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.

Human scabies is a highly contagious, globally prevalent, parasitic skin infestation caused by Sarcoptes scabiei var. hominis, also known as the itch mite. This parasite was identified in the 1687 by Bonomo and Cestoni using a light microscope; however, there is evidence of scabies as far back as 1200 BCE. 1 The most common symptoms of scabies, itching and a skin rash, are caused by a hypersensitivity reaction to the proteins and feces of the parasite about four to six weeks after infestation. Severe pruritus, especially at night, is the earliest and most common symptom of scabies. An erythematous, papular, pruritic rash with burrows on the hands, wrists, torso, and feet is also common. 1 Scabies continues to be a common dermatological disease internationally. A systematic review estimated the prevalence of scabies in various countries to be 0.2% to 71%. 2 In the United Kingdom, a general practice database review for scabies estimated prevalence to be 2.2 and 2.8 per 1000 in men and women, respectively. 3 Studies from Greece and Spain conducted in dermatology clinics concluded that scabies is encountered in approximately 4% of visits, particularly among immigrants and patients with low socioeconomic status. 4, 5 In developing countries the prevalence can be much higher, [6] [7] [8] [9] ranging as high as 87% in one study in Thai orphanages. 10 Although prevalence of scabies is low in developed countries, public health authorities are challenged to identify and treat individuals with scabies promptly to avoid transmission amongst close-quartered populations, such as within the growing population of asylum seekers and refugees. 11, 12 Scabies remains a risk to public health, and it is essential that frontline healthcare providers identify potential cases. Both under-and over-diagnosis are possible, and each is problematic. While missing the diagnosis can lead to both ongoing individual patient discomfort as well as rapid population spread, over-diagnosis can lead to inappropriate individual patient treatment and can create stress on healthcare systems with finite resources. Emergency Department (ED) providers may encounter and treat these patients as the first point of contact. After an overview of the disease and critical information pertaining to transmission and treatment, this article adapts the 3I (Identify-Isolate-Inform) Tool to assist frontline providers in the identification and management of potential cases of scabies presenting to the ED (Figure 1 ). The 3I Tool was originally developed for Ebola virus disease and subsequently modified for use in measles, Middle East Respiratory Syndrome (MERS), mumps, Zika, hepatitis A, pertussis, and 2019 nCoV . [13] [14] [15] [16] [17] [18] [19] [20]