An Outbreak of Scabies in the Same Ward and House after Discharge of a Scabies Patient

Abstract

In cases of crusted scabies, transmission by scales in clothing or a bed can occur without skin-to-skin contact, because the body of an infested patient contains several million mites. A male patient with ATL was diagnosed with crusted scabies after having been hospitalized for about one month from December 2005 in our Department of Internal Medicine. From February to July of 2006, 17 patients (11 males and 6 females) visited our Department of Dermatology with complaints of erythemas, papules, and nodules with intense itching on interdigital lesions, axillae, and genitalia. They were all diagnosed as having scabies. All of the infested patients were immunocompromised hosts, and they had been hospitalized during the same period as that of the index case and in the same internal ward. The period in which contact with the index case was possible was 1 to 33 days (median: 17.4 days) and the latent period was 1 to 6 months (mean: 3 months). None of the 17 patients had been in the same room as that of the index case. Another male patient with leukemia developed crusted scabies and was the index case for a second outbreak of scabies in another hospital 9 months later. Two of the medical staff in our hospital and 9 family members were also infested, and 3 people residing with the index case had repeated relapses of scabies. Clinical diagnosis of scabies in immunocompromised hosts is difficult because such patients have various rashes. It is therefore important to perform a KOH examination and to examine eruptions by dermoscopy in order to prevent outbreaks of scabies.