1. Scabies

2. Objectives: After the in-service, staff will be able to identify:
the mode of transmission for scabies.
at least 3 signs and symptoms of scabies.
at least 2 treatment options for scabies.
at least 5 nursing responsibilities related to control and prevention of scabies.

3. Facts
Present since eons of time, “itch” according to the Greeks and Romans
Giovanni Cosimo Bonomo discovered the mite in 1687
First seen under a microscope in 1687
300 million cases occur annually worldwide

4. Facts Fewer than 10-15 mites may be found on a person
Mites do not fly or jump
They crawl at a rate of 2.5 cm/min
May live on surfaces for 2-3 days
Immobile at temperatures below 20 ⁰C
Likes warm temperature

5. Facts
Norwegian (first described in Norway in the mid-1800s) or crusted scabies may be transmitted by “brief” skin-to-skin contact or by exposure to bedding, clothing, or even furniture
Norwegian scabies may be mitsaken for other skin conditions such as dermatitis or adverse drug reaction

6. Scabies Mite

7. Biology
Causative agent:
Sarcoptes
Scabiei var. hominis

8. Biology What happens? Male and female mite mates on skin surface
Female burrows into top layer of dead skin and lays eggs (1-2 daily) during her life cycle (1-2 months per CDC)
Males die after mating

9. Biology Stages in life cycle
Egg- oval, mm in length, hatches in 3-4 days; at least 3-4 eggs are deposited by the female
Larva- after egg is hatched; migrates to skin surface and burrows under skin; has only 3 pairs of legs; lasts about 3-4 days

10. Biology
Stages
Nymph- after larva molts (shedding); has 4 pairs of legs; found in molting pouches or hair follicles; looks similar to adults but smaller
Adult- round, sac-like eyeless mites; females 0.30 to 0.45 mm in length and mm in width; males slightly more than half of female size

11. Epidemiology and Risk Factors
Transmission- direct, prolonged, skin-to-skin contact
Persons at risk- household members of infected person
In adults, frequently sexually acquired
Who can get scabies? ANYONE

12. Typical Body Sites for Scabies

13. Typical Scabies

14. Clinical Presentation

15. Common Symptoms
For first-time infestation, appears about 2-6 weeks after being infested, up to 2 months
Appears sooner (1-4 days) if patient had scabies in the past
Skin rash, pimple like is common
Itching, severe especially at night

16. Common Symptoms
Burrows- tiny, raised, and crooked; grayish white or skin-colored lines; may be difficult to find; mostly in the webs of fingers, skin folds on the wrist, elbow, or knee; and the penis, breast, or shoulder blades

17. Common Symptoms Between fingers , wrist, elbow, armpit
Penis, nipples, waist, buttocks, shoulder
blades
Behind the ears in bedfast patients
Head, face, neck, palms, and soles often involved in infants and children

18. Atypical (Norwegian) Scabies

19. Diagnostic Test
Based on customary appearance and distribution of rash and presence of burrows
Skin scraping and microscopic examination to identification of mite, mite eggs, or feces (scybala)

20. Treatment
Apply scabicide to clean body and leave on as prescribed (8-14 hours)
Bedding, clothing, and towels should be washed (infected person and household members)
Trim fingernails and toenails as needed and apply scabicide between fingers and toes

21. Treatment
Repeat treatment if itching persists more than 2-4 weeks after treatment
Repeat treatment if new burrows or pimple-like rash continue to appear
Antibiotic if skin sores are infected
Anti-itch medication orally or by feeding tube to relieve itching and prevent scratching

22. Medications Permethrin 5% (Elimite)
- may be applied twice or more 1 week apart
Crotamition lotion or cream 10% (Eurax)
-not FDA approved for children
-safe for adults
Ivermectin- oral antiparasitic agent
-200 mcg/kg taken on an empty stomach
-2 or more doses may be necessary

23. Prevention and Control
AVOID DIRECT SKIN-TO-SKIN CONTACT WITH
INFESTED PERSON OR THE PERSON’S BEDDING,
CLOTHING, FURNITURE.
How?
USE YOUR PERSONAL PROTECTIVE
EQUIPMENTWHEN PROVIDING
CARE TOPATIENTS.

24. Prevention and Control
Treat contacts at the same time as the infested person.
Wash all beddings and clothing used anytime during the 3 days prior to treatment. NO dry cleaning.
Items that cannot be washed need to be bagged and sealed tightly for 2-3 days.

25. Prevention and Control
Rooms should be cleaned; vacuum all furniture.
Treat patients with encrusted scabies and their contacts rapidly and aggressively.

26. Questions?