Scabies outbreaks in ten care homes for elderly people: a prospective study of clinical features, epidemiology, and treatment outcomes

Abstract

Background: scabies outbreaks in Residential and Nursing Care for the elderly (RNC) are common,subject to diagnostic delay and hard to control. We studied clinical features, epidemiologyand outcomes.

Methods: dermatology-trained physicians examined residents during outbreaks in South East England. Scabies was diagnosed through pre-defined case definitions (definite/probable/possible), using dermatoscopy and microscopy as appropriate. Examinations were repeated following mass treatment.

Findings: 230 residents were examined in ten outbreaks between Jan 23, 2014 and April 13, 2015. Median age was 86·9 years, 174 (75·7%) were female, and 157 (68·3%) had dementia. 61 residents (26·5%) were diagnosed with definite/probable/possible scabies, of which three had crusted scabies. Physical signs were atypical. Over half those diagnosed were asymptomatic and only 39·3% (24/61) had burrows. Mites were visualised with dermatoscopy in seven cases (11.5%) and further confirmed by microscopy in three. 35 (57·4%) cases only had signs on normally covered areas of the body. Dementia was the only risk factor for a scabies diagnosis (2·37 (95% CI 1·38-4·07)). At follow up, there were no new cases but scabies persisted in 10 individuals.

Interpretation: clinical presentation of scabies in elderly RNC residents differs from classical descriptions familiar to clinicians. This is likely to contribute to delayed recognition and suboptimal management in this vulnerable group. Dermatoscopy and microscopy were of limited value. It is important healthcare workers are aware of the different presentation of scabies in this
group, and undertake thorough examinations, particularly in those with dementia.

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Identifiers

ORCID for Michael Head: orcid.org/0000-0003-1189-0531

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