Risk Factors for Delayed Diagnosis of Scabies in Hospitalized Patients From Long-Term Care Facilities

Lay, Chorng-Jang; Wang, Chun-Lung; Chuang, Hui-Ying; Chen, Yalan; Chen, Hsiang-Ling; Tsai, Shu-Juan; Tsai, Chen–Chi

doi:10.4021/jocmr520w

Cited by 20 publications

(19 citation statements)

References 18 publications

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“…As scabies is largely diagnosed on clinical grounds since there are no standardised laboratory tests available [2], treatment failure may occur due to wrong diagnosis, incorrect use of cream, or improper intake of oral treatments [4]. Therefore, early diagnosis confirmations and proper treatment are critical for avoiding the spread of infestation and outbreaks [18].…”

Section: Discussionmentioning

confidence: 99%

Increase of scabies infestations, Norway, 2006 to 2018

et al. 2019

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Between October and December 2018, several clinicians in Norway reported an increase in scabies diagnoses. We compared data from the Norwegian Syndromic Surveillance System on medical consultations for mite infestations with scabies treatment sales data to investigate this reported increase. From 2013 to 2018, consultations and sales of scabies treatments had almost increased by threefold, particularly affecting young adults 15–29 years. We recommend to increase awareness among clinicians to ensure timely diagnosis and treatment.

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Section: Discussionmentioning

confidence: 99%

Increase of scabies infestations, Norway, 2006 to 2018

et al. 2019

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“…Transmission is predominately person to person through close and prolonged contact, but fomites may also play a role in heavily infected patients, as in the case of crusted scabies (17). The clinical diagnosis of scabies remains problematic, especially in situations where the clinician's suspicion is low, especially in patients with atypical manifestations, or when clinical signs are modified by topical corticosteroids (18,19). Laboratory confirmation traditionally involves the use of skin scrapings for microscopic examination.…”

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confidence: 99%

Development of Conventional and Real-Time Quantitative PCR Assays for Diagnosis and Monitoring of Scabies

et al. 2015

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c Scabies remains the most prevalent, endemic, and neglected ectoparasitic infestation globally and can cause institutional outbreaks. The sensitivity of routine microscopy for demonstration of Sarcoptes scabiei mites or eggs in skin scrapings is only about 50%. Except for three studies using conventional or two-tube nested PCR on a small number of cases, no systematic study has been performed to improve the laboratory diagnosis of this important infection. We developed a conventional and a real-time quantitative PCR (qPCR) assay based on the mitochondrial cytochrome c oxidase subunit 1 (cox1) gene of S. scabiei. The cox1 gene is relatively well conserved, with its sequence having no high levels of similarity to the sequences of other human skin mites, pathogenic zoonotic mites, or common house dust mite species. This mitochondrial gene is also present in large quantities in arthropod cells, potentially improving the sensitivity of a PCR-based assay. In our study, both assays were specific and were more sensitive than microscopy in diagnosing scabies, with positive and negative predictive values of 100%. The S. scabiei DNA copy number in the microscopy-positive specimens was significantly higher than that in the microscopy-negative specimens (median S. scabiei DNA copy number, 3.604 versus 2.457 log 10 copies per reaction; P ‫؍‬ 0.0213). In the patient with crusted scabies, the qPCR assay performed on lesional skin swabs instead of scrapings revealed that the parasite DNA load took about 2 weeks to become negative after treatment. The utility of using lesional skin swabs as an alternative sample for diagnosis of scabies by PCR should be further evaluated. Scabies remains a significant infectious problem worldwide and is a problem not merely in developing countries but also in the developed world. An estimated 300 million cases of scabies occur globally every year, with scabies having a particular association with young children, poor hygiene, homelessness, crowdedness, and poverty in the tropical and subtropical regions (1). The prevalence of scabies in some populations, such as Australian aborigines, can be as high as 25 to 50%, and the burden of disease and morbidity are further aggravated by complications with bacterial pyoderma, including that caused by methicillin-resistant Staphylococcus aureus (2, 3). In developed countries, scabies causes significant public health issues in vulnerable individuals, such as individuals at the extremes of ages and immunocompromised hosts. For example, an estimated incidence of 233 to 470 per 100,000 person-years was reported in a national study conducted from 1994 to 2003 in England (4). In addition, outbreaks readily occur in the community in schools, hospitals (including intensive care units), and other institutions (5-10). Among immunocompromised patients, such as HIV-infected individuals, organ transplant recipients, and patients on biologics or other immunosuppressive therapies, scabies can occur as an unrecognized complication with considerable delays in diagnosis and...

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“…Furthermore, chronic steroids may obscure the diagnosis of scabies. In a retrospective study of hospitalized patients from long-term care facilities, chronic steroid use was identified as the risk factor among patients who had delayed diagnosis of scabies [ 22 ]. It is hard to believe that scabies could be life-threatening, but after 10 months of severe pruritus, the patient was considering withdrawal of immunosuppression and potential loss of allograft function, a move that would have considerably shortened his life expectancy.…”

Section: Discussionmentioning

confidence: 99%

Enigmatic pruritus in a kidney transplant patient

Yates

Bleyer

Yosipovitch

et al. 2013

Clinical Kidney Journal

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Pruritus is a common problem following a kidney transplant and is usually attributable to new medications related to transplantation. We present an unusual case of pruritus that began several months after kidney transplantation. After changing several immunosuppressive medications, numerous clinical visits and consideration by the patient of stopping immunosuppression, scabies was diagnosed as the cause. Treatment with oral ivermectin and topical permethrin resulted in complete resolution of symptoms within 1 week. Transplant physicians should consider common causes of pruritus unrelated to transplantation; diagnostic skin lesions of scabies may be absent.

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Risk Factors for Delayed Diagnosis of Scabies in Hospitalized Patients From Long-Term Care Facilities

Cited by 20 publications

References 18 publications

Increase of scabies infestations, Norway, 2006 to 2018

Increase of scabies infestations, Norway, 2006 to 2018

Development of Conventional and Real-Time Quantitative PCR Assays for Diagnosis and Monitoring of Scabies

Enigmatic pruritus in a kidney transplant patient

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