Elderly in Connecticut

Scabies in the Elderly

New Haven Resources

COMMUNICABLE DISEASE: CRUSTED NORWEGIAN SCABIES

               

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DEFINE THE DISEASE:

A contagious skin infection caused by a parasite. It is caused by a tiny and usually not directly visible parasite, the mite Sarcoptes scabiei, which burrows under the host's skin, causing intense allergic itching. The term "Norwegian scabies" refers instead to a particularly severe form of scabies that is also known as crusted scabies. Norwegian scabies, or crusted scabies, is different from regular “garden variety” scabies. Human immune response to this form allows for the infestation of an individual with hundreds of thousands of the mites.

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RISK FACTORS FOR DEVELOPING THE DISEASE:

The elderly and people with an impaired immune system, such as HIV, lymphoma, cancer, or those on immunosuppressive medications, are susceptible. On those with a weaker immune system, the host becomes a more fertile breeding ground for the mites, which spread over the host's body, except the face. Sufferers of crusted scabies exhibit scaly rashes, slight itching, and thick crusts of skin that contain thousands of mites.

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SUBCLINICAL DISEASE AND EXPOSURE TO THE DISEASE:

Subclinical disease is an illness that is staying below the surface of clinical detection. A subclinical disease has no recognizable clinical findings. It is distinct from a clinical disease, which has signs and symptoms that can be recognized.

With Norwegian Scabies, the materialization of symptoms, or burrowing paths of the mite into the epidural layer, usually can be noticed within 24 hours of parasitic contact. This usually affects the skin of the chest, back, face, and the palms of the hands and feet. Such areas make eradication of mites particularly difficult, as the crusts protect the mites from topical miticides, necessitating prolonged treatment of these areas.

A particular danger of crusted scabies is that these lesions often predispose to the development of secondary infections, as with Staphylococcus bacteria.

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TRANSMISSION (mode, incubation):

The disease may be transmitted from objects but is most often transmitted by direct skin-to-skin contact, with a higher risk with prolonged contact. Initial infections require four to six weeks to become symptomatic. Reinfection, however, may manifest symptoms within as little as 24 hours. The infection is transmitted by any close contact, including sexual contact, so scabies is considered to be one of the sexually transmitted diseases

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TREATMENT:

A number of medications are effective in treating scabies; however, treatment must often involve the entire household or community to prevent re-infection. Options to improve itchiness include antihistamines.

-Permethrin, topical cream (Elemite)

-Ivermectin, PO med (Stromectol)

While classical scabies is usually treated with one of the above, treatment of crusted scabies can require oral medications along with multiple applications of a scabicide cream.

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ROLE OF THE COMMUNITY HEALTH NURSE:

A Community Health Nurse should be an educator of the signs and symptoms. They should promote safe sex, even among the elderly. Also, the community nurse should teach and promote good hygiene, maintaining distance from those infected with the disease, and the importance of seeking treatment at the first sign of infection.

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LEVELS OF PREVENTION:

Mass treatment programs that use topical permethrin or oral ivermectin have been effective in reducing the prevalence of scabies in a number of populations. There is no vaccine available for scabies. The simultaneous treatment of all close contacts is recommended, even if they show no symptoms of infection (asymptomatic), to reduce rates of recurrence. Asymptomatic infection is relatively common. Objects in the environment pose little risk of transmission except in the case of crusted scabies, thus cleaning is of little importance. Rooms used by those with crusted scabies require thorough cleaning.

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SCABIES OUTBREAKS IN NURSING HOMES FOR THE ELDERLY

RESEARCH ARTICLE REVIEW:

The scabies mite is a parasite able to infest humans. Its clinical presentation is typical, although in elderly patients the clinical presentation may be altered. Diagnosis and treatment of the disease in this group can be difficult because elderly often live together in nursing home settings which promotes easy transmission from patient to patient. . Delay in diagnosis may induce rapid spread of the scabies mite, making immediate diagnosis and treatment crucial. Single cases of scabies should be treated with permethrin cream which has little adverse effects. Scabies out- breaks and cases of crusted scabies can easily be managed using combination therapy consisting of topical application of permethrin and two oral doses of ivermectin 200 μg/kg (administered 1 week apart). In addition to treatment of the scabies infestation, preventative measures are necessary, particularly in nursing homes.

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REFERENCES:

Subclinical Disease. Retrieved from MedicineNet.com on June 12, 2012 http://www.medterms.com/script/main/art.asp?articlekey=5578

Tjioe, M.,Vissers, W. (2008). Scabies Outbreaks in Nursing Homes for the Elderly. Drugs and Aging. 25(4): 299-306.