易被忽視的感染-疥瘡的治療與照護

Treatment and Prevention of Health-care Associated Scabies：A Neglected Skin Infection

疥瘡是由疥蟲感染引起的接觸傳染性皮膚病，具高度傳染力，對於老年人和醫療人員都有很高的致病率，常造成醫院或長期照護機構疥瘡群聚感染。典型的疥瘡患者臨床表徵是皮膚搔癢、紅丘疹和隧道狀病灶。但是免疫功能低下、心智障礙以及老年病患，其臨床表徵可能變得不典型，成為感染性甚高的挪威疥（Norwegian scabies），常見於長期照護機構。診斷疥瘡主要是依據病史，詳細的皮虜理學檢查和檢出疥蟲、蟲卵或糞便。疥瘡的治療包括permethrin cream、lindane、crotamiton、benzyl benzoate和口服的ivermectin。疥瘡患者應早期診斷，徹底治療，並確實隔離，跟患者有密切接觸的醫療人員和家屬需同時治療。醫療照護機構需要定期接受疥瘡治療和預防疥瘡的感染管制措施的在職教育。

Human scabies, a disease characterized by skin infestation with the arthropod mite, Sarcoptes scabiei, is infectious. In long-term care institutions, scabies infection can be a major threat because of hyperinfestation. Outbreaks of crusted scabies commonly occur in these settings. The common clinical manifestations of scabies include pruritis, burrows, and papular rash. The typical findings are intensive pruritic eruptions involving the interdigital spaces and flexure creases. However, the manifestations may be subtle in immunocompromised hosts and mentally retarded and elderly patients; as a result, the clinical diagnosis may be delayed in these patients. A definitive diagnosis is based on the contact history and the microscopic identification of mites, eggs, or fecal pellets. Scabies can be treated using permethrin cream, lindane, crotamiton, benzyl benzoate, and oral ivermectin. Scabies patients should receive early treatment and contact isolation to prevent further transmission of the infection. In addition, it is also important to treat all people who are not protected and are in close contact with scabies patients. To avoid an outbreak, health-care institutions should emphasize on employee education and take appropriate measures to prevent the disease transmission.