{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T23:23:03Z","timestamp":1782861783903,"version":"3.54.5"},"update-to":[{"DOI":"10.1371\/journal.pntd.0008994","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2021,1,4]],"date-time":"2021-01-04T00:00:00Z","timestamp":1609718400000}}],"reference-count":30,"publisher":"Public Library of Science (PLoS)","issue":"12","license":[{"start":{"date-parts":[[2020,12,18]],"date-time":"2020-12-18T00:00:00Z","timestamp":1608249600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosntds.org"],"crossmark-restriction":false},"short-container-title":["PLoS Negl Trop Dis"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Scabies is listed as a neglected tropical disease by the World Health Organization. Crusted scabies affects vulnerable and immunosuppressed individuals and is highly contagious because of the enormous number of <jats:italic>Sarcoptes scabiei<\/jats:italic> mites present in the hyperkeratotic skin. Undiagnosed and untreated crusted scabies cases can result in outbreaks of scabies in residential facilities and can also undermine the success of scabies mass drug administration programs.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods and principal findings<\/jats:title>\n<jats:p>Crusted scabies became a formally notifiable disease in the Northern Territory of Australia in 2016. We conducted a 2-year prospective study of crusted scabies cases notified between March 2016 and February 2018, with subsequent follow up for 22 months. Demographics, clinical and laboratory data, treatment and outcomes were analysed, with cases classified by severity of disease.<\/jats:p>\n<jats:p>Over the 2-year study period, 80 patients had 92 episodes of crusted scabies; 35 (38%) were Grade 1 crusted scabies, 36 (39%) Grade 2 and 21 (23%) Grade 3. Median age was 47 years, 47 (59%) were female, 76 (95%) Indigenous Australians and 57 (71%) from remote Indigenous communities. Half the patients were diabetic and 18 (23%) were on dialysis for end-stage kidney failure. Thirteen (16%) patients had no comorbidities, and these were more likely to have Grade 3 disease. Eosinophilia was present in 60% and high immunoglobulin E in 94%. Bacteremia occurred in 11 episodes resulting in one fatality with methicillin-susceptible <jats:italic>Staphylococcus aureus<\/jats:italic> bacteremia. Two other deaths occurred during admission and 10 others died subsequent to discharge consequent to comorbidities. Treatment generally followed the recommended guidelines, with 3, 5 or 7 doses of oral ivermectin depending on the documented grade of crusted scabies, together with daily alternating topical scabicides and topical keratolytic cream. While response to this therapy was usually excellent, there were 33 episodes of recurrent crusted scabies with the majority attributed to new infection subsequent to return to a scabies-endemic community.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Crusted scabies can be successfully treated with aggressive guideline-based therapy, but high mortality remains from underlying comorbidities. Reinfection on return to community is common while scabies remains endemic.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pntd.0008994","type":"journal-article","created":{"date-parts":[[2020,12,18]],"date-time":"2020-12-18T19:33:06Z","timestamp":1608319986000},"page":"e0008994","update-policy":"https:\/\/doi.org\/10.1371\/journal.pntd.corrections_policy","source":"Crossref","is-referenced-by-count":35,"title":["Crusted scabies; a 2-year prospective study from the Northern Territory of Australia"],"prefix":"10.1371","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6407-8155","authenticated-orcid":true,"given":"Tasnim","family":"Hasan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victoria L.","family":"Krause","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7548-4853","authenticated-orcid":true,"given":"Christian","family":"James","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8878-8837","authenticated-orcid":true,"given":"Bart J.","family":"Currie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2020,12,18]]},"reference":[{"issue":"16","key":"pntd.0008994.ref001","doi-asserted-by":"crossref","first-page":"1718","DOI":"10.1056\/NEJMcp052784","article-title":"Scabies","volume":"354","author":"O Chosidow","year":"2006","journal-title":"N Engl J Med"},{"issue":"8","key":"pntd.0008994.ref002","doi-asserted-by":"crossref","first-page":"894","DOI":"10.1016\/S1473-3099(18)30347-5","article-title":"Scabies outbreaks in ten care homes for elderly people: a prospective study of clinical features, epidemiology, and treatment outcomes","volume":"18","author":"JA Cassell","year":"2018","journal-title":"Lancet Infect Dis"},{"issue":"8","key":"pntd.0008994.ref003","doi-asserted-by":"crossref","first-page":"960","DOI":"10.1016\/S1473-3099(15)00132-2","article-title":"Prevalence of scabies and impetigo worldwide: a systematic review","volume":"15","author":"L Romani","year":"2015","journal-title":"Lancet Infect Dis"},{"issue":"11","key":"pntd.0008994.ref004","doi-asserted-by":"crossref","first-page":"2462","DOI":"10.1017\/S0950268816000443","article-title":"Retrospective analysis of institutional scabies outbreaks from 1984 to 2013: lessons learned and moving forward","volume":"144","author":"KE Mounsey","year":"2016","journal-title":"Epidemiol Infect"},{"key":"pntd.0008994.ref005","unstructured":"Australian Bureau of Statistics. Northern Territory (STE). 2018. Retrieved from: http:\/\/stat.abs.gov.au\/itt\/r.jsp?RegionSummary&region=7&dataset=ABS_REGIONAL_ASGS&geoconcept=REGION&measure=MEASURE&datasetASGS=ABS_REGIONAL_ASGS&datasetLGA=ABS_NRP9_LGA&regionLGA=REGION&regionASGS=REGION"},{"issue":"9","key":"pntd.0008994.ref006","doi-asserted-by":"crossref","first-page":"e2387","DOI":"10.1371\/journal.pntd.0002387","article-title":"A novel clinical grading scale to guide the management of crusted scabies","volume":"7","author":"JS Davis","year":"2013","journal-title":"PLoS Negl Trop Dis"},{"issue":"8","key":"pntd.0008994.ref007","doi-asserted-by":"crossref","first-page":"717","DOI":"10.1056\/NEJMct0910329","article-title":"Permethrin and ivermectin for scabies","volume":"362","author":"BJ Currie","year":"2010","journal-title":"N Engl J Med"},{"key":"pntd.0008994.ref008","unstructured":"Centre for Disease control. Healthy skin program: Guidelines for community control of scabies, skin sores, tinea and crusted scabies in the Northern Territory, 2015. 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