CRUSTED (NORWEGIAN) SCABIES IN A SPECIALIST HIV UNIT - SUCCESSFUL USEOF IVERMECTIN AND FAILURE TO PREVENT NOSOCOMIAL TRANSMISSION

A nosocomial outbreak of scabies in a specialist inpatient HIV unit re sulted from a patient admitted with crusted scabies. Treatment of his infestation with topical scabicides alone failed and he remained infec tious for several weeks. His infestation was then eradicated with comb ined topical treatment and oral ivermectin. In total, 14 (88%) out of 19 ward staff became symptomatic, and 4 (21%) had evidence of scabies on potassium hydroxide examination of skin scrapings. The ward infecti on control policy was changed to distinguish patients with crusted sca bies from those with ordinary scabies. A second patient with crusted s cabies was treated with combined oral and topical therapy early in his admission and nursed with more stringent isolation procedures. No nos ocomial transmission occurred and his infestation responded rapidly to treatment. Patients with crusted scabies require strict barrier nursi ng if nosocomial transmission is to be avoided. Ivermectin combined wi th topical scabicides may be a more efficacious treatment than topical scabicides alone in such patients.