Download Scabies for Physician Blast Fax #1 Oct. 3, 2016

10/3/2016
ATTN:
2016-29
Logan County Physicians
NORWEGIAN SCABIES BEING SEEN in LOGAN COUNTY
The Logan County Health District has been made aware of a confirmed case of Norwegian Scabies with multiple suspect cases being
evaluated.
Background
Generally scabies is an infestation of the skin by a human itch mite. Crusted (Norwegian) is a severe form that occur in some
persons with weakened immune system, persons with a disability or in the elderly. Crusted scabies have thick crusts with large
numbers of scabies mites and eggs. Persons with crusted scabies are very contagious to other persons and can spread easily both
by skin-to-skin contact and by contamination of items such as clothing, bedding and/or furniture. Persons may not show the usual
signs and symptoms such as the characteristic rash or itching. Persons with crusted scabies should receive quick and aggressive
treatment for the infestation to prevent outbreaks of scabies
Signs and Symptoms
The most common signs and symptoms of scabies are:
•
Intense itching (especially at night)
•
A pimple like itchy rash
•
Rash can include tiny blisters and scales
Each of these signs and symptoms may affect much of the body or be limited to common sites such as:
•
Wrists
•
Elbow
•
Armpit
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Webbing between the fingers
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Nipples/Penis
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Waist/belt-line
•
Buttocks
Transmission
Scabies is usually spread by direct, prolonged, skin-to-skin contact with a person who has scabies. Generally a quick handshake or
hug will not spread scabies. Scabies is spread easily to sexual partners and household members.
Scabies can be spread indirectly by sharing articles such as clothing, towels, or bedding used by an infested person; however, such
occurs much more easily when the infested person has crusted scabies.
On a person, scabies mites can live for as long as 1-2 months. Off a person, scabies mites usually do not survive more than 48-72
hours. Scabies will die if exposed to a temperature of 122 degrees Fahrenheit for 10 minutes.
If a person has never had scabies symptoms may take as long as 4-6 weeks to begin. It is important to remember that an infested
person can spread scabies during this time, even he/she does not have symptoms.
In a person who has had scabies symptoms usually appear much sooner (1-4 days) after exposure.
Testing and Reporting
Diagnosis of a scabies infestation usually is made based upon the customary appearance and distribution of the rash
and the presence of burrows. Whenever possible, the diagnosis of scabies should be confirmed by identifying the mite or mite
eggs or fecal matter (scybala). This can be done by carefully removing the mite from the end of its burrow using the tip of a needle
or by obtaining a skin scraping to examine under a microscope for mites, eggs, or mite fecal matter (scybala). However, a person
can still be infested even if mites, eggs, or fecal matter cannot be found; fewer than 10-15 mites may be present on an infested
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person who is otherwise healthy. However, persons with crusted scabies can be infested with thousands of mites and should be
considered highly contagious.
Prevention and Control
Scabies is prevented by avoiding direct skin-to-skin contact with an infested person or with items such as clothing or bedding used
by an infested person. Scabies treatment usually is recommended for members of the same household, particularly for those who
have had prolonged skin-to-skin contact.
All household members and other potentially exposed persons should be treated at the same time as the infested person to
prevent possible re-exposure and re-infestation.
•
Bedding and clothing worn or used next to the skin anytime during the 3 days before treatment should be machine
washed and dried using the hot water and hot dryer cycles or be dry-cleaned.
•
Items that cannot be dry-cleaned or laundered can be disinfested by storing in a closed plastic bag for several days to a
week.
•
Scabies mites generally do not survive more than 2 to 3 days away from human skin.
Children and adults usually can return to child care, school, or work the day after treatment.
Institutional outbreaks can be difficult to control and require a rapid, aggressive, and sustained response.
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Rooms/work space/vehicles used by an infested person with crusted scabies should be thoroughly cleaned and
vacuumed after use.
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Environmental disinfestation using pesticide sprays or fogs generally is unnecessary and is discouraged.
Treatment
All skin-to-skin contact/household members require treatment: For Crusted scabies: both oral and topical agents should be used:
1.
Ivermectin - Brand name product: Stromectol
Ivermectin is an oral antiparasitic agent approved for the treatment of worm infestations. Evidence suggests that oral
ivermectin may be a safe and effective treatment for scabies; however, ivermectin is not FDA-approved for this use. The
safety of ivermectin in children weighing less than 15 kg and in pregnant women has not been established.
For crusted scabies, ivermectin should be administered together with a topical agent. Oral ivermectin (200µg/kg/dose) should
be taken with food. Depending on infection severity, ivermectin should be taken in three doses (approximately days 1, 2, and
8), five doses (approximately days 1, 2, 8, 9, and 15), or seven doses (approximately days 1, 2, 8, 9, 15, 22, and 29).
See also attached article from the New England Journal of Medicine regarding Ivermectin for Crusted Scabies
2.
Permethrin cream 5% - Brand name product: Elimite
Permethrin is approved by the US Food and Drug Administration (FDA) for the treatment of scabies in persons who are at least
2 months of age. Permethrin is a synthetic pyrethroid similar to naturally occurring pyrethrins which are extracts from the
chrysanthemum flower. Permethrin is safe and effective when used as directed. Permethrin kills the scabies mite and eggs.
Permethrin is the drug of choice for the treatment of scabies. Topical permethrin should be administered every 2-3 days for 12 weeks to treat crusted scabies.
3.
Benzyl benzoate 25% (with or without tea tree oil)
Benzyl benzoate may be used as an alternative topical agent to permethrin. However, this agent may cause immediate skin
irritation. Lower concentrations may be used in children (10% or 12.5%).
4.
Keratolytic cream
A topical keratolytic cream may also be used to help reduce the crusting of the skin and aid in the absorption of the topical
permethrin or benzyl benzoate.
More information available at: www.cdc.gov/scabies or http://www.cdc.gov/parasites/scabies/health_professionals/meds.html
For further information or to report any persons under investigation, please notify the Infectious Disease Nurse by calling (937)
651-6901 or fax reports to (937) 592-6746.
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