Nosocomial Transmission and Infection Control Aspects of Parasitic and Ectoparasitic Diseases Part III. Ectoparasites/Summary and Conclusions

Abstract

As a rule, both the standard of hygiene and sanitation prevalent in hospitals in the United States and the rarity of parasitic diseases compared to viral, bacterial, and fungal infections, reduce the hazard of nosocomial acquisition of parasites to relatively trivial levels. However, abetted by the resultant low index of suspicion on the part of clinical staff, certain parasitic microorganisms may at times cause significant morbidity and even mortality in both normal and immunocompromised patients, as summarized in this review. Also, the nosocomial acquisition of parasites may be somewhat underappreciated because the incubation period for clinical illness may be days to weeks and thus a hospital-acquired infection may not be recognized as such, particularly if the parasite is endemic locally. Parasitic diseases have been a much more significant problem in certain special facilities, such as custodial institutions for the mentally ill or retarded, where crowding, poor environmental sanitation, and low levels of personal hygiene have in the past allowed the rapid dissemination and endemic occurrence of a large variety of parasitic infections. It is likely that nosocomial transmission of parasites may be an even greater problem in some hospitals in the tropics, where strict hygienic standards are costly or otherwise more difficult to maintain, and where often an increased proportion of the patient population harbors one or more parasites. However, the exact magnitude of the problem in tropical hospitals is also more difficult to determine because nosocomial acquisition of a parasitic infection may not be distinguished easily versus exogenous infection or reactivation of latent infection.(ABSTRACT TRUNCATED AT 250 WORDS)

Risk factors for recurrence of scabies: A retrospective study of scabies patients in a long-term care hospital

“…The present scabies epidemic in Japan began around 1975 and continues mostly in institutional settings such as nursing homes, long-term care hospitals and psychiatric hospitals. [1][2][3] Various factors have contributed to the outbreak of scabies in institutions: delay of diagnosis, misuse of corticosteroid and iatrogenic crusted scabies, 4 increased number of immunocompromised hosts due to population aging, and frequent patient transfers among hospitals. 5 Through investigations on institutional scabies outbreaks, we have found that a considerable number of patients suffer from recurrence of scabies.…”

Guideline for the diagnosis and treatment of scabies in Japan (third edition)

“…Fecal pellets dissolve easily with potassium hydroxide and can be stained with chlorazol black E. 39 At present, there is no established method for differentiating whether the mite is alive or dead. 40,41 Even in cases of eruption associated with scabies, the mite detection rate with microscopy varies widely, ranging 10-70%, 17,[42][43][44] so it is essential to improve the techniques of detection and to frequently repeat the test at different sites on the body. For efficient detection of S. scabiei, the mite burrows must be magnified with a dermoscope and the tips of the burrows examined.…”

“…However, even with epidemiological studies, it is often impossible to identify the crusted scabies that are the source of infection. 44,134,135 Patients with crusted scabies are often in poor general health, and may leave the affected group before diagnosis due to death or hospital transfer, so the affected person may be absent at the time the mass outbreak is recognized. In these situations, the patient first diagnosed with common scabies may be erroneously regarded as the source of infection.…”

Guideline for the diagnosis and treatment of scabies in Japan (second edition)

“…14,24,25 Even in cases of eruption associated with scabies, the mite detection rate with microscopy varies widely (10-60%) among reports. [26][27][28] It is therefore desirable to improve the techniques of detection and to conduct the test on multiple parts of each case. For efficient detection of mites (particularly in elderly individuals), it is essential to check carefully for burrows (formed along the folds of palm or planta) and the V-shaped wake-like scales.…”