Scabies, Research Paper Example

  1. Description

According to the Centers for Disease Control and Prevention, human scabies results from “an infestation of the skin by the human itch mite (Sarcoptes scabiei var. hominis).” (2012, p.1) The CDC reports that the microscopic scabies mite burrows into the upper layer of the skin where it lives and lays its eggs.” (2012, p.1) The scabies mite is generally spread through skin-to-skin contact that is “direct and prolonged” (Centers for Disease Control and Prevention, 2012, p.1) when coming in contact with a person who has scabies.

            Biology

The human itch mite is reported to be in the arthropod class Arachnida, subclass Acari, family Sarcoptidae. These mites are reported to burrow into the skin’s upper layer and to appear as “tiny raised serpentine lines that are grayish or skill-colored and can be a centimeter or more in length.” (Centers for Disease Control and Prevention, 2012, p.1) Other types of scabies mites cause animals to be infested however; these can only result in a “self-limited infestation in humans with temporary itching due to dermatitis” but are stated to not multiply on the human as the animal host. The scabies mite is reported as “awn obligate ectoparasite which must live on the outside of a mammal hot to survive.” (Michigan Department of Community Health, 2005, p.4)

The scabies mite is believed to be a single species however “with several physiological varieties or subspecies. The many variants of this species are generally considered to be very host-specific. Therefore, S. scabiei var. hominis, found on humans, can only develop and reproduce on a human host.” (Michigan Department of Community Health, 2005, p.4) Mites are reported to feed on the human host through use of their “mouthparts and front legs to dig into the stratum corneum (outer epidermal layer) of the skin. They ingest tissue as they burrow and also feed on lymph fluids secreted by underlying skin layers to meet their growth requirements.” (Michigan Department of Community Health, 2005, p.4) This activity and the response of the human immune system response to secretions of mites and feces are that which result in the individuals’ scratching of the skin and the scabs which form as well as any secondary infections, which follow. (Michigan Department of Community Health, 2005, paraphrased)

The life cycle of the human scabies mite is reported to be between 10 days (for male species) and 14 days (for female species). (Michigan Department of Community Health, 2005, paraphrased) The eggs of scabies mites are laid in the skin burrow, which the female occupies, and in three to four days, the larvae hatch, and after one-day crawl away to find a new site. In approximately two to three days, the larvae molt into the protonymph stage followed in another two to three days into a tritonymph stage. The third stage is the adult stage which takes place two to three days at the tritonymph stage at which time the mite are reproductively mature. (Michigan Department of Community Health, 2005, paraphrased)

            Transmission

Transmission occurs primarily by impregnated females transferring through skin contact or by fomites or bedding or clothing. The location of human scabies mite is often on the wrists or between the fingers. (Centers for Disease Control and Prevention, 2012, paraphrased) However, it is reported that other common sites of scabies include the elbow, armpit, penis, nipple, waist, buttocks, and shoulders blades. (Centers for Disease Control and Prevention, 2012, paraphrased) While the head, face, neck, palms, and soles are reported as often involved in “infants and very young children, but usually not adults and older children.” (Centers for Disease Control and Prevention, 2012, p.1)

            Complications

Complications include skin sores due to intense itching which can become infected resulting in bacteria on the skin and this can in some cases results in kidney inflammation of the kidneys called post-streptococcal glomerulonephritis.” (Centers for Disease Control and Prevention, 2012, p.1)

  1. Epidemiology

            Occurrence

Scabies is known to occur throughout the world and to affect all races and social classes of individuals. In conditions that are crowded, it is reported by the CDC that scabies may rapidly spread especially where there is frequent body contact. The primary sites of scabies outbreaks are reported to be such as “nursing homes, extended-care facilities, and prisons.” (Centers for Disease Control and Prevention, 2012, p.1)

            Contraction

Scabies in adults is commonly contracted through sexual activity. It is reported by the CDC that some individuals who are “immunocompromised, elderly, disabled, or debilitated persons are at risk for a severe form of scabies called crusted or Norwegian scabies.” (Centers for Disease Control and Prevention, 2012, p.1) Individuals with crusted scabies are reported to have “thick crusts of skin that contain large numbers of scabies mites and eggs.” (Centers for Disease Control and Prevention, 2012, p.1)

The mites in crusted scabies while reported to not be “more virulent than in non-crusted scabies” are still much larger in number stated at approximately 2 million per patient resulting in the high level of contagion through direct contact and even through transmission by shedding and contamination of such as “clothing, bedding, and furniture.” (Centers for Disease Control and Prevention, 2012, p.1) Those with crusted scabies require “quick and aggressive medical treatment for their infestation to prevention outbreaks of scabies.” (Centers for Disease Control and Prevention, 2012, p.1)

Diagnosis

Diagnosis is reported to be through “scraping of lesions that have not been scratched by the patient.” (Ohio.gov, nd) Generally, it is reported that several areas of the most severe itching sites are scraped to gain the sample of mites, or the eggs of feces of the mites. Mineral oil is used for coating the scalpel blade so that the collected specimen is not lost when it is transferred to the glass slide prior to being viewed under a low power microscope. Reported, as an alternative method of diagnosis is the ink prep involving a water-soluble solution of ink and its application over an area of lesions then wiped with an alcohol solution. The ink will be retained in any present burrows, which are then easily viewed by the naked eye. (Ohio.gov, nd, paraphrased)

III. Public Health Management

            Reporting

Individual cases are not reported however, it is necessary to report any scabies outbreaks in an institution to the local health department.

 

Treatment

Treatment for scabies involves the doctor prescribing a cream of lotion for topical application on the infected sites. (Nationwide Children’s Hospital, 2005, paraphrased ) At bedtime, one should take a warm soapy bath or shower and completely dry the skin before applying the medication to sites that are infected and as well to the entire body. (Nationwide Children’s Hospital, 2005, paraphrased )

When it is a child infected with scabies the child’s fingernails should be cut short to prevent scratching of the skin. It is recommended that socks should be placed over the child’s hand so that the child will not get the medicine in their mouth. (Nationwide Children’s Hospital, 2005, paraphrased ) Itching is reported to continue up to a few weeks following treatment and the doctor may prescribe anti-itch medication. The mite that causes scabies can live in bed linens and clothing up to a week therefore, it is necessary to wash all the clothing worn the week prior to treatment in very hot water. Bed linens should also be washed in very hot water. (Nationwide Children’s Hospital, 2005, paraphrased) . Products used to treat scabies include “Kwell, Eurax and Elimite” all of which are prescription products. The problem should be retreated in seven to ten days when Elimite is used. (Ohio.gov, nd)

            Health Care Workers Treatment and Prevention

All individuals who have had skin-to-skin contact with the individuals should be examined. It is reported that all health care workers that have had contact with the patient diagnosed with scabies should undergo treatment as well as households and sexual contacts of these workers since “they may be asymptomatic harborers of mites. Failure to treat these contacts may result in reinfestation of staff and reintroduction of the mite to the facility.  All treatment should be simultaneous.” (Ohio.gov, nd)

Hospital and health care clinic staff are “sent home with scabicide for overnight treatment, then return to work the following day. Patients need not be isolated after the initial treatment.” (Ohio.gov, nd) It is required that staff of hospitals and health care clinics wear gloves while providing care to the patient until initiation of the treatment and hands should be washed to lower transmission risks. It is reported that the scabies mite “… does not remain viable off the skin of the host for more than 24 hours. Environmental sprays and/or extermination are unnecessary.  Routine washing and drying of clothing, bedding and personal articles used by the index case and all contacts, or sealing those items which cannot be washed inside plastic bags for 7-10 days, is sufficient to kill the scabies mites.” (Ohio.gov, nd)

Specific strategies stated for control in a health care facility should be comprised of “an active surveillance program, which will detect infestations promptly.” (Ohio.gov, nd) Reports show that absence of control measures that are aggressive in nature can result in outbreaks that are costly in nature. (Ohio.gov, nd, paraphrased)

Summary and Conclusion

Scabies is contracted through skin-to-skin contact with infected individuals and requires treatment through specific prescription medications that are applied to the skin. Scabies is highly infectious and is diagnosed through scraping of skin and viewing under a microscope. Treatment also includes disinfection of clothing and bed linens through washing with very hot water. Health care institutions should take special care in treating those who have come in contact with the patient to ensure that there is not a large outbreak of scabies in their institution.

Bibliography

Biology (2012) Centers for Disease Control and Prevention. Retrieved from: http://www.cdc.gov/parasites/scabies/biology.html

Scabies (2005) Nationwide Children’s Hospital. Helping Hand. Retrieved from: http://www.nationwidechildrens.org/gd/applications/heh/pdf/HH-I-59.pdf

Scabies (2009) Ohio Government – ODH-IDCM. May 2009. Retrieved from: http://www.odh.ohio.gov/pdf/idcm/scabies.pdf

Scabies Disease (2012) Centers for Disease Control and Prevention. Retrieved from: http://www.cdc.gov/parasites/scabies/disease.html

Scabies Prevention and Control Manual (2005) Michigan Department of Community Health. May 2005. Retrieved from: http://www.michigan.gov/documents/scabies_manual_130866_7.pdf