies of my acquaintance were my fellow sufferers. At first,

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<v Speaker 1>the itching was not only not unpleasant, but was positively delightful.

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<v Speaker 1>Very soon, however, the proitis became terrific. I often awoke

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<v Speaker 1>at night, exhausted and panting from violent scratching begun in

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<v Speaker 1>my sleep. I lacerated the skin with my nails to

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<v Speaker 1>abate the tortured itching, for the smarting pain of the

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<v Speaker 1>upbraded surface was far preferable to the proitis. Sulfur ointment

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<v Speaker 1>relieved me entirely in three days.

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<v Speaker 2>The only difference I can discover between the army itch

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<v Speaker 2>and scabies as it is met with in civil practice

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<v Speaker 2>is a difference in degree. Soldiers frequently neglect to apply

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<v Speaker 2>for treatment until they are completely covered with the eruption,

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<v Speaker 2>and in such cases it is sometimes so marked by

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<v Speaker 2>lacerations made by the patient's nails and by secondary eruptions

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<v Speaker 2>that it would be difficult to recognize the disease. It

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<v Speaker 2>is not surprising that the disease should cover a larger

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<v Speaker 2>extent of the surface and appear upon the outside of

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<v Speaker 2>the limbs as well as in the flexures. When we

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<v Speaker 2>consider the crowded manner in which soldiers live in their

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<v Speaker 2>tents or barracks, and the carelessness that exists among them

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<v Speaker 2>in regard to personal cleanliness. That was a little harsh,

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<v Speaker 2>isn't it.

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<v Speaker 1>It is a little harsh. So those were quotes from

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<v Speaker 1>the American Civil War about scabies, which was apparently very endemic,

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<v Speaker 1>very prevalent throughout both armies, throughout the towns where the

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<v Speaker 1>armies passed through, and those quotes themselves were from a

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<v Speaker 1>couple of places. One the first one was from the

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<v Speaker 1>book The Itch Scabies by Errol Craig, and the second

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<v Speaker 1>was from an article by Cropley from two thousand and

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<v Speaker 1>six titled the army itch a dermatological mystery of the

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<v Speaker 1>American Civil War.

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<v Speaker 2>Mystery was it was? It was it?

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<v Speaker 1>I think the mystery was concluded to be like it

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<v Speaker 1>was skabyab It was definitely scaly, really bad scabies, and

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<v Speaker 1>like probably combined with just the general grossness.

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<v Speaker 2>That accompanied everything. I can only imagine.

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<v Speaker 1>I mean, I feel like I remember quotes from our

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<v Speaker 1>typhoid episode and it was just like pooping near water

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<v Speaker 1>sources and stuff like that. Pooping and holes was our

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<v Speaker 1>very first episode. Yeah, but probably applies. It was also, Yes,

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<v Speaker 1>scabies was also prevalent during World War One.

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<v Speaker 2>Blah blah words.

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<v Speaker 1>You know that's jumping ahead of things.

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<v Speaker 2>Hi, I'm Aaron Welsh and I'm Aaron Alman Updike.

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<v Speaker 1>And this is this podcast will kill you.

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<v Speaker 2>If you haven't guessed it. We're talking about scabies. It's

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<v Speaker 2>all just skabes today.

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<v Speaker 1>Gabies, scabies. I am really excited for this because we

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<v Speaker 1>haven't done something like this in quite a while.

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<v Speaker 2>It feels I mean, you know how when we were

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<v Speaker 2>doing Neurovirus, you were like, I was so nauseous recording

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<v Speaker 2>this episode. I have never been so itchy. Really. I

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<v Speaker 2>actually did have lice and it really made me feel

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<v Speaker 2>like I was like, do I do I have Lisay,

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<v Speaker 2>I'm like I I was so so so, like I'm

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<v Speaker 2>surprised that I don't have wounds from how much I

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<v Speaker 2>was scratching. My last reading about Scutty's, I did not

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<v Speaker 2>feel that itchy.

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<v Speaker 1>And I don't know why.

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<v Speaker 2>I don't know. Maybe because the.

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<v Speaker 1>History, I mean, but there were like a lot of

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<v Speaker 1>excerpts about the itchiness. I guess maybe I didn't read

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<v Speaker 1>as much about like the these widespread outbreaks, but people

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<v Speaker 1>certainly talked a lot about the the itch and also

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<v Speaker 1>like how enjoyable. Like that's something that I found really strange,

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<v Speaker 1>is that, like that's not the first firsthand when I

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<v Speaker 1>was talking about how enjoyable it was to itch or

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<v Speaker 1>to scratch the itch. Yeah, that's not the only time

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<v Speaker 1>I encountered that sentiment.

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<v Speaker 2>How interesting.

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<v Speaker 1>And then somebody else was like anyone who actually had

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<v Speaker 1>scabies probably does not agree with this, and.

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<v Speaker 2>Like so that's like just what doctors would say about

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<v Speaker 2>it back then. But like, yeah, I don't know, I mean,

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<v Speaker 2>maybe I do.

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<v Speaker 1>I will say that when I had really bad poison ivy,

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<v Speaker 1>that first hit of the hot water from the shower

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<v Speaker 1>head and it would just it, It would scratch it

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<v Speaker 1>in such a delightful way, but then it would lead

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<v Speaker 1>to uncontrollable itching. Yeah. Yeah, so maybe I can relate anyway,

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<v Speaker 1>Speaking of itching and scratching, it's quarantiny time, It's quarantin

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<v Speaker 1>any time. What are we drinking this week?

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<v Speaker 2>We're drinking the itch Itch.

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<v Speaker 1>The itch is. You know this episode is coming out

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<v Speaker 1>early Decement. I feel like it's nice cozy times, so

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<v Speaker 1>we're doing a cozy drink to hopefully soothe any sort

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<v Speaker 1>of itchy feeling or to have it is. Essentially, it's

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<v Speaker 1>like gingerbread vibes, is what we're going for us. We've

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<v Speaker 1>got rye whiskey, We've got a little bit of orange juice,

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<v Speaker 1>a little bit of ginger ale, and then like a

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<v Speaker 1>spiced syrup with molasses and spices.

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<v Speaker 2>It's going to be so yummy and cozy so that

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<v Speaker 2>you can cuddle up by the fire and scratch your itches.

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<v Speaker 2>You can find the full recipe for that quarantine as

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<v Speaker 2>well as our non alcoholic plusy Burta on our website,

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<v Speaker 2>this podcast witha dot com, and on all of our socials.

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<v Speaker 2>Great, And if you haven't already, please rate, review, and

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<v Speaker 2>So thank you so much, thank you, thank you, thank you.

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<v Speaker 2>On to a topic of today, great love it. We'll

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<v Speaker 2>take a quick break and then talk about the biology

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<v Speaker 2>of scabies. I have to just start this way because

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<v Speaker 2>it was one of those moments of you know, when

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<v Speaker 2>you see something in one place and then you can't

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<v Speaker 2>stop seeing it everywhere. Yeah, we just recorded our episode

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<v Speaker 2>on strep pyogenies and scarlet fever. So ready for this,

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<v Speaker 2>I'm ready. The first paper I read about scabies. It

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<v Speaker 2>was a review in The Lancet from two thousand and six.

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<v Speaker 2>It was a great paper. They start off, literally start

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<v Speaker 2>off the paper saying, I'm going to quote here quote.

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<v Speaker 2>Scabies is a neglected parasitic disease that is a major

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<v Speaker 2>public health problem in many resource poor regions. It causes

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<v Speaker 2>substantial morbidity from secondary infections and post infective complications such

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<v Speaker 2>as acute post streptococcle glomeriolonephritis. Oh g, I know, and

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<v Speaker 2>now everyone knows that is. It's when your kidneys get

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<v Speaker 2>attacked by your own self after a strep infection, which

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<v Speaker 2>is a major complication of scabies infection. So let's get

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<v Speaker 2>into it, shall we. Yeah, okay, but like.

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<v Speaker 1>Why is it just because strap is one of is

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<v Speaker 1>on many people all the time.

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<v Speaker 2>Yeah, it's because impetigo, which is the main superficial skin

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<v Speaker 2>infection caused by strep, is the main risk factor for

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<v Speaker 2>post strip glomery leonephritis, and scabies is a major risk

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<v Speaker 2>factor for a whole bunch of like secondary skin infections.

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<v Speaker 2>But skin infections are mostly caused by either staff or strap.

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<v Speaker 2>And so if it's strip, then you get this. Oh

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<v Speaker 2>my goodness, it's terrible, let's get into it. Yeah, so

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<v Speaker 2>scabies is an infection of your skin, but it's an

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<v Speaker 2>infection of your skin not with a bacteria, not with

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<v Speaker 2>a virus, but with a mite called Sarcopdi's SCABYI variant hominus.

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<v Speaker 2>And I feel like people might not know what the

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<v Speaker 2>heck a mite is. So a mite is an arachnid,

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<v Speaker 2>which means it's more closely related to spiders and ticks

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<v Speaker 2>than like mosquitoes or other insects. But I feel like

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<v Speaker 2>when you look at pictures of especially these particular mites,

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<v Speaker 2>they look more like tartar grades like water bears ampletely do. Yeah,

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<v Speaker 2>they're kind of cute.

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<v Speaker 1>Yeah, maybe not as cute as like a lause, but

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<v Speaker 1>pretty cute.

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<v Speaker 2>Yeah, I don't know. I kind of feel like they're

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<v Speaker 2>cuter than a laus but your around, judge. So they

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<v Speaker 2>have this like little head. You can barely even see

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<v Speaker 2>that they have a head. They kind of just have

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<v Speaker 2>these little chompy mouth parts, and then this really big, fat,

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<v Speaker 2>chunky body with these little rolls of like toddler legs

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<v Speaker 2>that don't look like they should be able to touch

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<v Speaker 2>the ground. And then they have little hairs coming off

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<v Speaker 2>of them. Yeah, and I don't know. They're kind of cute.

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<v Speaker 1>But when I say that, they're right now, right, especially.

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<v Speaker 2>All of the like generated images that aren't like real

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<v Speaker 2>pictures of them under a microscope.

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<v Speaker 1>They're really like the face app what's it called.

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<v Speaker 2>Yeah, one of the Instagram face filters put it.

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<v Speaker 1>Yeah, they've got Once you put filter on the mite,

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<v Speaker 1>it is it is much cuter than the laus. I

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<v Speaker 1>take back my earlier claim. They do have a lot

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<v Speaker 1>of spikes on them.

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<v Speaker 2>They have a lot of little hairs. Yeah, but this.

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<v Speaker 1>One, oh, that must be computer generated. Yeah, it's like

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<v Speaker 1>on the skin. It's very cute.

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<v Speaker 2>And I'm like, oh, right, it looks like a little

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<v Speaker 2>teddy bear, like a toddler. They're very cute. Anyways, they're

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<v Speaker 2>also incredibly tiny and aarin you asked before we recorded,

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<v Speaker 2>can you see these mites? And that paper that two

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<v Speaker 2>thousand and six review paper in The Lancet described them

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<v Speaker 2>as quote at the limit of human visibility. And of

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<v Speaker 2>course every paper sites how big they are. But I

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<v Speaker 2>have a real hard time conceptualizing how tiny something is

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<v Speaker 2>when you give me a number. So here is your concept,

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<v Speaker 2>Aaron of how small they are? Ready?

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<v Speaker 1>Okay, great.

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<v Speaker 2>Size twelve font. We all know that size, right did

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<v Speaker 2>you know that that size? Like font sizes are based

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<v Speaker 2>on measurement, and size twelve font is a unit of

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<v Speaker 2>measure called a pika. I learned a lot on Wikipedia.

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<v Speaker 2>It's just over four millimeters. That's how big size twelve

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<v Speaker 2>font is. These mites are size one font.

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<v Speaker 1>I'm not sure what you mean by twelve, Like, what

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<v Speaker 1>do you mean.

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<v Speaker 2>If you typed on a piece of paper and printed

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<v Speaker 2>out size twelve font, Yeah, it would be four millimeters

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<v Speaker 2>each letter.

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<v Speaker 1>Oh, each letter would be four millimeters.

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<v Speaker 2>Got yeah, okay, yeah, so mites are if you type

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<v Speaker 2>into your computer and change it to size one font,

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<v Speaker 2>that's how big a mite is.

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<v Speaker 1>So okay, But like like an H or like a C,

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<v Speaker 1>or like a period or a specific of questions? Yeah,

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<v Speaker 1>like I mean, because an H is very different than

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<v Speaker 1>a period, So like what so.

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<v Speaker 2>Not a period? Like a letter? Like a letter, like

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<v Speaker 2>a like a typical letter in a in size one font.

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<v Speaker 2>Type it into your computer. You can see it if

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<v Speaker 2>point four millimeters and there's a range, so maybe like

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<v Speaker 2>an M or a H. I don't know, there's a

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<v Speaker 2>range and the males are half that size. So the

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<v Speaker 2>males are even tinier.

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<v Speaker 1>Okay, I'm doing it with a t because that was

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<v Speaker 1>the first one that came up. There, you go one.

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<v Speaker 1>I can't see it, Yeah, I do, man, I can

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<v Speaker 1>see it exactly.

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<v Speaker 2>I wrote the word scabies in size twelve and then

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<v Speaker 2>I wrote it in size one next to each other,

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<v Speaker 2>just to keep that in my mind for this whole episode.

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<v Speaker 2>So they are very very very very small. Point four

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<v Speaker 2>millimeters is the average size for a female mite, and

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<v Speaker 2>the female mites are the ones who actually cause disease.

0:13:38.120 --> 0:13:44.560
<v Speaker 2>So these mites, Sarkopdi's scabyi variant hominus, is a human

0:13:44.720 --> 0:13:49.120
<v Speaker 2>specific mite. There are a lot of different mites in

0:13:49.200 --> 0:13:53.200
<v Speaker 2>the same genus sarcop Di's that cause disease in other animals,

0:13:53.640 --> 0:13:57.000
<v Speaker 2>and much like our friends the lice, they tend to

0:13:57.040 --> 0:14:01.200
<v Speaker 2>be very species specific, so every species of animal has

0:14:01.240 --> 0:14:03.920
<v Speaker 2>our own species of mites. We also have lots of

0:14:03.960 --> 0:14:07.720
<v Speaker 2>other mites that live on us, called Dermodex mites, and

0:14:07.800 --> 0:14:11.920
<v Speaker 2>these tend to not cause disease, but Sarcopti's sure does,

0:14:12.880 --> 0:14:15.160
<v Speaker 2>and their life cycle goes a little something like this.

0:14:16.040 --> 0:14:19.280
<v Speaker 2>Adult males and females find each other on our skin,

0:14:19.960 --> 0:14:23.200
<v Speaker 2>They mate and then the male dies and the female

0:14:23.200 --> 0:14:28.480
<v Speaker 2>then burrows herself into our skin. And conveniently, we've talked

0:14:28.480 --> 0:14:32.360
<v Speaker 2>about our skin layers relatively recently on our Retinoid's episode.

0:14:32.680 --> 0:14:36.960
<v Speaker 2>So these mites are staying incredibly superficial only in that

0:14:37.080 --> 0:14:40.360
<v Speaker 2>epidermal layer, so that very first layer of our skin,

0:14:40.840 --> 0:14:43.880
<v Speaker 2>and even within those layers of the epidermis, they only

0:14:43.880 --> 0:14:46.440
<v Speaker 2>go to like about the middle part of our epidermis,

0:14:46.440 --> 0:14:50.520
<v Speaker 2>So they're really superficial. But in order for something so

0:14:50.880 --> 0:14:54.280
<v Speaker 2>tiny to burrow underneath our skin, they spit out an

0:14:54.440 --> 0:14:58.320
<v Speaker 2>enzyme that essentially dissolves our skin cells, and then that's

0:14:58.360 --> 0:15:01.760
<v Speaker 2>what they eat, So they feed on our dissolved skin goop.

0:15:02.040 --> 0:15:04.600
<v Speaker 1>Yeah, it's kind of like maggots in that way.

0:15:04.760 --> 0:15:09.920
<v Speaker 2>Sort of. Yeah, exactly, just really small and they're really efficient.

0:15:10.120 --> 0:15:13.520
<v Speaker 2>They burrow pretty quickly. It takes them about thirty minutes

0:15:13.680 --> 0:15:17.920
<v Speaker 2>to make their little nest. And in their little nest,

0:15:18.000 --> 0:15:20.800
<v Speaker 2>in their burrow in our epidermis, they lay a whole

0:15:20.800 --> 0:15:21.520
<v Speaker 2>bunch of eggs.

0:15:22.000 --> 0:15:23.160
<v Speaker 1>How much is a whole bunch?

0:15:23.360 --> 0:15:24.800
<v Speaker 2>I knew you were going to ask, so we'll do

0:15:24.880 --> 0:15:28.000
<v Speaker 2>some air and math to tell you exactly they lay.

0:15:28.160 --> 0:15:30.320
<v Speaker 2>Some sources say like one to three or two to four,

0:15:30.440 --> 0:15:34.440
<v Speaker 2>so we'll call it an average of two eggs every day.

0:15:34.440 --> 0:15:36.600
<v Speaker 2>And those eggs take like three or four days to hatch,

0:15:37.400 --> 0:15:40.560
<v Speaker 2>and they live underneath our skin for about four to

0:15:40.680 --> 0:15:41.920
<v Speaker 2>six weeks.

0:15:43.080 --> 0:15:44.960
<v Speaker 1>And after the eggs hatch.

0:15:45.880 --> 0:15:49.120
<v Speaker 2>They lay two eggs a day every day for four

0:15:49.160 --> 0:15:53.560
<v Speaker 2>to six weeks. Oh I see yeah, yekay, So that's

0:15:53.680 --> 0:15:55.800
<v Speaker 2>about if you call it an average of two eggs

0:15:55.800 --> 0:15:58.560
<v Speaker 2>a day for an average of five weeks, it's about

0:15:58.560 --> 0:16:02.320
<v Speaker 2>seventy or so eggs that eat each female might is depositing.

0:16:02.960 --> 0:16:04.840
<v Speaker 1>And then at the end of that four to six

0:16:04.880 --> 0:16:09.040
<v Speaker 1>weeks they're just like peace out. Okay, yep, they die

0:16:08.680 --> 0:16:11.480
<v Speaker 1>they okay. A few questions here, give it to me.

0:16:11.840 --> 0:16:14.800
<v Speaker 1>When they hatch, where do they hang out there? Do

0:16:14.880 --> 0:16:16.720
<v Speaker 1>they have to find their own burrow? Do they just

0:16:16.920 --> 0:16:18.000
<v Speaker 1>go down the skin a bit?

0:16:18.120 --> 0:16:18.200
<v Speaker 3>Like?

0:16:18.280 --> 0:16:19.040
<v Speaker 1>What what's going on?

0:16:19.080 --> 0:16:21.760
<v Speaker 2>Great question? So when they hatch there, of course like

0:16:21.840 --> 0:16:24.400
<v Speaker 2>larvae or they call them like protonymphs. So they have

0:16:24.480 --> 0:16:27.200
<v Speaker 2>to eat our skin goop and then molt and grow

0:16:27.240 --> 0:16:30.240
<v Speaker 2>two more times before they become adults. And then they

0:16:30.280 --> 0:16:33.000
<v Speaker 2>will go out onto the surface of our skin and

0:16:33.080 --> 0:16:36.320
<v Speaker 2>find a mate of their own. And that process takes

0:16:36.320 --> 0:16:38.400
<v Speaker 2>a couple of weeks, so like ten to fourteen days

0:16:38.440 --> 0:16:42.520
<v Speaker 2>to go from hatched egg to adult, and in theory,

0:16:42.560 --> 0:16:45.080
<v Speaker 2>they could do this on your body or on another

0:16:45.160 --> 0:16:47.640
<v Speaker 2>human body if they're transferred to another host.

0:16:47.800 --> 0:16:51.840
<v Speaker 1>Because the female is laying eggs continuously for that chunk

0:16:51.880 --> 0:16:55.720
<v Speaker 1>of time. This can be like a growing infection. It's

0:16:55.760 --> 0:16:57.800
<v Speaker 1>not self limited, it can be.

0:16:58.240 --> 0:17:03.360
<v Speaker 2>But the average might burden is surprisingly only about five

0:17:03.440 --> 0:17:06.240
<v Speaker 2>to fifteen mites per person, which is a lot lower

0:17:06.560 --> 0:17:10.040
<v Speaker 2>than something like the LUs burden can be, and it's

0:17:10.040 --> 0:17:13.520
<v Speaker 2>honestly a lot lower than I expected. A lot of

0:17:13.520 --> 0:17:17.399
<v Speaker 2>this probably has to do with our immune response to

0:17:17.520 --> 0:17:19.160
<v Speaker 2>the mites, and we'll get into that in a little

0:17:19.160 --> 0:17:24.080
<v Speaker 2>bit more detail. However, there is also a condition called

0:17:24.240 --> 0:17:28.320
<v Speaker 2>crusted scabies, and in that situation, a person can be

0:17:28.480 --> 0:17:34.240
<v Speaker 2>infected unfortunately with hundreds, if not thousands, of mites because

0:17:34.280 --> 0:17:37.200
<v Speaker 2>they essentially can just grow and continue to grow unchecked

0:17:37.200 --> 0:17:38.240
<v Speaker 2>by our immune system.

0:17:38.880 --> 0:17:41.480
<v Speaker 1>Okay ooh yeah, how does that. We'll get it to

0:17:41.560 --> 0:17:43.919
<v Speaker 1>play into this, Okay, okay, yeah.

0:17:44.200 --> 0:17:46.439
<v Speaker 2>If there's any good news aside from the fact that

0:17:46.560 --> 0:17:49.920
<v Speaker 2>most of the time the mite burden is relatively low,

0:17:50.480 --> 0:17:54.879
<v Speaker 2>transmission also tends to require body contact and is not

0:17:55.119 --> 0:17:58.280
<v Speaker 2>as much reliant on foemtes, so like bedding or clothing

0:17:58.400 --> 0:18:00.480
<v Speaker 2>or things like that, which you might think of with

0:18:00.520 --> 0:18:02.520
<v Speaker 2>things like body lice, it's a little bit easier to

0:18:02.520 --> 0:18:06.560
<v Speaker 2>transmit that way. Yeah, they only live for a couple

0:18:06.600 --> 0:18:09.439
<v Speaker 2>of days max. Off of the body, but most of

0:18:09.440 --> 0:18:13.440
<v Speaker 2>the time, because the mite burden is relatively low, there's

0:18:13.480 --> 0:18:15.840
<v Speaker 2>not a lot of transmission that happens from things like

0:18:15.880 --> 0:18:19.479
<v Speaker 2>bedding or clothing. It usually takes fifteen to twenty minutes

0:18:19.520 --> 0:18:22.359
<v Speaker 2>of skin to skin contact for mite transmission to happen.

0:18:22.800 --> 0:18:23.119
<v Speaker 2>Got it.

0:18:23.720 --> 0:18:26.160
<v Speaker 1>Yeah, and it has to be the female mite.

0:18:26.760 --> 0:18:29.919
<v Speaker 2>Yeah, it's the female mites that are causing the disease.

0:18:30.000 --> 0:18:31.919
<v Speaker 2>That are the ones actually burrowing into our skin and

0:18:31.960 --> 0:18:32.600
<v Speaker 2>causing disease.

0:18:33.400 --> 0:18:37.600
<v Speaker 1>What proportion of eggs are male and female?

0:18:37.760 --> 0:18:39.560
<v Speaker 2>I have no idea, What a fun question.

0:18:39.760 --> 0:18:44.440
<v Speaker 1>No clue. Can scabies? Sorry?

0:18:44.840 --> 0:18:46.840
<v Speaker 2>I love it. I love I can see on your

0:18:46.880 --> 0:18:49.680
<v Speaker 2>face that you're just like I have so many questions

0:18:49.920 --> 0:18:50.239
<v Speaker 2>I do.

0:18:52.240 --> 0:18:56.960
<v Speaker 1>Can scabies mites? Are they known to transmit any pathogens?

0:18:57.320 --> 0:19:00.679
<v Speaker 2>Excellent questions. No, not any pathogens to humans that we

0:19:00.720 --> 0:19:04.280
<v Speaker 2>know of, thank you. Okay, So, as this might burrows

0:19:04.280 --> 0:19:06.760
<v Speaker 2>into our skin. As I kind of alluded to, it

0:19:06.800 --> 0:19:09.280
<v Speaker 2>really does kind of set off our immune system in

0:19:09.320 --> 0:19:12.880
<v Speaker 2>a way that's really important. We heard in our first

0:19:12.880 --> 0:19:17.040
<v Speaker 2>time to count just how itchy scabies can be, but

0:19:17.119 --> 0:19:20.320
<v Speaker 2>I just said that the mite burden itself is usually

0:19:20.320 --> 0:19:26.000
<v Speaker 2>relatively low. And it turns out that the itchiness and

0:19:26.040 --> 0:19:29.639
<v Speaker 2>the main symptoms that people get from a scaby's infection

0:19:30.440 --> 0:19:36.359
<v Speaker 2>are actually caused by a hypersensitivity reaction to the mites,

0:19:36.680 --> 0:19:39.439
<v Speaker 2>to the mites themselves, and to the feces, to the

0:19:39.480 --> 0:19:42.320
<v Speaker 2>poop that the mites are leaving in their burrow, just

0:19:42.359 --> 0:19:45.880
<v Speaker 2>like fleas, right, fleas can do that poison ivy. Arin,

0:19:46.000 --> 0:19:49.119
<v Speaker 2>you mentioned the itch from poison ivy and how you

0:19:49.200 --> 0:19:52.560
<v Speaker 2>like very specifically have like reactions to hot water and

0:19:52.600 --> 0:19:56.080
<v Speaker 2>things like that. This is the same type of hypersensitivity reaction,

0:19:56.760 --> 0:20:00.880
<v Speaker 2>which also means that this itch is no not limited

0:20:01.000 --> 0:20:05.919
<v Speaker 2>to the places where the mites are. The itch is everywhere.

0:20:06.000 --> 0:20:12.720
<v Speaker 2>It's a generalized, incredibly itchiness because it's hypersensitivity reaction everywhere.

0:20:13.560 --> 0:20:18.639
<v Speaker 2>The mites themselves most often infect places like your wrists,

0:20:19.320 --> 0:20:23.760
<v Speaker 2>the like interwebs between your fingers or toes, the areas

0:20:23.800 --> 0:20:28.960
<v Speaker 2>underneath your waistband, armpits, groin places like that, places that

0:20:29.000 --> 0:20:32.000
<v Speaker 2>are kind of like little areas that are easy for

0:20:32.040 --> 0:20:36.160
<v Speaker 2>them to like nestle their way in. And sometimes you

0:20:36.200 --> 0:20:40.840
<v Speaker 2>can see the areas where scabies actually infest. And when

0:20:40.880 --> 0:20:42.960
<v Speaker 2>you can see them, they're described as like this one

0:20:43.040 --> 0:20:46.480
<v Speaker 2>little kind of nodule or vesicle, this one area where

0:20:46.640 --> 0:20:49.800
<v Speaker 2>where the mite has actually made its burrow, and then

0:20:49.920 --> 0:20:54.760
<v Speaker 2>a little curvy, very short, little curvy burrow that just

0:20:54.840 --> 0:20:57.399
<v Speaker 2>looks like either a red or a dark or a

0:20:57.440 --> 0:21:00.480
<v Speaker 2>gray or a purple kind of line. And then maybe

0:21:00.480 --> 0:21:02.879
<v Speaker 2>a little vesicle in the place that the mite is

0:21:02.920 --> 0:21:05.679
<v Speaker 2>now living, like at the end of her barot. Okay,

0:21:05.880 --> 0:21:08.480
<v Speaker 2>but most of the time you can't see that at all,

0:21:08.520 --> 0:21:12.440
<v Speaker 2>and what you see instead are scratch marks all over

0:21:12.560 --> 0:21:17.239
<v Speaker 2>a person's body from itching. You can see other like

0:21:17.400 --> 0:21:20.399
<v Speaker 2>nodules that appear are other bumps that are all a

0:21:20.440 --> 0:21:23.679
<v Speaker 2>part of your immune response to these mites and to

0:21:23.880 --> 0:21:27.520
<v Speaker 2>all of the antigens that these mites are producing. And

0:21:27.880 --> 0:21:32.200
<v Speaker 2>the itch tends to happen weeks after the initial infection.

0:21:32.520 --> 0:21:36.320
<v Speaker 2>It's not like right away unless you've been infected with

0:21:36.400 --> 0:21:40.359
<v Speaker 2>mites before, in which case immediately will you feel itchy.

0:21:40.400 --> 0:21:41.760
<v Speaker 2>As soon as that might makes her home.

0:21:42.080 --> 0:21:46.000
<v Speaker 1>Yeah that I mean, it makes sense, Yeah, it makes sense.

0:21:46.119 --> 0:21:50.040
<v Speaker 1>It does because I had no idea weeks to mount

0:21:50.080 --> 0:21:51.080
<v Speaker 1>an immune responses.

0:21:51.320 --> 0:22:09.840
<v Speaker 3>Yes, wild yeah yeah yeah.

0:22:10.520 --> 0:22:15.320
<v Speaker 2>Now there is another phenomenon I mentioned crusted scabies, and

0:22:15.359 --> 0:22:18.680
<v Speaker 2>this is what happens when there are very large numbers

0:22:18.720 --> 0:22:22.119
<v Speaker 2>of mites that can establish an infection. But in this case,

0:22:22.200 --> 0:22:26.520
<v Speaker 2>there's very often an association with some kind of immunodeficiency,

0:22:27.080 --> 0:22:31.600
<v Speaker 2>whether that's HIV, whether it's topical or systemic steroid use,

0:22:31.840 --> 0:22:34.840
<v Speaker 2>whether it's people who are on immunosuppressive medication because of

0:22:34.880 --> 0:22:40.280
<v Speaker 2>an organ transplant, or maybe they are malnourished, lots of

0:22:40.280 --> 0:22:44.080
<v Speaker 2>different potential reasons that you could end up with crusted scabies.

0:22:44.520 --> 0:22:48.520
<v Speaker 2>But these situations are very very severe because what happens

0:22:48.600 --> 0:22:50.600
<v Speaker 2>is that there are so many mites that you end

0:22:50.680 --> 0:22:55.320
<v Speaker 2>up with these severe plaques where the skin is growing,

0:22:55.400 --> 0:22:59.280
<v Speaker 2>it becomes hyperkeratotic, which is that very thick, very scaly

0:22:59.680 --> 0:23:03.359
<v Speaker 2>like flax and scales, and these can flake off and

0:23:03.400 --> 0:23:06.760
<v Speaker 2>they harbor a lot of mites, which is why it's

0:23:06.800 --> 0:23:10.120
<v Speaker 2>more easy for things like bedding or clothing to serve

0:23:10.160 --> 0:23:13.920
<v Speaker 2>as a source of infection in these cases, got it, okay.

0:23:14.720 --> 0:23:18.640
<v Speaker 2>In all cases of scabies, there's a very high risk

0:23:18.760 --> 0:23:22.879
<v Speaker 2>of secondary infection, which means everywhere that you're scratching and

0:23:22.920 --> 0:23:25.320
<v Speaker 2>there's a break in the skin, it's really easy for

0:23:25.400 --> 0:23:29.920
<v Speaker 2>bacteria like streptococcus and staphylococcus to get into those wounds

0:23:30.240 --> 0:23:33.600
<v Speaker 2>and then cause either skin infections or especially in the

0:23:33.640 --> 0:23:37.399
<v Speaker 2>cases of crusted scabies, more severe infections like bloodstream infections

0:23:37.760 --> 0:23:42.080
<v Speaker 2>and sepsis and even death. So scabies is kind of

0:23:42.080 --> 0:23:44.840
<v Speaker 2>a big deal, especially because, as we'll talk about later,

0:23:44.960 --> 0:23:46.840
<v Speaker 2>it's still really really prevalent.

0:23:48.080 --> 0:23:50.880
<v Speaker 1>There seems like there are many different options for treatment.

0:23:52.000 --> 0:23:55.560
<v Speaker 1>There are what are those options and is there any

0:23:55.920 --> 0:23:59.959
<v Speaker 1>are there like treatment resistant mites or scabies?

0:24:00.080 --> 0:24:03.119
<v Speaker 2>Yeah, there are so most of the treatment options, and

0:24:03.160 --> 0:24:05.760
<v Speaker 2>there are a lot of different kinds. Most of them

0:24:05.800 --> 0:24:08.560
<v Speaker 2>are topical, which means that there are lotions creams that

0:24:08.600 --> 0:24:11.640
<v Speaker 2>you're putting on all over your body because again, you're

0:24:11.680 --> 0:24:14.280
<v Speaker 2>not sure exactly where the mites are most of the time,

0:24:15.080 --> 0:24:17.200
<v Speaker 2>so the treatment really has to go kind of everywhere.

0:24:17.840 --> 0:24:20.199
<v Speaker 2>And there are things like permethrin that's what we use

0:24:20.240 --> 0:24:23.680
<v Speaker 2>most commonly here in the States. Benzyl benzoate is another

0:24:23.720 --> 0:24:28.639
<v Speaker 2>one or sulfur compounds, and these are all generally very effective,

0:24:29.359 --> 0:24:31.680
<v Speaker 2>but there are a number of different things that can

0:24:31.680 --> 0:24:35.040
<v Speaker 2>contribute to either of them being difficult to implement, Like

0:24:35.200 --> 0:24:39.320
<v Speaker 2>some of these require multiple applications multiple times a day

0:24:39.400 --> 0:24:41.679
<v Speaker 2>for multiple days in a row, which can be sometimes

0:24:41.720 --> 0:24:44.359
<v Speaker 2>difficult to do, and some of them can cause a

0:24:44.359 --> 0:24:47.119
<v Speaker 2>lot of other skin reactions, like they can be itchy,

0:24:47.200 --> 0:24:50.120
<v Speaker 2>they can cause stinging and burning and be really uncomfortable

0:24:50.160 --> 0:24:54.280
<v Speaker 2>to put on. Then there is also insecticide resistance, especially

0:24:54.359 --> 0:24:57.840
<v Speaker 2>to things like permethrin. So yes, we do see some resistance,

0:24:58.720 --> 0:25:00.960
<v Speaker 2>and this is something that can also be induced, like

0:25:01.000 --> 0:25:03.840
<v Speaker 2>if you are repeatedly applying it, especially maybe not to

0:25:03.920 --> 0:25:06.880
<v Speaker 2>all surfaces of your body things like that, then you

0:25:06.920 --> 0:25:12.199
<v Speaker 2>can have resistance start to appear. But most of the

0:25:12.240 --> 0:25:14.959
<v Speaker 2>time we still rely on topical treatments. There is an

0:25:15.119 --> 0:25:18.880
<v Speaker 2>oral treatment as well. Everyone's heard of it now, it's ivvermactin.

0:25:19.080 --> 0:25:19.800
<v Speaker 1>I knew you were.

0:25:22.400 --> 0:25:24.919
<v Speaker 2>Ivremectin is a phenomenal option. We've talked about it on

0:25:24.920 --> 0:25:26.479
<v Speaker 2>this podcast before because we use it for a lot

0:25:26.520 --> 0:25:30.119
<v Speaker 2>of other parasitic diseases, especially worms, that's what it's mainly

0:25:30.200 --> 0:25:33.199
<v Speaker 2>used for. This tends to be used for things like

0:25:33.240 --> 0:25:38.240
<v Speaker 2>crusted scabies, which requires both oral and topical treatment because

0:25:38.240 --> 0:25:41.680
<v Speaker 2>it's so severe. It also can be used as a

0:25:41.720 --> 0:25:44.280
<v Speaker 2>second line if you treat someone with a topical and

0:25:44.359 --> 0:25:47.919
<v Speaker 2>it doesn't seem to go away, or in areas where

0:25:48.080 --> 0:25:51.600
<v Speaker 2>you have really, really high prevalence of scabies, then sometimes

0:25:51.680 --> 0:25:55.040
<v Speaker 2>oral i'veremectin is used as what's called mass drug administration,

0:25:55.119 --> 0:25:57.600
<v Speaker 2>so giving it to an entire community to try and

0:25:57.720 --> 0:26:00.800
<v Speaker 2>really wipe out scabies. There's a couple of things that

0:26:00.840 --> 0:26:04.040
<v Speaker 2>are important to know about scabies and the treatment for scabies.

0:26:04.800 --> 0:26:07.959
<v Speaker 2>First is that again sometimes people don't have symptoms of

0:26:07.960 --> 0:26:11.240
<v Speaker 2>scabies for weeks because it takes weeks for that itch

0:26:11.280 --> 0:26:15.760
<v Speaker 2>to first appear. But even after someone is treated, it

0:26:15.800 --> 0:26:20.160
<v Speaker 2>can take weeks for their symptoms to get better. And

0:26:20.200 --> 0:26:22.840
<v Speaker 2>that's again in part because so many of these symptoms

0:26:22.880 --> 0:26:25.560
<v Speaker 2>are due to our immune response to the mite antigen.

0:26:25.680 --> 0:26:29.280
<v Speaker 2>So these treatments are wiping out the mites, but they're

0:26:29.320 --> 0:26:33.560
<v Speaker 2>not necessarily treating the symptoms of the itch themselves. Okay,

0:26:34.080 --> 0:26:38.480
<v Speaker 2>reinfection can also happen because, especially when we use topical treatments,

0:26:38.560 --> 0:26:41.480
<v Speaker 2>mites can hide in some places like under the fingernails,

0:26:42.600 --> 0:26:45.480
<v Speaker 2>and so That's why sometimes it's hard to know are

0:26:45.480 --> 0:26:47.600
<v Speaker 2>the symptoms still there because the mites are still there

0:26:47.880 --> 0:26:50.240
<v Speaker 2>or just because the symptoms haven't gotten better in a

0:26:50.240 --> 0:26:52.040
<v Speaker 2>couple of weeks. But usually if it's not better in

0:26:52.080 --> 0:26:54.240
<v Speaker 2>a couple weeks, then you have to think is there

0:26:54.240 --> 0:26:56.560
<v Speaker 2>a reinfection or was it not scabies to begin with?

0:26:57.080 --> 0:27:03.680
<v Speaker 1>Gotcha? So Aaron, Yeah, why why do we scratch? Why

0:27:03.720 --> 0:27:05.720
<v Speaker 1>do we itch? Why do we scratch? Why do scratching

0:27:05.920 --> 0:27:06.680
<v Speaker 1>relieve an itch?

0:27:07.080 --> 0:27:14.719
<v Speaker 2>Oh? I have no idea. I actually can't believe that's

0:27:14.760 --> 0:27:16.959
<v Speaker 2>the first time that you've asked me that question. I know,

0:27:17.800 --> 0:27:20.959
<v Speaker 2>like we've talked about itching before. I don't know what

0:27:21.000 --> 0:27:22.920
<v Speaker 2>does it? What does it do? I mean, it's got

0:27:22.960 --> 0:27:27.840
<v Speaker 2>to be releasing some like neurotransmitters, right, that are that

0:27:27.880 --> 0:27:31.439
<v Speaker 2>are interacting with whatever the receptors are that are causing

0:27:31.520 --> 0:27:35.200
<v Speaker 2>us to feel that itch. H Then scratching somehow does

0:27:35.280 --> 0:27:38.200
<v Speaker 2>something to help relieve that. But I don't know. Yeah,

0:27:38.600 --> 0:27:40.359
<v Speaker 2>and like what think interesting episode?

0:27:40.720 --> 0:27:42.840
<v Speaker 1>Yeah? Just itching?

0:27:43.440 --> 0:27:43.960
<v Speaker 2>Yeah?

0:27:44.280 --> 0:27:49.280
<v Speaker 1>I yeah, because like if if it's something that's immune mediated,

0:27:49.640 --> 0:27:52.640
<v Speaker 1>something that's like driven by you know, like we we

0:27:52.720 --> 0:27:55.959
<v Speaker 1>control that, our bodies control that? Is it adaptive?

0:27:56.160 --> 0:27:58.679
<v Speaker 2>Is right? Evolutionarily, and now I'm thinking, like what is

0:27:58.720 --> 0:27:59.560
<v Speaker 2>the what.

0:27:59.520 --> 0:28:01.200
<v Speaker 1>Is the benefit out of an itch? I mean there's

0:28:01.200 --> 0:28:03.720
<v Speaker 1>probably many different things, like if there's maybe if you

0:28:03.800 --> 0:28:05.879
<v Speaker 1>feel a mosquito or something on your body.

0:28:06.160 --> 0:28:09.200
<v Speaker 2>I don't know, right, Oh, that's such an interesting question.

0:28:09.200 --> 0:28:10.680
<v Speaker 2>I don't know, and I need to look into it.

0:28:11.160 --> 0:28:13.520
<v Speaker 2>I didn't research itching, Aaron, which I had.

0:28:14.320 --> 0:28:16.919
<v Speaker 1>Well, just like it's you know, like how it is

0:28:16.960 --> 0:28:19.919
<v Speaker 1>described as pleasurable at first, or like to scratch its

0:28:20.040 --> 0:28:22.120
<v Speaker 1>preasurable at first, and like why does it feel good

0:28:22.119 --> 0:28:24.119
<v Speaker 1>to have your back scratched, your arms scratch?

0:28:24.160 --> 0:28:27.480
<v Speaker 2>You know, like what Yeah, those head scratchers and head scratchers,

0:28:27.520 --> 0:28:30.920
<v Speaker 2>those are Yeah, I don't know. What an interesting question, Aaron.

0:28:31.920 --> 0:28:33.040
<v Speaker 2>We're gonna have to look into it.

0:28:33.320 --> 0:28:34.000
<v Speaker 1>Yeah, we will.

0:28:34.040 --> 0:28:38.760
<v Speaker 2>Okay, Well, but I would like to know, Yeah, where

0:28:38.760 --> 0:28:40.800
<v Speaker 2>did these gabies come from? I mean, like, are you

0:28:40.800 --> 0:28:43.160
<v Speaker 2>gonna answer that? I don't know. They're just with us.

0:28:44.280 --> 0:28:47.640
<v Speaker 1>I'm gonna answer something. Okay, let's take a quick break

0:28:47.680 --> 0:29:18.040
<v Speaker 1>and we'll see what I talk about today. You can't

0:29:18.040 --> 0:29:22.080
<v Speaker 1>define the word scabies without mentioning the might that causes

0:29:22.160 --> 0:29:26.280
<v Speaker 1>the itch, and in that same vein, you can't describe

0:29:26.320 --> 0:29:30.760
<v Speaker 1>that might sarcopti's scaby i hominus without including that it

0:29:31.000 --> 0:29:35.600
<v Speaker 1>causes skin infestations in humans. The might and the itch

0:29:35.840 --> 0:29:42.320
<v Speaker 1>are indivisible, entwined, inseparable, but that hasn't always been the case.

0:29:42.560 --> 0:29:44.800
<v Speaker 2>I love that. Aaron I was like, yeah, I'm feeling

0:29:44.840 --> 0:29:47.960
<v Speaker 2>that that's not how it always was. You know.

0:29:48.280 --> 0:29:49.440
<v Speaker 1>I love a leading statement.

0:29:49.680 --> 0:29:50.280
<v Speaker 2>I love it.

0:29:51.600 --> 0:29:55.760
<v Speaker 1>For centuries, the itch and the might stood separately in

0:29:55.840 --> 0:29:59.760
<v Speaker 1>the eyes of medicine, with no clear causal relationship between

0:29:59.760 --> 0:30:05.640
<v Speaker 1>the two. And I call out medicine specifically because that's

0:30:05.760 --> 0:30:09.640
<v Speaker 1>where the confusion remained about the cause of scabies until

0:30:09.800 --> 0:30:15.200
<v Speaker 1>shockingly late in the history of medicine. Among the lay people,

0:30:15.360 --> 0:30:19.920
<v Speaker 1>the peasants, the commoners. Stavies was well known for thousands

0:30:19.960 --> 0:30:22.480
<v Speaker 1>of years to be caused by a creature, and that

0:30:22.600 --> 0:30:25.320
<v Speaker 1>it was the creature moving from person to person that

0:30:25.480 --> 0:30:26.560
<v Speaker 1>spread the itch.

0:30:27.440 --> 0:30:30.640
<v Speaker 2>I'm I love this story already. I am bought in.

0:30:31.120 --> 0:30:34.239
<v Speaker 1>When the night was finally widely recognized by medicine to

0:30:34.280 --> 0:30:36.720
<v Speaker 1>cause the itch with a capital eye as it was

0:30:36.800 --> 0:30:40.520
<v Speaker 1>kind of known. It was like scabies was known as the.

0:30:39.920 --> 0:30:43.640
<v Speaker 2>The itch, right. It was all the things that itch you,

0:30:44.040 --> 0:30:45.080
<v Speaker 2>this was the one.

0:30:45.440 --> 0:30:51.880
<v Speaker 1>The one yep, capital I, and this recognition marked a

0:30:51.960 --> 0:30:54.560
<v Speaker 1>huge turning point in the history of science and medicine.

0:30:55.120 --> 0:30:58.720
<v Speaker 1>It called into question concepts like the humoral theory of

0:30:58.800 --> 0:31:04.600
<v Speaker 1>disease or spontaneous generation where life just comes spontaneously out

0:31:04.640 --> 0:31:08.200
<v Speaker 1>of the maggots on the meat in organic material exactly.

0:31:07.920 --> 0:31:10.040
<v Speaker 2>Yeah, yeah, which.

0:31:09.840 --> 0:31:12.440
<v Speaker 1>Both of which had been accepted as truth or at

0:31:12.520 --> 0:31:15.440
<v Speaker 1>least had been leading causes of you know, explaining the

0:31:15.480 --> 0:31:18.640
<v Speaker 1>world around us for hundreds, if not thousands of years.

0:31:19.840 --> 0:31:24.480
<v Speaker 1>The recognition of the might causing scabies led to contentious

0:31:24.640 --> 0:31:30.880
<v Speaker 1>rivalries with public humiliation, prize money, and medical demonstrations. It

0:31:30.920 --> 0:31:35.080
<v Speaker 1>could even be argued that the might itch connection primed

0:31:35.120 --> 0:31:38.760
<v Speaker 1>the scientific world to accept Louis Pester's germ theory of

0:31:38.800 --> 0:31:42.360
<v Speaker 1>disease in the following decades. Stop it eron, I know,

0:31:42.920 --> 0:31:45.440
<v Speaker 1>would you have believed that this little might had this

0:31:45.640 --> 0:31:52.720
<v Speaker 1>much up its little mighty sleeve. I certainly had no idea.

0:31:53.680 --> 0:31:54.200
<v Speaker 2>I love it.

0:31:54.480 --> 0:31:57.120
<v Speaker 1>But before we get into this might revolution as I

0:31:57.160 --> 0:31:59.880
<v Speaker 1>am calling it, let's travel back to where it all began.

0:32:00.840 --> 0:32:04.120
<v Speaker 1>But where and when that is we don't fully know.

0:32:04.480 --> 0:32:08.840
<v Speaker 1>It's course surprise. One hypothesis suggests that humans and early

0:32:08.920 --> 0:32:12.800
<v Speaker 1>human ancestors have been infected for millennia with this might,

0:32:13.040 --> 0:32:17.760
<v Speaker 1>and that other Sarcopti's scabyie varieties evolved from our human might. So,

0:32:17.840 --> 0:32:20.680
<v Speaker 1>for instance, the might that causes one type of mange

0:32:20.720 --> 0:32:23.560
<v Speaker 1>in dogs and other canids was thought to jump from

0:32:23.640 --> 0:32:28.440
<v Speaker 1>humans to dogs after domestication, but another hypothesis suggests the

0:32:28.440 --> 0:32:31.640
<v Speaker 1>opposite happened, that when we welcome dogs into our lives,

0:32:31.680 --> 0:32:34.920
<v Speaker 1>we also welcomed a hitchhiking MTE that adapted to live

0:32:35.040 --> 0:32:36.520
<v Speaker 1>on us and cause us to itch.

0:32:36.880 --> 0:32:38.200
<v Speaker 2>Okay, I don't know.

0:32:38.240 --> 0:32:40.880
<v Speaker 1>As far as I could tell, how humans and mights

0:32:40.920 --> 0:32:44.200
<v Speaker 1>got acquainted with one another has yet to be fully resolved,

0:32:44.600 --> 0:32:46.160
<v Speaker 1>and maybe it will be by the time we do

0:32:46.240 --> 0:32:48.920
<v Speaker 1>our mange episode, which we will be doing at some

0:32:49.000 --> 0:32:51.400
<v Speaker 1>point in the future. Don't worry, we did not. This

0:32:51.440 --> 0:32:55.080
<v Speaker 1>is not mange erasure, this is not wombat might erasure.

0:32:55.160 --> 0:32:58.040
<v Speaker 1>We're going to cover all of the wildlife animal mange

0:32:58.480 --> 0:33:03.520
<v Speaker 1>scabies situations. Yeah, And as to the question of when

0:33:03.560 --> 0:33:08.040
<v Speaker 1>people first described scabies the itch, it's also less than

0:33:08.040 --> 0:33:11.080
<v Speaker 1>fully resolved. So some people point towards a line in

0:33:11.240 --> 0:33:15.760
<v Speaker 1>Leviticus in the Old Testament suggesting that the Hebrew term zarath,

0:33:16.040 --> 0:33:20.280
<v Speaker 1>which meant some sort of skin malady, actually meant the

0:33:20.320 --> 0:33:23.760
<v Speaker 1>itch or scapies, or was referring to that. Others say

0:33:23.760 --> 0:33:26.720
<v Speaker 1>that it was the ancient Romans who distinguished scabies from

0:33:26.760 --> 0:33:30.640
<v Speaker 1>other skin conditions, and in fact the term scabies comes

0:33:30.680 --> 0:33:36.160
<v Speaker 1>from the Latin scaberry scabbery, meaning to scrape or to scratch.

0:33:37.080 --> 0:33:40.480
<v Speaker 1>Much later, the mite genus name Sarcopti's comes from the

0:33:40.520 --> 0:33:44.880
<v Speaker 1>Greek word sarks for flesh and Coptian for to smite

0:33:45.080 --> 0:33:54.080
<v Speaker 1>or cut. The ancient Romans also proposed what would have

0:33:54.120 --> 0:33:57.480
<v Speaker 1>been and actually remains, as you mentioned, aaron an effective

0:33:57.480 --> 0:34:03.560
<v Speaker 1>treatment for scabies, sulfur with liquid pitch. Others still say, nah,

0:34:03.640 --> 0:34:05.800
<v Speaker 1>the Romans got it wrong. It was actually an ancient

0:34:05.880 --> 0:34:08.839
<v Speaker 1>China that the first true scabies description was made, And

0:34:08.840 --> 0:34:11.840
<v Speaker 1>not only that, but unlike the Old Testament and ancient

0:34:11.920 --> 0:34:15.120
<v Speaker 1>rom which just made note of the skin condition itself,

0:34:15.239 --> 0:34:19.480
<v Speaker 1>the itch itself, this early medical text from China in

0:34:19.520 --> 0:34:24.640
<v Speaker 1>the five hundred CE included mention of the parasite quote

0:34:25.239 --> 0:34:29.440
<v Speaker 1>the itchy scaby sores always contain a tiny worm. We

0:34:29.480 --> 0:34:31.800
<v Speaker 1>can extract it with a needle and see its worm

0:34:31.960 --> 0:34:32.920
<v Speaker 1>like shape when it.

0:34:32.880 --> 0:34:36.680
<v Speaker 2>Is dropped into water end quote, Well, that's weird.

0:34:37.000 --> 0:34:38.480
<v Speaker 1>I think when we think of worm, we think of

0:34:38.520 --> 0:34:42.760
<v Speaker 1>like earthworm, and I think that's not necessarily what because

0:34:43.080 --> 0:34:46.040
<v Speaker 1>worm pops up a lot in descriptions.

0:34:45.400 --> 0:34:48.600
<v Speaker 2>Of scabies over the years, but does not I mean

0:34:48.640 --> 0:34:53.040
<v Speaker 2>because the burrows are sometimes described as like surpiginous, which

0:34:53.040 --> 0:34:55.799
<v Speaker 2>to me, I mean that's like snakelike. But I think

0:34:55.800 --> 0:34:58.440
<v Speaker 2>of that as kind of wormy. But is a worm

0:34:58.480 --> 0:35:02.279
<v Speaker 2>not always kind of like long and wiggly, I.

0:35:02.239 --> 0:35:04.800
<v Speaker 1>Mean, if it's so tiny, like can you even tell?

0:35:04.880 --> 0:35:06.640
<v Speaker 2>It's just like, oh, that's what That's why I think

0:35:06.719 --> 0:35:09.279
<v Speaker 2>is weird. I mean, I mean because our other demodex

0:35:09.360 --> 0:35:12.200
<v Speaker 2>mites are longer, their bodies are like great little kind

0:35:12.200 --> 0:35:18.719
<v Speaker 2>of more tubular, tabular total, but these mites are just

0:35:18.760 --> 0:35:22.200
<v Speaker 2>so round. I just but I don't know, maybe worms

0:35:22.200 --> 0:35:22.760
<v Speaker 2>are different.

0:35:22.840 --> 0:35:25.479
<v Speaker 1>Also, this is translated so like I don't know if

0:35:25.560 --> 0:35:31.640
<v Speaker 1>like worm, if that is the closest approximation too, yeah, yeah, yeah. Unfortunately,

0:35:31.719 --> 0:35:33.840
<v Speaker 1>as is the case for so much of the history

0:35:33.880 --> 0:35:37.160
<v Speaker 1>of medicine, information from the non Western world rarely makes

0:35:37.160 --> 0:35:40.400
<v Speaker 1>it into reviews about this topic, and so it's really like,

0:35:40.760 --> 0:35:43.640
<v Speaker 1>is you know, is the worm the closest approximation is

0:35:43.680 --> 0:35:46.239
<v Speaker 1>that the right translation. I don't really know whether that

0:35:46.400 --> 0:35:51.360
<v Speaker 1>perception in terms of the worm causing the itch remained

0:35:51.440 --> 0:35:54.920
<v Speaker 1>the predominant view, right like that's but we do have

0:35:54.960 --> 0:35:58.360
<v Speaker 1>that text. In any case, in European medical writings, the

0:35:58.480 --> 0:36:04.560
<v Speaker 1>mite wasn't really mentioned alongside scabies, like scabies was just itch, right, bitch.

0:36:04.880 --> 0:36:08.360
<v Speaker 1>The itch was thought to be caused by what other

0:36:08.400 --> 0:36:13.600
<v Speaker 1>than a humoral imbalance, imbalance and thus treated with all

0:36:13.640 --> 0:36:18.200
<v Speaker 1>sorts of horrid little things like purges, foul smelling salves,

0:36:18.280 --> 0:36:22.879
<v Speaker 1>blood letting, and so on. Meanwhile, though in the non

0:36:22.920 --> 0:36:26.640
<v Speaker 1>medical crowd, people knew what was up, like peasant women

0:36:26.880 --> 0:36:29.960
<v Speaker 1>quote unquote knew that you could extract little bits from

0:36:29.960 --> 0:36:33.919
<v Speaker 1>the skin to relieve the itch, a practice disregarded by

0:36:33.920 --> 0:36:39.000
<v Speaker 1>medical men for being vulgar. A medical text from the

0:36:39.040 --> 0:36:43.080
<v Speaker 1>eleventh century in the Middle East says, quote the little

0:36:43.120 --> 0:36:47.040
<v Speaker 1>flesh worms which crawl under the skin of the hands, legs,

0:36:47.040 --> 0:36:50.520
<v Speaker 1>and feet, and there raise pustules full of water, are

0:36:50.560 --> 0:36:55.160
<v Speaker 1>called sirones, as, sooa, bat and asa. So small are

0:36:55.160 --> 0:36:58.560
<v Speaker 1>these animals that they can hardly be seen by the keenest.

0:36:58.160 --> 0:37:02.600
<v Speaker 2>Of vision and h I mean, I would agree with that,

0:37:02.600 --> 0:37:04.839
<v Speaker 2>that's true, size one font.

0:37:05.440 --> 0:37:09.480
<v Speaker 1>Size one. Saint Hildegarde of Bingen do you remember her

0:37:09.480 --> 0:37:12.160
<v Speaker 1>from our Migraines episodes? So she wrote about her visions,

0:37:12.200 --> 0:37:15.920
<v Speaker 1>and some people have said that these were migraine aura,

0:37:16.120 --> 0:37:19.840
<v Speaker 1>not actually like you know, or like aura inspired these visions,

0:37:20.120 --> 0:37:23.000
<v Speaker 1>right right, right, So she wrote around the twelfth century

0:37:23.040 --> 0:37:25.799
<v Speaker 1>that quote, there is another mint which is large. It

0:37:25.880 --> 0:37:28.840
<v Speaker 1>is hot rather than cold. This should be crushed and

0:37:28.880 --> 0:37:31.640
<v Speaker 1>placed above and around the place where the seren or

0:37:31.719 --> 0:37:34.920
<v Speaker 1>snevelzen are hurting the person with their nibbling, and they

0:37:34.960 --> 0:37:38.080
<v Speaker 1>will die as the coldest of the same mentha major

0:37:38.239 --> 0:37:41.800
<v Speaker 1>is rather bitter and therefore kills the above mentioned little worms,

0:37:41.880 --> 0:37:45.600
<v Speaker 1>which are born in the human flesh end quote. So

0:37:45.680 --> 0:37:49.080
<v Speaker 1>the little spontaneous generation there a little bit of worms. Yeah,

0:37:50.080 --> 0:37:54.239
<v Speaker 1>worms are a thing, Yeah, I guess so, yeah, it

0:37:54.320 --> 0:37:57.800
<v Speaker 1>might just be like bugs, you know, like little critters.

0:37:58.040 --> 0:38:01.680
<v Speaker 2>Yeah, maybe that's what they mean by worms. Huh. Yeah. Interesting.

0:38:02.000 --> 0:38:04.600
<v Speaker 1>And these passages I think are really interesting because they

0:38:04.640 --> 0:38:05.520
<v Speaker 1>show two things.

0:38:06.000 --> 0:38:06.160
<v Speaker 3>Right.

0:38:06.239 --> 0:38:09.400
<v Speaker 1>They show that people definitely observed the mites, even if

0:38:09.400 --> 0:38:13.120
<v Speaker 1>they called them worms in association with the itch, right,

0:38:13.360 --> 0:38:16.759
<v Speaker 1>But they didn't necessarily make the link that they caused

0:38:16.800 --> 0:38:21.960
<v Speaker 1>the itch. Hmm, Like there's not necessarily a causal relationship.

0:38:21.400 --> 0:38:26.640
<v Speaker 2>Right there, then the itches there, but they're also like

0:38:26.680 --> 0:38:28.439
<v Speaker 2>if you get rid of them, you'll feel better.

0:38:29.040 --> 0:38:32.000
<v Speaker 1>But also in some of these it seems like they're

0:38:32.000 --> 0:38:35.640
<v Speaker 1>describing the miight as arising from the itch, if that

0:38:35.680 --> 0:38:37.720
<v Speaker 1>makes sense, like a product of the itch.

0:38:38.080 --> 0:38:39.160
<v Speaker 2>Interesting. Yeah.

0:38:39.880 --> 0:38:42.360
<v Speaker 1>Over the next few centuries, a few passages here and

0:38:42.400 --> 0:38:45.040
<v Speaker 1>there allude to the possibility that the might could be

0:38:45.080 --> 0:38:48.440
<v Speaker 1>the cause of this itch, but they were overshadowed by

0:38:48.480 --> 0:38:52.160
<v Speaker 1>the predominant belief that the might was not related to scabies,

0:38:52.560 --> 0:38:57.120
<v Speaker 1>and that scabies was caused by a humoral imbalance. As

0:38:57.160 --> 0:39:00.279
<v Speaker 1>to how it could be contagious, which it was recogne

0:39:00.320 --> 0:39:03.840
<v Speaker 1>to be, that was explained simply by that the bad

0:39:03.920 --> 0:39:07.120
<v Speaker 1>scabies humors contained in the blood could reach the skin

0:39:07.239 --> 0:39:08.600
<v Speaker 1>and transfer it to other people.

0:39:08.719 --> 0:39:11.600
<v Speaker 2>That way, I got to love when you have an

0:39:11.600 --> 0:39:13.560
<v Speaker 2>explanation for everything that just false.

0:39:13.680 --> 0:39:19.120
<v Speaker 1>It's honestly, it's pretty wid But the tide started to

0:39:19.200 --> 0:39:24.279
<v Speaker 1>turn in the seventeenth century with two major advancements. Number one,

0:39:24.640 --> 0:39:28.960
<v Speaker 1>the first known depiction of an infectious organism, and number two,

0:39:29.560 --> 0:39:35.040
<v Speaker 1>the quote first comprehensive description of an infectious organism causing disease.

0:39:35.280 --> 0:39:37.040
<v Speaker 2>End quote scabies.

0:39:37.640 --> 0:39:42.360
<v Speaker 1>Scabies is the first one comprehensive description of an infectious

0:39:42.440 --> 0:39:48.760
<v Speaker 1>organism causing disease scabies skate bees, according to this book

0:39:49.320 --> 0:39:52.080
<v Speaker 1>and a few other things I've I've come across in papers.

0:39:52.160 --> 0:39:55.719
<v Speaker 2>Yeah, wow, yeah, I never knew that here.

0:39:55.920 --> 0:39:59.600
<v Speaker 1>I me either, I never suspected scabies. It kind of

0:39:59.640 --> 0:40:00.000
<v Speaker 1>makes sense.

0:40:00.080 --> 0:40:04.839
<v Speaker 2>And though because they're bigger exactly, so they're easier. Like, yes,

0:40:04.880 --> 0:40:07.760
<v Speaker 2>you still need a microscope to really see them. Well,

0:40:08.200 --> 0:40:11.160
<v Speaker 2>but like if you have better eyes than me, maybe

0:40:11.160 --> 0:40:13.360
<v Speaker 2>you can see them without or even just like a

0:40:13.400 --> 0:40:16.640
<v Speaker 2>magnifying glass, which they had back then.

0:40:17.360 --> 0:40:22.120
<v Speaker 1>But like what about like lice and like, yeah, that's.

0:40:21.920 --> 0:40:23.719
<v Speaker 2>Fair, but I mean it sounds like scabies where it

0:40:23.719 --> 0:40:25.080
<v Speaker 2>could feels like it could have been.

0:40:24.920 --> 0:40:29.759
<v Speaker 1>Either yeah exactly. Yeah, well okay. So in sixteen fifty seven,

0:40:30.000 --> 0:40:34.240
<v Speaker 1>using an early microscope, physician August Houptmann published a description

0:40:34.480 --> 0:40:38.480
<v Speaker 1>of the scabies mite, including an illustration a little oval,

0:40:38.760 --> 0:40:42.200
<v Speaker 1>six legged, tiny thing with four long hook things coming

0:40:42.239 --> 0:40:46.480
<v Speaker 1>out of its rear. It's very interesting drawing.

0:40:46.360 --> 0:40:49.719
<v Speaker 2>Two with only six legs. I mean, let me see

0:40:49.719 --> 0:40:54.239
<v Speaker 2>if I can find a picture of this Aaron. Okay, oh,

0:40:54.320 --> 0:40:58.960
<v Speaker 2>it's so cute. It's very cute. Yeah, it really doesn't

0:40:58.960 --> 0:40:59.879
<v Speaker 2>look that much like a.

0:41:00.160 --> 0:41:04.480
<v Speaker 1>Very detailed, but it's it's stuck, a little thing shooting

0:41:04.480 --> 0:41:07.839
<v Speaker 1>out of a I don't know, I.

0:41:07.760 --> 0:41:08.719
<v Speaker 2>Don't know what those are.

0:41:09.360 --> 0:41:13.200
<v Speaker 1>It's cute, though not perfect, but it was the second

0:41:13.280 --> 0:41:17.240
<v Speaker 1>advancement that would really get things going. In sixteen eighty seven,

0:41:17.400 --> 0:41:21.719
<v Speaker 1>Italian physician Giovanni Cossimo Bonimo, who was twenty four at

0:41:21.719 --> 0:41:26.520
<v Speaker 1>the time, and scientist Diacento Cestoni, who was fifty wrote

0:41:26.560 --> 0:41:31.120
<v Speaker 1>a letter to Francesco Reddy, a well known naturalist, and

0:41:31.239 --> 0:41:35.000
<v Speaker 1>in this letter, Bonomo described how, while working as a

0:41:35.040 --> 0:41:38.919
<v Speaker 1>physician on a ship carrying enslaved individuals, he saw men

0:41:39.040 --> 0:41:42.560
<v Speaker 1>removing small little bits from each other's skin to help

0:41:42.600 --> 0:41:46.440
<v Speaker 1>relieve their itch. He also saw poor women picking out

0:41:46.520 --> 0:41:49.680
<v Speaker 1>little pieces of material from their kid's skin using a needle.

0:41:50.440 --> 0:41:54.319
<v Speaker 1>And what makes Bonomo's observations unique is not that he

0:41:54.440 --> 0:41:58.080
<v Speaker 1>was the first physician to witness this practice and note it.

0:41:58.080 --> 0:42:00.400
<v Speaker 1>It's that he thought there might be something more to

0:42:00.480 --> 0:42:04.280
<v Speaker 1>it and actually followed it up with research. He enlisted

0:42:04.320 --> 0:42:07.160
<v Speaker 1>the help of his father's colleague Sistoni, who had the

0:42:07.160 --> 0:42:11.200
<v Speaker 1>good fortune of possessing a microscope. Using this microscope, they

0:42:11.239 --> 0:42:14.399
<v Speaker 1>examined the material that came from their patient's itchy skin

0:42:14.600 --> 0:42:18.600
<v Speaker 1>and found mite after mite, even mites laying eggs. Like

0:42:18.640 --> 0:42:22.400
<v Speaker 1>they watched mites laying eggs. Whoa, And they noted that

0:42:22.440 --> 0:42:27.400
<v Speaker 1>these creatures behaved like insects, and they reproduced, they laid eggs,

0:42:27.440 --> 0:42:30.120
<v Speaker 1>and they lived in burrows in the skin, causing the

0:42:30.239 --> 0:42:34.040
<v Speaker 1>itch not coming to life because of the itch not

0:42:34.200 --> 0:42:39.160
<v Speaker 1>there randomly. These mites, they hypothesized, were the direct cause

0:42:39.360 --> 0:42:45.120
<v Speaker 1>of the itch which had haunted and plagued humanity for millennia. Wow,

0:42:45.320 --> 0:42:47.960
<v Speaker 1>they weren't the first to describe this though, right, Like,

0:42:48.120 --> 0:42:50.879
<v Speaker 1>they literally watched people picking mites out of each other's skin.

0:42:51.080 --> 0:42:53.319
<v Speaker 2>Right, Everyone was like, well, yeah, dude, we knew this.

0:42:53.440 --> 0:42:57.760
<v Speaker 1>Get with the program, like welcome, welcome to the club.

0:42:58.400 --> 0:43:01.600
<v Speaker 1>So I think in that it's not necessarily fair to

0:43:01.600 --> 0:43:03.400
<v Speaker 1>say that they were the first to make this connection.

0:43:03.520 --> 0:43:07.440
<v Speaker 1>But they were the first, in a scientific formalized setting,

0:43:07.920 --> 0:43:12.000
<v Speaker 1>the first to describe this might, it's life cycle, its characteristics,

0:43:12.040 --> 0:43:14.600
<v Speaker 1>and to link it to the itch that these mites caused.

0:43:15.440 --> 0:43:17.520
<v Speaker 2>How interesting arin right?

0:43:18.160 --> 0:43:21.799
<v Speaker 1>Yeah, And this makes it the first official description of

0:43:21.840 --> 0:43:25.319
<v Speaker 1>an infectious disease and its causative agent. And again this

0:43:25.400 --> 0:43:29.680
<v Speaker 1>is sixteen eighty seven, so well well before germ theory.

0:43:29.719 --> 0:43:31.000
<v Speaker 2>Right, way way way before.

0:43:31.239 --> 0:43:35.080
<v Speaker 1>Yeah, it's it's pretty cool. Yeah, but also, like, what

0:43:35.200 --> 0:43:37.200
<v Speaker 1>the heck took so long?

0:43:37.560 --> 0:43:40.400
<v Speaker 2>Right? If everyone else knew it, why did it take.

0:43:40.440 --> 0:43:43.239
<v Speaker 1>So long for someone to actually note it down? Like,

0:43:43.280 --> 0:43:45.919
<v Speaker 1>first for a scientist to write about this might itch

0:43:46.000 --> 0:43:50.120
<v Speaker 1>causal relationship, and second for the scientific community to embrace it.

0:43:50.600 --> 0:43:54.480
<v Speaker 1>Because even though Bonomo enlisted the help of a renowned

0:43:54.600 --> 0:43:57.520
<v Speaker 1>naturalist in getting this observation out there, he was like, hey,

0:43:57.520 --> 0:43:59.880
<v Speaker 1>can you, like, I'm going to release this pamphlet, can

0:43:59.920 --> 0:44:01.799
<v Speaker 1>you you put your name on it and maybe write

0:44:01.840 --> 0:44:04.000
<v Speaker 1>a few extra things, and then that'll help get a

0:44:04.000 --> 0:44:08.160
<v Speaker 1>wider distribution so people think it's legit. Yeah, people were

0:44:08.200 --> 0:44:11.760
<v Speaker 1>like nah, it was largely rejected for another one hundred years.

0:44:13.040 --> 0:44:16.040
<v Speaker 1>There are several reasons I think contributed to this, and

0:44:16.160 --> 0:44:19.399
<v Speaker 1>the first one is practical. So, like you said, erin

0:44:19.520 --> 0:44:23.320
<v Speaker 1>the mites burrow is not directly where the itchy sores

0:44:23.440 --> 0:44:26.480
<v Speaker 1>tend to arise, a little bit farther away, so it's

0:44:26.480 --> 0:44:28.880
<v Speaker 1>not as clear that the two would be linked.

0:44:29.160 --> 0:44:32.360
<v Speaker 2>Okay, fair, yeah, oh true.

0:44:32.600 --> 0:44:36.720
<v Speaker 1>But the other main reason is simply the conservative nature

0:44:36.760 --> 0:44:41.440
<v Speaker 1>of science. For millennia, learned men discarded the wisdom of

0:44:41.520 --> 0:44:45.239
<v Speaker 1>peasants or women or non learned folks in general as

0:44:45.320 --> 0:44:49.600
<v Speaker 1>not scientifically valid without giving it due consideration, and this

0:44:49.680 --> 0:44:53.000
<v Speaker 1>superiority prevented them and still does in some ways today

0:44:53.120 --> 0:44:57.600
<v Speaker 1>from exploring ideas outside of the box. And science in

0:44:57.600 --> 0:45:00.960
<v Speaker 1>general is pretty rigid when presented with new information that

0:45:01.040 --> 0:45:05.120
<v Speaker 1>conflicts with established facts, which is not necessarily a bad thing.

0:45:05.840 --> 0:45:09.400
<v Speaker 1>Any new data, especially data that challenged the laws of nature,

0:45:09.760 --> 0:45:12.640
<v Speaker 1>like the humoral theory of disease, should be checked and

0:45:12.760 --> 0:45:16.400
<v Speaker 1>replicated and only then integrated into the body of knowledge.

0:45:16.480 --> 0:45:19.959
<v Speaker 1>This is part of what makes science trustworthy, this need

0:45:20.000 --> 0:45:23.480
<v Speaker 1>for a consensus. Of course, that's no excuse for closed

0:45:23.520 --> 0:45:28.000
<v Speaker 1>mindedness and gatekeeping, which unfortunately are other hallmarks of science.

0:45:28.400 --> 0:45:32.440
<v Speaker 1>So the concept that a tiny bug caused this dreadful

0:45:32.520 --> 0:45:37.120
<v Speaker 1>itch went against everything that scientists knew and learned about

0:45:37.120 --> 0:45:42.719
<v Speaker 1>how diseases worked. Bonomo and Sistoni anticipated this rejection, and

0:45:42.800 --> 0:45:46.080
<v Speaker 1>so this is why they had this ready lend his

0:45:46.280 --> 0:45:49.759
<v Speaker 1>name to this pamphlet. But I want to read you

0:45:49.800 --> 0:45:53.040
<v Speaker 1>a quote from this because I think it is well,

0:45:53.040 --> 0:45:55.359
<v Speaker 1>it's just really it's interesting, okay.

0:45:55.440 --> 0:45:55.880
<v Speaker 2>Quote.

0:45:56.080 --> 0:45:59.800
<v Speaker 1>Having frequently observed that the poor women, when their children

0:45:59.840 --> 0:46:02.719
<v Speaker 1>are troubled with the itch, do, with the point of

0:46:02.760 --> 0:46:06.120
<v Speaker 1>a pin, pull out of the scabby skin little bladders

0:46:06.120 --> 0:46:09.480
<v Speaker 1>of water and crack them like fleas upon their nails,

0:46:10.160 --> 0:46:13.560
<v Speaker 1>and that the scabby slaves in the bangyo at Leghorn

0:46:13.719 --> 0:46:17.520
<v Speaker 1>do often practice this mutual kindness upon one another. It

0:46:17.600 --> 0:46:20.879
<v Speaker 1>came into my mind to examine what these bladders might

0:46:21.000 --> 0:46:24.640
<v Speaker 1>really be. I quickly found an itchy person, and asking

0:46:24.680 --> 0:46:27.160
<v Speaker 1>him where he felt the greatest and most acute itching,

0:46:27.280 --> 0:46:30.120
<v Speaker 1>he pointed to a great many little pustules not yet

0:46:30.160 --> 0:46:33.520
<v Speaker 1>scabbed over, of which, picking out one with a very

0:46:33.560 --> 0:46:36.520
<v Speaker 1>fine needle and squeezing from it a thin water, I

0:46:36.600 --> 0:46:41.800
<v Speaker 1>took out a very small white globule, scarcely discernible. Observing

0:46:41.840 --> 0:46:43.640
<v Speaker 1>this with a microscope, I found it to be a

0:46:43.760 --> 0:46:48.319
<v Speaker 1>very minute, living creature, in shape resembling a tortoise of

0:46:48.360 --> 0:46:51.200
<v Speaker 1>whitish color, a little dark upon the back, with some

0:46:51.360 --> 0:46:54.800
<v Speaker 1>thin and long hairs, of nimble motion, with six feet

0:46:54.880 --> 0:46:57.279
<v Speaker 1>a sharp head with two little horns at the end

0:46:57.280 --> 0:46:58.640
<v Speaker 1>of the snout end.

0:46:58.719 --> 0:47:03.080
<v Speaker 2>Quote, I love that a tortoise a little to I

0:47:03.080 --> 0:47:03.600
<v Speaker 2>could see that.

0:47:03.960 --> 0:47:07.279
<v Speaker 1>Yeah, yeah, And they go on to describe how they

0:47:07.320 --> 0:47:10.480
<v Speaker 1>looked at more mites, They talk about treatment and contagiousness,

0:47:10.760 --> 0:47:15.719
<v Speaker 1>and they deliver this direct conclusion quote from this discovery.

0:47:16.040 --> 0:47:18.960
<v Speaker 1>It may be no difficult matter to give a more

0:47:19.120 --> 0:47:22.680
<v Speaker 1>rational account of the itch than authors have hitherto delivered

0:47:22.800 --> 0:47:25.520
<v Speaker 1>us like, you can't do better than this, essentially.

0:47:25.200 --> 0:47:26.160
<v Speaker 2>Right, yeah.

0:47:26.320 --> 0:47:29.920
<v Speaker 1>It being very probable that this contagious disease owes its

0:47:29.920 --> 0:47:33.480
<v Speaker 1>origin neither to the melancholy humor of Galen, nor the

0:47:33.520 --> 0:47:38.040
<v Speaker 1>corrosive acid of Sylvius, nor the particular ferment of Van Helmont,

0:47:38.280 --> 0:47:41.239
<v Speaker 1>nor the irritating salts in the serum or lympha of

0:47:41.280 --> 0:47:44.600
<v Speaker 1>the moderns. But it is no other than the continual

0:47:44.680 --> 0:47:48.360
<v Speaker 1>biting of these animal cules in the skin, by means

0:47:48.360 --> 0:47:50.799
<v Speaker 1>of which some portion of the serum oozing out through

0:47:50.800 --> 0:47:54.719
<v Speaker 1>the small apertures of the cutess, little watery bladders are made,

0:47:55.040 --> 0:47:58.440
<v Speaker 1>within which the insects, continuing to gnaw the infected, are

0:47:58.440 --> 0:48:01.640
<v Speaker 1>forced to scratch, and by scratching, increase the mischief and

0:48:01.719 --> 0:48:04.480
<v Speaker 1>thus renew the troublesome work, breaking not only the little

0:48:04.520 --> 0:48:07.680
<v Speaker 1>pustules but the skin too, and some little blood vessels

0:48:08.040 --> 0:48:11.840
<v Speaker 1>and to making scabs, crusty saurs and such like filthy symptoms.

0:48:11.960 --> 0:48:15.880
<v Speaker 2>End quote. So I there are so many little pieces

0:48:15.880 --> 0:48:20.400
<v Speaker 2>in that description that I loved, Aaron right, like, so

0:48:20.400 --> 0:48:21.200
<v Speaker 2>so so many.

0:48:21.800 --> 0:48:25.799
<v Speaker 1>I just the the increase, the mischief, thus the.

0:48:25.760 --> 0:48:28.719
<v Speaker 2>Mischief, Like it's like they're little and they're biting there,

0:48:28.760 --> 0:48:31.319
<v Speaker 2>like it just it's so many pieces of it, and

0:48:31.600 --> 0:48:35.719
<v Speaker 2>it does make so much logical sense too, even though

0:48:35.719 --> 0:48:37.480
<v Speaker 2>like they're technically a little bit wrong because it's like

0:48:37.600 --> 0:48:41.799
<v Speaker 2>hypersensitivity reaction, but like it is such a logical It

0:48:41.880 --> 0:48:44.680
<v Speaker 2>is such a logical description of what they saw and

0:48:44.800 --> 0:48:45.839
<v Speaker 2>what is going on.

0:48:46.080 --> 0:48:48.759
<v Speaker 1>Yeah, And I love how they're like, it's not the humors, bro,

0:48:49.120 --> 0:48:52.440
<v Speaker 1>it's not it's not that humor.

0:48:52.880 --> 0:48:54.480
<v Speaker 2>It's not the other humor you were thinking about. No,

0:48:54.520 --> 0:48:57.799
<v Speaker 2>I already thought it, right, They're just like it's this,

0:48:58.280 --> 0:49:00.359
<v Speaker 2>and like they keep going with it. They're not just like, yeah,

0:49:00.360 --> 0:49:02.160
<v Speaker 2>there's a mite in the skin, clearly, They're like, no, dude,

0:49:02.200 --> 0:49:05.120
<v Speaker 2>the mite is there and it's biting, and then it

0:49:05.200 --> 0:49:07.200
<v Speaker 2>keeps biting and it makes a little pustul and then

0:49:07.200 --> 0:49:08.799
<v Speaker 2>you itch at it and then you scratch it and

0:49:08.800 --> 0:49:11.320
<v Speaker 2>then you push it in further, and then it keeps biting,

0:49:11.360 --> 0:49:14.040
<v Speaker 2>and now you've broken the skin. Like they just they

0:49:14.440 --> 0:49:16.600
<v Speaker 2>they keep going and going. It's so good and.

0:49:16.560 --> 0:49:19.400
<v Speaker 1>It's all laid out there, so it's so straightforward that

0:49:19.960 --> 0:49:23.160
<v Speaker 1>it must have been widely accepted and settled things once

0:49:23.200 --> 0:49:23.640
<v Speaker 1>and for all.

0:49:23.840 --> 0:49:26.840
<v Speaker 2>Right, But no, of course, never, ever, ever, ever.

0:49:28.040 --> 0:49:31.160
<v Speaker 1>The resistance largely came in the form of, well, but

0:49:31.200 --> 0:49:33.359
<v Speaker 1>the worms have nothing to do with the itch. They

0:49:33.400 --> 0:49:36.319
<v Speaker 1>grew up out of the disease tissue, like you with

0:49:36.400 --> 0:49:37.759
<v Speaker 1>maggat rotted meat.

0:49:37.880 --> 0:49:40.319
<v Speaker 2>Right, what a weird Like I know that we have

0:49:40.400 --> 0:49:43.600
<v Speaker 2>to like take our modern brains out of this, but like,

0:49:43.760 --> 0:49:45.360
<v Speaker 2>what a weird thing to think.

0:49:45.520 --> 0:49:49.240
<v Speaker 1>It's a hard it's harder to do when you're literally

0:49:49.280 --> 0:49:54.680
<v Speaker 1>confronted with ample evidence of this, right exactly millennia, Yeah,

0:49:55.040 --> 0:50:00.400
<v Speaker 1>I mean, but yeah, and those voices of resistance found

0:50:00.440 --> 0:50:04.640
<v Speaker 1>out this well reasoned explanation for nearly one hundred years

0:50:04.680 --> 0:50:06.480
<v Speaker 1>after this pamphlet was published.

0:50:06.840 --> 0:50:07.040
<v Speaker 2>Wow.

0:50:07.440 --> 0:50:10.360
<v Speaker 1>Eventually, though, with more interest in the might and the itch,

0:50:10.440 --> 0:50:13.640
<v Speaker 1>the accepted knowledge began to shift, and a good number

0:50:13.680 --> 0:50:17.640
<v Speaker 1>of these publications directly mentioned how they observed quote unquote

0:50:17.680 --> 0:50:21.400
<v Speaker 1>like peasant and village elders extracting the might from the skin,

0:50:21.560 --> 0:50:24.080
<v Speaker 1>saying that this knowledge has existed and has been passed

0:50:24.120 --> 0:50:26.560
<v Speaker 1>down for a very long time, but it's only just

0:50:26.719 --> 0:50:31.239
<v Speaker 1>now finding its way into the scientific literature, and it

0:50:31.239 --> 0:50:34.480
<v Speaker 1>would take a final push to put the last shred

0:50:34.520 --> 0:50:38.760
<v Speaker 1>of doubt to rest. In the early eighteen hundreds, wow,

0:50:38.880 --> 0:50:42.280
<v Speaker 1>I know. Right at the Hotel Saint Luis and Paris,

0:50:42.560 --> 0:50:46.759
<v Speaker 1>which was a scabies hospital, two factions emerged about the

0:50:46.800 --> 0:50:49.759
<v Speaker 1>cause of the condition. On the pro mite side was

0:50:49.800 --> 0:50:53.640
<v Speaker 1>the director Jean Louis Alibert and on the other Francois

0:50:53.719 --> 0:50:57.120
<v Speaker 1>Vincent Raspaio. Things came to a boil when a challenge

0:50:57.360 --> 0:51:01.439
<v Speaker 1>was issued find the might and receive your reward, which

0:51:01.480 --> 0:51:04.839
<v Speaker 1>was three hundred francs, or fail and live with your

0:51:04.840 --> 0:51:10.759
<v Speaker 1>shame forever. So Raspail set up a public demonstration this

0:51:10.880 --> 0:51:14.280
<v Speaker 1>is the anti mite side, where he pretended to find

0:51:14.280 --> 0:51:17.600
<v Speaker 1>the mite and was like, oh my gosh, it's actually here.

0:51:17.680 --> 0:51:21.560
<v Speaker 1>This is incredible, and it was like, pich I planted it.

0:51:21.560 --> 0:51:24.760
<v Speaker 1>It's just a cheese mite. So he had someone plant

0:51:24.880 --> 0:51:28.880
<v Speaker 1>a cheese mite. Like too much time on your hands.

0:51:28.640 --> 0:51:31.400
<v Speaker 2>Oh my god, I just what I know?

0:51:31.880 --> 0:51:33.160
<v Speaker 1>Can you imagine it.

0:51:33.440 --> 0:51:37.319
<v Speaker 2>Also, I love imagining someone in the eighteen hundreds going, so.

0:51:40.320 --> 0:51:43.279
<v Speaker 1>This is like a public demonstration, Like, I want to

0:51:43.280 --> 0:51:46.719
<v Speaker 1>know how well it was attended, was it advertised? Was

0:51:46.719 --> 0:51:49.759
<v Speaker 1>he just like on just like randomly on the sidewalk

0:51:49.760 --> 0:51:50.560
<v Speaker 1>on a Tuesday.

0:51:50.960 --> 0:51:53.040
<v Speaker 2>I also now want to know more about cheese mites.

0:51:53.320 --> 0:51:59.280
<v Speaker 1>So I agree, Okay, there's so many mites in the world.

0:51:59.440 --> 0:52:01.959
<v Speaker 2>What if it's how many mite?

0:52:04.000 --> 0:52:06.799
<v Speaker 1>And I guess. So that was the I suppose the

0:52:06.880 --> 0:52:10.239
<v Speaker 1>humiliating moment for the pro mite side that was like,

0:52:10.920 --> 0:52:12.520
<v Speaker 1>just kidding, it's a cheese mite.

0:52:12.680 --> 0:52:15.719
<v Speaker 2>I mean, it seems humiliating for him, but I wasn't there,

0:52:15.760 --> 0:52:16.319
<v Speaker 2>so I don't know.

0:52:16.440 --> 0:52:18.440
<v Speaker 1>All right, no, let's see benefit of the doubt for

0:52:18.480 --> 0:52:23.840
<v Speaker 1>the full scenario. But the pro miters would get the

0:52:23.960 --> 0:52:28.560
<v Speaker 1>last laugh. In eighteen thirty four, when medical student Simon

0:52:28.640 --> 0:52:32.359
<v Speaker 1>Francois Renucci was like, you know what, I'm I am

0:52:32.400 --> 0:52:36.440
<v Speaker 1>going to find this, like I know that this that'

0:52:36.480 --> 0:52:38.719
<v Speaker 1>scabies is caused by a mite, and I'm going to

0:52:38.760 --> 0:52:41.800
<v Speaker 1>show everyone. And so he gathered a bunch of doctors

0:52:41.840 --> 0:52:44.960
<v Speaker 1>together and was like, I'm doing this demonstration here, and

0:52:45.040 --> 0:52:49.239
<v Speaker 1>he pulled a mite from a patient in front of

0:52:49.280 --> 0:52:51.920
<v Speaker 1>everyone and was like, here it is. I found it.

0:52:51.920 --> 0:52:53.920
<v Speaker 1>It's a little bits in the borough, a little bit away.

0:52:54.320 --> 0:52:57.960
<v Speaker 1>There's a great illustration of this historic moment with Renucci

0:52:58.440 --> 0:53:01.600
<v Speaker 1>holding up the mite for all all to see, which

0:53:01.640 --> 0:53:04.400
<v Speaker 1>just like cracks me up because I'm like, I can't

0:53:04.440 --> 0:53:09.680
<v Speaker 1>see it in size one font but it's like triumphantly

0:53:09.760 --> 0:53:14.040
<v Speaker 1>with his arm in the air and this demonstration this

0:53:14.239 --> 0:53:16.319
<v Speaker 1>like I found the mic here, here it is in

0:53:16.360 --> 0:53:18.200
<v Speaker 1>this person. I don't know how it took so long

0:53:18.239 --> 0:53:20.920
<v Speaker 1>for this to happen. Yeah, this was the start of

0:53:21.000 --> 0:53:24.480
<v Speaker 1>a monumental shift away from the humoral theory of disease.

0:53:25.120 --> 0:53:28.560
<v Speaker 1>And this isn't like, this isn't the thing that made

0:53:28.600 --> 0:53:32.359
<v Speaker 1>people go, oh maybe we should question right, a combination

0:53:32.560 --> 0:53:34.960
<v Speaker 1>of things, right. It sort of was like it was

0:53:35.040 --> 0:53:38.600
<v Speaker 1>part of the transition away from that. The rest of

0:53:38.600 --> 0:53:42.560
<v Speaker 1>the eighteen hundred saw Ferdinand rittervon Hebra, who I mentioned

0:53:42.600 --> 0:53:46.239
<v Speaker 1>in our Loopus episode. So he was an early scientific dermatologist,

0:53:46.280 --> 0:53:48.120
<v Speaker 1>because like, I come across these names and I'm like,

0:53:48.800 --> 0:53:51.640
<v Speaker 1>some familiar where are you coming from? And then I

0:53:51.719 --> 0:53:57.879
<v Speaker 1>just like search our transcripts. He distinguished the might cause

0:53:57.960 --> 0:54:01.080
<v Speaker 1>scabies from other itchy skin conditions which had been called

0:54:01.120 --> 0:54:03.880
<v Speaker 1>scabies in the past, and that was probably part of

0:54:03.920 --> 0:54:06.080
<v Speaker 1>what led to this like long confusion. It was just

0:54:06.080 --> 0:54:08.799
<v Speaker 1>like if you're itgy, it's called scabies.

0:54:08.440 --> 0:54:11.279
<v Speaker 2>Right right right? It was the itch, but it it

0:54:11.400 --> 0:54:13.719
<v Speaker 2>is the might yes, yeah.

0:54:13.760 --> 0:54:16.040
<v Speaker 1>And then this also helped on the treatment front to

0:54:16.080 --> 0:54:19.840
<v Speaker 1>determine which ointments were or were not effective, and the

0:54:19.880 --> 0:54:22.759
<v Speaker 1>early twentieth century marked a jump forward in our understanding

0:54:22.760 --> 0:54:27.640
<v Speaker 1>of scaby's epidemiology. As you can imagine, scabies mites love

0:54:27.680 --> 0:54:31.360
<v Speaker 1>a war, they love chaos, and World War Two, with

0:54:31.400 --> 0:54:34.919
<v Speaker 1>its crowded barracks, offered a great opportunity for these little

0:54:34.920 --> 0:54:38.800
<v Speaker 1>guys to infest to their hearts content and infest they did,

0:54:39.200 --> 0:54:42.120
<v Speaker 1>and they didn't just get under the soldier's skin. By

0:54:42.120 --> 0:54:45.200
<v Speaker 1>the nineteen forties, between one and two million people in

0:54:45.239 --> 0:54:49.400
<v Speaker 1>the British Isles had scabies. This was a problem in

0:54:49.480 --> 0:54:52.520
<v Speaker 1>need of a serious solution, and Kenneth Mellanbie, who was

0:54:52.520 --> 0:54:55.799
<v Speaker 1>a British entomologist, felt up to the task. So he

0:54:55.840 --> 0:54:59.120
<v Speaker 1>directed a series of experiments where he exposed human quote

0:54:59.160 --> 0:55:04.319
<v Speaker 1>unquote volunteers who were primarily conscientious objectors. So this was

0:55:04.400 --> 0:55:06.879
<v Speaker 1>like they refused to join the war effort, and so

0:55:06.960 --> 0:55:09.920
<v Speaker 1>he proposed this as like, oh, show your service to

0:55:10.000 --> 0:55:15.320
<v Speaker 1>the country in another way. Yeah, And it's interesting because

0:55:15.360 --> 0:55:19.200
<v Speaker 1>I think there has been, of course some criticism of this,

0:55:19.960 --> 0:55:22.040
<v Speaker 1>you know, even with the ethics at the time. I

0:55:22.080 --> 0:55:24.920
<v Speaker 1>do think it's relevant to note that he was morally

0:55:24.920 --> 0:55:29.600
<v Speaker 1>opposed to experimentation on what he felt were not true volunteers,

0:55:30.200 --> 0:55:33.560
<v Speaker 1>like people in prison or people who couldn't really say no,

0:55:34.000 --> 0:55:37.719
<v Speaker 1>like children and so on. So that part is interesting

0:55:37.760 --> 0:55:39.600
<v Speaker 1>to me. But I also don't know how much power

0:55:39.800 --> 0:55:41.840
<v Speaker 1>conscientious objectors had to say no.

0:55:42.760 --> 0:55:43.759
<v Speaker 2>Yeah, I don't know enough.

0:55:43.960 --> 0:55:46.319
<v Speaker 1>I don't know the context enough for that. But in

0:55:46.360 --> 0:55:49.160
<v Speaker 1>any case, he directed a series of experiments where he

0:55:49.280 --> 0:55:55.280
<v Speaker 1>exposed these conscientious objectors to various items like blankets, towels, pants, shirts, socks,

0:55:55.400 --> 0:55:58.600
<v Speaker 1>underwear that had been used by people infested with scabies,

0:55:58.640 --> 0:56:01.320
<v Speaker 1>to see how long it would take to cause an infection.

0:56:02.520 --> 0:56:08.000
<v Speaker 1>For centuries, scabies had the reputation of being super duper contagious,

0:56:08.520 --> 0:56:10.360
<v Speaker 1>like all you had to do to get it was

0:56:10.560 --> 0:56:13.359
<v Speaker 1>touch a blanket used by a person with scabies, look

0:56:13.400 --> 0:56:16.000
<v Speaker 1>at someone who had skabies, like it was just like

0:56:16.239 --> 0:56:19.720
<v Speaker 1>whoa the most contagious thing. Ever, but Melanie's experiments showed

0:56:19.719 --> 0:56:22.759
<v Speaker 1>that this was not the case. He found it near

0:56:22.920 --> 0:56:26.400
<v Speaker 1>impossible to get any of his volunteers infected, much to

0:56:26.440 --> 0:56:30.799
<v Speaker 1>their relief, I imagine, And when they did get infected eventually,

0:56:31.120 --> 0:56:34.839
<v Speaker 1>it took weeks for symptoms to show how which, as

0:56:34.920 --> 0:56:36.920
<v Speaker 1>you mentioned, Aaron, yep, and it was much sooner though

0:56:36.960 --> 0:56:39.200
<v Speaker 1>if you had had scabies before, so it'd be like

0:56:39.400 --> 0:56:43.120
<v Speaker 1>six weeks or twenty four hours, right, that's it. Yeah,

0:56:43.160 --> 0:56:44.760
<v Speaker 1>And he even tried it on himself.

0:56:45.360 --> 0:56:45.800
<v Speaker 2>Quote.

0:56:45.960 --> 0:56:48.680
<v Speaker 1>My own experience was typical. I allowed a mite to

0:56:48.719 --> 0:56:51.600
<v Speaker 1>burrow into my own wrist and observed it almost like

0:56:51.640 --> 0:56:55.360
<v Speaker 1>a pet, for two months. Each day the tunnel was enlarged,

0:56:55.440 --> 0:56:57.680
<v Speaker 1>eggs were located in the burrow, but I had no

0:56:57.880 --> 0:57:00.880
<v Speaker 1>skin reaction. It was only in the fifth week that

0:57:00.920 --> 0:57:03.720
<v Speaker 1>a redness was observed around the might and that skin

0:57:03.800 --> 0:57:08.920
<v Speaker 1>irritation became obvious quote interesting. He also found that scabies

0:57:08.920 --> 0:57:11.920
<v Speaker 1>could only be transmitted by a female mite, not eggs,

0:57:11.960 --> 0:57:14.880
<v Speaker 1>not immature mites, and that female mites don't live very

0:57:14.960 --> 0:57:18.320
<v Speaker 1>long out like outside of the human body. And this

0:57:18.480 --> 0:57:21.439
<v Speaker 1>meant that the Ministry of Health could better spend their

0:57:21.480 --> 0:57:25.760
<v Speaker 1>time and money, tracking down contacts of affected individuals and

0:57:25.800 --> 0:57:29.840
<v Speaker 1>treating them rather than destroying or disinfecting blankets and bedding.

0:57:30.200 --> 0:57:32.800
<v Speaker 2>Oh my gosh, Yes, that's so good public.

0:57:32.440 --> 0:57:38.320
<v Speaker 1>Hell right resource management. Despite his work, the misconception of

0:57:38.320 --> 0:57:42.200
<v Speaker 1>scabies as a super contagious condition remains to this day,

0:57:42.720 --> 0:57:45.760
<v Speaker 1>and I think it contributes to the stigma that scabies

0:57:45.800 --> 0:57:49.720
<v Speaker 1>carries with it. Scabies as a medical condition is extremely

0:57:49.840 --> 0:57:54.320
<v Speaker 1>uncomfortable and can be dangerous in some occasions. But that's

0:57:54.360 --> 0:57:56.400
<v Speaker 1>just one part of the story. For the hundreds of

0:57:56.480 --> 0:58:01.280
<v Speaker 1>millions of people around the globe that developed scabies every year. Shame,

0:58:01.560 --> 0:58:06.400
<v Speaker 1>social isolation, avoidance, These are common experiences in people with scabies,

0:58:06.760 --> 0:58:09.720
<v Speaker 1>and they can discourage a person from seeking treatment or

0:58:09.760 --> 0:58:13.600
<v Speaker 1>informing other people about exposure. And while we have treatment

0:58:14.080 --> 0:58:16.600
<v Speaker 1>that is for the most part effective, while we have

0:58:16.720 --> 0:58:20.680
<v Speaker 1>control measures, we still need to really improve on actually

0:58:20.680 --> 0:58:24.440
<v Speaker 1>putting those in place, which means decreasing the stigma associated

0:58:24.480 --> 0:58:28.080
<v Speaker 1>with scabies. And so on that note, Aaron, can you

0:58:28.120 --> 0:58:30.520
<v Speaker 1>tell me where we are with scabies today?

0:58:31.000 --> 0:59:07.800
<v Speaker 2>I would love to right after this break. Globally, the

0:59:07.840 --> 0:59:12.320
<v Speaker 2>World Health Organization estimates that at any given moment, two

0:59:12.400 --> 0:59:17.400
<v Speaker 2>hundred million people worldwide are affected by scabies, with over

0:59:17.480 --> 0:59:22.240
<v Speaker 2>four hundred million people affected cumulatively each year. It's like

0:59:22.320 --> 0:59:27.440
<v Speaker 2>four hundred million cases each year. And it's everywhere. It is,

0:59:27.520 --> 0:59:32.640
<v Speaker 2>everywhere that humans are, there is scabies. But even with

0:59:32.760 --> 0:59:37.320
<v Speaker 2>all of that knowledge, our data is actually really cuddy,

0:59:37.400 --> 0:59:40.440
<v Speaker 2>and there is a real need for better evaluation and

0:59:40.480 --> 0:59:46.960
<v Speaker 2>better monitoring. While scabies exist everywhere, it exists differently in

0:59:47.000 --> 0:59:51.240
<v Speaker 2>different places across the globe. In most high income countries,

0:59:51.720 --> 0:59:56.760
<v Speaker 2>we see it in sometimes in outbreaks in places like hospitals,

0:59:57.120 --> 1:00:02.840
<v Speaker 2>nursing homes, among homeless populations, though it can also occur sporadically,

1:00:03.000 --> 1:00:07.920
<v Speaker 2>right like anybody can potentially get scabies. But in developing

1:00:07.960 --> 1:00:11.920
<v Speaker 2>and underresourced areas of the world, both urban and rural areas,

1:00:12.560 --> 1:00:16.920
<v Speaker 2>prevalence can sometimes be as high as ten percent, and

1:00:17.080 --> 1:00:20.720
<v Speaker 2>in some regions, in some studies, prevalence has been as

1:00:20.760 --> 1:00:23.720
<v Speaker 2>high as twenty to thirty percent and over fifty percent

1:00:23.800 --> 1:00:27.080
<v Speaker 2>in children, who tend to be even more affected than adults.

1:00:28.720 --> 1:00:32.520
<v Speaker 2>So this is a huge, huge problem worldwide, not only

1:00:32.560 --> 1:00:35.000
<v Speaker 2>because like we've talked about a lot so far, like

1:00:35.040 --> 1:00:39.560
<v Speaker 2>this is a very potentially painful, very bothersome infection, super

1:00:39.600 --> 1:00:44.240
<v Speaker 2>super itchy Also, the itching is much much worse at night,

1:00:44.920 --> 1:00:47.720
<v Speaker 2>and that is something that I could not find data

1:00:47.760 --> 1:00:50.680
<v Speaker 2>on as to like why does the itch? Why is

1:00:50.680 --> 1:00:52.360
<v Speaker 2>the itch so much worse at night? But it is.

1:00:53.920 --> 1:00:57.200
<v Speaker 2>But scabies is also a massive risk factor for things

1:00:57.240 --> 1:01:01.160
<v Speaker 2>like secondary bacterial infections, and I mentioned it at the

1:01:01.320 --> 1:01:04.360
<v Speaker 2>very very top. But this causes also not just the

1:01:04.360 --> 1:01:08.720
<v Speaker 2>infections themselves, but then morbidity and mortality from things that

1:01:08.760 --> 1:01:13.480
<v Speaker 2>happen as a result of those infections. One paper estimated

1:01:13.480 --> 1:01:17.680
<v Speaker 2>that up to ten percent of kids with scabies end

1:01:17.760 --> 1:01:20.320
<v Speaker 2>up with renal damage, and that renal damage is not

1:01:20.360 --> 1:01:23.439
<v Speaker 2>from the mites, it's from the bacterial infections that get

1:01:23.480 --> 1:01:26.400
<v Speaker 2>in because of the mites. Right, Like, I had no

1:01:26.520 --> 1:01:28.760
<v Speaker 2>idea that it was such a big deal me either.

1:01:29.880 --> 1:01:34.080
<v Speaker 2>It's also really common to misdiagnosis in the US and

1:01:34.160 --> 1:01:37.000
<v Speaker 2>across the globe. In one paper, up to forty five

1:01:37.040 --> 1:01:40.440
<v Speaker 2>percent of people in the US, even at dermatology offices,

1:01:40.680 --> 1:01:43.400
<v Speaker 2>were misdiagnosed the first time that they came in and

1:01:43.440 --> 1:01:47.320
<v Speaker 2>saw physician. Is what is a common misdiagnosis? It could

1:01:47.360 --> 1:01:50.520
<v Speaker 2>be eczema, it could be just a topic dermatitis, it

1:01:50.520 --> 1:01:54.360
<v Speaker 2>could be just any kind of nonspecific itchyness, got it

1:01:54.520 --> 1:02:00.520
<v Speaker 2>lots of different things and also interesting and very depressing. Fact. Again,

1:02:00.600 --> 1:02:02.760
<v Speaker 2>I just scaby's felt so much bigger to me than

1:02:02.800 --> 1:02:05.960
<v Speaker 2>I realized. The Global Burden of Disease study, which is

1:02:06.040 --> 1:02:08.480
<v Speaker 2>this big study, I've cited it multiple times, they try

1:02:08.520 --> 1:02:10.400
<v Speaker 2>and look at like overall burdens of a whole bunch

1:02:10.440 --> 1:02:13.480
<v Speaker 2>of different diseases. So a report from twenty fifteen on

1:02:13.600 --> 1:02:20.439
<v Speaker 2>scabies specifically estimated that scabies contributes more disability adjusted life

1:02:20.520 --> 1:02:25.160
<v Speaker 2>years than something like atrial fibrillation, which is really common

1:02:25.240 --> 1:02:28.800
<v Speaker 2>and most people have probably heard of it, so it

1:02:28.840 --> 1:02:33.800
<v Speaker 2>has a huge amount of disability associated with it. But

1:02:34.440 --> 1:02:39.240
<v Speaker 2>this paper also estimated that mortality due to scabies was zero,

1:02:40.360 --> 1:02:43.160
<v Speaker 2>which if you think about it, is not entirely true

1:02:43.200 --> 1:02:47.520
<v Speaker 2>because we know that especially crusted scabies can contribute to

1:02:47.560 --> 1:02:50.840
<v Speaker 2>super imposed infections that can lead to sepsis that absolutely

1:02:50.880 --> 1:02:55.600
<v Speaker 2>can be deadly, and things like poststrep glomerial neephritis or

1:02:55.800 --> 1:02:59.120
<v Speaker 2>rheumatic heart disease can also be a consequence of infections

1:02:59.320 --> 1:03:02.600
<v Speaker 2>that are a concepts of scabies. So it's just overall

1:03:02.600 --> 1:03:04.880
<v Speaker 2>a much bigger deal, and the World Health Organization knows

1:03:04.920 --> 1:03:09.160
<v Speaker 2>that luckily, and so as of twenty seventeen, scabies are

1:03:09.200 --> 1:03:12.600
<v Speaker 2>actually considered a neglected tropical disease along with a number

1:03:12.600 --> 1:03:17.360
<v Speaker 2>of other ectoparasites, and their twenty thirty targets are to

1:03:18.000 --> 1:03:21.800
<v Speaker 2>do a few different things to try and really address scabies. First,

1:03:22.040 --> 1:03:27.040
<v Speaker 2>they're trying to integrate mass drug administration anywhere that prevalence

1:03:27.080 --> 1:03:30.720
<v Speaker 2>of scabies is higher than ten percent, which sounds, I mean,

1:03:30.960 --> 1:03:33.560
<v Speaker 2>sounds both low and high. Like imagining ten percent of

1:03:33.560 --> 1:03:37.919
<v Speaker 2>a population infected with scabies sounds awful, but it also

1:03:38.000 --> 1:03:41.200
<v Speaker 2>in terms of like mass drug administration campaigns, seems low.

1:03:41.760 --> 1:03:43.640
<v Speaker 2>But I think part of that is because people can

1:03:43.680 --> 1:03:47.080
<v Speaker 2>be asymptomatic and treatment can take such a long time

1:03:47.160 --> 1:03:51.040
<v Speaker 2>and things like that. So anywhere that which also means

1:03:51.080 --> 1:03:55.080
<v Speaker 2>that we need better data because we don't necessarily know

1:03:55.200 --> 1:03:58.680
<v Speaker 2>everywhere where prevalence might be ten percent or greater. And

1:03:59.320 --> 1:04:02.400
<v Speaker 2>it seems like that is where most of the research

1:04:02.440 --> 1:04:05.480
<v Speaker 2>on scabies is actually happening, and where the focus really

1:04:05.600 --> 1:04:08.880
<v Speaker 2>seems to be is on epidemiological level research like where

1:04:09.040 --> 1:04:11.760
<v Speaker 2>is it, what is the prevalence really and how can

1:04:11.800 --> 1:04:14.800
<v Speaker 2>we then use public health measures to get control of

1:04:14.840 --> 1:04:18.280
<v Speaker 2>this disease? Because we have treatments, we have options, we're

1:04:18.320 --> 1:04:21.080
<v Speaker 2>just not maybe implementing them in the most effective way currently.

1:04:22.600 --> 1:04:25.120
<v Speaker 2>So that's where we stand with scabies today.

1:04:25.240 --> 1:04:27.680
<v Speaker 1>It's such a huge it's such a huge problem.

1:04:27.760 --> 1:04:31.080
<v Speaker 2>It really is. I just I feel like I did

1:04:31.080 --> 1:04:33.520
<v Speaker 2>not recognize it. I think also, Aaron, you mentioned the

1:04:33.800 --> 1:04:38.280
<v Speaker 2>stigma that's associated with it. That's a huge, like it

1:04:38.360 --> 1:04:42.160
<v Speaker 2>is very real, and that is real everywhere across the globe.

1:04:42.160 --> 1:04:45.240
<v Speaker 2>That's real in developing countries. That is definitely real here

1:04:45.280 --> 1:04:47.720
<v Speaker 2>in the US. I have seen that firsthand, where if

1:04:47.760 --> 1:04:50.960
<v Speaker 2>somebody comes into a hospital with scabies, they are treated

1:04:50.960 --> 1:04:53.600
<v Speaker 2>differently than somebody who doesn't have scabies. And that's a problem.

1:04:53.720 --> 1:04:58.720
<v Speaker 1>Mm hmm. There's a lot of I think preconceived notions

1:04:58.760 --> 1:05:03.080
<v Speaker 1>about scabs that then leads to this sort of treatment

1:05:03.120 --> 1:05:06.440
<v Speaker 1>that is perpetuates stigma and shame and isolation and all

1:05:06.440 --> 1:05:06.760
<v Speaker 1>these things.

1:05:06.960 --> 1:05:09.320
<v Speaker 2>It's seen as like something that is dirty or something

1:05:09.360 --> 1:05:10.360
<v Speaker 2>like that. Exactly.

1:05:10.600 --> 1:05:14.520
<v Speaker 1>Yeah, it's like literally any person can get scabies.

1:05:14.640 --> 1:05:19.919
<v Speaker 2>If you have skin, human skin, you can get scabies. Yeah, yeah,

1:05:20.080 --> 1:05:21.160
<v Speaker 2>that's that's what it is.

1:05:21.240 --> 1:05:21.920
<v Speaker 1>Bottom line.

1:05:23.600 --> 1:05:25.880
<v Speaker 2>Well, if you'd like to learn more about scabies, we

1:05:25.920 --> 1:05:28.000
<v Speaker 2>have a lot of information for you. We do.

1:05:28.600 --> 1:05:30.520
<v Speaker 1>I have a handful of papers, but the place where

1:05:30.560 --> 1:05:33.720
<v Speaker 1>I got most of my information was a great book

1:05:33.760 --> 1:05:37.040
<v Speaker 1>which I already mentioned, called The Itch Scabies by Eryl Craig,

1:05:37.400 --> 1:05:40.160
<v Speaker 1>and it's all about scabies. So there's a lot of

1:05:40.160 --> 1:05:43.120
<v Speaker 1>information there. And then there's again I want to shout

1:05:43.120 --> 1:05:45.680
<v Speaker 1>out that paper by Cropy from two thousand and six

1:05:45.840 --> 1:05:49.200
<v Speaker 1>called the Army Itch, a dermatological mystery of the American

1:05:49.240 --> 1:05:49.800
<v Speaker 1>Civil War.

1:05:50.480 --> 1:05:52.760
<v Speaker 2>I have a number of papers, I said already. There

1:05:52.800 --> 1:05:55.160
<v Speaker 2>was a Lancet article review from two thousand and six

1:05:55.320 --> 1:05:59.040
<v Speaker 2>just called scabies. It was great, really nice overview. There

1:05:59.120 --> 1:06:00.960
<v Speaker 2>was one from the Journey All of the American Academy

1:06:00.960 --> 1:06:04.680
<v Speaker 2>of Dermatology from twenty twenty called Ectoparasites scabies. That was

1:06:04.680 --> 1:06:06.720
<v Speaker 2>another good one. And honestly, there's a bunch of other

1:06:06.760 --> 1:06:09.240
<v Speaker 2>papers that are reviews. There's that Global Burden of Disease

1:06:09.280 --> 1:06:12.760
<v Speaker 2>study from twenty fifteen. And we'll post the list of

1:06:12.760 --> 1:06:14.960
<v Speaker 2>sources from this episode and every single one of our

1:06:15.000 --> 1:06:17.040
<v Speaker 2>episodes on our website, This podcast will Kill You dot

1:06:17.080 --> 1:06:18.720
<v Speaker 2>Com under the episodes tab.

1:06:19.240 --> 1:06:21.920
<v Speaker 1>Thank you to Bloodmobile for providing the music for this

1:06:21.960 --> 1:06:23.920
<v Speaker 1>episode and all of our episodes.

1:06:24.400 --> 1:06:27.000
<v Speaker 2>Thank you to Leona Scilacchi and Tom Brifogel for the

1:06:27.080 --> 1:06:27.920
<v Speaker 2>audio mixing.

1:06:28.360 --> 1:06:30.320
<v Speaker 1>Thank you to everyone at Exactly Right.

1:06:30.560 --> 1:06:32.880
<v Speaker 2>And thank you to you listeners. We hope you're not

1:06:32.960 --> 1:06:35.520
<v Speaker 2>too itchy after listening to this episode.

1:06:35.360 --> 1:06:38.200
<v Speaker 1>H and we hope you learned something about scabies.

1:06:38.320 --> 1:06:39.040
<v Speaker 2>We certainly did.

1:06:39.760 --> 1:06:43.880
<v Speaker 1>And a big thank you as always to our wonderful, excellent, fantastic,

1:06:43.960 --> 1:06:47.400
<v Speaker 1>lovely patrons. We appreciate your support. It means the world

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<v Speaker 1>to us. Thank it really does. Thank you so much. Well,

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<v Speaker 1>until next time, wash your hands.

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<v Speaker 2>You feelthy animals.

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<v Speaker 4>Ombud Buba, Buba, Buba bu