Large Nosocomial Outbreak Associated with a Norwegian Scabies Index Case Undergoing TNF-α Inhibitor Treatment: Management and Control

Belvisi, Valeria; Orsi, Giovanni Battista; Borgo, Cosmo Del; Fabietti, Paolo; Ianari, A.; Albertoni, F.; Porcelli, Patricia; Potenza, Concetta; Mastroianni, Claudio Maria

doi:10.1017/ice.2015.188

Cited by 20 publications

(13 citation statements)

References 9 publications

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“…One of the most important risk factors for nosocomial outbreaks is the failure to recognize scabies in patients by attending clinicians. The crusted scabies has particularly atypical presentation making it difficult to diagnose and high risk of transmission, therefore it has been the index case in most recent outbreaks [4]. The misdiagnosis of scabies is common due to its multifarious manifestation and the absence of available and appropriate diagnostic laboratory tests [5].…”

Section: Introductionmentioning

confidence: 99%

Diagnostic value of the molecular detection of Sarcoptes scabiei from a skin scraping in patients with suspected scabies

et al. 2020

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Scabies is a highly contagious parasitic disease associated with long-term residence in nursing homes, and it is a public health burden worldwide. However, atypical skin manifestations are frequent and the widely used diagnostic test based on microscopic examinations has limited sensitivity. We evaluated the diagnostic value of polymerase chain reaction (PCR) from skin scraping in patients with suspected scabies. Adult patients with suspected scabies, unrelated diseases or healthy volunteers were enrolled at a tertiary hospital, in Seoul, South Korea, from December 2017 through October 2018. We classified participants based on the consensus criteria established by the International Alliance for the Control of Scabies in 2018; confirmed (microscopic mite detection), clinical (scabies burrow or typical lesions with two history features including itch and close contact with scabies patients), suspected scabies (typical lesion with one history feature or atypical lesion with two history features), or no scabies. PCR was performed on the skin scrapings to target the cytochrome c oxidase subunit 1 (cox1) gene of Sarcoptes scabiei. A total of 47 participants, 33 with suspected scabies, 10 with unrelated diseases, and 4 healthy volunteers were enrolled. Of the 33 patients, 22 were classified as confirmed scabies, 2 as clinical scabies, 6 as suspected scabies, and 3 as no scabies. The sensitivities of the microscopic examination were 100%, 92%, and 73% in confirmed scabies; confirmed and clinical scabies; and confirmed, clinical, and suspected scabies, respectively (p = 0.006). The sensitivities of PCR were 86%, 83%, and 80% in confirmed scabies; confirmed and clinical scabies; and confirmed, clinical, and suspected scabies, respectively (p = 0.59). The specificity of the scabies PCR in the no scabies control was 100% (95% CI = 80-100).PCR testing for scabies may be helpful in the improvement of sensitivity for the diagnosis of scabies by clinical criteria.

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Section: Introductionmentioning

confidence: 99%

Diagnostic value of the molecular detection of Sarcoptes scabiei from a skin scraping in patients with suspected scabies

et al. 2020

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“…hominis infestation [1]. In such infestations, the mites colonize the stratum corneum by the thousands [4,7]. CS preferentially develops in individuals with cellular immunity deficiency (organ transplant recipients, bone marrow recipients, persons with human immunodeficiency virus [HIV], lymphomas, etc…) and debilitated individuals (dementia, Down syndrome, quadriplegic, etc…) [1][2][3][4][5].…”

Section: Discussionmentioning

confidence: 99%

“…Skin biopsies of CS patients have revealed an absence of B lymphocytes or specific antibodies but a large quantity of T lymphocytes (T cells) with a high CD8?/CD4? ratio [7], suggesting an important role of CD8? T cells against CS.…”

Section: Discussionmentioning

confidence: 99%

“…T-cells is fourfold higher than that for CD8? T-cells [7]. The precise role of the cytotoxic T cells in CS is not yet clear.…”

Section: Discussionmentioning

confidence: 99%

“…It is possible that the mental deficit of these patients also contributes to CS due to an altered interpretation of itching if present [5,9]. In addition, patients with Down syndrome often live in institutions with other debilitated residents, which are typical environments favoring scabies epidemics [7].…”

Section: Discussionmentioning

confidence: 99%

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Risankizumab-Aggravated Crusted Scabies in a Patient with Down Syndrome

Senterre

Jouret

Collins

et al. 2020

Dermatol Ther (Heidelb)

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Risankizumab, an interleukin (IL)-23 antagonist, is a highly effective treatment for moderate to severe psoriasis. Crusted scabies (CS) is a rare and severe form of scabies, occurring mainly in immunosuppressed patients and/or neurologically or mentally ill patients. A young girl with Down syndrome was diagnosed with a hyperkeratotic form of psoriasis. As treatment with topical dermocorticosteroids, UVB-phototherapy and acitretin for 6 weeks did not improve the lesions, two injections of risankizumab were administered. Following these injections, the lesions became rapidly even more severely crusted, and new lesions appeared on the extremities and the face of the patient. There was histological evidence of a high charge of scabies, leading to a diagnosis of CS. The patient was hospitalized and successfully treated by local permethrine and systemic ivermectine. This case suggests that even though anti-IL23 antagonists display an excellent overall safety profile, a particular caution for infections should still be respected in patients with underlying risk factors.

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