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A scabies outbreak in an inpatient rehabilitation setting

Published:October 13, 2022DOI:https://doi.org/10.1016/j.ajic.2022.10.003

      Highlights

      • Delayed diagnosis caused a scabies outbreak.
      • Use of steroids converted ordinary scabies to crusted scabies.
      • Effective nosocomial infection control without mass prophylaxis treatment.
      • Nurses and physical therapists are the most affected.

      Abstract

      Background

      Scabies is a skin infection transmitted by close person-to-person contact. Crusted scabies is a more severe type which is more contagious. Delayed diagnosis of scabies could lead to an outbreak.

      Methods

      The outbreak occurred at a 435-bed academic medical center with 76 inpatient rehabilitation beds. The index patient was incarcerated and admitted to our hospital in February 2022. The patient developed crusted scabies after steroids treatment.

      Results

      The patient was treated with oral ivermectin (200 mcg/kg, maximum dose 15 mg) and topical permethrin 5%. All units were followed for 6 weeks since diagnosis of the index patient. A total of 46 healthcare workers (20 nurses and 26 physical therapists) were exposed. Twenty-nine presented symptoms and were treated with ivermectin and permethrin or only ivermectin. No physicians, other patients, or prison guards were affected. There was no secondary household transmission of those exposed healthcare workers.

      Conclusions

      Scabies is highly contagious in high-risk patients. Early diagnosis and effective infection control are of vital importance.

      Key Words

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