Scabies education in secondary schools: A multicenter study.

Background: The aim of this study was to educate secondary school students on etiology, risk factors, clinical features, treatment, and prevention of scabies; to evaluate their knowledge base on scabies before and after an educational intervention; and to reassess this knowledge base and behavioral change, 6 months after, on a second visit. Methods: Questionnaires with standard questions on scabies, graded to a maximum score of 10, were administered to students in junior secondary Classes 1 and 2 across 4 states in Nigeria. Information obtained included subjects' demographics, scabies symptomatology, risks, and preventive behaviors. Students with active scabies were diagnosed and treated. Data were analyzed with STATA. Results: The mean test scores for the pretest and posttest at first visit were 2.82 ± 1.38 and 6.30 ± 1.09, respectively. This difference was statistically significant at t = 3.95, P = 0.004. Six months later, when the same schools were re-visited, the mean test scores for the pretest and posttest were 4.63 ± 0.54 and 5.87 ± 0.25, respectively. This difference was also significant at t = 4.13, P = 0.003. The prevalence of scabies was 3.5% at first visit and 4.34% at second visit; t = 0.24, P = 0.41. Conclusions: Secondary school students lack basic education on scabies and exhibit high-risk behaviors for scabies transmission. Knowledge on scabies needs constant reinforcement.

RésuméContexte: Le but de cette étude était d'éduquer les élèves du secondaire sur l'étiologie, les facteurs de risque, les caractéristiques cliniques, le traitement et la prévention de la gale; évaluer leur base de connaissances sur la gale avant et après une intervention éducative; et de réévaluer cette base de connaissances et ce changement de comportement, six mois après, lors d'une deuxième visite. Méthodes: Des questionnaires contenant des questions standard sur la gale, notés à un score maximum de 10, ont été administrés aux élèves des classes 1 et 2 du premier cycle du secondaire dans 4 États du Nigéria. Les informations obtenues comprenaient la démographie des sujets, la symptomatologie de la gale, les risques et les comportements préventifs. Les étudiants atteints de gale active ont été diagnostiqués et traités. Les données ont été analysées avec STATA. Résultats: Les scores moyens aux tests avant et après le test lors de la première visite étaient respectivement de 2,82 ± 1,38 et 6,30 ± 1,09. Cette différence était statistiquement significative à t = 3,95, p = 0,004. Six mois plus tard, lorsque les mêmes écoles ont été revues, les scores moyens aux tests avant et après test étaient respectivement de 4,63 ± 0,54 et 5,87 ± 0,25. Cette différence était également significative à t = 4,13, p = 0,003. La prévalence de la gale était de 3,5% lors de la première visite et de 4,34% lors de la deuxième visite; t = 0,24, p = 0,41. Conclusions: Les élèves du secondaire manquent d'éducation de base sur la gale et présentent des comportements à haut risque de transmission de la gale. Les connaissances sur la gale nécessitent un renforcement constant.

Susceptibility of patients receiving chemotherapy for haematological malignancies to scabies.

BACKGROUND: Scabies is a contagious dermatosis. The risk factors for its transmission remain unclear. A scabies outbreak, involving patients who were receiving chemotherapy for haematological malignancies, occurred at our hospital. METHODS: The outbreak population was analysed to determine whether the incidence of scabies was higher among contact patients receiving chemotherapy for haematological malignancies. RESULTS: A patient with crusted scabies was the index case, and 18 of 78 contact healthcare workers (HCWs) and 22 of 135 contact patients were diagnosed with classical scabies. Ten of 17 contact patients with haematological malignancies and 12 of 118 contact patients with other diseases were infected with scabies. The incidence rate was significantly higher among the patients with haematological malignancies (P<0.001). The patients with haematological malignancies had a significantly lower mean minimum neutrophil count than those with other diseases (1159/µL vs 3761/µL, P=0.0012). Most haematological patients did not require special nursing assistance, suggesting that the higher incidence of scabies among these patients resulted from their immunodeficiency rather than greater skin-to-skin contact with infected HCWs. CONCLUSION: Our study suggests that patients receiving chemotherapy for haematological malignancies are more susceptible to scabies than patients with other diseases, and require stricter protection.

Pruritus in ordinary scabies: IL-31 from macrophages induced by overexpression of thymic stromal lymphopoietin and periostin.

BACKGROUND: Scabies is a common contagious skin disease caused by an infestation of the skin by Sarcoptes scabiei var. hominis. A hallmark symptom of scabies is severe itch. METHODS: We sought to determine the generation of a pruritogenic cytokine, interleukin (IL)-31, together with immune profiles in skin lesions of ordinary scabies through immunohistochemical and immunofluorescent studies. To elucidate the pathological mechanisms of IL-31 generation, murine peritoneal macrophages were stimulated with various T helper 2 (Th2) cytokines and proteins ex vivo. RESULTS: A large number of CCR4(+) Th2 cells, eosinophils, and basophils infiltrated in scabies lesions. Increased generation of IL-31, thymic stromal lymphopoietin (TSLP), and periostin was also observed. A major population of IL-31(+) cells were Arginase-1(+)/CD163(+) M2 macrophages. Murine peritoneal macrophages showed an M2 phenotype and generated IL-31 when stimulated with TSLP and periostin. CONCLUSION: IL-31 appeared to be largely generated by M2 macrophages in ordinary scabies lesions. This IL-31 induction was mediated by TSLP and periostin.

The Epidemiology of Scabies and Pediculosis in Kayseri.

OBJECTIVE: The present study aimed to evaluate scabies and pediculosis cases in the city of Kayseri and to contribute to the epidemiological data in Turkey. METHODS: Data for the present study were obtained from the Kayseri Directorate of Public Health. The distribution of lice and scabies according to age, sex, and years was evaluated retrospectively. RESULTS: A total of 3908 scabies and 4762 pediculosis cases have been reported from the central and peripheral districts of Kayseri between January 2006 and April 2017. It was observed that the number of female cases is higher in both infestations. When positive cases were evaluated according to age, it appears that scabies cases in the 25-44 age group and pediculosis cases in the 10-14 age group are higher. At the same time, in the first 4 months of 2017, it was observed that the number of cases in both infestations was two times higher than that in the previous year. CONCLUSION: We believe that scabies and pediculosis infestations are still a major public health concern in Turkey and its city.

Scabies is strongly associated with acute rheumatic fever in a cohort study of Auckland children.

AIM: This study sought to determine whether scabies infection is associated with acute rheumatic fever (ARF) or chronic rheumatic heart disease (CRHD). METHODS: A cohort study was undertaken using health records of children aged 3-12 years attending an oral health service for the first time. Subjects were then linked to hospital diagnoses of scabies and ARF or CRHD. RESULTS: A total of 213 957 children free of rheumatic heart disease at baseline were available for analysis. During a mean follow-up time of 5.1 years, 440 children were diagnosed with ARF or CRHD in hospital records. Children diagnosed with scabies during follow-up were 23 times more likely to develop ARF or CRHD, compared with children who had no scabies diagnosis. After adjustment for confounders in a Cox model, the association reduced but remained strong (adjusted hazard ratio: 8.98; 95% confidence interval: 6.33-20.2). In an analysis restricted to children hospitalised at least once during follow-up, the adjusted hazard ratio for the same comparison was 3.43 (95% confidence interval: 1.85-6.37). CONCLUSIONS: A recent diagnosis of scabies from hospital records is strongly associated with a subsequent diagnosis of ARF. Further investigation of the role that scabies infestation may play in the aetiology of ARF is warranted.

Serie parasitosis en dermatología: escabiosis / Series parasitosis in dermatology: scabies

La escabiosis es una ectoparasitosis pruriginosa producida por el ácaro Sarcoptes scabiei, variedad hominis, específica del ser humano. Si bien su distribución es universal, con frecuencia es subdiagnosticada por asociarla únicamente a hacinamiento y malos hábitos de higiene. Se transmite por contacto directo con una persona afectada o a través de fómites, por lo que es muy común el contagio de los convivientes. Presentamos un caso de escabiosis en una paciente anciana evaluada por prurito generalizado. (AU)

Scabies is a human specific pruritic ectoparasitosis produced by the mite Sarcoptes scabiei var. hominis. Although it has a worldwide distribution, it is often underdiagnosed because it is only associated with overcrowding and poor hygiene. It is transmitted by a direct contact with an affected person or through fomites. The transmission to cohabitants is very common. We present a case of scabies in an elderly patient with generalized pruritus. (AU)

Scabies and impetigo prevalence and risk factors in Fiji: a national survey.

BACKGROUND: Scabies is recognised as a major public health problem in many countries, and is responsible for significant morbidity due to secondary bacterial infection of the skin causing impetigo, abscesses and cellulitis, that can in turn lead to serious systemic complications such as septicaemia, kidney disease and, potentially, rheumatic heart disease. Despite the apparent burden of disease in many countries, there have been few large-scale surveys of scabies prevalence or risk factors. We undertook a population-based survey in Fiji of scabies and impetigo to evaluate the magnitude of the problem and inform public health strategies. METHODOLOGY/PRINCIPAL FINDINGS: A total of 75 communities, including villages and settlements in both urban and rural areas, were randomly selected from 305 communities across the four administrative divisions, and all residents in each location were invited to participate in skin examination by trained personnel. The study enrolled 10,887 participants. The prevalence of scabies was 23.6%, and when adjusted for age structure and geographic location based on census data, the estimated national prevalence was 18.5%. The prevalence was highest in children aged five to nine years (43.7%), followed by children aged less than five (36.5%), and there was also an indication of prevalence increasing again in older age. The prevalence of scabies was twice as high in iTaukei (indigenous) Fijians compared to Indo-Fijians. The prevalence of impetigo was 19.6%, with a peak in children aged five to nine years (34.2%). Scabies was very strongly associated with impetigo, with an estimated 93% population attributable risk. CONCLUSIONS: As far as we are aware, this is the first national survey of scabies and impetigo ever conducted. We found that scabies occurs at high levels across all age groups, ethnicities, and geographical locations. Improved strategies are urgently needed to achieve control of scabies and its complications in endemic communities.

Risk factors for recurrence of scabies: a retrospective study of scabies patients in a long-term care hospital.

A considerable number of patients suffer recurrence of scabies. To elucidate risk factors for recurrence of scabies, we compared patients who experienced scabies recurrence and those who suffered scabies only once. We conducted a retrospective review of medical records of all scabies patients in a long-term care hospital for the elderly (300 beds; six wards) for a period of 42 months to determine frequency of scabies onsets, underlying diseases, history of treatment, and demographic data such as age and sex. One hundred and forty-eight patients and five hospital staff members suffered scabies during the 42-month study period. All staff members and 98 patients had no recurrence, while 50 patients experienced at least one recurrence of scabies. The cumulative number of scabies diagnoses was 228. The rates of scabies onset and recurrence were considerably different among wards. The dementia unit showed the highest rate of onset and recurrence. In addition to frequent exposure to infectious sources, problematic behavior, such as lying in other patients beds, might cause the high recurrence rate in dementia units. Higher serum total lymphocyte count and topical use of γ-benzene hexachloride were associated with lower risk of scabies recurrence. Recurrence of scabies is not uncommon among elderly patients in institutional settings. Impaired immunity may be a risk factor for recurrence of scabies. Groups with a high onset rate of scabies pose a high likelihood of recurrence. Problematic behavior of demented patients may increase the risk of recurrence. Use of effective topical treatment may effectively prevent recurrence.

Norwegian scabies in a malnourished young adult: a case report.

A 19-year-old male was admitted to the medical ward with complaints of fever and swelling of the ankle and wrist joints of about two weeks duration. The patient developed hyperkeratotic lesions of the skin over the hands, elbow and back about three weeks after admission. Antistreptolysin O, rheumatoid factor, and Widal tests as well as Chickungunya, brucella, HIV and antinuclear antibodies were negative. Culture of blood sample and pus aspirate from the ankle and chest yielded a pure growth of Staphylococcus epidermidis. Potassium hydroxide (KOH) mount of the scrapings from crusted skin lesions showed plenty of adult mites, eggs and faecal pellets of Sarcoptes scabiei. A diagnosis of crusted scabies with secondary bacterial infection was made and the patient was treated successfully with oral ivermectin, topical permethrin and vancomycin.

Dermoscopy of Norwegian scabies in a patient with acquired immunodeficiency syndrome.

The authors report here on the case of a female patient with Norwegian (crusted) scabies and acquired immunodeficiency syndrome whose compliance with antiretroviral therapy was poor. Definitive diagnosis was confirmed by direct microscopic examination, which revealed numerous Sarcoptes scabei. Dermoscopy showed pathognomonic scabetic burrows and brownish structures in the shape of a hand-glider with a millipede-like appearance. The latter constitutes a diagnostic feature in the pathology of Norwegian scabies that has not yet been described. The patient responded well to oral ivermectin and topical vaseline with sulphur at a proportion of 10%. There was a simultaneous improvement in dermoscopic parameters.

Dermatology of the patient with HIV.

Cutaneous diseases occur in most people infected with human immunodeficiency virus (HIV) and at a higher rate than people not infected with HIV. Common HIV-related rashes and rashes made unusual by HIV infection are reviewed.

Dermoscopia da sarna crostosa associada à síndrome da imunodeficiência adquirida / Dermoscopy of Norwegian scabies in a patient with acquired immunodeficiency syndrome

Os autores relatam o caso de uma paciente com sarna norueguesa e síndrome da imunodeficiência adquirida com baixa aderência à terapia antirretroviral. O diagnóstico definitivo foi confirmado pelo exame parasitológico direto. A dermatoscopia mostrou sulcos escabióticos e estruturas acastanhadas em asa-delta já descritas, além de uma estrutura morfologicamente semelhante a um gongolo (diplopodasímile). Esta última representa um elemento patodiagnóstico da SN não previamente descrito. Houve boa reposta clínica ao uso oral da ivermectina e ao uso tópico da vaselina com enxofre a 10 por cento, com concomitante melhora dos parâmetros dermatoscópicos.

The authors report here on the case of a female patient with Norwegian (crusted) scabies and acquired immunodeficiency syndrome whose compliance with antiretroviral therapy was poor. Definitive diagnosis was confirmed by direct microscopic examination, which revealed numerous Sarcoptes scabei. Dermoscopy showed pathognomonic scabetic burrows and brownish structures in the shape of a hand-glider with a millipede-like appearance. The latter constitutes a diagnostic feature in the pathology of Norwegian scabies that has not yet been described. The patient responded well to oral ivermectin and topical vaseline with sulphur at a proportion of 10 percent. There was a simultaneous improvement in dermoscopic parameters.