一起内科病房挪威疥暴发的治疗与防控
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摘要
目的回顾一起挪威疥暴发的治疗与防控措施。方法 2014-10-23,1例患阿尔茨海默病多年的83岁退休女教师以"肺部感染"收入清华大学医院内科病房。入院时即发现该患者周身较多皮疹,且搔抓不止。治疗过程中发现该患者护工及多例患者、护工、家属、医护人员陆续出现皮疹,2015-03-19,原发患者刮片镜检发现大量疥螨、虫卵及粪便,确诊挪威疥。挪威疥暴发诊断确立后,立即进行上报、成立挪威疥防控小组、追踪记录接触者、治疗、隔离、环境消杀等。结果共治疗64例患者、员工及家属,其中查到病原体者仅6例。原发患者外用药物2个月,结痂均脱落,指趾间无脱屑,经反复多次镜检未发现疥螨及虫卵。其他患者治疗2～4个疗程。2个月后所有确诊及疑似患者未发生反复,而且相关人员未出现新发患者。结论早期诊断和治疗挪威疥是预防疥疮暴发的关键措施,一旦发生了疥疮暴发,一定要注意控制好原发患者,并追寻病区内所有与原发患者有接触者,同时治疗及预防非常重要。
Objective To review the treatment and prevention of Norwegian scabies in one outbreak.Methods One retired female teacher at the age of 83 years who suffered from Alzheimer's disease for many years was admitted to the internal medicine ward of Tsinghua University Hospital with lung infection in 23 October 2014.Upon admission,the patient was found to have a lot of rashes around the body and she kept scratching.During the treatment,the patient's care workers and many other patients,family members,and medical staff were found to have rashes as well.In 19 March 2015,the scraping microscopy of the primary patient revealed a large number of sarcoptes mites,eggs and feces,and the patient was confirmed with Norwegian scabies.We reported the Norwegian scabies outbreak immediately,and formed the Norwegian scabies prevention and control team after the diagnosis.All contact persons were tracked,treated,and isolated,and insecticide measures were implemented.Results A total of 64 patients,personnel and their family members were treated,of whom only six found pathogens in their bodies.The primary patient was treated with topical drug for 2 months.After the treatment,her scars were shed,and there was no scaling between toes.After repeated microscopic examinations,no mites and eggs were found.Other patients were treated for two to four courses.All confirmed and suspected patients had no recurrence 2 months later,and no new patient was found.Conclusion Early diagnosis and treatment of Norwegian scabies is the most important measure to manage outbreak.Once an outbreak occurs,it is necessary to pay attention to control the primary patients and to track all the patients in the ward contacting with the original patient.In the meantime,treatment and prevention are very important.
Objective To review the treatment and prevention of Norwegian scabies in one outbreak.Methods One retired female teacher at the age of 83 years who suffered from Alzheimer's disease for many years was admitted to the internal medicine ward of Tsinghua University Hospital with lung infection in 23 October 2014.Upon admission,the patient was found to have a lot of rashes around the body and she kept scratching.During the treatment,the patient's care workers and many other patients,family members,and medical staff were found to have rashes as well.In 19 March 2015,the scraping microscopy of the primary patient revealed a large number of sarcoptes mites,eggs and feces,and the patient was confirmed with Norwegian scabies.We reported the Norwegian scabies outbreak immediately,and formed the Norwegian scabies prevention and control team after the diagnosis.All contact persons were tracked,treated,and isolated,and insecticide measures were implemented.Results A total of 64 patients,personnel and their family members were treated,of whom only six found pathogens in their bodies.The primary patient was treated with topical drug for 2 months.After the treatment,her scars were shed,and there was no scaling between toes.After repeated microscopic examinations,no mites and eggs were found.Other patients were treated for two to four courses.All confirmed and suspected patients had no recurrence 2 months later,and no new patient was found.Conclusion Early diagnosis and treatment of Norwegian scabies is the most important measure to manage outbreak.Once an outbreak occurs,it is necessary to pay attention to control the primary patients and to track all the patients in the ward contacting with the original patient.In the meantime,treatment and prevention are very important.
引文
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[8]ARLIAN L G,FELDMEIER H,MORGAN M S.The potential for a blood test for scabies[J].PLoS Negl Trop Dis,2015,9(10):e0004188.DOI:10.1371/journal.pntd.0004188.
[9]LEPPARD B,NABURI A E.The use of ivermectin in controlling an outbreak of scabies in a prison[J].Br J Dermatol,2000,143(3):520-523.
[10]ALMOND D S,GREEN C J,GEURIN D M,et al.Lesson of the week:norwegian scabies misdiagnosed as an adverse drug reaction[J].BMJ,2000,320(7226):35-36.
[11]ROBERTS L J,HUFFAM S E,WALTONG S F,et al.Crusted scabies:clinical and immunological findings in seventy-eight patients and a review of the literature[J].J Infect,2005,50(5):375-381.DOI:10.1016/j.jinf.2004.08.033.
[12]WALTON S F,BEROUKAS D,ROBERTS-THOMSON P,et al.New insights into disease pathogenesis in crusted(Norwegian)scabies:the skin immune response in crusted scabies[J].Br JDermatol,2008,158(6):1247,1255.
[13]BOUVRESSE S,CHOSIDOW O.Scabies in healthcare settings[J].Curr Opin Infect Dis,2010,23(2):111-118.DOI:10.1097/QCO.0b013e328336821b.
[14]VOROU R,REMOUDAKI H D,MALTEZOU H C.Nosocomial scabies[J].Hosp Infect,2007,65(1):9-14.
[2]BADIAGA S,MENARD A,TISSOT DUPONT H,et al.Prevalence of skin infections in sheltered homeless[J].Eur JDermatol,2005,15(5):382-386.
[3]EJIDOKUN O O,ARUNA O S,O'NEILL B.A scabies outbreak in a further education college in Gloucestershire[J].Epidemiol Infect,2007,135(3):455-457.
[4]TJIOE M,VISSERS W H.Scabies outbreaks in nursing homes for the elderly:recognition,treatment options and control of reinfestation[J].Drugs Aging,2008,25(4):299-306.
[5]CHOSIDOW O.Scabies and pediculosis[J].Lancet,2000,355(9206):819-826.
[6]MCLEAN F E.The elimination of scabies:a task for our generation[J].Int J Dermatol,2013,52(10):1215-1223.
[7]ANDREWS R M,KEARNS T,CONNORS C,et al.A regional initiative to reduce skin infections amongst aboriginal children living in remote communities of the Northern Territory,Australia[J].PLoS Negl Trop Dis,2009,3(11):e554.
[8]ARLIAN L G,FELDMEIER H,MORGAN M S.The potential for a blood test for scabies[J].PLoS Negl Trop Dis,2015,9(10):e0004188.DOI:10.1371/journal.pntd.0004188.
[9]LEPPARD B,NABURI A E.The use of ivermectin in controlling an outbreak of scabies in a prison[J].Br J Dermatol,2000,143(3):520-523.
[10]ALMOND D S,GREEN C J,GEURIN D M,et al.Lesson of the week:norwegian scabies misdiagnosed as an adverse drug reaction[J].BMJ,2000,320(7226):35-36.
[11]ROBERTS L J,HUFFAM S E,WALTONG S F,et al.Crusted scabies:clinical and immunological findings in seventy-eight patients and a review of the literature[J].J Infect,2005,50(5):375-381.DOI:10.1016/j.jinf.2004.08.033.
[12]WALTON S F,BEROUKAS D,ROBERTS-THOMSON P,et al.New insights into disease pathogenesis in crusted(Norwegian)scabies:the skin immune response in crusted scabies[J].Br JDermatol,2008,158(6):1247,1255.
[13]BOUVRESSE S,CHOSIDOW O.Scabies in healthcare settings[J].Curr Opin Infect Dis,2010,23(2):111-118.DOI:10.1097/QCO.0b013e328336821b.
[14]VOROU R,REMOUDAKI H D,MALTEZOU H C.Nosocomial scabies[J].Hosp Infect,2007,65(1):9-14.