Scabies Epidemics Research Articles

Crusted scabies in AIDS patient, a clinical challenge to be sorted out with a simple bedside test.

Norwegian or crusted scabies is a highly contagious severe variant of scabies described first among leprosy patients in Norway in 1848 by Boeck and Danielsen. Herein, we report a case of crusted scabies in an AIDS patient with large hyperpigmented macules covered with thick crusts present over the axilla, inguinal region, and gluteal region. Treatment started immediately with ivermectin, permethrin, and keratolytics after doing KOH microscopy. Mite population may exceed 1 million/person. Hence, it is highly infectious and can set off epidemics of scabies in home or institutions.

Control of scabies outbreaks in an Italian hospital: An information-centered management strategy

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. 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. 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. 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.

Detection of scabies: A systematic review of diagnostic methods.

Accurate diagnosis of scabies infection is important for patient treatment and for public health control of scabies epidemics. To systematically review the accuracy and precision of history, physical examination and tests for diagnosing scabies. 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. 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. 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.

Scabies in healthcare settings

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. 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. 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.

Scabies by Kenneth Mellanby

Epidemics of scabies are often associated with wars or other times of social upheaval. This was particularly evident during the Second World War when it was estimated that there were one to two million patients with scabies in Great Britain. This article reviews the work of the zoologist Kenneth Mellanby of England and evaluates his contribution to our knowledge of the diagnosis and treatment of scabies in the Second World War. Using humans, Mellanby studied the transmission and treatment of this disease. Among his contributions were knowledge of how many mites the average patient had, and where they were located. He clearly noted and described that the scabies rash was not limited to the location of the mites on the body; he attributed the rash in areas with no mites to "a true sensitization." He found that "fomites were not the major method of transmissions.

Scabies by Kenneth Mellanby

Background: Epidemics of scabies are often associated with wars or other times of social upheaval. This was particularly evident during the Second World War when it was estimated that there were one to two million patients with scabies in Great Britain. Objective: This article reviews the work of the zoologist Kenneth Mellanby of England and evaluates his contribution to our knowledge of the diagnosis and treatment of scabies in the Second World War. Conclusion: Using humans, Mellanby studied the transmission and treatment of this disease. Among his contributions were knowledge of how many mites the average patient had, and where they were located. He clearly noted and described that the scabies rash was not limited to the location of the mites on the body; he attributed the rash in areas with no mites to “a true sensitization.” He found that “fomites were not the major method of transmissions.”

Controlling scabies in institutional settings: a review of medications, treatment models, and implementation.

Scabies is a global problem and a significant source of morbidity in nursing home residents and workers because of its highly contagious nature. It is also a problem in hospitals that care for the elderly, the debilitated, and the immunocompromised. New outbreaks continue to occur, despite controlling the recurrent epidemics. Scabies manifests as papules, pustules, burrows, nodules, and occasionally urticarial papules and plaques. Most of the patients with scabies experience severe pruritus. A subset of patients have crusted or Norwegian scabies. These patients, who are usually debilitated or immunocompromised, do not experience the urge to scratch, and therefore do not scratch their own skin. Diagnosis of scabies is based on patient history, physical examination, and demonstration of mites, eggs, or scybala (black or brown football-shaped masses of feces of scabies) on microscopic examination. Scabies can be treated with topical or oral therapies. Topical treatments include 5% permethrin cream, 1% lindane (gamma benzene hexachloride) lotion, 6% precipitated sulfur in petrolatum, crotamiton, malathion, allethrin spray, and benzyl benzoate. Ivermectin, the only oral treatment, is not approved for scabies in the US. Most authorities advocate using a scabicide several times, specifically once a week over a period of 2-3 weeks. In an outbreak of scabies in a nursing home, residents, staff, and frequent visitors should all be treated even if they are not symptomatic. Ivermectin is useful in treating patients with Norwegian or crusted scabies, or who are debilitated. Ivermectin has no serious reported adverse effects. Model treatment plans to stop scabies epidemics have been developed. These plans coordinate treatment of all persons exposed (including ivermectin for debilitated patients), isolation of infected patients, disinfection of objects that patients have come into contact with, and education and reassurance of the medical staff. Failure to coordinate notification, education, treatment, and disinfection leads to failure to control scabies epidemics. Control of epidemics of institutional scabies requires attention to treatment effects and logistics. Treatment is low risk, but cumbersome because many individuals need be treated. It is advisable to restrict, where possible, the number of staff members that deal with scabies patients to limit the spread of the scabies. Prolonged surveillance is required for the eradication of institutional scabies. While the foregoing plans require coordination of all involved personnel and sustained efforts, they are necessary to halt the spread of scabies to patients and staff, to enhance their morale, and to prevent deterioration of labor and public relations.

Atypical presentation of scabies among nursing home residents.

Scabies epidemics are not uncommon in nursing homes. Effective treatment is enhanced by prompt clinical diagnosis and early intervention. The clinical presentation of scabies may vary in older, immunocompromised or cognitively impaired persons. We performed a retrospective study of all residents diagnosed with scabies in a multilevel long-term care geriatric facility. The duration of the outbreak was from May to September 2000. Fifteen residents contracted scabies during the outbreak. All affected residents had predominantly truncal lesions. Twelve residents had diffuse erythematous, papulosquamous lesions. Pruritus occurred in only 5 residents. Three residents with severe dementia and notably impaired functional status failed to respond to Permethrin cream (5%). All 3 residents responded to treatment with oral Ivermectin. Older nursing home residents with scabies may present with atypical skin lesions. Residents with cognitive impairment and restricted mobility may be treatment resistant. The diagnosis of scabies should be considered in any nursing home resident with an unexplained generalized rash. Residents with dementia and severe functional impairment that fail to respond to Permethrin cream (5%) may benefit from treatment with oral Ivermectin.

Scratching the itch: management of scabies in A&E

Epidemics of scabies seem to occur in 20–25-year cycles. One of the resultant problems is that few A&E nurses practice through more than one epidemic and with each new outbreak of scabies, the latest generation of A&E nurses have to learn how to recognize and manage the disease. This article describes scabies, how to recognize it and the treatment options available. Although uncertainty remains, Permethrin is the first treatment of choice and should be used in the 5% cream form, not the 100% lotion. Crusted Norwegian scabies requires prompt and careful attention along with Specialist advice. The challenge for A&E staff is to recognize scabies, treat it appropriately and to help educate those most at risk.

Epidemiology and control of scabies in an Egyptian village

Some studies have addressed the epidemiology of scabies among rural populations in developing countries; however, the epidemiology of scabies among the rural population in Egypt is unknown. We sought to determine the magnitude of scabies infestation in an Egyptian village and to evaluate the control measures after 1 year. This study was carried out on 3147 residents of Mit-Moaned village in Dakahlia govemorate, Egypt. It was a cross-sectional follow-up study where the same individuals examined in round I were re-examined in round III. The two rounds were separated by a period of 1 year, during which infested patients were followed up and new cases were discovered (round II). Patients and their household contacts received treatment with topical permethrin. Patients showing resistance to permethrin received a single oral dose of ivermectin. In round III, the overall prevalence rate of scabies was reduced from 5.4% in round I to 1.1%. The incidence of new cases among susceptible persons during round II was 1.1%. Scabies was significantly (P < 0.05) more prevalent among families of large size, high crowding index at night, low socioeconomic standards, and those receiving their water supply from a hand pump. Children younger than 10 years showed the highest prevalence. Our data provide the first complete picture of the epidemiology of scabies in rural Egypt. The epidemiologic characteristics of the disease should be considered in the design of disease control programs for other villages with scabies epidemics. Our findings revealed that good control was achieved with the following: increased awareness and better case finding, education of the staff at the rural health unit, improved hygiene measures, and massive treatment campaigns using effective drugs such as topical permethrin and oral ivermectin.

Scabies Epidemic: Price and Prejudice

Scabies epidemics are not unusual, and the recommended way of stopping them is by simultaneous treatment of everybody in the facility; this has been known since the last century, when Norwegian scabies was a problem in Norway. When this is not done, scabies epidemics can smolder for months. Scabies should not spread with good infection control measures, but we learned that a good infection control service is not enough. Efforts have to be done to educate everybody in the hospital, including laundry workers, and to improve work conditions.

Scabies: an epidemiologic reassessment.

Scabies is a highly contagious parasitic infestation whose exact nature is unknown. A reassessment of epidemiologic data questions accepted ideas such as that scabies is a sexually transmitted disease; 30-year cycles of scabies epidemics exist; changes in the immune status of the host population (herd immunity) are epidemiologically significant; fomite transmission is rare; and blacks are resistant to the mite. Scabies epidemics are due to several factors and improved surveillance is needed before the disease can be better controlled.

Treatment of Today's Scabies and Pediculosis

RECENTLY we noted 1 the increase of scabies in the United States following an eight-year pandemic in most of the world. 2,3 The cyclic nature of scabies epidemics is not understood, but immunologic factors, especially delayed hypersensitivity, probably play a significant role. 4 Based on extrapolation from experience in previous cycles in this century, the current epidemic may abate by approximately 1980. SCABIES Principles of Management The diagnosis should be made with certainty, preferably by identifying the mite (principally in direct skin scrapings, at times by cutaneous biopsy) prior to instituting therapy. If the mite cannot be detected, there should be a review of suggestive features, and the more such features, the more positive is the diagnosis. A decision as to risk-to-benefit ratio must take into account the efficacy of the scabicide. Unfortunately, there has been limited interest in comparative, controlled efficacy trials of scabicides since World War II. The

Treatment of today's scabies and pediculosis

RECENTLY we noted¹the increase of scabies in the United States following an eight-year pandemic in most of the world.^2,3The cyclic nature of scabies epidemics is not understood, but immunologic factors, especially delayed hypersensitivity, probably play a significant role.⁴Based on extrapolation from experience in previous cycles in this century, the current epidemic may abate by approximately 1980. <h3>SCABIES</h3><h3>Principles of Management</h3> The diagnosis should be made with certainty, preferably by identifying the mite (principally in direct skin scrapings, at times by cutaneous biopsy) prior to instituting therapy. If the mite cannot be detected, there should be a review of suggestive features, and the more such features, the more positive is the diagnosis. A decision as to risk-to-benefit ratio must take into account the efficacy of the scabicide. Unfortunately, there has been limited interest in comparative, controlled efficacy trials of scabicides since World War II. The