Scabies

Objectives: After the in-service, staff will be able to identify: the mode of transmission for scabies. at least 3 signs and symptoms of scabies. at least 2 treatment options for scabies. at least 5 nursing responsibilities related to control and prevention of scabies.

Facts Present since eons of time, “itch” according to the Greeks and Romans Giovanni Cosimo Bonomo discovered the mite in 1687 First seen under a microscope in 1687 300 million cases occur annually worldwide

Facts Fewer than 10-15 mites may be found on a person Mites do not fly or jump They crawl at a rate of 2.5 cm/min May live on surfaces for 2-3 days Immobile at temperatures below 20 ⁰C Likes warm temperature

Facts Norwegian (first described in Norway in the mid-1800s) or crusted scabies may be transmitted by “brief” skin-to-skin contact or by exposure to bedding, clothing, or even furniture Norwegian scabies may be mitsaken for other skin conditions such as dermatitis or adverse drug reaction

Scabies Mite

Biology Causative agent: Sarcoptes Scabiei var. hominis

Biology What happens? Male and female mite mates on skin surface Female burrows into top layer of dead skin and lays eggs (1-2 daily) during her life cycle (1-2 months per CDC) Males die after mating

Biology Stages in life cycle Egg- oval, 0.10-0.15 mm in length, hatches in 3-4 days; at least 3-4 eggs are deposited by the female Larva- after egg is hatched; migrates to skin surface and burrows under skin; has only 3 pairs of legs; lasts about 3-4 days

Biology Stages Nymph- after larva molts (shedding); has 4 pairs of legs; found in molting pouches or hair follicles; looks similar to adults but smaller Adult- round, sac-like eyeless mites; females 0.30 to 0.45 mm in length and 0.25-0.35 mm in width; males slightly more than half of female size

Epidemiology and Risk Factors Transmission- direct, prolonged, skin-to-skin contact Persons at risk- household members of infected person In adults, frequently sexually acquired Who can get scabies? ANYONE

Typical Body Sites for Scabies

Typical Scabies

Clinical Presentation

Common Symptoms For first-time infestation, appears about 2-6 weeks after being infested, up to 2 months Appears sooner (1-4 days) if patient had scabies in the past Skin rash, pimple like is common Itching, severe especially at night

Common Symptoms Burrows- tiny, raised, and crooked; grayish white or skin-colored lines; may be difficult to find; mostly in the webs of fingers, skin folds on the wrist, elbow, or knee; and the penis, breast, or shoulder blades

Common Symptoms Between fingers , wrist, elbow, armpit Penis, nipples, waist, buttocks, shoulder blades Behind the ears in bedfast patients Head, face, neck, palms, and soles often involved in infants and children

Atypical (Norwegian) Scabies

Diagnostic Test Based on customary appearance and distribution of rash and presence of burrows Skin scraping and microscopic examination to identification of mite, mite eggs, or feces (scybala)

Treatment Apply scabicide to clean body and leave on as prescribed (8-14 hours) Bedding, clothing, and towels should be washed (infected person and household members) Trim fingernails and toenails as needed and apply scabicide between fingers and toes

Treatment Repeat treatment if itching persists more than 2-4 weeks after treatment Repeat treatment if new burrows or pimple-like rash continue to appear Antibiotic if skin sores are infected Anti-itch medication orally or by feeding tube to relieve itching and prevent scratching

Medications Permethrin 5% (Elimite) - may be applied twice or more 1 week apart Crotamition lotion or cream 10% (Eurax) -not FDA approved for children -safe for adults Ivermectin- oral antiparasitic agent -200 mcg/kg taken on an empty stomach -2 or more doses may be necessary

Prevention and Control AVOID DIRECT SKIN-TO-SKIN CONTACT WITH INFESTED PERSON OR THE PERSON’S BEDDING, CLOTHING, FURNITURE. How? USE YOUR PERSONAL PROTECTIVE EQUIPMENTWHEN PROVIDING CARE TOPATIENTS.

Prevention and Control Treat contacts at the same time as the infested person. Wash all beddings and clothing used anytime during the 3 days prior to treatment. NO dry cleaning. Items that cannot be washed need to be bagged and sealed tightly for 2-3 days.

Prevention and Control Rooms should be cleaned; vacuum all furniture. Treat patients with encrusted scabies and their contacts rapidly and aggressively.

Questions?