Infection control investigations and treatment of discharged patients following exposure to scabies in a tertiary hospital

Abstract number: 1734_159

Schousboe M., Armstrong K.

Objective: Review of an outbreak of scabies originating in an infected patient with Bullous Pemphigus Vulgaris (BPV).

Methods: A 58-year-old woman admitted to a cardiology ward with arrhythmia and cardiac symptoms had a history of BPV, diabetes mellitus and cellulitis of the legs. She stayed 54 days in five wards in two hospitals and mainly admitted into multi-bed rooms with no restriction of her movements. She was treated with methylprednisolone and cyclophosphamide.

``Norwegian'' Scabies was diagnosed 16 days before her death. She was isolated with contact precautions and the infection treated topically and given oral ivermectin. However, microscopy of skin scrapings for the scabies mite remained positive until her death.

The infection caused staff and patient exposure, but no transmission was found until a city laboratory reported a further case to the Infection Control Service. A ``look back'' of patients who could have been exposed to the index case was carried out and information was sent to General Practitioners.

Results: During the subsequent four months, 31 patients were diagnosed with scabies. Age groups were 40–96 years mean age 75. 8 scabies infections were known to have been diagnosed by microscopic identification of the scabies mite or the eggs. The others were a clinical diagnosis.

Contacts were treated with permethrin cream. 6 were known to require several applications. The Infection Control Service (ICS) became the contact for follow-up for 5 patients of which 3 required referral to a specialist for alternative treatment including oral ivermectin.

Several staff consulted the ICS and were treated.

Conclusion: Scabies is difficult to diagnose in immunosuppresed patients or in the presence of dermatological disease. Elderly people have few reactions to the mite. ``Norwegian scabies'' is a crusted highly contagious form of scabies. It is often overlooked, lacking the itchiness and lesions seen in people with normal immunity.

The outbreak showed spread via formites in hospitals. Scabies is often not considered by medical practitioners. Steroids used as symptomatic treatment will aggravate the infection. Technical skill is required by laboratory staff when recovering and identifying the mite from skin scrapings.

Session Details

Date: 31/03/2007
Time: 00:00-00:00
Session name: European Society of Clinical Microbiology and Infectious Diseases
Location: ICC, Munich, Germany
Presentation type:
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