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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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Lee E, Park SY, Lee E, Kim TH. Previous Long-term Care Facility Admission as a Risk Factor for Scabies in a Medical Facility. J Korean Med Sci 2021; 36:e337. [PMID: 34931498 PMCID: PMC8688348 DOI: 10.3346/jkms.2021.36.e337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 11/11/2021] [Indexed: 11/21/2022] Open
Abstract
The study aimed to elucidate simple and effective risk factors for scabies infection in the medical environment for early detection and prevention of exposure to other patients and medical staff. We conducted a case-control study of patients who were diagnosed with scabies among hospitalized patients between 2008 and 2019 in an acute-care teaching hospital. Each case was matched according to sex and age with two randomly selected controls without scabies during hospitalization. Clinical characteristics of cases at the time of hospital admission were compared to those of the control group. The scabies group included 34 patients and 68 patients who were included in the control group. After adjusting for confounding factors, previous long-term care facility admission was only associated with scabies (adjusted odds ratio, 5.44; 95% confidence interval, 1.46-20.27; P = 0.012). Careful examination, particularly for patients with previous long-term care facility admission, might be useful for the early detection of scabies.
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Affiliation(s)
- Eunyoung Lee
- Division of Infectious Diseases, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Se Yoon Park
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea.
| | - Eunjung Lee
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Tae Hyong Kim
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
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Sunderkötter C, Wohlrab J, Hamm H. Scabies: Epidemiology, Diagnosis, and Treatment. DEUTSCHES ARZTEBLATT INTERNATIONAL 2021; 118:695-704. [PMID: 34615594 DOI: 10.3238/arztebl.m2021.0296] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 03/26/2021] [Accepted: 07/14/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Scabies is a skin infestation whose incidence is apparently rising. METHODS This review is based on pertinent articles retrieved by a selective search of PubMed on diagnosis and treatment strategies. RESULTS Thread-like papules (burrows), new, intense pruritus, and dermatitis guide the suspected diagnosis which is confirmed by the microscopic or dermatoscopic demonstration of scabies mites. The first line therapy is topical application of permethrin, in accordance with the current recommendations for its use. Other treatment options include systemic ivermectin and topical crotamiton or benzyl benzoate. A combination of permethrin and ivermectin is used to treat otherwise intractable cases and is generally indicated for the treatment of crusted scabies. Known causes of treatment failure include improper application of the external agents, failure of repeated treatment with ivermectin, incomplete decontamination of furnishings and clothes, failure to simultaneously treat contact persons, absence of written documents explaining treatment modalities, and the patient's belonging to a risk group. Even though there has not yet been any direct proof of resistance of scabies mites to permethrin, there is a rising number of welldocumented cases of poor response to this agent. Moxidectin is a new substance now undergoing clinical testing. CONCLUSION Treatment of scabies according to the guidelines and the additional recommendations reported here should result in effective curing, even in cases that are thought to be intractable.
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Affiliation(s)
- Cord Sunderkötter
- Department of Dermatology and Venereology, Martin Luther University Halle-Wittenberg, Halle (Saale); Institute of Applied Dermatopharmacy, Martin Luther University Halle-Wittenberg, Halle (Saale); Department of Dermatology, Venereology and Allergology, University Hospital Würzburg
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Jastaniah MWA, Zimmo ZFK, Bakallah MWS, Hantoush MSS, Abdal-Aziz M. Clinical presentation and risk factors of increased scabies cases in the Western region of Saudi Arabia in 2016-2018. Saudi Med J 2020; 40:820-827. [PMID: 31423520 PMCID: PMC6718851 DOI: 10.15537/smj.2019.8.24360] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To describe the clinical characteristics of scabies in the Makkah province and analyze risk factors associated with the outbreak. Methods: A cross-sectional study was conducted between June 2016 and June 2018 by collecting the data of patients reported to have infestations at King Abdulaziz Medical City, Makkah, Saudi Arabia. A comparative analysis was conducted of patients reported before and during the outbreak of scabies. Results: Of the 352 patients identified, the range of cases was 0-24 cases per month before the months of the outbreak (March to April 2018). However, the actual number of cases reported increased 2.8 times the expected maximum in April 2018. Saudi nationals were 2.5 times more affected than non-Saudi nationals during the outbreak period compared to before the outbreak (95%CI: 1.02, 6.05, p=0.045). Symptoms involving upper arms, axillae (53.7% versus 68.7%, p=0.048), and torso (50% versus 66.4%, p=0.033) were significantly under-represented among outbreak patients. The presence of additional comorbidities was reported more frequently in patients diagnosed with scabies before versus during the outbreak months (25.8% versus 8.2%, p=0.014). Permethrin prescriptions increased (75.6% versus 41%), crotamiton prescriptions decreased (13.5% versus 48%), and the hospitalization was lower (3.8% versus 13.5%) during the outbreak. Conclusion: The clinical presentation and risk factors of scabies change significantly with scabies outbreaks, and consequently so do the lines of treatment in Saudi Arabia. The present study highlights the importance of adopting strategies related to community infection control and prevention.
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Affiliation(s)
- Mohammed Wasil A Jastaniah
- Department of Infection Prevention and Control, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, Kingdom of Saudi Arabia. E-mail.
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Mueller SM, Gysin S, Schweitzer M, Schwegler S, Haeusermann P, Itin P, Bart T, Denz RS, Steffen T, Kuehl R, Widmer AF, Brandt O. Implementation and evaluation of an algorithm for the management of scabies outbreaks. BMC Infect Dis 2019; 19:200. [PMID: 30819115 PMCID: PMC6394030 DOI: 10.1186/s12879-019-3818-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Accepted: 02/13/2019] [Indexed: 11/28/2022] Open
Abstract
Background Infestations with scabies mites are a global burden affecting individuals of all ages, classes and ethnicities. As poor sanitation and overcrowding favor the transmission of this highly contagious disease, epidemic outbreaks are frequently observed among displaced persons and asylum seekers. Due to the growing influx of refugees during the last years, public health authorities in host countries are frequently confronted with the challenge to treat individuals with diagnosed or suspected scabies promptly and effectively to avoid further spreading of the infestation. This study aimed to establish a straightforward and efficient algorithm for rapid screening and treatment of large numbers of patients with confirmed or suspected scabies infestations. Methods Forty-eight individuals (58% males, mean age 22.4 yrs.) from Syria with suspected scabies infestation were allocated to 3 colour-coded groups: (1) no signs or symptoms of infestation, (2) itch only, and (3) itch and typical skin lesions. Patients were treated with a single (group 1) or two doses of oral ivermectin at an interval of 7 days (group 2), or with a combination of 2 doses of ivermectin plus 2 applications of permethrin ointment at an interval of 7 days (group 3). Follow-ups were performed 4 weeks after initial treatments. Results All individuals with signs and/or symptoms of infestation had improved skin lesion; in 10/11 (90.9%) lesion had completely resolved. All individuals with initial itch only (n = 32) reported improvement of its intensity or complete resolution. None of the patients of group 1 developed itch or skin lesions. The algorithm was reapplied in 4 individuals (8.3%) after 4 weeks and the outbreak was completely controlled after 8 weeks. Colour-coding ensured fast flow of information between health-care providers at the interfaces of the algorithm. Conclusions Our algorithm proved to be both highly efficient for treatment of large numbers of patients with suspected or diagnosed scabies infestation as well as for prevention of spreading of the disease. Hence, this algorithm is well suited for the management of scabies mass outbreaks.
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Affiliation(s)
- Simon M Mueller
- Department of Dermatology, University Hospital Basel, Petersgraben 4, 4056, Basel, Switzerland.
| | - Stefan Gysin
- Department of Dermatology, University Hospital Basel, Petersgraben 4, 4056, Basel, Switzerland
| | - Michael Schweitzer
- Department of Dermatology, University Hospital Basel, Petersgraben 4, 4056, Basel, Switzerland
| | - Simon Schwegler
- Department of Dermatology, University Hospital Basel, Petersgraben 4, 4056, Basel, Switzerland
| | - Peter Haeusermann
- Department of Dermatology, University Hospital Basel, Petersgraben 4, 4056, Basel, Switzerland
| | - Peter Itin
- Department of Dermatology, University Hospital Basel, Petersgraben 4, 4056, Basel, Switzerland
| | - Thomas Bart
- Department of Health, Medical Services, Social Medicine, 4056, Basel, Canton of Basel-City, Switzerland
| | - Ruth Spieler Denz
- Department of Health, Medical Services, Social Medicine, 4056, Basel, Canton of Basel-City, Switzerland
| | - Thomas Steffen
- Department of Health, Medical Services, Social Medicine, 4056, Basel, Canton of Basel-City, Switzerland
| | - Richard Kuehl
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, 4056, Basel, Switzerland
| | - Andreas F Widmer
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, 4056, Basel, Switzerland
| | - Oliver Brandt
- Department of Dermatology, University Hospital Basel, Petersgraben 4, 4056, Basel, Switzerland
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Affected healthcare workers during outbreaks: A report from the German consulting center for infection control (BZH) outbreak registry. Infect Control Hosp Epidemiol 2019; 40:113-115. [DOI: 10.1017/ice.2018.274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Ong CY, Vasanwala FF. Infected with Scabies Again? Focus in Management in Long-Term Care Facilities. Diseases 2018; 7:diseases7010003. [PMID: 30597979 PMCID: PMC6473425 DOI: 10.3390/diseases7010003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 12/11/2018] [Accepted: 12/22/2018] [Indexed: 12/01/2022] Open
Abstract
Scabies is a significant public health condition in long-term care facilities, plaguing even developed countries. Although treatments are available, eradication and control of scabies cases still remain a challenge due to delays in diagnosis and difficulties in maintaining preventive and surveillance measures. Prompt treatment of patients and their contacts that are affected, along with concomitant education of health staff and family members, are paramount. Environmental disinfestation is also a concern.
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Affiliation(s)
- Chong Yau Ong
- Department of Family Medicine, Division of Medicine, Sengkang General Hospital, Singapore 544886, Singapore.
- SingHealth Duke-NUS Family Medicine Academic Clinical Programme, Singapore 544886, Singapore.
| | - Farhad Fakhrudin Vasanwala
- Department of Family Medicine, Division of Medicine, Sengkang General Hospital, Singapore 544886, Singapore.
- SingHealth Duke-NUS Family Medicine Academic Clinical Programme, Singapore 544886, Singapore.
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Beeres DT, Ravensbergen SJ, Heidema A, Cornish D, Vonk M, Wijnholds LD, Hendriks JJH, Kleinnijenhuis J, Omansen TF, Stienstra Y. Efficacy of ivermectin mass-drug administration to control scabies in asylum seekers in the Netherlands: A retrospective cohort study between January 2014 - March 2016. PLoS Negl Trop Dis 2018; 12:e0006401. [PMID: 29771941 PMCID: PMC5957329 DOI: 10.1371/journal.pntd.0006401] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 03/22/2018] [Indexed: 11/18/2022] Open
Abstract
Scabies is a skin infestation with the mite Sarcoptes scabiei causing itch and rash and is a major risk factor for bacterial skin infections and severe complications. Here, we evaluated the treatment outcome of 2866 asylum seekers who received (preventive) scabies treatment before and during a scabies intervention programme (SIP) in the main reception centre in the Netherlands between January 2014 and March 2016. A SIP was introduced in the main national reception centre based on frequent observations of scabies and its complications amongst Eritrean and Ethiopian asylum seekers in the Netherlands. On arrival, all asylum seekers from Eritrea or Ethiopia were checked for clinical scabies signs and received ivermectin/permethrin either as prevention or treatment. A retrospective cohort study was conducted to compare the reinfestations and complications of scabies in asylum seekers who entered the Netherlands before and during the intervention and who received ivermectin/permethrin. In total, 2866 asylum seekers received treatment during the study period (January 2014 –March 2016) of which 1359 (47.4%) had clinical signs of scabies. During the programme, most of the asylum seekers with scabies were already diagnosed on arrival as part of the SIP screening (580 (64.7%) of the 897). Asylum seekers with more than one scabies episode reduced from 42.0% (194/462) before the programme to 27.2% (243/897) during the programme (RR = 0.64, 95% CI = 0.55–0.75). Development of scabies complications later in the asylum procedure reduced from 12.3% (57/462) to 4.6% (41/897). A scabies prevention and treatment programme at start of the asylum procedure was feasible and effective in the Netherlands; patients were diagnosed early and risk of reinfestations and complications reduced. To achieve a further decrease of scabies, implementation of the programme in multiple asylum centres may be needed. The high number of asylum seekers arriving in Europe between 2014 and 2016 emphasized the importance to expand knowledge on best practice regarding health care provision and control of infectious diseases that may come with migration. Adequate control of scabies is important to prevent severe forms of scabies and prevent spread of the disease. Studies on interventions preventing or treating scabies in asylum seekers are very limited. To the best of our knowledge, this is the first study that provides data on an intervention targeting scabies in asylum seekers. This study shows that a scabies prevention and treatment programme at start of the asylum procedure is feasible and effective in the Netherlands. Patients were diagnosed early and risk of reinfestations and complications reduced. The programme may be used both to improve clinical practice and could serve as model for future policies on similar programmes.
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Affiliation(s)
- Dorien T. Beeres
- University of Groningen, Department of Internal Medicine, Infectious Disease Unit, University Medical Centre Groningen, Groningen, The Netherlands
| | - Sofanne J. Ravensbergen
- University of Groningen, Department of Internal Medicine, Infectious Disease Unit, University Medical Centre Groningen, Groningen, The Netherlands
- * E-mail:
| | - Annelies Heidema
- Primary Health Care Centre for Asylum Seekers (GCA), Ter Apel, The Netherlands
| | - Darren Cornish
- Babylon Primary Health Care Services, Elst, The Netherlands
| | - Machiel Vonk
- Municipal health Care Centre Groningen, Groningen, The Netherlands
| | | | - Jessica J. H. Hendriks
- Health Care Service for Asylum seekers (Gezondheidscentrum Asielzoekers), Wageningen, The Netherlands
| | - Johanneke Kleinnijenhuis
- University of Groningen, Department of Internal Medicine, Infectious Disease Unit, University Medical Centre Groningen, Groningen, The Netherlands
| | - Till F. Omansen
- University of Groningen, Department of Internal Medicine, Infectious Disease Unit, University Medical Centre Groningen, Groningen, The Netherlands
| | - Ymkje Stienstra
- University of Groningen, Department of Internal Medicine, Infectious Disease Unit, University Medical Centre Groningen, Groningen, The Netherlands
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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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Guideline for the diagnosis and treatment of scabies in Japan (third edition). J Dermatol 2017; 44:991-1014. [DOI: 10.1111/1346-8138.13896] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 03/23/2017] [Indexed: 11/30/2022]
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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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Furuya K, Nakajima H, Sasaki Y, Ishiko A, Urita Y. A scabies outbreak in a diabetic and collagen disease ward: Management and prevention. Exp Ther Med 2016; 12:3711-3715. [PMID: 28105102 DOI: 10.3892/etm.2016.3845] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 10/05/2016] [Indexed: 11/05/2022] Open
Abstract
Scabies is an infection caused by Sarcoptes scabiei. In developed countries, scabies remains an important public health problem in hospitals and care facilities among elderly or immunocompromised patients. There are a number of medical providers who have not experienced scabies and there has been confusion surrounding its management and prevention. Therefore, the aim of the present study was to identify the optimal approach for the management and prevention of scabies. A scabies outbreak occurred between June 2014 and October 2014 in the Toho University School of Medicine, Omori Hospital (Tokyo, Japan), and the current study investigates factors concerning the outbreak, such as disease recognition, diagnostic strategy, medical staff experience and correspondence after the outbreak occurred. Six patients were newly diagnosed with scabies including patients, medical staff and family of the medical staff. An infection control committee was implemented and required a follow-up survey of 181 people (144 patients and 37 medical staff). It took ~4 months to resolve the outbreak. Scabies is highly infectious, and sufficient knowledge is required to care for the patients and prevent the infection of healthy people. In this example, the spread of infection was controlled by prompt action.
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Affiliation(s)
- Kenta Furuya
- Department of General Medicine and Emergency Care, Toho University School of Medicine, Omori Hospital, Ota-ku, Tokyo 143-8541, Japan
| | - Hitoshi Nakajima
- Department of General Medicine and Emergency Care, Toho University School of Medicine, Omori Hospital, Ota-ku, Tokyo 143-8541, Japan
| | - Yousuke Sasaki
- Department of General Medicine and Emergency Care, Toho University School of Medicine, Omori Hospital, Ota-ku, Tokyo 143-8541, Japan
| | - Akira Ishiko
- Department of Dermatology, Toho University School of Medicine, Omori Hospital, Ota-ku, Tokyo 143-8541, Japan
| | - Yoshihisa Urita
- Department of General Medicine and Emergency Care, Toho University School of Medicine, Omori Hospital, Ota-ku, Tokyo 143-8541, Japan
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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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Large Nosocomial Outbreak Associated with a Norwegian Scabies Index Case Undergoing TNF-α Inhibitor Treatment: Management and Control. Infect Control Hosp Epidemiol 2015; 36:1358-60. [PMID: 26288185 DOI: 10.1017/ice.2015.188] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
We describe a large outbreak associated with a crusted (Norwegian) scabies case in an immunocompromised patient following treatment with TNF-α inhibitor (adalimumab) for psoriasis arthritis. The increasing use of TNF-α inhibitors should induce clinicians to consider this serious parasitic infection when evaluating skin rashes in patients receiving biologic therapies.
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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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Chuang S, Howley PP, Lin SH. Implementing systems thinking for infection prevention: The cessation of repeated scabies outbreaks in a respiratory care ward. Am J Infect Control 2015; 43:499-505. [PMID: 25798774 DOI: 10.1016/j.ajic.2015.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Revised: 01/30/2015] [Accepted: 02/02/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Root cause analysis (RCA) is often adopted to complement epidemiologic investigation for outbreaks and infection-related adverse events in hospitals; however, RCA has been argued to have limited effectiveness in preventing such events. We describe how an innovative systems analysis approach halted repeated scabies outbreaks, and highlight the importance of systems thinking for outbreaks analysis and sustaining effective infection prevention and control. METHODS Following RCA for a third successive outbreak of scabies over a 17-month period in a 60-bed respiratory care ward of a Taiwan hospital, a systems-oriented event analysis (SOEA) model was used to reanalyze the outbreak. Both approaches and the recommendations were compared. RESULTS No nosocomial scabies have been reported for more than 1975 days since implementation of the SOEA. Previous intervals between seeming eradication and repeat outbreaks following RCA were 270 days and 180 days. Achieving a sustainable positive resolution relied on applying systems thinking and the holistic analysis of the system, not merely looking for root causes of events. CONCLUSION To improve the effectiveness of outbreaks analysis and infection control, an emphasis on systems thinking is critical, along with a practical approach to ensure its effective implementation. The SOEA model provides the necessary framework and is a viable complementary approach, or alternative, to RCA.
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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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Bader MS, Brooks AA, Srigley JA. Postexposure management of healthcare personnel to infectious diseases. Hosp Pract (1995) 2015; 43:107-27. [PMID: 25728206 PMCID: PMC7103705 DOI: 10.1080/21548331.2015.1018091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 02/09/2015] [Indexed: 11/16/2022]
Abstract
Healthcare personnel (HCP) are at risk of exposure to various pathogens through their daily tasks and may serve as a reservoir for ongoing disease transmission in the healthcare setting. Management of HCP exposed to infectious agents can be disruptive to patient care, time-consuming, and costly. Exposure of HCP to an infectious source should be considered an urgent medical concern to ensure timely management and administration of postexposure prophylaxis, if available and indicated. Infection control and occupational health departments should be notified for management of exposed HCP, identification of all contacts of the index case, and application of immediate infection control measures for the index case and exposed HCP, if indicated. This article reviews the main principles of postexposure management of HCP to infectious diseases, in general, and to certain common infections, in particular, categorized by their route of transmission, in addition to primary prevention of these infections.
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Affiliation(s)
- Mazen S. Bader
- Department of Medicine, Hamilton Health sciences, Juravinski hospital and Cancer Centre, Hamilton, Ontario, Canada
| | - Annie A. Brooks
- Department of Pharmacy, Hamilton Health Sciences, Juravinski hospital and Cancer Centre, Hamilton, Ontario, Canada
| | - Jocelyn A. Srigley
- Department of Medicine, Infection Prevention and Control, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
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Yélamos O, Mir-Bonafé JF, López-Ferrer A, Garcia-Muret MP, Alegre M, Puig L. Crusted (Norwegian) scabies: an under-recognized infestation characterized by an atypical presentation and delayed diagnosis. J Eur Acad Dermatol Venereol 2014; 30:483-5. [PMID: 25428862 DOI: 10.1111/jdv.12867] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- O Yélamos
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - J F Mir-Bonafé
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - A López-Ferrer
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - M P Garcia-Muret
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - M Alegre
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - L Puig
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
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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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Capobussi M, Sabatino G, Donadini A, Tersalvi CA, Castaldi S. Control of scabies outbreaks in an Italian hospital: an information-centered management strategy. Am J Infect Control 2014; 42:316-20. [PMID: 24581020 DOI: 10.1016/j.ajic.2013.10.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Revised: 10/07/2013] [Accepted: 10/08/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Scabies is a dermatologic infestation caused by Sarcoptes scabiei. In industrialized countries, hospitals and other health structures can sometimes be hit. The optimal management of scabies outbreaks still has to be established, mass prophylaxis being one possible option. METHODS To identify the optimal approach to containing this re-emerging disease, a local health authority in Lombardy, Northern Italy, carried out an epidemiologic study into 2 scabies epidemics that took place from September to December 2012 in a 600-bed hospital with 26,000 admissions a year. RESULTS Over a 3-month period, there were 12 cases of scabies on 4 wards; 43 contacts received prophylaxis. When the first cases were identified, an information campaign involving all hospital personnel was immediately set up. Regular staff meetings were organized, and information leaflets were distributed to patients. Family doctors of discharged patients were informed of the outbreak. CONCLUSION A management model based on an information-centered strategy was used in place of mass prophylaxis to deal with scabies epidemics. The success of this approach was confirmed by the managers of the hospital involved (reduced expenditure for prophylactic drugs) and by hospital staff who did not have to deal with potential drug adverse effects.
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Affiliation(s)
- Matteo Capobussi
- Scuola di Specializzazione in Igiene e Medicina Preventiva, University of Milan, Milan, Italy.
| | | | - Annalisa Donadini
- Servizio di Medicina Preventiva nelle Comunità, ASL Como, Como, Italy
| | | | - Silvana Castaldi
- Scuola di Specializzazione in Igiene e Medicina Preventiva, University of Milan, Milan, Italy; Fondazione IRCCS Ospedale Maggiore Policlinico, Milan, Italy
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FitzGerald D, Grainger RJ, Reid A. Interventions for preventing the spread of infestation in close contacts of people with scabies. Cochrane Database Syst Rev 2014; 2014:CD009943. [PMID: 24566946 PMCID: PMC10819104 DOI: 10.1002/14651858.cd009943.pub2] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Scabies, caused by Sarcoptes scabiei variety hominis or the human itch mite, is a common parasitic infection. While anyone can become infected, it causes significant morbidity in immunocompromised hosts and it spreads easily between human hosts where there is overcrowding or poor sanitation. The most common symptom reported is itch which is worse at night. As the symptoms are attributed to an allergic reaction to the mite, symptoms usually develop between four to six weeks after primary infection. Therefore, people may be infected for some time prior to developing symptoms. During this time, while asymptomatic, they may spread infection to others they are in close contact with. Consequently, it is usually recommended that when an index case is being treated, others who have been in close contact with the index case should also be provided with treatment. OBJECTIVES To assess the effects of prophylactic interventions for contacts of people with scabies to prevent infestation in the contacts. SEARCH METHODS We searched electronic databases (Cochrane Occupational Safety and Health Review Group Specialised Register, CENTRAL (The Cochrane Library), MEDLINE (Ovid), Pubmed, EMBASE, LILACS, CINAHL, OpenGrey and WHO ICTRP) up to November 2013. SELECTION CRITERIA Randomised controlled trials (RCTs) or cluster RCTs which compared prophylactic interventions which were given to contacts of index cases with scabies infestation. Interventions could be compared to each other, or to placebo or to no treatment. Both drug treatments and non-drug treatments were acceptable. DATA COLLECTION AND ANALYSIS Two authors intended to extract dichotomous data (developed infection or did not develop infection) for the effects of interventions and report this as risk ratios with 95% confidence intervals. We intended to report any adverse outcomes similarly. MAIN RESULTS We did not include any trials in this review. Out of 29 potentially-relevant studies, we excluded 16 RCTs as the data for the contacts were either not reported or were reported only in combination with the outcomes for the index cases. We excluded a further 11 studies as they were not RCTs. We also excluded one study as not all subjects were examined at baseline and follow-up, and another as it was a case study. AUTHORS' CONCLUSIONS The effects of providing prophylactic treatments for contacts of people with scabies to prevent infestation are unknown. We need well-designed RCTs of the use of prophylactic measures to prevent the transmission of scabies conducted with people who had the opportunity for prolonged skin contact with an index case, such as family members, healthcare workers or residential care personnel, within the previous six weeks.
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Affiliation(s)
| | - Rachel J Grainger
- Tallaght Hospital, a teaching hospital of Trinity College DublinMicrobiology DepartmentTallaghtDublin 24Ireland
| | - Alex Reid
- Tallaght Hospital, a teaching hospital of Trinity College DublinOccupational Health DepartmentDublinIreland24
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Mohebbipour A, Saleh P, Goldust M, Amirnia M, Zadeh YJ, Mohamad RM, Rezaee E. Comparison of oral ivermectin vs. lindane lotion 1% for the treatment of scabies. Clin Exp Dermatol 2013; 38:719-23. [PMID: 23772999 DOI: 10.1111/ced.12079] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2012] [Indexed: 11/27/2022]
Abstract
BACKGROUND Scabies is a common parasitic infestation that is an important public-health problem in many resource-poor regions. It is commonly treated with the insecticides ivermectin and permethrin. AIM To compare the efficacy and safety of oral ivermectin vs. lindane lotion 1% for the treatment of scabies. METHODS In total, 148 patients with scabies were enrolled, and were randomized into two groups: the first group received a single dose of oral ivermectin 200 μg/kg body weight, and the second group were treated with two applications of topical lindane lotion 1%, with a 1-week interval between applications. Treatment was evaluated at intervals of 2 and 4 weeks, and if there was treatment failure at the 2-week follow-up, treatment was repeated. RESULTS A single dose of ivermectin provided a cure rate of 60.8% at the 2-week follow-up, which increased to 89.1% at the 4-week follow-up. after crossing over to the lindane lotion 1% group. Treatment with two applications of lindane lotion 1%, with a 1-week interval between them, was effective in 47.2% of patients at the 2-week follow-up, which increased to 72.9% at the 4-week follow-up after this treatment was repeated. CONCLUSIONS A single dose of ivermectin was as effective as two applications of lindane lotion 1% at the 2-week follow-up. After repeat treatment, ivermectin was superior to lindane lotion 1% at the 4-week follow up. The delay in clinical response with ivermectin suggests that it may not be effective against all the stages in the life cycle of the parasite.
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Affiliation(s)
- A Mohebbipour
- Department of Dermatology, Department of mathematics Ardebil Branch, Islamic Azad University, Tabriz, Iran
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Tollitt J, Duncan A, Woywodt A. Of mites and men: scabies in patients with kidney disease. Clin Kidney J 2013; 6:125-7. [PMID: 26019839 PMCID: PMC4432458 DOI: 10.1093/ckj/sft024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Accepted: 02/19/2013] [Indexed: 11/13/2022] Open
Affiliation(s)
- James Tollitt
- Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, Lancashire, UK
| | - Alison Duncan
- Department of Dermatology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, Lancashire, UK
| | - Alexander Woywodt
- Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, Lancashire, UK
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Lester J, Sbicca JA, Bercovitch L. Ethical dilemmas and legal pitfalls in prescribing for the uninsured indigent patient: reconciling the irreconcilable. J Am Acad Dermatol 2013; 68:672-674. [PMID: 23522407 DOI: 10.1016/j.jaad.2012.05.046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2012] [Revised: 04/26/2012] [Accepted: 05/02/2012] [Indexed: 11/28/2022]
Affiliation(s)
- Jenna Lester
- Department of Dermatology, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | | | - Lionel Bercovitch
- Department of Dermatology, Warren Alpert Medical School of Brown University, Providence, Rhode Island.
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Fitzgerald D, Kevitt FA, Reid A. Treatment of close contacts of people with scabies for preventing re-infestation or spread of infestation in contacts. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2012. [DOI: 10.1002/14651858.cd009943] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Khan A, O’Grady S, Muller MP. Rapid control of a scabies outbreak at a tertiary care hospital without ward closure. Am J Infect Control 2012; 40:451-5. [PMID: 21868131 DOI: 10.1016/j.ajic.2011.05.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2011] [Revised: 05/14/2011] [Accepted: 05/16/2011] [Indexed: 10/17/2022]
Abstract
BACKGROUND Although scabies outbreaks in hospitals are frequent, the optimal approach to management of these outbreaks has not yet been defined. We describe a hospital scabies outbreak that was successfully controlled without ward closure. METHODS An outbreak of scabies at a teaching hospital and subsequent control measures were investigated. Outcomes included the number of cases affecting patients and staff, number of patients and staff requiring prophylaxis, duration of the outbreak, and cost of the outbreak. Outcomes were compared with those in a similar outbreak occurring at the same hospital 20 years earlier and with other published descriptions of hospital scabies outbreaks. RESULTS In January 2010, a patient who had undergone renal transplantation was admitted 3 times to St. Michael's Hospital, but a diagnosis of scabies was not considered until the final admission. Widespread exposure of patients and staff on 2 wards prompted the establishment of an outbreak management team. Initial interventions focused on isolation and treatment of the index case and on contact tracing to identify and treat secondary cases and to offer prophylaxis to direct contacts. Five symptomatic staff members and 2 patient cases were quickly identified, an outbreak was declared, and mass simultaneous prophylaxis was initiated on the 2 involved wards. A single case occurred 2 weeks after the mass prophylaxis program in a staff member who had not received the prophylaxis. Six weeks after the onset of symptoms, the end of the outbreak was declared. No additional cases have been reported up to the time of publication. The total cost of the outbreak was $20,000. CONCLUSIONS Early recognition of crusted scabies is essential to prevent outbreaks. Once an outbreak occurs, prompt control of the index patient and rapid tracing of contacts to identify secondary cases are necessary. When prolonged exposure to a case of crusted scabies results in multiple secondary cases, institution of simultaneous mass prophylaxis is the most efficient strategy for terminating the outbreak and can be implemented without ward closure.
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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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Lay CJ, Wang CL, Chuang HY, Chen YL, Chen HL, Tsai SJ, Tsai CC. Risk factors for delayed diagnosis of scabies in hospitalized patients from long-term care facilities. J Clin Med Res 2011; 3:72-7. [PMID: 21811533 PMCID: PMC3140926 DOI: 10.4021/jocmr520w] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2011] [Indexed: 12/02/2022] Open
Abstract
Background Delayed diagnosis of scabies can cause an institutional outbreak, which causes considerably economic burden to control. This study was to find the risk factors for delayed diagnosis of scabies in hospitalized patients from long-term care facilities. Methods We conducted a retrospective analysis of the hospitalized patients from long-term care facilities, diagnosed to have scabies between January 2006 and December 2008. A stepwise logistic regression analysis was performed to determine the risk factors for delayed diagnosis of scabies. Results A total of 706 episodes with scabies were identified retrospectively in 399 hospitalized patients from long-term care facilities. Of these, 44 episodes were considered as delayed diagnosis of scabies. These patients were more associated with chronic usage of steroid (73% vs. 10%, P < 0.001) and had longer duration of hospitalization than the others (30 vs. 13 days, P < 0.001). After logistic regression, steroid therapy was the risk factor of delayed diagnosis of scabies (odds ratio: 23.493). Conclusions In the patients from long-term care facilities, clinical physicians should pay more attention to those with chronic usage of steroid to avoid delayed diagnosis of scabies. Keywords Scabies; Delayed diagnosis; Risk factor; Long-term care facility
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Affiliation(s)
- Chorng-Jang Lay
- Division of Infectious Disease, Department of Medicine, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
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Bellarbre F, Fougère B, Baudemont C, Merlet-Chicoine I, Paccalin M. Crusted scabies: Misdiagnosis in the elderly. Eur Geriatr Med 2011. [DOI: 10.1016/j.eurger.2011.01.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Lassa S, Campbell MJ, Bennett CE. Epidemiology of scabies prevalence in the U.K. from general practice records. Br J Dermatol 2011; 164:1329-34. [PMID: 21574970 DOI: 10.1111/j.1365-2133.2011.10264.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Scabies is a contagious parasitic infestation which causes an allergic reaction to just a few mites. OBJECTIVES To examine the epidemiology of scabies consultations in the U.K. by age, sex, region of the country and time. METHODS Data were obtained from the THIN (The Health Information Network) database provided by EPIC U.K. in which each consultation episode is coded according to a 'READ' code. Data were available for 1997-2005 inclusive (9 years) for approximately 8·5% of the U.K. population from 12 regions of the U.K. We used harmonic analysis to model the data over time and derived cycle amplitudes and phases for each region in the U.K. RESULTS There was a significantly greater infestation rate among females with a relative risk of 1·24 (P < 0·001) relative to males. The age group 10-19 years had the highest infestation rates (with rates of 4·55 per 1000 and 5·92 per 1000 for males and females, respectively). The middle age groups had the smallest infestation rates. A cycle with length of between 15 and 17 years was derived, and the phase times of the cycles for each region suggested a progression of the disease originating from the North East, spreading to Northern parts of the U.K. and then to the Midlands and the South. CONCLUSIONS The study confirms earlier studies with regard to the age/sex distribution of scabies. We suggest a contagious pattern of spread of scabies infestation in the U.K. with an epidemic cycle length of 15-17 years.
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Affiliation(s)
- S Lassa
- School of Health and Related Research, University of Sheffield, Sheffield, UK
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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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Affiliation(s)
- Bart J Currie
- Menzies School of Health Research, Royal Darwin Hospital, Darwin, NT, Australia.
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