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Last Login: Dec 29, 2013
Member Since: Dec 29, 2013
Age: 35
Location: US
Scabies treat
Typical Scabies Patients with typical (conventional) scabies usually have only 10 to 15 live adult female mites on the body at any given time. purchase permethrin cream 5% Usually, only one or two mites, and frequently none, are recovered from skin scrapings. Intense pruritis, usually worse at night, and a papular rash with or without burrows occur. The rash and pruritis result from an immune-mediated delayed hypersensitivity reaction to the mite, its eggs, and fecal material. Areas of the body commonly involved are wrists, finger webs, antecubital fossae, anterior axillary folds, breasts, waistline, lower abdomen, genitals, and buttocks. The scalp and face are rarely involved in adults, but may be observed in young children with scabies. Atypical Scabies When diagnosis and treatment are delayed, scabies can have an unusual or atypical presentation, involving heavy infestation with hundreds to thousands of mites. Atypical clinical presentations are more prevalent in institutionalized or debilitated patients, or those who are immunosuppressed from underlying disease or drug therapy. When extensive hyperkeratotic skin lesions with crusting and scaling develop, the infestation is called crusted scabies or hyperkeratotic (formerly “Norwegian”) scabies. Crusted scabies is highly contagious because thousands of mites are imbedded in the thick crusts and easily shed in scales and flakes from affected skin. Crusted scabies is commonly misdiagnosed by dermatologists, and patients with crusted scabies may develop symptoms of typical scabies in as little as a few days. C. EPIDEMIOLOGY OF SCABIES 1. Transmission Transfer of the mite is usually from one person to another by direct skin-toskin contact. Procedures such as bathing a patient, applying body lotions, back rubs, or any extensive hands-on contact can provide an opportunity for mite transmission. Mites may also be transmitted via clothing, bed linen or other fomites. Fomites play a minor role in situations where the infestation in the source case is typical scabies; the inanimate environment of patients with crusted scabies, however, has been shown to be heavily contaminated with infectious mature and immature mites. In HCF, scabies may be introduced into the facility by a newly admitted resident with an unrecognized infestation or by visitors or health care workers as a result of contact with an infested person in the home or community. 2. Incubation Period In a previously unexposed healthy individual, the interval between exposure and the onset of itching is usually 4-6 weeks. In persons who have been sensitized to the mite by a previous infestation, re-exposure may produce 6 symptoms in 48 hours or less (owing to prior sensitization to the mite and its saliva and feces). Following exposure to a source case with crusted scabies involving extremely large numbers of mites, the incubation period may be reduced from the usual time of 4-6 weeks to as little as a few days. 3. Period of Communicability Since the scabies mite is an ectoparasite, an exposed individual is potentially immediately infectious to others, even in the absence of symptoms. Cases are communicable from the time of infestation until mites and eggs are destroyed by treatment. D. DIAGNOSIS Definitive diagnosis requires microscopic identification of the mite and/or its eggs or fecal pellets on specimens collected by skin scraping, biopsy or other means (Appendix A, “Diagnosis of Scabies by Skin Scraping”). The yield from skin scrapings is highly dependent on the experience of the operator and the severity of the infestation. A negative skin scraping from a person with typical scabies does not rule out scabies infestation; mites are easily recovered, however, in skin scrapings from persons with crusted scabies. III. SCABIES PREVENTION AND CONTROL PROGRAMS It is recommended that HCF incorporate a scabies prevention program that involves all levels of the health care team. The program should include an assessment of the skin, hair and nail beds of all new admissions as soon as possible following arrival. Pruritus, rashes and skin lesions should be documented and brought to the attention of the nursing supervisor and the attending physician for further follow-up. Essential elements of a successful scabies prevention program include: 1. Written policies and procedures for prevention and control of nosocomial scabies; 2. Health care workers who are trained to be suspicious of scabies in themselves or their patients if unexplained rash or pruritus occurs in themselves or their patients, and to report such occurrences to their supervisors; 3. A policy to screen newly admitted patients for scabies during the initial assessment (especially if transferred from another healthcare facility) and any suspect patient will immediately be placed on contact isolation until examined for scabies; 4. A policy that all new employees (especially employees who work at more than one facility) will be screened for scabies as part of pre-employment screening; 7 5. Access to and use as needed of the diagnostic skills of a consultant experienced in recognizing scabies to evaluate difficult or unusual cases or response to treatment; 6. Assurance of adequate support from hospital administration, medical staff, infection control, employee health and line staff for appropriate evaluation and treatment of employees, in-house patients and exposed discharged patients should an outbreak of nosocomial scabies occur.
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Commented on a profile mentalgg
Dec 29, 13
Commented on a profile mentalgg
Dec 29, 13