Cases Of Scabies Research Articles

A 35‐month prospective study on onset of scabies in a psychiatric hospital: Discussion on patient transfer and incubation period

This study was conducted to evaluate the risk factors of scabies introduction into a hospital. We addressed the following question: Do patients transferred from other institutions pose a higher risk than patients from the community? From July 2003 to May 2006, a trained physician surveyed the inpatients and staff of a psychiatric hospital (six wards, 300 beds) on a monthly basis. During the study period, specific infection control measures beyond standard precautions, such as prophylactic treatment, were not adopted. There were 333 newly-admitted patients during the study period and among them, 122 were transferred from other institutions. Seven patients were diagnosed with scabies. Two of these patients were infected while in the hospital (secondary infection), thus the number of introduced scabies cases (index cases) was five. Four of the index cases were transferred from other institutions (three from psychiatric hospitals and one from a nursing home). The source of infection for one index case was unexplained. The rate of scabies infection among transferred patients was 3.3% while the infection rate among patients from the community was 0.5%. Therefore, transferred patients pose a higher risk than those from the community. The average time from admission to diagnosis of scabies was 141 days (range 34-313 days). The hospital personnel checked the skin condition of all patients at admission and none of the four patients showed symptoms of scabies.

Journal Scan: Ivermectin: A New Treatment for the Seven-Year Itch

Journal Scan: Ivermectin: A New Treatment for the Seven-Year Itch

Topical permethrin and oral ivermectin in the management of scabies: A prospective, randomized, double blind, controlled study

Scabies is a highly contagious and intensely pruritic parasitic infestation. It is a re-emerging infection in the new millennium especially with HIV pandemic and a significant health problem in developing countries. Various treatment modalities have been used since time immemorial but the search for an ideal scabicide is ongoing. In this study, we compared the therapeutic efficacy of single application of topical 5% permethrin with oral ivermectin (200 μg/kg/dose) in a single-dose and a two-dose regimen in patients with scabies. 120 clinically diagnosed cases of scabies (>5 years of age and/or >15 kg) were randomized into three treatment groups A, B, C of 40 patients each; receiving either topical 5% permethrin (group A) or oral ivermectin (200 μg/kg/dose) in a single dose (group B) or double dose regimen (group C) repeated at 2 weeks interval. Patients were followed up at 1, 2, and 4 weeks interval. At each visit, cure rate (>50% improvement in lesion count and pruritus and negative microscopy) was assessed and compared. Cure rate in three treatment groups at the end of 4 weeks was 94.7% (A), 90% (B), 89.7% (C), and thus all three treatment modalities were equally efficacious. However, at 1 week follow up, group A patients reported better improvement in both lesion count and pruritus. Both permethrin and ivermectin in both single and two dose regimen are equally efficacious and well tolerated in scabies. However, permethrin has a rapid onset of action.

A case of Scabies with Lesions Resembling Perforating Folliculitis and Uremic Pruritus

A case of Scabies with Lesions Resembling Perforating Folliculitis and Uremic Pruritus

Factors Related to Missed Diagnosis of Incidental Scabies Infestations in Patients Admitted Through the Emergency Department to Inpatient Services

Scabies is highly contagious and requires prompt diagnosis and implementation of infection control measures to prevent transmission and outbreaks. This study investigated the clinical and administrative correlates associated with missed diagnosis of scabies in an emergency department (ED). This was a retrospective study of patients with incidental scabies infestations who were admitted to a university hospital via the ED during a 4-year period. A total of 135 inpatients were identified as having scabies; among them, 111 patients (82%) had visited the ED. Scabies were diagnosed during the ED stay in 39 of 111 patients (35%), while the diagnosis was missed in the ED in 72 patients (65%). Although no geographic clusters suggestive of nosocomial scabies transmission were registered, 160 medical workers and one hospitalized patient received prophylactic treatment due to direct skin-to-skin contact with inpatient scabies cases during the study period. Overcrowding (odds ratio [OR] = 8.4; 95% confidence interval [CI] = 1.9 to 38.0) and time constraints (OR = 8.2; 95% CI = 1.9 to 34.7) in the ED were associated with a missed diagnosis of scabies during ED stay. Patients with lower illness severity scores were at higher risk for failure to diagnose and to treat scabies prior to hospital admission (OR = 5.7; 95% CI = 1.6 to 20.9). Missed diagnoses of scabies during ED stay may result in nosocomial spread and increase the unnecessary use of prophylactic treatments. ED overcrowding, time constraints, and less severe illness compromise ED recognition of scabies. Health care workers should be especially alert for signs of scabies infestations under these conditions.

Recurrent Bullous Scabies

scabies is a common infestation that usually presents as a pruriginous eruption consisting of erythematous papules, nodules, and excoriations. Diagnosis relies mostly on clinical features, including the identification of scabietic burrows. Several atypical clinical manifestations have been reported; bullous presentations are particularly rare and intriguing. a case of recurrent bullous scabies is reported. an 87-year-old institutionalized woman developed a pruriginous eruption that mimicked bullous pemphigoid. Histopathologic examination revealed blistering at the subepidermal level and a mixed inflammatory infiltrate with numerous eosinophils. Scabies mites were identified on dermoscopy and on skin scrapings, allowing a diagnosis of bullous scabies. Despite effective treatment with topical lindane, failure to control scabies in her institution led to recurrences of her peculiar blistering infestation. Immunofluorescence studies were always negative. these observations underscore the mite's role in the pathogenesis of blister formation and illustrate current challenges in scabies' diagnosis and management.

Sarna ampollosa con respuesta terapéutica a la ivermectina

Bullous scabies is a rare disease that is usually diagnosed in elderly patients. The clinical, histological, and immunological findings are identical to bullous pemphigoid. In a review of the literature, we found reports of 24 cases. We present a new case of bullous scabies in a 72-year-old man. The lesions responded to treatment with oral ivermectin.

Bullous Scabies Responding to Ivermectin Therapy

Bullous scabies is a rare disease that is usually diagnosed in elderly patients. The clinical, histological, and immunological findings are identical to those of bullous pemphigoid. In a review of the literature, we found reports of 24 cases. We present a new case of bullous scabies in a 72-year-old man. The lesions responded to treatment with oral ivermectin.

Frequency of Scabies in Iraq: Survey in a Dermatology Clinic

The burden of scabies is highest in tropical countries, but recent data from Iraq are scanty. To estimate the frequency of scabies in patients of a dermatology clinic in central Iraq. The study was conducted in Tikrit (Iraq), between May 2007 and February 2008. A total of 1,194 patients presenting to a dermatology clinic were included in the study. During the study period, 132 [1.1%] patients with scabies were identified. The frequency was 13.5% in males and 8.6% in females [P = 0.007]. Frequency in children was 15.6% and 9.8% in adults [P = 0.007]. About 91% of cases were younger than 45 years. The treatment of scabies cases with 5% permethrin cream resulted in a cure rate of 80.3% following a single application, and was increased to 95.5% after a second application. Cure was achieved in all cases after a third application. Prevalence of scabies was high in a dermatology clinic, and prisoners were identified as high-risk group. Mass treatment of scabies either by oral ivermectin or topical permethrin is suggested.

Management of Chamois in Bavaria (Germany): The Importance of Game Activities in Scabies Control.

In Bavaria (Germany), scabies was registered for the first time in the year 1824 among the chamois population of the Berchtesgaden region, and disappeared 6 years later. For the next 119 years, the chamois populations in the Bavarian Alps seemed not to be infected by scabies. But in 1949 scabies occurred again in the Bavarian chamois populations east of the River Inn, with origin in the Berchtesgaden region. Scabies has been recorded repeatedly since then. Whereas between 1949 and the early 1990s scabies had a great impact on the development of the chamois populations in the Bavarian Alps east of the river Inn, the disease has had little significance since 1995. As it is assumed that there is a link between high population density and the occurrence of scabies among chamois, hunting bags (as indicators of population density) were compared with the recorded scabies cases (shot or deceased game) among chamois populations in the Bavarian state forests east of the river Inn. Data collected from the Berchtesgaden Forest Office were further analysed according to age and sex parameters. There is a highly significant, inverse, non-parametric correlation between recorded incidences of scabies and hunting bags in the whole study area and in the area of Berchtesgaden Forest Office. The results of the analysis show that bucks were slightly more likely to be registered with scabies than does (p=0.018). Young animals (yearlings and juveniles) played only a secondary role in terms of scabies prevalence. Both the historical background of scabies in the Alps and the present study support the above-mentioned hypothesis that the incidence of scabies in chamois is related to high chamois population densities. The spread of scabies can therefore be slowed down or prevented by increasing game bags over a large area.

The Incidence and Clinical Characteristics of Herpes Zoster Among Children and Adolescents After Implementation of Varicella Vaccination

The varicella-zoster virus (VZV) vaccine strain may reactivate to cause herpes zoster. Limited data suggest that the risk of herpes zoster in vaccinated children could be lower than in children with naturally acquired varicella. We examine incidence trends, risk and epidemiologic and clinical features of herpes zoster disease among children and adolescents by vaccination status. Population-based active surveillance was conducted among <20 years old residents in Antelope Valley, California, from 2000 through 2006. Structured telephone interviews collected demographic, varicella vaccination and disease histories, and clinical information. From 2000 to 2006, the incidence of herpes zoster among children<10 years of age declined by 55%, from 42 cases reported in 2000 (74.8/100,000 persons; 95% confidence interval [95% CI]: 55.3-101.2) to 18 reported in 2006 (33.3/100,000; 95% CI: 20.9-52.8; P<0.001). During the same period, the incidence of herpes zoster among 10- to 19-year-olds increased by 63%, from 35 cases reported in 2000 (59.5/100,000 persons; 95% CI: 42.7-82.9) to 64 reported in 2006 (96.7/100,000; 95% CI: 75.7-123.6; P<0.02). Among children aged<10 years, those with a history of varicella vaccination had a 4 to 12 times lower risk for developing herpes zoster compared with children with history of varicella disease. Varicella vaccine substantially decreases the risk of herpes zoster among vaccinated children and its widespread use will likely reduce overall herpes zoster burden in the United States. The increase in herpes zoster incidence among 10- to 19-year-olds could not be confidently explained and needs to be confirmed from other data sources.

Risk factors of scabies in psychiatric and long‐term care hospitals: A nationwide mail‐in survey in Japan

Despite the commonness of scabies in Japanese institutional settings, the nationwide prevalence of scabies has not been elucidated. This study was conducted to assess the prevalence of scabies and control measures in Japanese hospitals. A questionnaire on scabies epidemiology (e.g. number of patients and onsets of outbreak) and preventive measures were sent to psychiatric hospitals and long-term care hospitals nationwide (n = 1795) in January 2005. Seven hundred and forty-one hospitals responded (41.3%). Three hundred and thirty-three (44.9%) respondent hospitals had one or more scabies cases in 2004. Among 159 hospitals that had experienced scabies outbreak, only 32 of them reported cases of crusted scabies. Multivariate regression analysis showed that hospitals had a greater number of beds, and that acute- and long-term care wards were more likely to experience scabies onsets. Hospitals that compiled their infection control manuals on scabies, treated suspicious patients with scabicides without confirmed diagnosis, and performed skin checkup of inpatients were more likely to experience scabies cases. Infection control personnel should be aware that unrecognized crusted scabies can cause outbreaks. Higher patient turnover is a risk factor for scabies introduction into a hospital. Preventive measures against scabies, such as patient screening at admission and treating all suspicious patients without confirmed diagnosis, were not effective to avoid scabies introduction.

Scabies

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.

Community Management of Endemic Scabies in Remote Aboriginal Communities of Northern Australia: Low Treatment Uptake and High Ongoing Acquisition

BackgroundScabies and skin infections are endemic in many Australian Aboriginal communities. There is limited evidence for effective models of scabies treatment in high prevalence settings. We aimed to assess the level of treatment uptake amongst clinically diagnosed scabies cases and amongst their household contacts. In addition, we aimed to determine the likelihood of scabies acquisition within these households over the 4 weeks following treatment provision.Methods and FindingsWe conducted an observational study of households in two scabies-endemic Aboriginal communities in northern Australia in which a community-based skin health program was operating. Permethrin treatment was provided for all householders upon identification of scabies within a household during home visit. Households were visited the following day to assess treatment uptake and at 2 and 4 weeks to assess scabies acquisition among susceptible individuals. All 40 households in which a child with scabies was identified agreed to participate in the study. Very low levels of treatment uptake were reported among household contacts of these children (193/440, 44%). Household contacts who themselves had scabies were more likely to use the treatment than those contacts who did not have scabies (OR 2.4, 95%CI 1.1, 5.4), whilst males (OR 0.6, 95%CI 0.42, 0.95) and individuals from high-scabies-burden households (OR 0.2, 95%CI 0.08, 0.77) were less likely to use the treatment. Among 185 susceptible individuals, there were 17 confirmed or probable new diagnoses of scabies recorded in the subsequent 4 weeks (9.2%). The odds of remaining scabies-free was almost 6 times greater among individuals belonging to a household where all people reported treatment uptake (OR 5.9, 95%CI 1.3, 27.2, p = 0.02).ConclusionThere is an urgent need for a more practical and feasible treatment for community management of endemic scabies. The effectiveness and sustainability of the current scabies program was compromised by poor treatment uptake by household contacts of infested children and high ongoing disease transmission.

The Economic Burden of Pediculosis Pubis and Scabies Infections Treated on an Outpatient Basis in the United States: Evidence From Private Insurance Claims Data, 2001–2005

The Economic Burden of Pediculosis Pubis and Scabies Infections Treated on an Outpatient Basis in the United States: Evidence From Private Insurance Claims Data, 2001–2005

Scabies Outbreak in an Intensive Care Unit with 1,659 Exposed Individuals—Key Factors for Controlling the Outbreak

To investigate a large outbreak of scabies in an intensive care unit of a university hospital and an affiliated rehabilitation center, and to establish effective control measures to prevent further transmission. Outbreak investigation. The intensive care unit of a 750-bed university hospital and an affiliated 92-bed rehabilitation center. All exposed individuals were screened by a senior staff dermatologist. Scabies was diagnosed on the basis of (1) identification of mites by skin scraping, (2) identification of mites by dermoscopy, or (3) clinical examination of patients without history of prior treatment for typical burrows. During a follow-up period of 6 months, the attack rate was calculated as the number of symptomatic individuals divided by the total number of exposed individuals. All exposed healthcare workers (HCWs) and their household members underwent preemptive treatment. Initially, the most effective registered drug in Switzerland (ie, topical lindane) was prescribed, but this prescription was switched to topical permethrin or systemic ivermectin as a result of the progression of the outbreak. Individuals with any signs or symptoms of scabies underwent dermatological examination. Within 7 months, 19 cases of scabies were diagnosed, 6 in children with a mean age of 3.1 years after exposure to the index patient with HIV and crusted scabies. A total of 1,640 exposed individuals underwent preemptive treatment. The highest attack rate of 26%-32% was observed among HCWs involved in the care of the index patient. A too-restricted definition of individuals at risk, noncompliance with treatment, and the limited effectiveness of lindane likely led to treatment failure, relapse, and reinfestation within families. Crusted scabies resulted in high attack rates among HCWs and household contacts. Timely institution of hygienic precautions with close monitoring and widespread, simultaneous scabicide treatment of all exposed individuals are essential for control of an outbreak.

A Case of Canine Scabies Caused by Notoedres cati Showing Poor Response to Ivermectin Therapy

猫小穿孔疥癬虫Notoedres catiは猫疥癬の原因寄生虫であり，猫から猫へ接触により容易に感染する。疥癬虫は一般には宿主特異性が高いとされているが，猫小穿孔疥癬虫はときに犬にも感染するとされている。著者らは，疥癬に罹患した同居猫をもつ10歳，雌のマルチーズの皮膚から，猫小穿孔疥癬虫の虫体と虫卵を検出したことから，自験例における同寄生虫の感染を確認した。自験例はイベルメクチン皮下投与ならびにアミトラズ薬浴により治療を行ったが，症状の改善ならびに疥癬虫の陰転を得るまでに3ヵ月余を要した。

Scabies Outbreaks in Nursing Homes for the Elderly

The scabies mite is an ectoparasite able to infest humans. Its clinical presentation is typical, although in immunocompromised, mentally retarded and elderly patients the clinical presentation may be altered. Diagnosis may therefore be difficult in such patient groups, who often reside in nursing homes. Because delay in diagnosis may induce rapid spread of the scabies mite, immediate diagnosis and treatment are necessary. Normal scabies (scabies vulgaris) and crusted scabies (scabies crustosa, scabies norvegica), although sometimes difficult to diagnose, especially in the elderly, are fortunately quite easy to treat. However, the elderly patient may experience toxicity from local or systemic scabicidal treatment. Single cases of scabies vulgaris should be treated with permethrin cream because of its outstanding efficacy and favourable adverse events profile. Scabies outbreaks and cases of scabies crustosa can easily be managed using combination therapy consisting of topical application of permethrin and two oral doses of ivermectin 200 microg/kg (administered 1 week apart). In addition to treatment of the scabies infestation, preventative measures are necessary, particularly in nursing homes.

Brote de sarna en un hospital terciario a partir de un caso de sarna costrosa

In February 2005 we performed an epidemiological study of an outbreak of scabies in a tertiary-care hospital which started from a crusted scabies case. We detected 10 secondary cases, 8 in healthcare workers and 2 in hospitalized patients. The attack rate was 4.1%. In contrast to previously described outbreaks, the crusted scabies case was recognized at admission. The outbreak causes were: lacking adherence to contact precautions, long stay of the primary case in the hospital ward and delay of specific treatment. The main control measures were: alerting the hospital services about the outbreak, performing epidemiologic surveillance, coordinating with the Hospital Direction and the Occupational Health Department, education of healthcare workers in control measures, implementation of isolation measures and treatment of cases and contacts with 5% permethrin topical lotion.

Safety of benzyl benzoate lotion and permethrin in pregnancy: a retrospective matched cohort study

To assess the safety of benzyl benzoate lotion (BBL) and permethrin, topical treatments for scabies, during pregnancy. A retrospective controlled cohort study. Refugee and migrant women attending antenatal clinics (ANC) on the Thai-Burmese border between August 1993 and April 2006. Women treated with either BBL (25%) or permethrin (4%) were identified from a manual search of antenatal records. Each case of scabies was matched with four scabies-free controls for gravidity, age, smoking status, malaria, period of treatment and gestational age at treatment. Conditional Poisson regression was used to estimate risk ratios for outcomes of pregnancy (proportion of abortions, congenital abnormalities, neonatal deaths, stillbirths and premature babies), mean birthweight and estimated median gestational age, for scabies and scabies-free women, independently for BBL and permethrin. There were no statistically significant differences in pregnancy outcomes between women who were treated with either BBL (n = 444) compared with their matched controls (n = 1,776) or permethrin (n = 196) treated women and their matched controls (n = 784). Overall, only 10.9% (n = 66) of treatments were in the first trimester. Retreatment rates were higher with BBL 16.4%, than permethrin 9.7%, P = 0.038. Scabies was more common during cooler periods. We found no evidence of adverse effects on pregnancy outcome due to topical 25% BBL or 4% permethrin.