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Das P, Mannu A, Vasudevan B, Krishnan LP, Priya S. Erythrodermic scabies in a systemic sclerosis patient. Indian J Dermatol Venereol Leprol 2024; 0:1-2. [PMID: 38899417 DOI: 10.25259/ijdvl_384_2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Accepted: 04/09/2024] [Indexed: 06/21/2024]
Affiliation(s)
- Pankaj Das
- Department of Dermatology, Armed Forces Medical College, Pune, Maharashtra, India
| | - Anand Mannu
- Department of Dermatology, Armed Forces Medical College, Pune, Maharashtra, India
| | - Biju Vasudevan
- Department of Dermatology, Armed Forces Medical College, Pune, Maharashtra, India
| | | | - Silky Priya
- Department of Dermatology, Armed Forces Medical College, Pune, Maharashtra, India
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Wu X, Yang F, Zhang R. Frequent Misdiagnosis of Scabies as Eczema in China: A Descriptive Study of 23 Cases. Int J Gen Med 2024; 17:1615-1623. [PMID: 38690199 PMCID: PMC11060170 DOI: 10.2147/ijgm.s458731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 04/10/2024] [Indexed: 05/02/2024] Open
Abstract
Objective To outline the clinical manifestations observed in patients with scabies misdiagnosed as generalized eczema, analyse the factors contributing to these misdiagnoses and explore potential reasons for the resurgence of scabies. Patients and Methods A retrospective analysis was performed to investigate the patients with scabies misdiagnosed as generalized eczema. Results We included 23 patients, with twelve (52.17%) being male and eleven (47.83%) female. The illness duration ranged from 0.5 to 7 months. Among all patients, 12 (52.17%) were residents of nursing homes, 5 (21.74%) were staff members of these facilities, 4 (17.39%) were caregivers of long-term hospitalized relatives, 1 (4.35%) was a construction worker, and 1 (4.35%) had a history of tourism. The rash predominantly affected the trunk and extremities, 12 patients (52.17%) are each involved the perineum and fingers webbings. The presentations included erythema, papules, and nodules. The main complaint of all patients was nocturnal itch. Under direct microscopy, 5 patients (21.74%) tested positive for scabies mites, and 3 (13.04%) showed histopathological features consistent with scabies. All patients were initially misdiagnosed with generalized eczema. Conclusion Over half of all patients diagnosed with scabies either resided or worked in long-term care facilities. The lack of awareness of scabies among medical staff in long-term care facilities readily led to frequent misdiagnosis. Comprehensive measures should be implemented urgently to strengthen disease management.
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Affiliation(s)
- Xumei Wu
- Department of Dermatology, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China
- Department of Dermatology, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, People’s Republic of China
| | - Feifei Yang
- Department of Dermatology, Tongzhou Maternal & Child Health Hospital of Beijing, Beijing, People’s Republic of China
| | - Ruina Zhang
- Department of Dermatology, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China
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Harries L, Traidl S, Klespe KC, Werfel T. [Eczema and its treatment in older adults]. DERMATOLOGIE (HEIDELBERG, GERMANY) 2023; 74:678-686. [PMID: 37638989 DOI: 10.1007/s00105-023-05206-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/18/2023] [Indexed: 08/29/2023]
Abstract
Eczema encompass a wide range of dermatoses that can affect elderly patients in particular. Common differential diagnoses in elderly patients include asteatotic eczema, late-onset atopic dermatitis, allergic contact dermatitis, early phases of mycosis fungoides, eczematous and pruriginous variants of premonitory bullous pemphigoid, as well as eczematized scabies and post-scabietic eczema. Given the partly overlapping clinical presentations, accurate diagnosis plays a crucial role in the management of these conditions. Therapeutic options depend on the underlying disease and necessitate an individualized approach. This review presents relevant types of eczema in older adults together with diagnostic and therapeutic approaches. In addition to confirming the diagnosis and selecting the appropriate treatment, aspects relevant to the care of older patients should be incorporated into the tailored therapeutic approach.
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Affiliation(s)
- Leonard Harries
- Klinik für Dermatologie, Allergologie und Venerologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.
| | - Stephan Traidl
- Klinik für Dermatologie, Allergologie und Venerologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - Kai-Christian Klespe
- Klinik für Dermatologie, Allergologie und Venerologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - Thomas Werfel
- Klinik für Dermatologie, Allergologie und Venerologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
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Skayem C, Majda A, Gary C, Hemery F, Mahé E, Caux F, Dupin N, Senet P, Greder-Belan A, Hillion B, Meni C, Saiag P, Bellaud G, Bleibtreu A, Lariven S, Bollens D, Descamps V, Molina JM, Bouchaud O, Vittecoq D, Do-Pham G, Foulet F, Botterel F, Chosidow O, Bernigaud C. Severe Scabies: A French Multi-centre Study Involving 95 Patients with Crusted and Profuse Disease and Review of the Literature. Acta Derm Venereol 2023; 103:adv00878. [PMID: 36861856 PMCID: PMC9993169 DOI: 10.2340/actadv.v103.5351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 02/01/2023] [Indexed: 03/03/2023] Open
Abstract
The aim of this multi-centre French retrospective study was to identify severe, i.e. crusted and profuse, scabies patients. Records were retrieved from 22 Dermatology or Infectious Diseases departments in the Ile-de-France from January 2009 to January 2015 to characterize epidemiology, demography, diagnosis, contributing factors, treatment features, and outcomes in severe scabies. A total of 95 inpatients (57 crusted and 38 profuse) were included. A higher number of cases was observed among elderly patients (>75 years), mostly living in institutions. Thirteen patients (13.6%) reported a history of previously treated scabies. Sixty-three patients (66.3%) had been seen by a previous practitioner for the current episode (up to 8 previous visits). Initial misdiagnosis (e.g. eczema, prurigo, drug-related eruptions, psoriasis) was documented in 41 patients (43.1%). Fifty-eight patients (61%) had already received 1 or more previous treatments for their current episode. Forty percent received corticosteroids or acitretin for an initial diagnosis of eczema or psoriasis. Median time from the onset of symptoms to the diagnosis of severe scabies was 3 months (range 0.3-22). Itch was present in all patients at diagnosis. Most patients (n=84, 88.4%) had comorbidities. Diagnostic and therapeutic approaches varied. Complications occurred in 11.5% of cases. To date, there is no consensus for diagnosis and treatment, and future standardization of is required for optimal management.
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Affiliation(s)
- Charbel Skayem
- Dermatology Department, Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpital Henri-Mondor, Créteil, France.
| | - Askour Majda
- Dermatology Department, Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpital Henri-Mondor, Créteil, France
| | - Charlotte Gary
- Dermatology Department, Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpital Henri-Mondor, Créteil, France
| | - Francois Hemery
- Service d'Information Médicale, DSIGHM, APHP, Hôpital Henri-Mondor, Créteil, France
| | - Emmanuel Mahé
- Dermatology Department, Centre Hospitalier Victor Dupouy, Argenteuil, France
| | - Frederic Caux
- Dermatology Department, APHP, Hôpital Avicenne, Bobigny, France
| | - Nicolas Dupin
- Dermatology Department, APHP, Hôpital Cochin, Pavillon Tarnier, Paris, France
| | - Patricia Senet
- Dermatology Department, APHP, Hôpital Tenon, Sorbonne Université, Paris, France
| | - Alix Greder-Belan
- Service de Médecine Interne et Unité de Maladies Infectieuses et Tropicales, Centre Hospitalier de Versailles, Hôpital Mignot, Le Chesnay, France
| | - Brigitte Hillion
- Dermatology Department, Centre Hospitalier Marne la Vallée, Jossigny, France
| | - Cecile Meni
- Dermatology Department, APHP, Hôpital Necker-Enfants malades, Paris, France
| | - Philippe Saiag
- Dermatology Department, APHP, Hôpital Ambroise Paré, Boulogne-Billancourt, France
| | - Guillaume Bellaud
- Infectious Diseases Department, APHP, Hôpital Tenon, Hôpitaux Universitaires Paris-Est, Paris, France
| | - Alexandre Bleibtreu
- Infectious Diseases Department, APHP, Hôpital Bichat Claude Bernard, Paris, France
| | - Sylvie Lariven
- Infectious Diseases Department, APHP, Hôpital Bichat Claude Bernard, Paris, France
| | - Diane Bollens
- Infectious Diseases Department, APHP, Hôpital Saint-Antoine, Paris, France
| | - Vincent Descamps
- Dermatology Department, APHP, Hôpital Bichat Claude Bernard, Paris, France
| | - Jean-Michel Molina
- Infectious Diseases Department, APHP, Hôpital Saint-Louis, Paris, France
| | - Olivier Bouchaud
- Infectious Diseases Department, APHP, Hôpital Avicenne, Bobigny, France
| | - Daniel Vittecoq
- Infectious Diseases Department, APHP, CHU Bicêtre, Le Kremlin Bicêtre, France
| | - Gia Do-Pham
- Service de Médecine Interne, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Francoise Foulet
- Research Group Dynamic, EA7380, Faculté de Santé de Créteil, Ecole Nationale Vétérinaire d'Alfort, USC ANSES, Université Paris-Est Créteil, Créteil, France
| | - Francoise Botterel
- Research Group Dynamic, EA7380, Faculté de Santé de Créteil, Ecole Nationale Vétérinaire d'Alfort, USC ANSES, Université Paris-Est Créteil, Créteil, France
| | - Olivier Chosidow
- Dermatology Department, Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpital Henri-Mondor, Créteil, France
| | - Charlotte Bernigaud
- Dermatology Department, Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpital Henri-Mondor, Créteil, France.
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Xu T, Durst M, Keck T, Dixon H, Yassin MH. A Scabies Outbreak in an Inpatient Rehabilitation Setting. Am J Infect Control 2022; 51:705-709. [DOI: 10.1016/j.ajic.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 10/03/2022] [Accepted: 10/04/2022] [Indexed: 11/30/2022]
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Mow M, Thean LJ, Parnaby M, Mani J, Rafai E, Sahukhan A, Kama M, Tuicakau M, Kado J, Romani L, Engelman D, Whitfeld M, Kaldor J, Steer A, Carvalho N. Costs of mass drug administration for scabies in Fiji. PLoS Negl Trop Dis 2022; 16:e0010147. [PMID: 35113888 PMCID: PMC8846527 DOI: 10.1371/journal.pntd.0010147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 02/15/2022] [Accepted: 01/05/2022] [Indexed: 12/03/2022] Open
Abstract
In 2019, the Murdoch Children’s Research Institute in partnership with the Fiji Ministry of Health and Medical Services carried out an integrated mass drug administration (MDA) for the treatment of scabies and lymphatic filariasis in the Northern Division of Fiji (population estimate 131,914). We conducted a retrospective micro-costing exercise focused on the cost of scabies control in order to inform budgeting and policy decision making in an endemic setting. We collected detailed information on financial and economic costs incurred by both parties during the course of the MDA campaign (April 2018 to July 2019). We also conducted interviews with personnel involved in the financial administration of the MDA campaign. The economic cost of delivering two doses of ivermectin was US$4.88 per person. The cost of donated drugs accounted for 36.3% of total MDA costs. In this first large-scale MDA for the public health control of scabies, the estimated cost of delivering MDA per person for scabies was considerably more expensive than the costs reported for other neglected tropical diseases. The important cost drivers included the remuneration of health care workers who were extensively involved in the campaign, coverage of hard-to-reach, mainly rural populations and the two-dose regimen of ivermectin. These results highlight the importance of these cost determinants and can be used to plan current and future MDA programs. Scabies poses a significant burden on both health and economic systems. The Global Burden of Disease estimated that this skin disease affects more than 200 million people globally. However, the economic burden of scabies has not been studied widely and there are limited data on the cost of treating scabies in highly endemic areas. We conducted a costing study of a mass drug administration (MDA) program in the Northern Division of Fiji (population of 131,914). We collected financial and economic costs of administering ivermectin and permethrin to the whole of the Northern Division population in order to estimate the per capita cost of delivering MDA. The costs of MDA for scabies in Fiji were higher than those estimated in previous studies of MDA for other neglected tropical diseases. The study highlights significant cost components of implementing a large-scale MDA and provides key insights for the design and implementation of future MDA programs for scabies. It also adds to the general knowledge in understanding cost inputs and estimating the overall cost-effectiveness of this public health intervention.
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Affiliation(s)
- Maria Mow
- Tropical Diseases Group, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
- * E-mail:
| | - Li Jun Thean
- Tropical Diseases Group, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Matthew Parnaby
- Tropical Diseases Group, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
| | - Jyotishna Mani
- Tropical Diseases Group, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
| | - Eric Rafai
- Ministry of Health and Medical Services, Suva, Fiji
| | | | - Mike Kama
- Ministry of Health and Medical Services, Suva, Fiji
| | | | - Joseph Kado
- Ministry of Health and Medical Services, Suva, Fiji
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia
| | - Lucia Romani
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Daniel Engelman
- Tropical Diseases Group, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
- Melbourne Children’s Global Health, Melbourne Children’s Campus, The Royal Children’s Hospital, Melbourne, Victoria, Australia
| | - Margot Whitfeld
- Department of Dermatology, St. Vincent’s Hospital, Sydney, New South Wales, Australia
- School of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - John Kaldor
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Andrew Steer
- Tropical Diseases Group, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
- Melbourne Children’s Global Health, Melbourne Children’s Campus, The Royal Children’s Hospital, Melbourne, Victoria, Australia
| | - Natalie Carvalho
- School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
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El-Moamly AA. Scabies as a part of the World Health Organization roadmap for neglected tropical diseases 2021-2030: what we know and what we need to do for global control. Trop Med Health 2021; 49:64. [PMID: 34399850 PMCID: PMC8366162 DOI: 10.1186/s41182-021-00348-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 07/05/2021] [Indexed: 01/02/2023] Open
Abstract
Background Scabies is an under-recognized global health problem with an unacceptably high prevalence in many settings worldwide. Fortunately, the World Health Organization (WHO) has formally designated scabies as a neglected tropical disease in 2017, in the hope of increasing awareness and encouraging efforts to eradicate it. Also, scabies has recently been included as part of the WHO roadmap for neglected tropical diseases 2021–2030, aimed at ending the neglect to attain the Sustainable Development Goals. Main abstract body This review article places scabies in focus. The literature was reviewed to explore discussions on controversial issues in scabies control, with the aim of clarifying whether global control of scabies is a feasible and worthwhile objective. The existing status of scabies and its burden are discussed along with future prospects for its global control. The article investigates the feasibility of scabies control and provides updates on the various impediments to this goal, such as challenges related to transmission, diagnosis, treatment, and vaccine development. Also examined are relevant research needs, success factors, and reasons for failure. This article aims to increase the global awareness of scabies and promote discussion, enhance coordinated international efforts, and ultimately, enact change at the national and worldwide levels toward the control of this preventable disease of the poor. Conclusion Despite the current challenges, scabies control is now within reach. With sustained interventions, continuous resources, and sincere commitment and support, scabies global control appears to be a worthwhile, realistic goal that is potentially achievable in the not so distant future.
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Affiliation(s)
- Amal A El-Moamly
- Department of Medical Parasitology, Faculty of Medicine, Suez Canal University, Round Road, Ismailia, Postal Code 41522, Egypt.
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Rinaldi G, Porter K. Mass drug administration for endemic scabies: a systematic review. TROPICAL DISEASES TRAVEL MEDICINE AND VACCINES 2021; 7:21. [PMID: 34193305 PMCID: PMC8247067 DOI: 10.1186/s40794-021-00143-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 06/01/2021] [Indexed: 11/25/2022]
Abstract
Background Scabies is an extremely fastidious infestation caused by the Sarcoptes scabiei mite. It causes a persistent itch that can disrupt a person’s mental health, sleep, and overall quality of life. In endemic areas, treatment by targeting symptomatic individuals and their contacts is often unsuccessful due to an asymptomatic period and high rates of re-infection. To overcome this, Mass Drug Administration (MDA) is often used to treat the whole community, irrespective of whether individuals presently have scabies. This review summarises the evidence for the effectiveness of MDA in treating scabies. Methods An exhaustive literature review was conducted on MEDLINE, EMBASE, Web of Science and Scopus. All peer-reviewed articles published in English January 1990 to March 2020 were eligible and only if the studies were primary and interventional. Furthermore, the intervention had to be a pharmacological MDA method involving human subjects. Results TWELVE articles that qualified for inclusion were identified. MDA for scabies significantly reduced its prevalence in communities at follow up. Some of the drivers of success were communities with low levels of migration, an uptake of MDA of > 85%, the use of oral Ivermectin therapy, the treatment of children and pregnant women within the treated population, and repeated treatment for participants diagnosed with scabies at baseline. Conclusions The average absolute reduction in prevalence of scabies was 22.0% and the relative reduction average was 73.4%. These results suggest MDA is effective in treating scabies in the endemic community. Further evidence is needed surrounding MDA use in urban areas with increased levels of migration. Importantly, MDA should not substitute the tackling of socioeconomic factors which contribute to endemic disease such as good sanitation and hygiene. Supplementary Information The online version contains supplementary material available at 10.1186/s40794-021-00143-5.
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Affiliation(s)
- Giulia Rinaldi
- Institute for Global Health, University College London, London, UK.
| | - Kholoud Porter
- Institute for Global Health, University College London, London, UK
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Crusted scabies; a 2-year prospective study from the Northern Territory of Australia. PLoS Negl Trop Dis 2020; 14:e0008994. [PMID: 33338053 PMCID: PMC7781478 DOI: 10.1371/journal.pntd.0008994] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 01/04/2021] [Accepted: 11/19/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Scabies is listed as a neglected tropical disease by the World Health Organization. Crusted scabies affects vulnerable and immunosuppressed individuals and is highly contagious because of the enormous number of Sarcoptes scabiei mites present in the hyperkeratotic skin. Undiagnosed and untreated crusted scabies cases can result in outbreaks of scabies in residential facilities and can also undermine the success of scabies mass drug administration programs. METHODS AND PRINCIPAL FINDINGS Crusted scabies became a formally notifiable disease in the Northern Territory of Australia in 2016. We conducted a 2-year prospective study of crusted scabies cases notified between March 2016 and February 2018, with subsequent follow up for 22 months. Demographics, clinical and laboratory data, treatment and outcomes were analysed, with cases classified by severity of disease. Over the 2-year study period, 80 patients had 92 episodes of crusted scabies; 35 (38%) were Grade 1 crusted scabies, 36 (39%) Grade 2 and 21 (23%) Grade 3. Median age was 47 years, 47 (59%) were female, 76 (95%) Indigenous Australians and 57 (71%) from remote Indigenous communities. Half the patients were diabetic and 18 (23%) were on dialysis for end-stage kidney failure. Thirteen (16%) patients had no comorbidities, and these were more likely to have Grade 3 disease. Eosinophilia was present in 60% and high immunoglobulin E in 94%. Bacteremia occurred in 11 episodes resulting in one fatality with methicillin-susceptible Staphylococcus aureus bacteremia. Two other deaths occurred during admission and 10 others died subsequent to discharge consequent to comorbidities. Treatment generally followed the recommended guidelines, with 3, 5 or 7 doses of oral ivermectin depending on the documented grade of crusted scabies, together with daily alternating topical scabicides and topical keratolytic cream. While response to this therapy was usually excellent, there were 33 episodes of recurrent crusted scabies with the majority attributed to new infection subsequent to return to a scabies-endemic community. CONCLUSIONS Crusted scabies can be successfully treated with aggressive guideline-based therapy, but high mortality remains from underlying comorbidities. Reinfection on return to community is common while scabies remains endemic.
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Martínez-Pallás I, Aldea-Manrique B, Ramírez-Lluch M, Manuel Vinuesa-Hernando J, Ara-Martín M. Scabies outbreak during home confinement due to the SARS-CoV-2 pandemic. J Eur Acad Dermatol Venereol 2020; 34:e781-e783. [PMID: 32810303 PMCID: PMC7461221 DOI: 10.1111/jdv.16879] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 08/02/2020] [Accepted: 08/11/2020] [Indexed: 11/27/2022]
Affiliation(s)
- I Martínez-Pallás
- Department of Dermatology, Lozano Blesa Clinical Hospital, 15th San Juan Bosco Ave, Zaragoza, Spain
| | - B Aldea-Manrique
- Department of Dermatology, Lozano Blesa Clinical Hospital, 15th San Juan Bosco Ave, Zaragoza, Spain
| | - M Ramírez-Lluch
- Department of Dermatology, Lozano Blesa Clinical Hospital, 15th San Juan Bosco Ave, Zaragoza, Spain
| | | | - M Ara-Martín
- Department of Dermatology, Lozano Blesa Clinical Hospital, 15th San Juan Bosco Ave, Zaragoza, Spain
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Arora P, Rudnicka L, Sar-Pomian M, Wollina U, Jafferany M, Lotti T, Sadoughifar R, Sitkowska Z, Goldust M. Scabies: A comprehensive review and current perspectives. Dermatol Ther 2020; 33:e13746. [PMID: 32484302 DOI: 10.1111/dth.13746] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 05/17/2020] [Accepted: 05/28/2020] [Indexed: 02/06/2023]
Abstract
Human scabies is a contagious skin infestation caused by the parasitic mite Sarcoptes scabiei var. hominis. It is a common skin disease worldwide that occurs not only in the underprivileged sections of society but also in developed countries. In 2009, World Health Organization (WHO) recognized scabies as "neglected tropical disease (NTD)" or NTD thus emphasizing the need for community awareness and proper treatment strategies. This review attempts to summarize the varied clinical presentation of the disease and describes the advances in diagnosis and management including the ongoing search for novel agents to overcome the problems associated with conventional treatments. The literature research includes peer-reviewed articles (clinical trials or scientific reviews). Studies were identified by searching electronic databases (MEDLINE and PubMed) till February 2020 and reference lists of respective articles. Only articles published in English language were included.
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Affiliation(s)
- Pooja Arora
- Department of Dermatology, PGIMER and Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - Lidia Rudnicka
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
| | - Marta Sar-Pomian
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
| | - Uwe Wollina
- Department of Dermatology and Allergology, Städtisches Klinikum Dresden, Academic Teaching Hospital of the Technical University of Dresden, Dresden, Germany
| | - Mohammad Jafferany
- College of Medicine, Central Michigan University, Saginaw, Michigan, USA
| | - Torello Lotti
- University of Studies Guglielmo Marconi, Rome, Italy
| | | | - Zuzanna Sitkowska
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
| | - Mohamad Goldust
- University of Rome G. Marconi, Rome, Italy.,Bidar Skin Center, Tehran, Iran.,Department of Dermatology, University Medical Center Mainz, Mainz, Germany.,Department of Dermatology, University Hospital Basel, Basel, Switzerland
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Kim JH, Cheong HK. Epidemiologic Trends and Seasonality of Scabies in South Korea, 2010-2017. THE KOREAN JOURNAL OF PARASITOLOGY 2019; 57:399-404. [PMID: 31533406 PMCID: PMC6753298 DOI: 10.3347/kjp.2019.57.4.399] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 06/07/2019] [Indexed: 11/23/2022]
Abstract
Scabies is a parasitic skin infection with intense itching. Scabies infection seriously impairs quality of life, while outbreaks in medical institutions cause financial losses. This study aimed to present the annual and seasonal trend of prevalence of scabies in the national population. Scabies cases were extracted from National Health Insurance Service database and its epidemiologic characteristics were assessed. To analyze the seasonality of scabies occurrence, temperature and humidity were included in the model as weather factors, and the per capita gross national income index was adjusted. The annual prevalence by age group was 0.56-0.69 per 1,000 persons until the age of 40 years and peaked at 3.0-4.1 per 1,000 persons in the age group over 80 years. The number of women diagnosed with scabies has been consistently higher compared to that of men since 2010. Mean number of cases diagnosed as scabies was lowest in spring, approximately 4,000 cases, when the average temperature was less than 5°C at 2 months prior, whereas more than 6,000 scabies cases occurred in autumn when temperatures exceeded 25°C at 2 months prior. This study presents the epidemiological characteristics and seasonality of all cases nationwide over 8 years and will help to establish control policies.
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Affiliation(s)
- Jong-Hun Kim
- Department of Social and Preventive Medicine, Sungkyunkwan University School of Medicine, Suwon 16419, Korea
| | - Hae-Kwan Cheong
- Department of Social and Preventive Medicine, Sungkyunkwan University School of Medicine, Suwon 16419, Korea
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Do we know how scabies outbreaks in residential and nursing care homes for the elderly should be managed? A systematic review of interventions using a novel approach to assess evidence quality. Epidemiol Infect 2019; 147:e250. [PMID: 31496448 PMCID: PMC6805746 DOI: 10.1017/s0950268819001249] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Currently no national guidelines exist for the management of scabies outbreaks in residential or nursing care homes for the elderly in the United Kingdom. In this setting, diagnosis and treatment of scabies outbreaks is often delayed and optimal drug treatment, environmental control measures and even outcome measures are unclear. We undertook a systematic review to establish the efficacy of outbreak management interventions and determine evidence-based recommendations. Four electronic databases were searched for relevant studies, which were assessed using a quality assessment tool drawing on STROBE guidelines to describe the quality of observational data. Nineteen outbreak reports were identified, describing both drug treatment and environmental management measures. The quality of data was poor; none reported all outcome measures and only four described symptom relief measures. We were unable to make definitive evidence-based recommendations. We draw on the results to propose a framework for data collection in future observational studies of scabies outbreaks. While high-quality randomised controlled trials are needed to determine optimal drug treatment, evidence on environmental measures will need augmentation through other literature studies. The quality assessment tool designed is a useful resource for reporting of outcome measures including patient-reported measures in future outbreaks.
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Delaunay P, Hérissé A, Hasseine L, Chiaverini C, Tran A, Mary C, Del Giudice P, Marty P, Akhoundi M, Hubiche T. Scabies polymerase chain reaction with standardized dry swab sampling: an easy tool for cluster diagnosis of human scabies. Br J Dermatol 2019; 182:197-201. [DOI: 10.1111/bjd.18017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2019] [Indexed: 11/27/2022]
Affiliation(s)
- P. Delaunay
- Parasitologie‐Mycologie Hôpital de l'Archet Centre Hospitalier Universitaire de Nice Nice France
- MIVEGEC UMR IRD 224‐CNRS 5290‐Université de Montpellier Montpellier France
| | - A.L. Hérissé
- Parasitologie‐Mycologie Hôpital de l'Archet Centre Hospitalier Universitaire de Nice Nice France
- Urgences Pédiatriques Centre Hospitalier Universitaire Hôpital Pédiatrique Lenval Nice France
| | - L. Hasseine
- Parasitologie‐Mycologie Hôpital de l'Archet Centre Hospitalier Universitaire de Nice Nice France
| | - C. Chiaverini
- Dermatologie Hôpital de l'Archet Centre Hospitalier Universitaire de Nice Nice France
| | - A. Tran
- Urgences Pédiatriques Centre Hospitalier Universitaire Hôpital Pédiatrique Lenval Nice France
| | - C. Mary
- Parasitologie‐Mycologie Assistance Publique des Hôpitaux de Marseille Hôpital de La Timone Marseille France
| | | | - P. Marty
- Parasitologie‐Mycologie Hôpital de l'Archet Centre Hospitalier Universitaire de Nice Nice France
- Inserm U1065 Centre Méditerranéen de Médecine Moléculaire Université Nice‐Sophia Antipolis Nice France
| | - M. Akhoundi
- Parasitologie‐Mycologie Hôpital de l'Archet Centre Hospitalier Universitaire de Nice Nice France
- MIVEGEC UMR IRD 224‐CNRS 5290‐Université de Montpellier Montpellier France
| | - T. Hubiche
- Dermatologie Hôpital de l'Archet Centre Hospitalier Universitaire de Nice Nice France
- Infectiologie‐Dermatologie Hôpital Bonnet Fréjus France
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16
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Chandler D, Fuller L. A Review of Scabies: An Infestation More than Skin Deep. Dermatology 2018; 235:79-90. [DOI: 10.1159/000495290] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 11/12/2018] [Indexed: 11/19/2022] Open
Abstract
Human scabies, a common infestation, has a worldwide distribution with a variable impact and presentation depending on the clinical situation. In developed, high-income settings, health institution and residential home outbreaks challenge health and social care services. In resource-poor settings, it is the downstream sequelae of staphylococcal and streptococcal bacteraemia, induced by scratching, which have a significant impact on the long-term health of communities. Over the past decade scabies has been recognised as a “neglected tropical disease” (NTD) by the World Health Organisation, has an accepted practical system of global diagnostic criteria and is being adopted into integrated programmes of mass drug administration for NTDs in field settings. This review seeks to summarise the recent advances in the understanding of scabies and highlight the advocacy and research headlines with their implication for diagnosis and management of outbreaks and individuals. In addition, it will indicate the priorities and questions that remain.
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Marotta M, Toni F, Dallolio L, Toni G, Leoni E. Management of a family outbreak of scabies with high risk of spread to other community and hospital facilities. Am J Infect Control 2018; 46:808-813. [PMID: 29397231 DOI: 10.1016/j.ajic.2017.12.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 12/06/2017] [Accepted: 12/06/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND In developed countries, scabies is observed sporadically or as institutional outbreaks in hospitals and other health facilities. In the family context, outbreaks generally involve a limited number of cases. METHODS A local health authority in Emilia-Romagna (Northern Italy) carried out an epidemiologic investigation on a family outbreak of scabies that included an unusually high number of cases. Its possible connection with a nosocomial case in a long-term care facility (LTCF) and outbreak management are discussed. RESULTS Among the household members, 8 confirmed cases occurred (attack rate, 87.5%). Another case was reported in a patient of an LTCF where one of the family cases worked as a sociosanitary operator. In total, 244 contacts were placed under surveillance. The control strategy focused on a mass information campaign addressed to all contacts and the training of health care personnel. In addition, specific prophylaxis (permethrin 5%) was performed in 108 high-risk contacts and LTCF patients and staff. CONCLUSIONS The control measures were successful in preventing the spread of the outbreak. However, misdiagnosis and the tendency of people to hide the symptoms caused the late recognition and underestimation of the cases, contributing to delayed control measures and increasing the economic and human resources required for outbreak management.
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Affiliation(s)
- Manfredo Marotta
- Unit of Hygiene and Public Health, Local Health Authority of Romagna, Rimini, Italy
| | - Francesco Toni
- Unit of Hygiene and Public Health, Local Health Authority of Romagna, Rimini, Italy
| | - Laura Dallolio
- Department of Biomedical and Neuromotor Sciences, Unit of Hygiene, Public Health and Medical Statistics, University of Bologna, Bologna, Italy.
| | - Greta Toni
- Unit of Hygiene and Public Health, Local Health Authority of Romagna, Rimini, Italy
| | - Erica Leoni
- Department of Biomedical and Neuromotor Sciences, Unit of Hygiene, Public Health and Medical Statistics, University of Bologna, Bologna, Italy
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Thomas J, Davey R, Peterson GM, Carson C, Walton SF, Spelman T, Calma T, Dettwiller P, Tobin J, McMillan F, Collis P, Naunton M, Kosari S, Christenson JK, Bartholomaeus A, McEwen J, Fitzpatrick P, Baby KE. Treatment of scabies using a tea tree oil-based gel formulation in Australian Aboriginal children: protocol for a randomised controlled trial. BMJ Open 2018; 8:e018507. [PMID: 29858405 PMCID: PMC5988111 DOI: 10.1136/bmjopen-2017-018507] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION In remote Aboriginal communities in Australia, scabies affects 7 out of 10 children before their first birthday. This is more than six times the rate seen in the rest of the developed world. Scabies infestation is frequently complicated by bacterial infection, leading to the development of skin sores and other more serious consequences, such as septicaemia and chronic heart and kidney diseases. Tea tree oil (TTO) has been used as an antimicrobial agent for several decades with proven clinical efficacy. Preclinical investigations have demonstrated superior scabicidal properties of TTO compared with widely used scabicidal agents, such as permethrin 5% cream and ivermectin. However, current data are insufficient to warrant a broad recommendation for its use for the management of scabies because previous studies were small or limited to in vitro observations. METHODS AND ANALYSIS A pragmatic first trial will examine the clinical efficacy of a simple and low-cost TTO treatment against paediatric scabies and the prevention of associated secondary bacterial infections, with 1:1 randomisation of 200 participants (Aboriginal children, aged 5-16 years and living in remote Australia) into active control (permethrin 5% cream) and treatment (5% TTO gel) groups. The primary outcome for the study is clinical cure (complete resolution). Secondary outcome measures will include relief of symptoms, recurrence rate, adverse effects, adherence to treatment regimen and patient acceptability. ETHICS AND DISSEMINATION The project has received approvals from the University of Canberra Human Research Ethics Committee (HREC 16-133), Wurli-Wurlinjang Health Service Indigenous subcommittee and the Aboriginal Medical Services Alliance Northern Territory reference group. The results of this study will be published in core scientific publications, with extensive knowledge exchange activities with non-academic audiences throughout the duration of the project. TRIAL REGISTRATION ACTRN12617000902392; Pre-results.
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Affiliation(s)
- Jackson Thomas
- Faculty of Health, University of Canberra, Canberra, Australia
| | - Rachel Davey
- Faculty of Health, University of Canberra, Canberra, Australia
| | | | - Christine Carson
- School of Medicine and Pharmacology, The University of Western Australia, Perth, Australia
- Translational Renal Research Group, Harry Perkins Institute of Medical Research, Perth, Australia
| | - Shelley F Walton
- Faculty of Science, Health, Education and Engineering, University of the Sunshine Coast, Maroochydore DC, Australia
| | - Tim Spelman
- Burnet Institute for Medical Research and Public Health, Melbourne, Australia
| | - Tom Calma
- University of Canberra, Canberra, Australia
| | - Pascale Dettwiller
- Flinders University Rural Clinic School, Flinders University, Adelaide, Australia
| | - Jacinta Tobin
- Department of Child and Adolescent Health, Mackay Hospital and Health Service, West Mackay, Australia
| | - Faye McMillan
- School of Nursing, Midwifery and Indigenous Health, Charles Sturt University, Bathurst, Australia
| | - Paul Collis
- Faculty of Health, University of Canberra, Canberra, Australia
| | - Mark Naunton
- Faculty of Health, University of Canberra, Canberra, Australia
| | - Sam Kosari
- Faculty of Health, University of Canberra, Canberra, Australia
| | | | | | - John McEwen
- Faculty of Health, University of Canberra, Canberra, Australia
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Abstract
A variety of arthropods, protozoa, and helminths infect the skin and subcutaneous tissues and may be identified by anatomic pathologists in standard cytology and histology preparations. The specific organisms seen vary greatly with the patient's exposure history, including travel to or residence in endemic countries. Arthropods are the most commonly encountered parasites in the skin and subcutaneous tissues and include Sarcoptes scabei, Demodex species, Tunga penetrans, and myiasis-causing fly larvae. Protozoal parasites such as Leishmania may also be common in some settings. Helminths are less often seen, and include round worms (eg, Dirofilaria spp.), tapeworms (eg, Taenia solium, Spirometra spp.), and flukes (eg, Schistosoma spp.). This review covers the epidemiologic and histopathologic features of common parasitic infections of the skin and subcutaneous tissues.
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20
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Thomas J, Christenson JK, Walker E, Baby KE, Peterson GM. Scabies-An ancient itch that is still rampant today. J Clin Pharm Ther 2017; 42:793-799. [DOI: 10.1111/jcpt.12631] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 09/04/2017] [Indexed: 12/31/2022]
Affiliation(s)
- J. Thomas
- Faculty of Health; University of Canberra; Bruce ACT Australia
| | | | - E. Walker
- Faculty of Health; University of Canberra; Bruce ACT Australia
| | - K. E. Baby
- The Canberra Hospital; Yamba Drive; Garran ACT Australia
| | - G. M. Peterson
- Faculty of Health; University of Tasmania; Hobart TAS Australia
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Adler N, Tay J, McLellan S, Klintworth G, Cheng A, Aung A. Nosocomial crusted scabies outbreak: Important infection prevention lessons learned from a small case series. Infect Dis Health 2017. [DOI: 10.1016/j.idh.2017.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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22
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Sunderkötter C, Feldmeier H, Fölster‐Holst R, Geisel B, Klinke‐Rehbein S, Nast A, Philipp S, Sachs B, Stingl J, Stoevesandt J, Hamm H. S1‐Leitlinie zur Diagnostik und Therapie der Skabies – Kurzfassung. J Dtsch Dermatol Ges 2016; 14:1160-1171. [DOI: 10.1111/ddg.13130_g] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Cord Sunderkötter
- Abteilung für Translationale Dermatoinfektiologie und Klinik für Hautkrankheiten Münster
| | - Hermann Feldmeier
- Institut für Mikrobiologie und Hygiene Charité – Universitätsmedizin Berlin
| | | | - Bertram Geisel
- Landesgesundheitsamt Baden‐Württemberg im Regierungspräsidium Stuttgart
| | | | - Alexander Nast
- Division of Evidence based Medicine (dEBM), Klinik für Dermatologie, Venerologie und Allergologie Charité – Universitätsmedizin Berlin
| | - Sandra Philipp
- Klinik für Dermatologie, Venerologie und Allergologie Charité – Universitätsmedizin Berlin
| | | | - Julia Stingl
- Bundesinstitut für Arzneimittel und Medizinprodukte Bonn
| | - Johanna Stoevesandt
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie Universitätsklinikum Würzburg
| | - Henning Hamm
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie Universitätsklinikum Würzburg
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Sunderkötter C, Feldmeier H, Fölster‐Holst R, Geisel B, Klinke‐Rehbein S, Nast A, Philipp S, Sachs B, Stingl J, Stoevesandt J, Hamm H. S1 guidelines on the diagnosis and treatment of scabies – short version. J Dtsch Dermatol Ges 2016; 14:1155-1167. [DOI: 10.1111/ddg.13130] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Cord Sunderkötter
- Department of Translational Dermatoinfectiology and Department of Dermatology Münster Germany
| | - Hermann Feldmeier
- Institute of Microbiology and Hygiene Charité – University Medicine Berlin Germany
| | | | - Bertram Geisel
- State Health Department Baden‐Wurttemberg Regional Administrative Authority Stuttgart Germany
| | | | - Alexander Nast
- Division of Evidence based Medicine (dEBM), Department of Dermatology, Venereology and Allergology Charité – University Medicine Berlin Germany
| | - Sandra Philipp
- Department of Dermatology, Venereology and Allergology Charité – University Medicine Berlin Germany
| | | | - Julia Stingl
- The Federal Institute for Drugs and Medical Devices Bonn
| | - Johanna Stoevesandt
- Department of Dermatology, Venereology and Allergology University Hospital Würzburg
| | - Henning Hamm
- Department of Dermatology, Venereology and Allergology University Hospital Würzburg
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Abstract
Scabies is a common, highly contagious skin parasitosis caused by Sarcoptes scabiei var. hominis. Early identification and prompt treatment of infested subjects is essential, as missed diagnosis may result in outbreaks, considerable morbidity, and significantly increased economic burden. The standard diagnostic technique consists of mites' identification by microscopic examination of scales obtained by skin scraping. This is a time-consuming and risk-associated procedure that is also not suitable to a busy practice. In recent years, some advanced and noninvasive techniques such as videodermatoscopy, dermatoscopy, reflectance confocal microscopy, and optical coherence tomography have demonstrated improved efficacy in the diagnosis of scabies. Their advantages include rapid, noninvasive mass screening and post-therapeutic follow-up, with no physical risk. A greater knowledge of these techniques among general practitioners and other specialists involved in the intake care of overcrowded populations vulnerable to scabies infestations is now viewed as urgent and important in the management of outbreaks, as well as in consideration of the recent growing inflow of migrants in Europe from North Africa.
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Affiliation(s)
- Giuseppe Micali
- Dermatology Clinic, University of Catania, Catania, Italy
- * E-mail:
| | | | | | - Olivier Chosidow
- Department of Dermatology and Allergy, Hôpital Tenon, Paris, France
| | - Robert A. Schwartz
- Dermatology and Pathology, Rutgers University New Jersey Medical School, Newark, New Jersey, United States of America
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Retrospective analysis of institutional scabies outbreaks from 1984 to 2013: lessons learned and moving forward. Epidemiol Infect 2016; 144:2462-71. [PMID: 27019288 DOI: 10.1017/s0950268816000443] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Scabies outbreaks can be disruptive in institutional settings, and are associated with considerable but under-researched morbidity, especially in vulnerable populations. In this paper, we describe key findings from a retrospective review of scabies outbreaks reported in the literature over the past 30 years. We undertook this review to gain insights into the impact of institutional outbreaks, the burden in terms of attack rates, economic costs, treatment trends, the types of index cases and outbreak progression. We found 84 reports over 30 years, with outbreaks most frequently reported in aged care facilities (n = 40) and hospitals (n = 33). On average, scabies outbreaks persisted for 3 months, and the median attack rate was 38%. While 1% lindane was once the most commonly employed acaricide, 5% permethrin and oral ivermectin are increasingly used. Crusted scabies represented the index case for 83% of outbreaks, and scabies was misdiagnosed in 43% outbreaks. The frequency of reported scabies outbreaks has not declined consistently over time suggesting the disease is still highly problematic. We contend that more research and practice emphasis must be paid to improve diagnostic methods, surveillance and control, health staff education and management of crusted scabies to prevent the development of scabies outbreaks in institutional settings.
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Abstract
Background Scabies afflicts millions of people worldwide, but it is very difficult to diagnose by the usual skin scrape test, and a presumptive diagnosis is often made based on clinical signs such as rash and intense itch. A sensitive and specific blood test to detect scabies would allow a physician to quickly make a correct diagnosis. Objective Our objective was to profile the mite-specific antibodies present in the sera of patients with ordinary scabies. Methods Sera of 91 patients were screened for Ig, IgD, IgE, IgG and IgM antibodies to S. scabiei, as well as to the house dust mites Dermatophagoides farinae, D. pteronyssinus and Euroglyphus maynei. Results 45%, 27% and 2.2% of the patients had measurable amounts of mixed Ig, IgG and IgE that recognized scabies mite antigens. However, 73.6% of the scabies patients had serum IgM that recognized scabies proteins, and all except two of them also had IgM that recognized all of the three species of dust mites. No patient had serum antibody exclusively reactive to scabies mite antigens. Conclusions Co-sensitization or cross-reactivity between antigens from scabies and house dust mites confounds developing a blood test for scabies. Scabies, caused by the mite S. scabiei that burrows in the skin of humans, is a contagious skin disease that affects millions of people worldwide. It is a significant public health burden in economically disadvantaged populations, and outbreaks are common in nursing homes, daycare facilities, schools and workplaces in developed countries. It causes significant morbidity, and in chronic cases, associated bacterial infections can lead to renal and cardiac diseases. Scabies is very difficult to diagnose by the usual skin scrape test, and a presumptive diagnosis is often made based on clinical signs such as rash and itch that can mimic other skin disease. A sensitive and specific blood test to detect scabies-specific antibodies would allow a physician to quickly make a correct diagnosis. Our manuscript reports the antibody isotype profiles of the sera of two groups of patients with ordinary scabies (17 from the US and 74 from Brazil) and concludes that such a blood test should be based on circulating IgM type antibodies that do not also recognize antigens of the related and ubiquitous house dust mites. Both are important considerations for research for developing a blood test for the diagnosis of scabies.
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Jungbauer FH, Veenstra-Kyuchukova YK, Koeze J, KruijtSpanjer MR, Kardaun SH. Management of nosocomial scabies, an outbreak of occupational disease. Am J Ind Med 2015; 58:577-82. [PMID: 25777802 DOI: 10.1002/ajim.22438] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2015] [Indexed: 11/09/2022]
Abstract
BACKGROUND The optimal approach to managing institutional scabies outbreaks has yet to be defined. We report on outbreak managements are needed. METHODS We report on a large outbreak of scabies in three acute care wards in a tertiary university teaching hospital in the Netherlands. RESULTS The outbreak potentially effected 460 patients and 185 health care workers who had been exposed to the index patient. CONCLUSION Containment of an outbreak relies on a quick and strict implementation of appropriate infection control measures and should include simultaneous treatment of all infested persons and exposed contacts to prevent secondary spread and prolonged post-intervention surveillance.
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Affiliation(s)
- Frank H.W. Jungbauer
- Department of Occupational Health; University of Groningen; Groningen the Netherlands
| | - Yanka K. Veenstra-Kyuchukova
- Department of Medical Microbiology and Infection Prevention Bacteriology and Hospital Hygiene; University of Groningen; Groningen the Netherlands
| | - Jacqueline Koeze
- Department of Critical Care; University of Groningen; Groningen the Netherlands
| | | | - Sylvia H. Kardaun
- Department of Dermatology; University Medical Centre Groningen; University of Groningen; Groningen the Netherlands
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Development of Conventional and Real-Time Quantitative PCR Assays for Diagnosis and Monitoring of Scabies. J Clin Microbiol 2015; 53:2095-102. [PMID: 25903566 DOI: 10.1128/jcm.00073-15] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 04/13/2015] [Indexed: 11/20/2022] Open
Abstract
Scabies remains the most prevalent, endemic, and neglected ectoparasitic infestation globally and can cause institutional outbreaks. The sensitivity of routine microscopy for demonstration of Sarcoptes scabiei mites or eggs in skin scrapings is only about 50%. Except for three studies using conventional or two-tube nested PCR on a small number of cases, no systematic study has been performed to improve the laboratory diagnosis of this important infection. We developed a conventional and a real-time quantitative PCR (qPCR) assay based on the mitochondrial cytochrome c oxidase subunit 1 (cox1) gene of S. scabiei. The cox1 gene is relatively well conserved, with its sequence having no high levels of similarity to the sequences of other human skin mites, pathogenic zoonotic mites, or common house dust mite species. This mitochondrial gene is also present in large quantities in arthropod cells, potentially improving the sensitivity of a PCR-based assay. In our study, both assays were specific and were more sensitive than microscopy in diagnosing scabies, with positive and negative predictive values of 100%. The S. scabiei DNA copy number in the microscopy-positive specimens was significantly higher than that in the microscopy-negative specimens (median S. scabiei DNA copy number, 3.604 versus 2.457 log10 copies per reaction; P = 0.0213). In the patient with crusted scabies, the qPCR assay performed on lesional skin swabs instead of scrapings revealed that the parasite DNA load took about 2 weeks to become negative after treatment. The utility of using lesional skin swabs as an alternative sample for diagnosis of scabies by PCR should be further evaluated.
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Head MG, Walker SL, Nalabanda A, Bostock J, Cassell JA. Researching Scabies Outbreaks among People in Residential Care and Lacking Capacity to Consent: A Case Study. Public Health Ethics 2015. [DOI: 10.1093/phe/phv011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
Scabies infection is antediluvian and ubiquitous both in developing and developed countries, yet often neglected. Scabies has a predilection to infect vulnerable subsets of population in crowding conditions, typically applicable to residents in the nursing home. The mite incites a unique immunological response from human hosts. Scabies does not manifest as a singular skin condition and may present atypically in older adults, the majority of nursing home residents, where delay has deleterious consequences. Further, pruritus or itching, the hallmark of scabies infection, is a common complaint from a variety of causes among older adults. Hence, the diagnosis is often delayed or missed. There are several pharmacological treatment options; long-term care practitioners need to understand the characteristics of each agent before selection. Even more relevant is the importance of nonpharmacological aspects of management, crucial in the success of averting spread or outbreaks in long-term care settings.
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Scabies outbreaks in residential care homes: factors associated with late recognition, burden and impact. A mixed methods study in England. Epidemiol Infect 2014; 143:1542-51. [PMID: 25195595 DOI: 10.1017/s0950268814002143] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Scabies is an important public health problem in residential care homes. Delayed diagnosis contributes to outbreaks, which may be prolonged and difficult to control. We investigated factors influencing outbreak recognition, diagnosis and treatment, and staff experiences of outbreak control, identifying areas for intervention. We carried out a semi-structured survey of managers, affected residents and staff of seven care homes reporting suspected scabies outbreaks in southern England over a 6-month period. Attack rates ranged from 2% to 50%, and most cases had dementia (37/39, 95%). Cases were diagnosed clinically by GPs (59%) or home staff (41%), none by dermatologists. Most outbreaks were attributable to avoidably late diagnosis of the index case. Participants reported considerable challenges in managing scabies outbreaks, including late diagnosis and recognition of outbreaks; logistically difficult mass treatment; distressing treatment processes and high costs. This study demonstrates the need for improved support for care homes in detecting and managing these outbreaks.
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Murakonda P, Yazdanbaksh K, Dharmarajan TS. Scabies in the nursing home, misdiagnosis means costs, and embarrassment: story of a centenarian smitten by scabies! J Am Med Dir Assoc 2013; 15:74-5. [PMID: 24359700 DOI: 10.1016/j.jamda.2013.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 11/04/2013] [Indexed: 11/18/2022]
Affiliation(s)
- Padmavathi Murakonda
- Montefiore Medical Center (Wakefield Campus), Bronx, NY; University Hospital of Albert Einstein College of Medicine, Bronx, NY; New York Medical College, Valhalla, NY
| | - Khashayar Yazdanbaksh
- Montefiore Medical Center (Wakefield Campus), Bronx, NY; University Hospital of Albert Einstein College of Medicine, Bronx, NY
| | - T S Dharmarajan
- Montefiore Medical Center (Wakefield Campus), Bronx, NY; University Hospital of Albert Einstein College of Medicine, Bronx, NY; New York Medical College, Valhalla, NY
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Abstract
PURPOSE OF REVIEW Features of endemic scabies are specific in resource-poor and underprivileged communities, with implications for control measures on the community level. In this review, these special aspects are addressed. RECENT FINDINGS Scabies is endemic in many resource-poor communities, with a prevalence of 20% and higher. Transmission is influenced by social attitudes, migration, access to healthcare services, housing conditions, hygiene conditions, and crowding. Endemic scabies occurs with severe infestations, complications, and sequels, mainly in children. Sleep loss as a result of scabies-related itching is common. Complications include secondary infections by group A streptococci and acute poststreptococcal glomerulonephritis. Shame, restriction of leisure activities, and stigmatization are common. Treatment of scabies includes a variety of topical compounds, but control on the community level is not an easy task. As ivermectin kills a variety of other parasites, this oral drug is increasingly used for mass treatment. Intervention should address socioemotional aspects using an integrated approach with professionals from different areas, and the community. SUMMARY Scabies is a neglected disease and needs to be perceived as an important public health problem causing morbidity in many resource-poor communities. Future work on epidemiology, clinical aspects, transmission dynamics, socioeconomic aspects, and sustainable control in resource-poor communities is needed.
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Investigation of a scabies outbreak in a kindergarten in Constance, Germany. Eur J Clin Microbiol Infect Dis 2012; 32:373-80. [DOI: 10.1007/s10096-012-1752-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Accepted: 09/10/2012] [Indexed: 10/27/2022]
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Stoevesandt J, Carlé L, Leverkus M, Hamm H. Control of large institutional scabies outbreaks. J Dtsch Dermatol Ges 2012; 10:637-47. [PMID: 22458610 DOI: 10.1111/j.1610-0387.2012.07892.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Scabies outbreaks in community facilities may reach large dimensions and take a protracted course. Highly contagious crusted scabies is a major cause of nosocomial outbreaks. PATIENTS AND METHODS On the occasion of an extensive scabies outbreak in a north Bavarian sheltered workshop and its associated residential homes with over 500 exposed individuals, a multifaceted control strategy was developed and pursued. Knowledge from a comprehensive review of the literature was utilized. RESULTS Our successful scabies elimination concept includes: 1) Careful organization (formation of an outbreak management team, registration and information of all exposed individuals, prospective time management, financial calculation); 2) simultaneous clinical examination of all individuals at risk; 3) synchronous topical treatment of all exposed individuals with permethrin 5 % cream on day 0, repeated treatment of proven and doubtful cases on days 1 and 14; systemic treatment of selected cases with oral ivermectin; 4) decontamination and quarantine measures; 5) follow-up investigations and repeated treatment if indicated. CONCLUSIONS Management of large institutional scabies outbreaks requires a high degree of motivation, communication skills and perseverance.
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Affiliation(s)
- Johanna Stoevesandt
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Josef-Schneider-Straße 2, Würzburg, Germany.
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Rosendahl C, Cameron A, Weedon D. Pre-emptive diagnosis of a case of scabies by dermatopathology. Dermatol Pract Concept 2012. [PMID: 24765554 DOI: 10.5826/dpc.0201a12.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2022] Open
Affiliation(s)
| | | | - David Weedon
- Sullivan Nicolaides Pathology, Brisbane, Australia
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Leung V, Miller M. Detection of scabies: A systematic review of diagnostic methods. THE CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY = JOURNAL CANADIEN DES MALADIES INFECTIEUSES ET DE LA MICROBIOLOGIE MEDICALE 2011; 22:143-6. [PMID: 23205026 PMCID: PMC3222761 DOI: 10.1155/2011/698494] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Accurate diagnosis of scabies infection is important for patient treatment and for public health control of scabies epidemics. OBJECTIVE To systematically review the accuracy and precision of history, physical examination and tests for diagnosing scabies. METHODS Using a structured search strategy, Medline and Embase databases were searched for English and French language articles that included a diagnosis of scabies. Studies comparing history, physical examination and/or any diagnostic tests with the reference standard of microscopic visualization of mites, eggs or fecal elements obtained from skin scrapings or biopsies were included for analysis. Data were extracted using standard criteria. RESULTS History and examination of pruritic dermatoses failed to accurately diagnose scabies infection. Dermatoscopy by a trained practitioner has a positive likelihood ratio of 6.5 (95% CI 4.1 to 10.3) and a negative likelihood ratio of 0.1 (95% CI 0.06 to 0.2) for diagnosing scabies. The accuracy of other diagnostic tests could not be calculated from the data in the literature. CONCLUSIONS In the face of such diagnostic inaccuracy, clinical judgment is still practical in diagnosing scabies. Two tests are used - the burrow ink test and handheld dermatoscopy. The burrow ink test is a simple, rapid, noninvasive test that can be used to screen a large number of patients. Handheld dermatoscopy is an accurate test, but requires special equipment and trained practitioners. Given the morbidity and costs of scabies infection, and that studies to date lack adequate internal and external validity, research to identify or develop accurate diagnostic tests for scabies infection is needed and justifiable.
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Affiliation(s)
- Victor Leung
- Division of Infectious Diseases, Department of Medicine, McGill University
| | - Mark Miller
- Division of Infectious Diseases, Department of Medicine, Jewish General Hospital, Montreal, Quebec
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Abstract
PURPOSE OF REVIEW In industrialized countries, epidemics of scabies are mainly described within families or in institutions such as healthcare settings. Control of institutional scabies is associated with a considerable working and economic burden, but guidelines for the management are scarce. RECENT FINDINGS The prevalence of institutional scabies is probably underestimated. Identified risk factors for institutional scabies outbreaks include the institution type, extensive physical contact with patients and movement of patients, the existence of crusted scabies, a long diagnostic delay and failures in implementation of infection control or treatment plans.Atypical clinical features (hyperinfestation, scabies in the elderly or in children) may be misdiagnosed. Control of institutional scabies outbreaks relies on prompt recognition of the index case, constitution of an outbreak management team, determination of the extent of the outbreak and risk factors for spread, immediate implementation of infection control practices, adequate education of all involved persons, simultaneous treatment of cases and of all exposed individuals and concomitant environmental disinfection. Prolonged surveillance is imperative to eradicate scabies. SUMMARY The inclusion of institutionalized patients in randomized controlled trials would be beneficial as present data concerning scabicide effectiveness are obtained from trials that recruited individual participants and do not take into account a global strategy.
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Abstract
Scabies is an ectoparasite caused by the mite Sarcoptes scabiei var hominis, an obligate human parasite. There are about 300 million cases of scabies in the world each year. Common predisposing factors are overcrowding, immigration, poor hygiene, poor nutritional status, homelessness, dementia, and sexual contact. Direct skin-to-skin contact between 15 and 20 minutes is needed to transfer the mites from one person to another. The diagnosis suspected with a clinical history of itch, worse at night, affecting other family members, clinical distribution, and appearance. Definite diagnosis relies on microscopic identification of the mites, eggs, or fecal pellets with 10% potassium hydroxide, ink enhancement, tetracycline fluorescence tests, or mineral oil; other methods include: epiluminescence light microscopy and S. scabiei DNA. The most commonly used treatment modalities are permethrin and ivermectin. Persistence of symptoms for 2-6 weeks after successful treatment is common. Most recurrences are because of reinfection from untreated contacts.
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Affiliation(s)
- Maria I Hicks
- Geisinger Dermatology, Danville, Pennsylvania 17822, USA.
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Smith PW, Bennett G, Bradley S, Drinka P, Lautenbach E, Marx J, Mody L, Nicolle L, Stevenson K. SHEA/APIC guideline: infection prevention and control in the long-term care facility, July 2008. Infect Control Hosp Epidemiol 2008; 29:785-814. [PMID: 18767983 PMCID: PMC3319407 DOI: 10.1086/592416] [Citation(s) in RCA: 163] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Philip W Smith
- Professor of Infectious Diseases, Colleges of Medicine and Public Health, University of Nebraska Medical Center, Omaha, Nebraska 68198-5400, USA.
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Smith PW, Bennett G, Bradley S, Drinka P, Lautenbach E, Marx J, Mody L, Nicolle L, Stevenson K. SHEA/APIC Guideline: Infection prevention and control in the long-term care facility. Am J Infect Control 2008; 36:504-35. [PMID: 18786461 PMCID: PMC3375028 DOI: 10.1016/j.ajic.2008.06.001] [Citation(s) in RCA: 135] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2007] [Revised: 05/07/2008] [Accepted: 05/19/2008] [Indexed: 01/09/2023]
Affiliation(s)
- Philip W Smith
- College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska 68198-5400, USA.
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Matheï C, Niclaes L, Suetens C, Jans B, Buntinx F. Infections in residents of nursing homes. Infect Dis Clin North Am 2008; 21:761-72, ix. [PMID: 17826622 DOI: 10.1016/j.idc.2007.07.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Infectious diseases are a very common occurrence in nursing homes. While the reasons for preventing infections are the same in nursing homes and in acute hospitals, several considerations relevant to prevention of infection differ in nursing homes. Infection control measures should be based upon the particularities of the specific setting of a nursing home and its residents.
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Affiliation(s)
- Catharina Matheï
- Department of General Practice, KU Leuven, Kapucijnenvoer 33 blok J, 3000 Leuven, Belgium.
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Garcia C, Iglesias D, Terashima A, Canales M, Gotuzzo E. Use of ivermectin to treat an institutional outbreak of scabies in a low-resource setting. Infect Control Hosp Epidemiol 2007; 28:1337-8. [PMID: 17994513 DOI: 10.1086/521657] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2007] [Accepted: 07/05/2007] [Indexed: 11/03/2022]
Abstract
In a limited-resource hospital in Lima, Peru, 23 (63.9%) of 36 healthcare workers developed pruritus and/or skin lesions after contact with a patient with classic scabies. Of these 23, a total of 5 healthcare workers had scabies confirmed by microscopy. Oral ivermectin was used to control the outbreak effectively.
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Affiliation(s)
- Coralith Garcia
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru.
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Walton SF, Currie BJ. Problems in diagnosing scabies, a global disease in human and animal populations. Clin Microbiol Rev 2007; 20:268-79. [PMID: 17428886 PMCID: PMC1865595 DOI: 10.1128/cmr.00042-06] [Citation(s) in RCA: 188] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Scabies is a worldwide disease and a major public health problem in many developing countries, related primarily to poverty and overcrowding. In remote Aboriginal communities in northern Australia, prevalences of up to 50% among children have been described, despite the availability of effective chemotherapy. Sarcoptic mange is also an important veterinary disease engendering significant morbidity and mortality in wild, domestic, and farmed animals. Scabies is caused by the ectoparasitic mite Sarcoptes scabiei burrowing into the host epidermis. Clinical symptoms include intensely itchy lesions that often are a precursor to secondary bacterial pyoderma, septicemia, and, in humans, poststreptococcal glomerulonephritis. Although diagnosed scabies cases can be successfully treated, the rash of the primary infestation takes 4 to 6 weeks to develop, and thus, transmission to others often occurs prior to therapy. In humans, the symptoms of scabies infestations can mimic other dermatological skin diseases, and traditional tests to diagnose scabies are less than 50% accurate. To aid early identification of disease and thus treatment, a simple, cheap, sensitive, and specific test for routine diagnosis of active scabies is essential. Recent developments leading to the expression and purification of S. scabiei recombinant antigens have identified a number of molecules with diagnostic potential, and current studies include the investigation and assessment of the accuracy of these recombinant proteins in identifying antibodies in individuals with active scabies and in differentiating those with past exposure. Early identification of disease will enable selective treatment of those affected, reduce transmission and the requirement for mass treatment, limit the potential for escalating mite resistance, and provide another means of controlling scabies in populations in areas of endemicity.
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Affiliation(s)
- Shelley F Walton
- Menzies School of Health Research, Institute of Advanced Studies, Charles Darwin University, and Department of Medicine, Royal Darwin Hospital, Casuarina NT 0811, Australia.
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