CA - Unusual but serious infections: Scabies

Question 1

What are the signs and symptoms of scabies?

Answer 1

1. intense itching, especially at night
2. pimple-like skin rash
3. usually between fingers, skin folds of the wrist, elbow, knee, or armpit
4. on the penis, nipples, waist, buttocks, shoulder blades
5. tiny burrows on the skin
   - mite tunneling beneath skin surface
6. Infants & young children:
   - rash on the head, face, neck, palms, and soles

Question 2

What are the risk factors of scabies?

Answer 2

1. close skin-to-skin contact
2. crowded areas like nursing homes, extended care facilities, detention facilities like jails and prisons, childcare

Question 3

How does scabies spread?

Answer 3

1. Direct, extended, skin-to-skin contact
2. Sharing clothing, towels, or bedding used by an infected person
3. Homeless shelters or encampments

Question 4

How to prevent scabies?

Answer 4

1. Avoid direct skin-to-skin contact
2. Avoid sharing items like clothing or bedding

Question 5

How to control the spread of scabies?

Answer 5

1. treat all household members and close contacts at the same time as the person with scabies.
   - prevent possible re-exposure and reinfestation.
2. Wash all clothing, towels, and bedding used
   - machine wash using hot water > 50°C for 10 minutes
   - kills mites and eggs
3. Dry-clean items that can’t be washed or sealed in a closed plastic bag for at least 72 hours to a week.
4. Avoid skin-to-skin contact with others until treatment is complete.
5. Notify people you had direct skin-to-skin contact with during the previous two months and encourage them to seek treatment.
6. Scabies mites generally do not survive more than two to three days away from human skin.

Question 6

Treatment and recovery

Answer 6

1. Apply Scabicide lotion to all parts of the body
2. For infants and children: Apply Scabicide lotion to all parts of the body + entire head and neck
3. Infants: Only permethrin or sulfur ointment can be used
   - apply to clean body and left on for the recommended time before washing it off.
4. The itching of scabies is due to a hypersensitivity reaction (allergy) to mites and their faeces, so itching may continue for several weeks after treatment even if all the mites and eggs are killed.

However, if itching still is present two to four weeks after treatment or if new burrows or pimple-like rash appear, retreatment may be necessary.

Question 7

How do you diagnose scabies?

Answer 7

1. Physical exam findings and history
2. Skin scrape or remove the mite from the end of its burrow
   - examined under microscope to confirm scabies.
3. A person can still have scabies even if mites, eggs, or feces are not found.
   Fewer than 10 – 15 mites may be present on an infected person who is otherwise healthy.

Question 8

If you’ve never had scabies before, and you touched a patient with scabies, when do you start itching first?

Answer 8

first time:
4 – 8 weeks
- person with infestation can transmit scabies even if they do not have symptoms.

Question 9

If you’ve had scabies before, and you touched a patient with scabies, when do you start itching first?

Answer 9

1-4 days