The economic and health burdens of diseases caused by group A Streptococcus in New Zealand.

OBJECTIVES: In preparation for the future arrival of a group A Streptococcus (GAS) vaccine, this study estimated the economic and health burdens of GAS diseases in New Zealand (NZ). METHODS: The annual incidence of GAS diseases was based on extrapolation of the average number of primary healthcare episodes managed each year in general practices (2014-2016) and on the average number of hospitalizations occurring each year (2005-2014). Disease incidence was multiplied by the average cost of diagnosing and managing an episode of disease at each level of care to estimate the annual economic burden. RESULTS: GAS affected 1.5% of the population each year, resulting in an economic burden of 29.2 million NZ dollars (2015 prices) and inflicting a health burden of 2373 disability-adjusted life years (DALYs). Children <5 years of age were the most likely age group to present for GAS-related healthcare. Presentations for superficial throat and skin infections (predominantly pharyngitis and impetigo) were more common than other GAS diseases. Cellulitis contributed the most to the total economic and health burdens. Invasive and immune-mediated diseases disproportionately contributed to the total economic and health burdens relative to their frequency of occurrence. CONCLUSION: Preventing GAS diseases would have substantial economic and health benefits in NZ and globally.

Integration of Management Strategies for Skin-Related Neglected Tropical Diseases.

The concept of skin neglected tropical diseases has been widely adopted into the policy and strategy of various organizations, governments, nongovernmental organizations, and health agencies. By pooling information and resources across different diseases, whose primary manifestations affect the skin, it is possible to deliver integrated surveillance and control programs and promote advocacy and reduction of disability and stigma. A further key part of the skin neglected tropical diseases program is the development and validation of training methods for front-line health workers. Networks that allow those involved in this work to share and compare expertise are being developed through various organizations.

Developing evidence-based guidance for assessment of suspected infections in care home residents.

BACKGROUND: The aim of this study was to update and refine an algorithm, originally developed in Canada, to assist care home staff to manage residents with suspected infection in the United Kingdom care home setting. The infections of interest were urinary tract infections, respiratory tract infections and skin and soft tissue infection. METHOD: We used a multi-faceted process involving a literature review, consensus meeting [nominal group technique involving general practitioners (GPs) and specialists in geriatric medicine and clinical microbiology], focus groups (care home staff and resident family members) and interviews (GPs), alongside continual iterative internal review and analysis within the research team. RESULTS: Six publications were identified in the literature which met inclusion criteria. These were used to update the algorithm which was presented to a consensus meeting (four participants all with a medical background) which discussed and agreed to inclusion of signs and symptoms, and the algorithm format. Focus groups and interview participants could see the value in the algorithm, and staff often reported that it reflected their usual practice. There were also interesting contrasts between evidence and usual practice informed by experience. Through continual iterative review and analysis, the final algorithm was finally presented in a format which described management of the three infections in terms of initial assessment of the resident, observation of the resident and action by the care home staff. CONCLUSIONS: This study has resulted in an updated algorithm targeting key infections in care home residents which should be considered for implementation into everyday practice.

Dermatological conditions encountered in The Independent State of Samoa and an exploration of possible strategies to manage dermatological health-care needs in this resource-poor setting.

This report adds to the limited existing literature concerning dermatoses in Samoa. Conditions encountered during a 4-day private clinic are reported. Amongst the 75 patients reviewed, eczema was the most frequent condition diagnosed. This was followed by infective dermatoses particularly pityriasis versicolor and tinea infections. Reassuringly, in 97% of cases, suitable medications were available locally.

The ALT-70 cellulitis model maintains predictive value at 24 and 48 hours after presentation.

BACKGROUND: Cellulitis has many potential mimickers, and its misdiagnosis often leads to unnecessary hospitalizations and higher health care costs. The ALT-70 predictive model offers an objective tool to help differentiate between cellulitis and other clinically similar conditions at the time of initial emergency department (ED) presentation. OBJECTIVE: To evaluate the performance of the ALT-70 predictive model at 24 and 48 hours following ED presentation. METHODS: We performed a retrospective review of our prior cohort and expanded our data collection to include data at 24 and 48 hours after initial ED presentation. We compared classification measures for the ALT-70 at the time of initial ED presentation, 24 hours after presentation, and 48 hours after presentation. RESULTS: There was a statistically significant difference in median ALT-70 score between patients with true cellulitis and those with mimickers of cellulitis at all time points. Sensitivity, specificity, positive predictive value, and negative predictive value of the ALT-70 score was similar across all 3 time points. LIMITATIONS: Single-center design may reduce generalizability. CONCLUSION: At 24 and 48 hours, the ALT-70 performed similarly to the way it performed at the time of initial ED presentation, allowing for its use in a wider array of clinical settings.

Warts transmitted in families and schools: a prospective cohort.

BACKGROUND AND OBJECTIVE: Cutaneous warts are common in primary schoolchildren; however, knowledge on the routes of transmission of human papillomavirus (HPV) causing warts is scarce. This study examines the association between the degree of HPV exposure and incidence of warts in primary schoolchildren to support evidence-based recommendations on wart prevention. METHODS: In this prospective cohort study, the hands and feet of all children in grades 1 to 7 (aged 4-12 years) of 3 Dutch primary schools were inspected for the presence of warts at baseline and after 11 to 18 months of follow-up. Data on the degree of HPV exposure included information obtained from parental questionnaires: preexistent warts, warts in family, prevalence of warts at baseline in the class, and use of public places (eg, swimming pools). RESULTS: Of the 1134 eligible children, 97% participated; the response rate from parental questionnaires was 77%, and loss to follow-up was 9%. The incidence for developing warts was 29 per 100 person-years at risk (95% confidence interval [CI] 26-32). Children with a white skin type had an increased risk of developing warts (hazard ratio [HR] 2.3, 95% CI 1.3-3.9). Having family members with warts (HR 2.08, 95% CI 1.52-2.86) and wart prevalence in the class (HR 1.20 per 10% increase, 95% CI 1.03-1.41) were independent environmental risk factors. CONCLUSIONS: The degree of HPV exposure in the family and school class contributes to the development of warts in schoolchildren. Preventive recommendations should focus more on limiting HPV transmission in families and school classes, rather than in public places.

[Store-and-forward teledermatology: assessment of validity in a series of 2000 observations]. / Teledermatología diferida: análisis de validez en una serie de 2.000 observaciones.

BACKGROUND AND OBJECTIVES: The aim of this study was to assess the validity of store-and-forward teledermatology as a tool to support physicians in primary care and hospital emergency services and reduce the requirement for face-to-face appointments. Diagnostic validity and the approach chosen for patient management (face-to-face vs teledermatology) were compared according to patient origin and diagnostic group. MATERIAL AND METHODS: Digital images from 100 patients were assessed by 20 different dermatologists and the diagnoses offered were compared with those provided in face-to-face appointments (gold standard). The proposed management of the different groups of patients was also compared. RESULTS: The percentage complete agreement was 69.05% (95% confidence interval [CI], 66.9%-71.0%). The aggregate agreement was 87.80% (95% CI, 86.1%-89.0%). When questioned about appropriate management of the patients, observers elected face-to-face consultation in 60% of patients (95% CI, 58%-61%) and teledermatology in 40% (95% CI, 38%-41%). Diagnostic validity was higher in patients from primary care (76.1% complete agreement and 91.8% aggregate agreement) than those from hospital emergency services (61.8% complete agreement, 83.4% aggregate agreement) (p < 0.001) and teledermatology was also chosen more often in patients from primary care compared with those from emergency services (42% vs 38%; p=0.003). In terms of diagnostic group, higher validity was observed for patients with infectious diseases (73.3% complete agreement and 91.3% aggregate agreement) compared to those with inflammatory disease (70.8% complete agreement and 86.4% aggregate agreement) or tumors (63.0% complete agreement and 87.2% aggregate agreement) (p <0.001). Teledermatology was also chosen more often in patients with infectious diseases (52%) than in those with inflammatory disease (40%) or tumors (28%) (p <0.001). CONCLUSIONS: Store-and-forward teledermatology has a high level of diagnostic validity, particularly in those cases referred from primary care and in infectious diseases. It can be considered useful for the diagnosis and management of patients at a distance and would reduce the requirement for face-to-face consultation by 40%.

[Activity report on a rapid post-emergency consultation for the management of dermatological emergencies [corrected]]. / Bilan d'activité d'une consultation post-urgence rapide pour la prise en charge des urgences dermatologiques.

BACKGROUND: Dermatological emergencies generally consist of infection and inflammation, including cutaneous drug reactions. Most patients are either not seen again or else are followed by their GP, but it may be a long time before they see a dermatologist once more, even if monitoring is necessary. We created a rapid post-emergency consultation reserved for these patients alone requiring short-term reevaluation, and we report the results of the new consultation herein. RESULTS: One consultation per week is exclusively for patients seen in dermatological emergency units requiring rapid reassessment (i.e. within two weeks) for follow-up or in cases of uncertainty in the diagnosis. Between June 2008 and June 2009, 40 consultations were carried out, with 370 patients being enrolled and 214 attending the consultation (40% absenteeism), i.e. 3% of emergency unit patients. The mean time from the emergency consultation was 9.2 days and the reasons for consultation were: 34% infectious dermatoses, 36% inflammatory dermatoses, 7.5% cutaneous drug reactions and 19% miscellaneous diagnosis, with 4.2% uncertainty about diagnosis. The outcome after the emergency consultation was favourable in 76% of cases (complete healing or improvement). A follow-up consultation was proposed in 41.5% of cases, with 77.5% of patients attending. While the creation of this consultation did not significantly reduce the number of patients returning to the emergency service, it was welcomed by all dermatologists in charge of such dermatological emergency services. CONCLUSION: This rapid post-emergency consultation forms a small part of the activities of the dermatological emergency unit but is positive in the view of the dermatologists in charge of emergency consultations since it means patients can be given appointments soon after initial treatment, thus avoiding the need to return to the emergency unit. The diseases seen at this unit are similar to those seen in the emergency unit. While absenteeism is considerable, this type of consultation results in the organisation of further ongoing care for 40% of patients, most of whom comply with treatment.

Skin disorders among school children in rural Tanzania and an assessment of therapeutic needs.

Eight hundred and twenty primary school children were examined to assess the spectrum and prevalence of skin diseases in rural Tanzania. In all, 55% of the children had one or several skin disorders, but only 33% of all diagnoses in a cluster of 14% of the children required treatment. Tinea versicolor was found in 26.2%, pyoderma and dermatophytoses in less than 10%, while few children had scabies or eczematous lesions.

A new application of BCG antibody for rapid screening of various tissue microorganisms.

BACKGROUND: In routine dermatopathology there is growing demand for a simple, fast, cost-effective, and highly sensitive screening tool for the detection of microorganisms. OBJECTIVE: Our purpose was to determine whether immunostaining with polyclonal anti-Mycobacterium bovis (BCG), which is known for its interspecies cross-reactivity, is a suitable screening method for many common microorganisms in dermatopathologic specimens. METHODS: A total of 254 formalin-fixed, paraffin-embedded skin specimens of viral, protozoal, fungal, and bacterial infections were stained with appropriate histochemical stains and with anti-BCG. RESULTS: Anti-BCG labeled bacteria and fungi with high sensitivity and minimal background staining, but did not react with spirochetes, viruses, or protozoa (Leishmania). The quality and sensitivity of anti-BCG staining were superior to conventional histochemical stains. CONCLUSION: Because of its cross-reactivity with many bacteria and fungi as well as its high sensitivity and minimal background staining, the anti-BCG immunostain is a promising screening tool for the detection of the most common bacterial and fungal microorganisms in paraffin-embedded skin specimens.

An infectious disease day care unit--the first year.

Details are given of what is believed to be the first Day Care Unit in the U.K. for the diagnosis and treatment of infection and infectious diseases. The reaction of referring doctors and their patients has been favourable, cross-infection in the home has not been a problem and some potentially life-threatening infections have been diagnosed earlier than might otherwise have been the case. Capital and running costs were relatively small and the use of inpatient beds for infectious diseases became more efficient.