FAIRMONT - About a month ago, The Clinic at Walmart started seeing a trend: patients with bug bites that itched so bad they were unable to sleep.
Linda McClintock is a certified nurse practitioner and the main provider at The Clinic at Walmart, which is affiliated with Mayo Clinic Health System in Fairmont. With 32 years in the health field, she has been to able to quickly diagnose the culprit.
"Just from my little clinic, and understand there are other clinics seeing them too, I've seen about 40 cases this past month," she said. " ... Of course, people are freaked out when they find out, the looks on their face.
"'I stay clean,' they say. 'I wash my clothes. What do you mean I have scabies?'"
According to the National Library of Medicine, "Scabies is an easily spread skin disease caused by a very small type of mite."
The itching comes as the mite digs under the skin, forming burrows in which it lays eggs, dines on epithelial tissue and poops, McClintock explained.
How easily does it spread? That's up for debate. Prolonged skin-to-skin contact is one way to catch scabies, but it's not the only way. Scientists are finding the human parasite is more resilient than they first thought.
"They used to think scabies could only live 15 minutes on a dry surface and they would die, but now it's 24 to 36 hours on a dry surface," said McClintock, who suspects the Minnesota State Fair is where some of her patients picked up the mite. Public restrooms, hotels and even changing rooms at clothing stores are other potential places she listed for catching scabies.
"It doesn't mean that you're dirty. It doesn't mean that you have poor hygiene. People of all incomes get it. In some places it's actually epidemic," she said.
While the recent outbreak isn't as serious as other places McClintock has worked - most of the cases she has treated are adults, not school-age children - there is a lot of it going around, and people should be aware of the symptoms.
Different people have different reactions to scabies. For some, the itching is so intense it keeps them awake at night. Others may just appear to have a light rash, which can make diagnosis tricky.
"In some people, they're allergic to the mites that burrow under the skin and lay eggs, so it can be mistaken for hives. It can also be mistaken for eczema ... or you can mistake it for a fungal skin infection," McClintock said.
To identify the problem as scabies, she looks at the pattern of the bites, the remedies patients have tried, and other family members, since the scabies typically spread to other people in a household, though it may not impact everyone in that household. For whatever reason, some human hosts are tastier than others, so some people are less likely to catch the mite.
The symptoms can show themselves immediately, or take six to eight weeks to appear. Its evasiveness is part of what helps scabies thrive.
"If people think it's bug bites or something, they're scratching sometimes for weeks or months 'til they come in, and in the meantime, they're spreading it," McClintock said.
The good news is that once properly diagnosed by a health care provider, the treatment for scabies is relatively simple and affordable. A pill is available, but it's expensive and most insurance companies won't cover it, so McClintock usually prescribes elimite cream instead.
Patients should apply the cream from the chin down, covering 100 percent of their body, including under the fingernails. For any bites on the scalp or face, she recommends spot treatment. The ointment is clear with no odor, and should be kept on for up to 18 hours. Then wash and dry recently used clothing, bedding and towels, using hot water. McClintock recommends two treatments a week apart.
"Once you put this cream on once, you are no longer contagious," she said. "Normally you don't need that treatment a week later, but I like to make sure they're all dead."
Even after the mites have died, the itching will likely continue for a couple weeks, or even last as long as a month, until you shed enough skin cells to discard the dead mites and eggs.
More helpful information on scabies is available on Mayo Clinic's website, at www.mayoclinic.com/health/scabies/DS00451