Abstract
Lower urinary tract symptoms (LUTS) are including an overactive bladder, voiding and storing urine. The causes of LUTS include infectious and inflammatory. In this paper we present a rare case of LUTS caused by scabies mites and could be the third case reported in the medical literature. A 12-year-old child came to hospital complaining of tenesmus, dysuria and hematuria several days ago. A diagnosis of LUTS was established and investigations showed the scabie mite is the possible cause for the disease. Scabies mites have the ability of entering into the urinary tract leading to LUTS in patients affected with scabies.
Keywords: Scabies, LUTS, Ivermectin, Case report
1. Introduction
Lower urinary tract symptoms (LUTS) refers to any combination of urinary symptoms that are primarily associated with overactive bladder and storage and voiding disturbances.1 Symptoms typically include daytime urinary frequency, nocturia, urgency, incontinence and voiding symptoms.2 LUTS affects millions of people around the world, which is a significant part of daily practice.1 The most common causes of LUTS are infectious and inflammatory conditions such as prostatitis. Inflammation may result from a bacterial infection, viral infection, drug induced inflammation, or idiopathic inflammation.2 Other etiologies include primary bladder dysfunction and urethral strictures.3 In this paper, we present a rare case of LUTS caused by scabie mite. This case should be the third such case reported in the medical literature.
2. Case presentation
A 12-year-old male from a low socio-economic background was admitted to the urology department complaining of tenesmus, dysuria, and hematuria several days earlier. On examination, there were no skin lesions, urethral discharge, or genital sores, and urine analysis findings were within normal limits with no organisms found. A solitary motile scabie mite was unexpectedly found upon microscopic analysis (Fig. 1). Other lab testing turned up nothing extraordinary. The aforementioned observations led to the diagnosis of LUTS brought on by scabie mite infestation. The Dermatologist used a single dosage of ivermectin 200 mg/kg to treat the patient. To eradicate the scabie mite completely, the same dose was administered again after a week. Within a week of starting medication, all symptoms disappeared.
Fig. 1.
Microscopic view of scabie mite in a urine sample.
3. Discussion
Lower urinary tract symptoms are none specific term and could be describe a variety of lower urinary tract symptoms, including storage and voiding symptoms, which may also be associated with concurrent pelvic or testicular pain and discomfort.3 Regarding to our case, the main complaint of patient was tenesmus and hematuria a few days ago. Several causes were described as factors for LUTS including infectious, inflammatory, and functional disorders.2 In the present case, all possible reasons for LUTS were denied. This strongly suggests that the scabie mite is the cause of the disease. A literature review showed only two reportes of scabies mites in urine samples.4,5 However, our case should be the third such case in the literature. The previous cases suggested that the scabies mites was coming from outside surface of the urogenital organs into urinary tract, which is corresponding with our case. The treatment of LUTS is tailored depending on the causes of the patient's symptoms and level of bother. The first-line of treatment includes behavioral therapy and lifestyle modifications.2,3 Second-line of treatment includes pharmacologic agents such as a-antagonists, anti-muscarinics, and b3-adrenoreceptor agonists. Typically, medications are reserved for patients with a clearly delineated diagnosis, such as primary bladder neck obstruction or detrusor hyperactivity/overactive bladder.2 However, regarding to our case, we gave the patient a single dose of ivermectin and repeat the same dosage after a week to eradicate the scabie mite which is the possible underlying cause of LUTS.
4. Conclusion
Scabies mites is a rare cause of LUTS, and physicians should keep such entity in mind as a cause of LUTS in patients with a history of scabies.
Assistance with the study
None.
Financial support and sponsorship
None.
Presentation
None.
Declaration of competing interest
None.
Acknowledgements statement
None.
References
- 1.Cornu J.-N. Current advances in male lower urinary tract symptoms assessment and management: more and more questions. Curr Opin Urol. 2016;26(1):1–2. doi: 10.1097/MOU.0000000000000250. [DOI] [PubMed] [Google Scholar]
- 2.Beland L., Martin C., Han J.S. Lower urinary tract symptoms in young men—causes and management. Curr Urol Rep. 2022;23(2):29–37. doi: 10.1007/s11934-022-01087-9. [DOI] [PubMed] [Google Scholar]
- 3.Alawamlh O.A.H., Goueli R., Lee R.K. Lower urinary tract symptoms, benign prostatic hyperplasia, and urinary retention. Med Clin. 2018;102(2):301–311. doi: 10.1016/j.mcna.2017.10.005. [DOI] [PubMed] [Google Scholar]
- 4.Rahman M. Scabies mites (Sarcoptes scabiei) in urine. J Hosp Infect. 1981 Mar;2(1):101–102. doi: 10.1016/0195-6701(81)90015-3. [DOI] [PubMed] [Google Scholar]
- 5.Patnaik R. Acarus scabiei in urine. Int J Dermatol. 1978 Sep 1;17(7):582. doi: 10.1111/j.1365-4362.1978.tb06004.x. [DOI] [PubMed] [Google Scholar]