Crusted Scabies

Another disease that's rare in the US but prevalent in the NT is crusted scabies. Scabies is a fairly common skin condition that results from infestation with the mite, Sarcoptes scabiei. Crusted scabies, is caused by the same mite that causes scabies in the US. However, crusted, or Norwegian scabies, is a severe form of the disease that results from hyper-infestation with thousands of mites. It's thought that it results from a failure of the infected individuals immune system to control the proliferation of the mite.

Scabies is endemic among the Aboriginal population of the NT with estimates of up to 50% of Aboriginal people infested with the mite & the NT has the highest rates of crusted scabies in the world. It's a very serious disease & has a reported mortality rate of up to 50% over five years & requires admission to the hospital for intensive treatment.

This week, I saw my first case of crusted scabies. We admitted a 64-year-old indigenous woman who was found outdoors unconscious, severely malnourished, & infested with a rampant case of crusted scabies. Practically every surface of her body was involved with her scalp & arms being the most severely affected with heaped up layers of crust. She's such a sad wisp of humanity--severely cachectic weighing little more than 70-80 lbs. We've suspected systemic sepsis from secondary pyoderma & have been treating her with antibiotics in addition to the scabies treatments. This morning, she had an asystolic cardiac arrest & is now in the ICU . . . Very sad. I've never seen anything like this. The severity of & extent of pathology in the diseases I'm seeing here really hit me today, ans the indigenous patients carry a disproportionate burden of disease & so many of them are young & extremely sick.