Diagnosis: Norwegian scabies
Based on our physical findings and the lab work, we diagnosed Norwegian scabies and urosepsis in this patient.
Norwegian scabies, also known as crusted scabies, is an uncommon form of scabies infestation that was first described in Norway.1 The causative organism is the burrowing mite Sarcoptes scabie, which is the same organism that is involved in ordinary scabies. The difference, though, is that the level of infestation with Norwegian scabies is more severe.
Definitive diagnosis depends on microscopic identification of the mites, their eggs, eggshell fragments, or mite pellets. Patients who have Norwegian scabies also have extremely elevated total serum immunoglobulin E and G levels.2 In addition, these patients are predisposed to secondary infections.
Clinically, multiple yellow to brown hyperkeratotic plaques with significant xerosis are seen on the acral areas, including the scalp, face, and palmoplantar region. The toenails and fingernails may also show dystrophic changes with variable thickening.
Who’s at risk?
In general, patients with dementia or mental retardation and those who are immunocompromised are most susceptible to Norwegian scabies.3 In ordinary scabies, the number of mites is usually less than 20 per individual.3 However, in cases involving an impaired immune response, it is difficult to control the numbers of mites in the infected skin, and a Norwegian scabies host may harbor more than 1 million mites.3
Despite the high mite load, most patients suffer only mild discomfort and tend to ignore the condition.3 This leads to delayed diagnosis and treatment.
A disease that spreads quickly. This disease is transmitted by close skin to skin contact and contact with infested clothing, bedding, or furniture. In nursing homes, patients with unrecognized Norwegian scabies are often the source of transmission to other residents and staff members.4