Educational Resource for Long-Term Care

​​​​Welcome to the summer edition of The Lowdown, an educational resource for long-term care. Summer brings the joy of picnics and time spent outdoors—along with ticks, mosquitos, parasites, and fungi. This edition focuses on diseases caused by these organisms and ways to help protect you and your residents. Happy reading!

Ticks are “vectors” that carry and transmit several serious diseases. The Pennsylvania Department of Environmental Protection (DEP) tests ticks to identify diseases they are carrying and this year found ticks infected with Lyme disease, Rocky Mountain spotted fever, anaplasmosis, babesiosis, ehrlichiosis, deer tick virus (a type of Powassan virus), and tularemia. Protecting you and your residents against tick bites is important to prevent transmission of these diseases.1

Lyme disease is the most commonly reported tick-borne disease in the United States. It is transmitted by the bite of an infected blacklegged (deer) tick and caused by the bacterium Borrelia burgdorferi. Symptoms of Lyme disease include fever, headache, fatigue, and a characteristic “bull’s-eye” skin rash called erythema migrans. Studies show not everyone develops a rash (only 70%–80% of those infected).^1,2

Pennsylvania has one of the highest numbers of confirmed Lyme disease cases in the country. On May 13, 2022, the Pennsylvania Department of Health (DOH) issued a health advisory to notify providers of a recent increase in tick-related visits to emergency rooms. Ticks are found in grassy, wooded, and brushy areas. Many exposures happen in your own yard. With more residents going outside in nice weather and tick exposures increasing in spring and summer months, it is important to protect you and your residents from tick bites.^1,2

For more information, visit:

DOH Health Advisory “Lyme Disease and Other Tickborne Diseases in Pennsylvania”

Lyme Disease (Centers for Disease Control and Prevention)

2020 Lyme Disease and Other Tickborne Diseases Surveillance Report (DOH, September 2022)​

Scabies is a highly contagious, parasitic skin infestation caused by a microscopic mite, Sarcoptes scabiei. Scabies is mainly spread by direct skin-to-skin contact during patient care, or in severe cases, the mites can transfer from infested clothing, bedding, or the environment. Lotions or topical medications can serve as a reservoir (habitat) for mites that can survive up to seven days in oil-based solutions.^3,4

Mites cannot jump or fly, but they can crawl. A fertilized female mite tunnels under the surface layer of the skin and lays two to three eggs each day. These eggs hatch in three to four days, then larvae surface, burrow, and feed on skin cells until they mature, after which the cycle repeats. Scratching the itchy skin can spread mites under fingernails to other parts of the body, a new host, or fomites (inanimate objects that can transfer disease). Transmission can continue until the mites and eggs are killed.^3,4

The primary symptoms are a raised rash and intense itching caused by an allergic reaction to the mites, eggs, and fecal pellets under the skin in the burrow. You can diagnose scabies by the clinical manifestation; an ink test to identify a burrow; the microscopic examination of skin scrapings for mites, their eggs, or fecal matter; or by an adhesive tape test to visualize mites.^3,4

Early diagnosis and treatment is important to prevent an outbreak. Prescription scabicides can kill scabies mites and their eggs. Itching may last for several weeks after treatment as the dead mites, eggs, eggshells, and fecal pellets emerge from the burrows. Repeat treatment may be necessary.^3,4

Place residents in contact precautions with strict use of personal protective equipment until 24 hours after treatment begins. Wash linens in hot water and dry on high heat. Clean and vacuum the room daily, including changing the vacuum bag. For items that can’t be laundered, secure in a plastic bag for at least 72 hours. Educate staff, residents, and visitors on symptoms and control methods.^3,4

Tools available from PSA:

Scabies Transmission, Symptoms, Diagnosis, and Control

Scabies Case/Contact Investigation Line List

Scabies Outbreak Control Checklist

Mosquito bites are common and usually harmless, but certain types of mosquitos can spread severe disease, including malaria, Zika, chikungunya, dengue, West Nile virus (WNV), and Eastern equine encephalitis (EEE).5 Unfortunately, most of these viruses have no vaccines or specific medications to treat them.⁵

In the United States, WNV is the most common virus spread by mosquitos, but cases of EEE and St. Louis encephalitis have been reported.

WNV epidemic flares up in the summer and continues into the fall. It spreads through the bite of an infected mosquito. About 80% of people infected with WNV have no symptoms, but some will develop fever, headache, nausea, vomiting, or a skin rash lasting a few days to several weeks. This can progress severe illness manifested by high fever, confusion, muscle weakness, paralysis, coma, and death. These symptoms may last for several weeks and cause permanent neurological damage. Ten percent of people who develop severe illness die.6

Your residents are at risk, especially people who are over 60 years of age or have certain medical conditions, such as cancer, diabetes, hypertension, or kidney disease, or have had an organ transplant.⁶

As residents spend more time outdoors, it is important to protect them and yourself from bites:Wear long-sleeved shirts and long pants.

​For more information, visit:

West Nile Virus Fact Sheet (DOH)

West Nile Virus Prevention (CDC)

West Nile Virus Surveillance and Control Guidelines (CDC)

Ringworm (tinea corporis) is a contagious fungal infection caused by dermatophyte molds. It is a common infection of the skin, hair, or nails. Ringworm gets its name because of its appearance, described as a scaly, ring-shaped, circular rash.^7,8

Ringworm spreads through direct skin contact with infected people and animals. It can also spread by sharing personal items or through contact with infected linens or surfaces found in moist areas, such as showers, tubs, or bathroom floors. The severity of ringworm can range from mild, scaly lesions to reddened, draining lesions if a secondary bacterial infection develops.^7,8 Ringworm rarely causes serious illness, but people with weakened immune systems, such as the elderly or those with HIV, may find it difficult to get rid of the infection.⁸

Things you can do to reduce the risk of transmission:^7,8

​For more information, visit: 

Ringworm Information for Healthcare Professionals (CDC)

Ringworm (Mayo Clinic)