Active case detection methods for crusted scabies and leprosy: A systematic review.

BACKGROUND: Crusted scabies is endemic in some remote Aboriginal communities in the Northern Territory (NT) of Australia and carries a high mortality risk. Improvement in active case detection (ACD) for crusted scabies is hampered by a lack of evidence about best practice. We therefore conducted a systematic review of ACD methods for leprosy, a condition with similar ACD requirements, to consider how findings could be informative to crusted scabies detection. METHODS AND PRINCIPLE FINDINGS: We conducted systematic searches in MEDLINE, CINAHL, Scopus and the Cochrane Database for Systematic Reviews for studies published since 1999 that reported at least one comparison rate (detection or prevalence rate) against which the yield of the ACD method could be assessed. The search yielded 15 eligible studies from 511. Study heterogeneity precluded meta-analysis. Contact tracing and community screening of marginalised ethnic groups yielded the highest new case detection rates. Rapid community screening campaigns, and those using less experienced screening personnel, were associated with lower suspect confirmation rates. There is insufficient data to assess whether ACD campaigns improve treatment outcomes or disease control. CONCLUSION: This review demonstrates the importance of ACD campaigns in communities facing the highest barriers to healthcare access and within neighbourhoods of index cases. The potential benefit of ACD for crusted scabies is not quantified, however, lessons from leprosy suggest value in follow-up with previously identified cases and their close contacts to support for scabies control and to reduce the likelihood of reinfection in the crusted scabies case. Skilled screening personnel and appropriate community engagement strategies are needed to maximise screening uptake. More research is needed to assess ACD cost effectiveness, impact on disease control, and to explore ACD methods capable of capturing the homeless and highly mobile who may be missed in household centric models.

Scabies Among Elderly Korean Patients with Histories of Leprosy.

A scabies epidemic, traced by the hospital-based surveillance system, was reported in a Korean leprosarium. A total of 200 symptomatic cases were found during 2012-2014 among 570 elderly former leprosy patients. Most of cases were classic type scabies (87%) and aged 75 years and older (72%). Surveillance system for early diagnosis and prompt intervention was applied and the scabies epidemic was controlled effectively in this long-term care facility.

Crusted scabies.

Crusted scabies is a rare manifestation of scabies characterized by uncontrolled proliferation of mites in the skin. In immunocompromised patients, this infestation is characterized by crusted lesions. The occurrence of the disease in human immunodeficiency virus-infected patients and the widespread use of immunosuppressive agents has led to a renewed interest in the disease. Early recognition and treatment is necessary to avoid an outbreak of scabies. This review highlights the pathogenesis, predisposing factors, clinical features and treatment of crusted scabies.

[Combination of three cutaneous diseases in Mayotte]. / Une triple atteinte dermatologique a Mayotte.

This report describes the case of a young woman from Mayotte (Comoros Islands) who presented a combination of three cutaneous diseases, i.e. pityriasis versicolor, scabies, and multibacillary leprosy. Symptoms of leprosy were concealed by those of the other two diseases. After multidrug therapy for leprosy, the patient developed erythema nodosum leprosum that was successfully treated using pentoxifylline. Combination of cutaneous diseases can alter usual presentations and lead to misdiagnosis. It is important to take into account possible disease combination to establish proper diagnosis and prescribe effective treatment.

Definition of an algorithm for the management of common skin diseases at primary health care level in sub-Saharan Africa.

In order to help primary health care (PHC) workers in developing countries in the care of common skin diseases, an algorithm for the management of pyoderma, scabies, superficial mycoses, contact dermatitis and referral of early leprosy cases (based on the identification of diseases through the presence of objective key signs, and on treatments by generic drugs) was elaborated. One thousand patients were seen by trained dermatologists, who established diagnoses and treatments; in addition, there was systematic recording of each key sign, according to the successive algorithm steps. We compared the diagnostics and treatments obtained for several combinations of diagnostic signs, with those of the dermatologists. Sensitivity, specificity, positive predictive value and negative predictive value of defined combinations were high for pyoderma, scabies and superficial mycoses. Values were less exact for dermatitis and leprosy, but were considered sufficient for the level of health care targeted. The apportionment of treatments between the algorithm and the dermatological approaches was considered appropriate in more than 80% of cases; mismanagement was possible in 7% of cases, with few predictable harmful consequences. The algorithm was found satisfactory for the management of the dermatological priorities according to the standards required at the PHC level.

Lepromatous lymphadenopathy and concomitant tuberculous axillary lymphadenitis with sinus. A case report.

A 25-year-old male patient with florid lepromatous leprosy presented with right axillary lymphadenopathy and a discharging sinus. He also had scabies with chronic right otitis media. Histopathological examination of the lymph node revealed lepromatous lymphadenitis coexisting with tuberculosis. This unusual combination of two different clinical entities is recorded in this case report.