使用丙烯菊酯、氯菊酯和伊维菌素管理疥疮地方性暴发。

Management of endemic outbreaks of scabies with allethrin, permethrin, and ivermectin.

作者信息

Paasch U, Haustein U F

机构信息

Department of Dermatology, University of Leipzig, Germany.

出版信息

Int J Dermatol. 2000 Jun;39(6):463-70. doi: 10.1046/j.1365-4362.2000.00990.x.

DOI:10.1046/j.1365-4362.2000.00990.x

PMID:10944095

Abstract

BACKGROUND

At three residences for the elderly, recurrent scabies infestations became out of control. Due to the failure of repeated, nonsynchronized therapeutic efforts with conventional external anti-scabies treatments, an eradication program had to be developed. We describe a protocol for the management of outbreaks of scabies.

METHODS

According to the clinical examination and microscopically identified mites, all individuals of the population (IOP: patients, staff, and family members) were divided into two groups: (a) healthy and infested IOP; and (b) cases with crusted scabies. The first group was treated simultaneously once with external scabicides (allethrin or permethrin). All others were hospitalized and treated either with systemic ivermectin or with the latter in combination with permethrin.

RESULTS

In 252 IOP living in three residences for the elderly, clinical signs of scabies were reported in 91.5%, 78.5%, and 15.4% of the patients (age 55-97 years; mean, 80.5 years), 54.1%, 32.9%, and 16.6% of staff members, and in 7%, 3%, and 0% of family members. The infested IOP showed crusted scabies (index cases) in 5.3%, 5.0%, and 1.7%, common scabies in 43.1%, 36.7%, and 7.1%, and postscabiotic dermatitis in 10.3%, 7.6%, and 3.5%. In 99.2% of the synchronously treated IOP in group (a) (n = 240), the conventional treatment with permethrin cream 5% or allethrin spray was effective. Group (b) (n=12) received ivermectin (12 mg) once (n=5) or twice (n= 7) after an interval of 8 days. One index case received permethrin three times.

CONCLUSIONS

Outbreaks of scabies in populations of elderly people require special management for disease control. Synchronous treatment with external permethrin cream 5% or allethrin spray, including all IOP once, and close control offers a time-saving, cheap, and reliable method. Crusted scabies should be treated by oral administration of ivermectin once or twice after an interval of 8 days. Additional applications of permethrin and mechanical clearing of hyperkeratotic subungual areas shorten the course.

摘要

背景

在三所养老院中，疥疮反复感染变得难以控制。由于使用传统外用抗疥疮治疗方法进行的反复、不同步治疗均告失败，因此必须制定一项根除计划。我们描述了一种疥疮暴发管理方案。

方法

根据临床检查和显微镜下鉴定的螨虫，将所有人群个体（干预对象：患者、工作人员和家庭成员）分为两组：（a）健康且感染疥疮的干预对象；（b）结痂性疥疮病例。第一组同时接受一次外用杀疥剂（炔戊菊酯或氯菊酯）治疗。所有其他患者住院治疗，使用全身性伊维菌素或伊维菌素与氯菊酯联合治疗。

结果

在居住于三所养老院的252名干预对象中，报告有疥疮临床症状的患者分别占91.5%、78.5%和15.4%（年龄55 - 97岁；平均80.5岁），工作人员分别占54.1%、32.9%和16.6%，家庭成员分别占7%、3%和0%。感染疥疮的干预对象中，结痂性疥疮（索引病例）分别占5.3%、5.0%和1.7%，普通疥疮分别占43.1%、36.7%和7.1%，疥疮后皮炎分别占10.3%、7.6%和3.5%。在（a）组同步接受治疗的干预对象中，99.2%（n = 240）使用5%氯菊酯乳膏或炔戊菊酯喷雾进行的传统治疗有效。（b）组（n = 12）在间隔8天后接受一次（n = 5）或两次（n = 7）伊维菌素（12 mg）治疗。一名索引病例接受了三次氯菊酯治疗。