Scabies: Application of the Novel Identify-Isolate-Inform Tool for Detection and Management

Cheng, Tabitha A.; Mzahim, Bandr; Koenig, Kristi L.; Alsugair, Abdulrahman; Al-Wabel, Abdussalam; Almutairi, Bandar Saad; Maysa, Eshmawi; Kahn, Christopher A.

Secondary bacterial infections can develop in persons infested with scabies, particularly since the rash is typically intensely pruritic and scratching compromises the skin barrier and may introduce bacteria, particularly in patients with poor fingernail hygiene. Streptococcus or staphylococcus infections can cause impetigo, paronychia, cellulitis, or abscesses. 33 Sequelae of these bacterial infections include bacteremia leading to sepsis, acute post-streptococcal glomerulonephritis, and rheumatic heart disease. 22, 33 The most vulnerable populations to scabies infestations are young children, the elderly, and the immunocompromised. These populations are especially susceptible to secondary complications of infestation. Given transmission is favored in conditions of crowding and poor sanitation, outbreaks have been seen in refugee camps and asylum seeker shelters. 12 Crusted scabies, also known as Norwegian scabies, is particularly serious with a high mortality rate from bacterial sepsis. 34 Caused by a hyperinfestation of the scabies mites, crusted scabies is characterized by development of a severe inflammatory response and hyperkeratosis (thickened skin crusts). 35 Any skin area might be affected, but commonly affected regions include the scalp, hands, and feet. Crusts are malodorous and nails are thickened and discolored. Most cases of the crusted variant are linked to immunocompromised hosts; however, cases of crusted scabies have occurred without identifiable risk factors. 35 From a public health perspective, patients with crusted scabies are highly infectious and, given they carry a significant number of mites, they can be the primary source of a community scabies outbreak. Furthermore, crusted scabies is difficult to manage, often requiring multiple treatments. 35