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1.
West J Emerg Med ; 21(2): 191-198, 2020 Feb 21.
Artigo em Inglês | MEDLINE | ID: mdl-32191175

RESUMO

Scabies is a highly contagious, globally prevalent, parasitic skin infestation caused by Sarcoptes scabiei var. hominis, also known as the itch mite. There have been outbreaks not only in the developing world, but also in the developed world among refugees and asylum seekers. Once infested with scabies mites, symptomatic patients, as well as asymptomatic carriers, quickly spread the disease through direct skin-to-skin contact. Typically, symptoms of scabies are characterized by an erythematous, papular, pruritic rash associated with burrows. Treatment of scabies involves using topical or systemic scabicides and treating secondary bacterial infections, if present. Given the prevalence and contagiousness of scabies, measures to prevent its spread are essential. Through application of the novel Identify-Isolate-Inform (3I) Tool, emergency medical providers can readily identify risk factors for exposure and important symptoms of the disease, thus limiting its spread through prompt scabicide therapy; isolate the patient until after treatment; and inform local public health authorities and hospital infection prevention, when appropriate. Ultimately, these three actions can aid public health in controlling the transmission of scabies cases, thus ensuring the protection of the general public from this highly contagious skin infestation.


Assuntos
Ivermectina/administração & dosagem , Assistência ao Paciente/métodos , Escabiose , Animais , Antiparasitários/administração & dosagem , Protocolos Clínicos , Serviço Hospitalar de Emergência/organização & administração , Saúde Global , Humanos , Prevalência , Sarcoptes scabiei , Escabiose/diagnóstico , Escabiose/epidemiologia , Escabiose/terapia
2.
4.
J Am Acad Dermatol ; 82(3): 533-548, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31310840

RESUMO

Scabies is an ectoparasitic dermatosis caused by Sarcoptes scabiei var. hominis and is a public health issue in all countries regardless of socioeconomic status. In high-income countries, delays in diagnosis can lead to institutional outbreaks; in low- and middle-income countries, poor access to health care contributes to disease undertreatment and long-term systemic sequelae. With scabies now recognized as a neglected tropical disease by the World Health Organization, increased awareness and systematic efforts are addressing gaps in diagnosis and treatment that impede scabies control. This review summarizes the available data and provides an update on scabies epidemiology, clinical features, diagnosis, management, and public health considerations.


Assuntos
Surtos de Doenças/prevenção & controle , Inseticidas/uso terapêutico , Doenças Negligenciadas/terapia , Sarcoptes scabiei , Escabiose/terapia , Animais , Diagnóstico Tardio , Diagnóstico Diferencial , Avaliação da Deficiência , Carga Global da Doença , Humanos , Doenças Negligenciadas/diagnóstico , Doenças Negligenciadas/epidemiologia , Doenças Negligenciadas/parasitologia , Anos de Vida Ajustados por Qualidade de Vida , Escabiose/diagnóstico , Escabiose/epidemiologia , Escabiose/parasitologia , Pele/diagnóstico por imagem , Pele/parasitologia , Organização Mundial da Saúde
5.
J Cutan Pathol ; 47(1): 52-56, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31381175

RESUMO

Indeterminate cell histiocytosis (ICH) is an extremely rare disease and little is known about its etiology. Patients usually present with nodular, dermal proliferations of indeterminate cells, which characteristically resemble Langerhans cells but lack Birbeck granules. The clinical course is highly variable, ranging from spontaneous regression to rapid progression with reports of extracutaneous involvement, subsequent acute myeloid leukemias, and associated B-cell lymphomas. Rare cases of ICH-like reactions have been reported in the setting of scabies infestations as well as in patients who had been bitten by ticks and mosquitos. We present a successfully treated case of indeterminate cell-rich post scabietic nodules in an otherwise healthy 8-month-old boy and review the literature on similar cases. Clinical context is essential for correct interpretation of these indolent ICH-mimicking lesions, and to avert unnecessary patient anxiety and aggressive management.


Assuntos
Histiocitose de Células de Langerhans , Escabiose , Histiocitose de Células de Langerhans/diagnóstico , Histiocitose de Células de Langerhans/etiologia , Histiocitose de Células de Langerhans/patologia , Histiocitose de Células de Langerhans/terapia , Humanos , Lactente , Masculino , Escabiose/complicações , Escabiose/diagnóstico , Escabiose/patologia , Escabiose/terapia
7.
Acta Med Port ; 33(12): 803-810, 2020 Dec 02.
Artigo em Português | MEDLINE | ID: mdl-33496250

RESUMO

INTRODUCTION: Scabies outbreaks in healthcare institutions are an emerging problem. To determine the best management strategy is a topical matter. We analyzed two hospital scabies outbreaks and reviewed the management strategy of institutional scabies outbreaks. MATERIAL AND METHODS: We performed an observational retrospective study of two independent scabies outbreaks that occurred in a Portuguese tertiary hospital in 2018. Following the identification of the index cases, scabies cases and exposed individuals, we calculated the attack rate in patients and professionals. We also evaluated the treatment and infection control measures, as well as the global cost of each outbreak. RESULTS: The hospital outbreaks of scabies occurred in two wards of Internal Medicine. Both had as index cases institutionalized patients with dermatosis at the time of admission. In the Ward 1, there have been identified 409 exposed individuals, 14 cases of scabies and the attack rate was 3.4%. In the Ward 2, there have been identified 254 exposed individuals, 17 cases and the attack rate was 6.7%. Topical treatment was prescribed to the cases and environmental measures were implemented. DISCUSSION: In our analysis, both outbreaks had as index cases institutionalized patients and had a significant impact, with hundreds of exposed individuals and considerable costs. The analysis of hospital scabies outbreaks is mostly retrospective and represents an opportunity to review its best management strategy. CONCLUSION: Implementation of guidelines on tackling scabies outbreaks in institutional settings is urgent.


Assuntos
Infecção Hospitalar/epidemiologia , Surtos de Doenças , Escabiose/epidemiologia , Adulto , Idoso de 80 Anos ou mais , Infecção Hospitalar/terapia , Feminino , Humanos , Masculino , Portugal/epidemiologia , Estudos Retrospectivos , Escabiose/terapia , Centros de Atenção Terciária
9.
Epidemiol Infect ; 147: e250, 2019 08 05.
Artigo em Inglês | MEDLINE | ID: mdl-31496448

RESUMO

Currently no national guidelines exist for the management of scabies outbreaks in residential or nursing care homes for the elderly in the United Kingdom. In this setting, diagnosis and treatment of scabies outbreaks is often delayed and optimal drug treatment, environmental control measures and even outcome measures are unclear. We undertook a systematic review to establish the efficacy of outbreak management interventions and determine evidence-based recommendations. Four electronic databases were searched for relevant studies, which were assessed using a quality assessment tool drawing on STROBE guidelines to describe the quality of observational data. Nineteen outbreak reports were identified, describing both drug treatment and environmental management measures. The quality of data was poor; none reported all outcome measures and only four described symptom relief measures. We were unable to make definitive evidence-based recommendations. We draw on the results to propose a framework for data collection in future observational studies of scabies outbreaks. While high-quality randomised controlled trials are needed to determine optimal drug treatment, evidence on environmental measures will need augmentation through other literature studies. The quality assessment tool designed is a useful resource for reporting of outcome measures including patient-reported measures in future outbreaks.


Assuntos
Surtos de Doenças/prevenção & controle , Transmissão de Doença Infecciosa/prevenção & controle , Controle de Infecções/métodos , Escabiose/epidemiologia , Escabiose/prevenção & controle , Idoso , Infecções Comunitárias Adquiridas/diagnóstico , Infecções Comunitárias Adquiridas/epidemiologia , Infecções Comunitárias Adquiridas/prevenção & controle , Infecções Comunitárias Adquiridas/terapia , Infecção Hospitalar/diagnóstico , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/prevenção & controle , Infecção Hospitalar/terapia , Humanos , Casas de Saúde , Escabiose/diagnóstico , Escabiose/terapia , Reino Unido/epidemiologia
10.
BMJ Open ; 9(9): e030635, 2019 09 24.
Artigo em Inglês | MEDLINE | ID: mdl-31551385

RESUMO

INTRODUCTION: Skin is important in Australian Aboriginal culture informing kinship and identity. In many remote Aboriginal communities, scabies and impetigo are very common. Untreated skin infections are painful, itchy and frequently go untreated due to under-recognition and lack of awareness of their potential serious complications. We hypothesise that the skin infection burden in remote Aboriginal communities can be reduced by implementing streamlined training and treatment pathways integrated with environmental health and health promotion activities, tested in the See, Treat, Prevent (SToP skin sores and scabies) trial. METHODS AND ANALYSIS: SToP will evaluate a skin control programme using a stepped-wedge, cluster randomised trial design with three intervention components (the 'SToP activities'): (1) seeing skin infections (development of training resources implemented within a community dermatology model); (2) treating skin infections (employing the latest evidence for impetigo, and scabies treatment); and (3) preventing skin infections (embedded, culturally informed health promotion and environmental health activities). Four community clusters in the remote Kimberley region of Western Australia will participate. Following baseline data collection, two clusters will be randomly allocated to the SToP activities. At 12 months, the remaining two clusters will transition to the SToP activities. The primary outcome is the diagnosis of impetigo in children (5-9 years) at school-based surveillance. Secondary outcome measures include scabies diagnosis, other child health indicators, resistance to cotrimoxazole in circulating pathogenic bacteria, determining the economic burden of skin disease and evaluating the cost effectiveness of SToP activities. ETHICS AND DISSEMINATION: This study protocol was approved by the health ethics review committees at the Child and Adolescent Health Service (Approval number RGS0000000584), the Western Australian Aboriginal Health Ethics Committee (Reference number: 819) and the University of Western Australia (Reference RA/4/20/4123). Study findings will be shared with community members, academic and medical communities via publications and presentations, and in reports to funders. Authorship for all publications based on this study will be determined in line with the Uniform Requirements for Manuscripts Submitted to Biomedical Journals published by the International Committee of Medical Journal Editors. Sharing results with organisations and communities who contributed to the study is paramount. The results of the SToP trial will be shared with participants in a suitable format, such as a single summary page provided to participants or presentations to communities, the Kimberly Aboriginal Health Planning Forum Research Subcommittee and other stakeholders as appropriate and as requested. Communication and dissemination will require ongoing consultation with Aboriginal communities to determine appropriate formats. TRIAL REGISTRATION NUMBER: ACTRN12618000520235.


Assuntos
Saúde Ambiental/métodos , Promoção da Saúde/métodos , Serviços de Saúde do Indígena , Impetigo , Escabiose , Serviços de Saúde Escolar , Austrália/epidemiologia , Criança , Efeitos Psicossociais da Doença , Análise Custo-Benefício , Dermatologia/educação , Dermatologia/métodos , Feminino , Humanos , Impetigo/economia , Impetigo/epidemiologia , Impetigo/terapia , Masculino , Ensaios Clínicos Pragmáticos como Assunto , Escabiose/economia , Escabiose/epidemiologia , Escabiose/terapia , Ensino/organização & administração , Austrália Ocidental/epidemiologia
13.
Trop Med Int Health ; 24(3): 280-293, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30582783

RESUMO

We conducted a systematic review of the treatment, prevention and public health control of skin infections including impetigo, scabies, crusted scabies and tinea in resource-limited settings where skin infections are endemic. The aim is to inform strategies, guidelines and research to improve skin health in populations that are inequitably affected by infections of the skin and the downstream consequences of these. The systematic review is reported according to the PRISMA statement. From 1759 titles identified, 81 full text studies were reviewed and key findings outlined for impetigo, scabies, crusted scabies and tinea. Improvements in primary care and public health management of skin infections will have broad and lasting impacts on overall quality of life including reductions in morbidity and mortality from sepsis, skeletal infections, kidney and heart disease.


Assuntos
Dermatomicoses/terapia , Impetigo/terapia , Escabiose/terapia , Dermatomicoses/prevenção & controle , Humanos , Impetigo/prevenção & controle , Saúde Pública , Escabiose/prevenção & controle
14.
Dermatol Ther ; 32(4): e12665, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30216601

RESUMO

Tropical regions receive a significant part of the traveling population. It is very important that health professionals are familiar with the main tropical skin diseases and able to advice patients appropriately. This article reviews the main tropical diseases of travelers, with an emphasis on diagnosis, management, and prevention. Among others, cutaneous larva migrans, myiasis, tungiasis, Chagas disease, Dengue fever, African trypanosomiasis, filariasis, and leishmaniasis are discussed. Increasing awareness among travelers and health care professionals can help reduce morbidity and mortality. Continued research on new drugs and vaccines is needed to reduce the risks of tropical diseases.


Assuntos
Dermatopatias/terapia , Viagem , Doença de Chagas/diagnóstico , Doença de Chagas/prevenção & controle , Doença de Chagas/terapia , Exantema/diagnóstico , Exantema/prevenção & controle , Exantema/terapia , Humanos , Larva Migrans/diagnóstico , Larva Migrans/prevenção & controle , Larva Migrans/terapia , Leishmaniose/diagnóstico , Leishmaniose/prevenção & controle , Leishmaniose/terapia , Miíase/diagnóstico , Miíase/prevenção & controle , Miíase/terapia , Escabiose/diagnóstico , Escabiose/prevenção & controle , Escabiose/terapia , Dermatopatias/diagnóstico , Dermatopatias/prevenção & controle , Tripanossomíase Africana/diagnóstico , Tripanossomíase Africana/prevenção & controle , Tripanossomíase Africana/terapia , Tungíase/diagnóstico , Tungíase/prevenção & controle , Tungíase/terapia , Febre Amarela/diagnóstico , Febre Amarela/prevenção & controle , Febre Amarela/terapia
15.
J Theor Biol ; 462: 466-474, 2019 02 07.
Artigo em Inglês | MEDLINE | ID: mdl-30502410

RESUMO

Some of the most important wildlife diseases involve environmental transmission, with disease control attempted via treatments that induce temporary pathogen resistance among hosts. However, theoretical explanations of such circumstances remain few. A mathematical model is proposed and investigated to analyse the dynamics and treatment of environmentally transmitted sarcoptic mange in a population of bare-nosed wombats. The wombat population is structured into four classes representing stages of infection, in a model that consists of five non-linear differential equations including the unattached mite population. It is shown that four different epidemiological outcomes are possible. These are: (1) extinction of wombats (and mites); (2) mite-free wombat populations; (3) endemic wombats and mites coexisting, with the wombats' population reduced below the environmental carrying capacity; and (4) a stable limit cycle (sustained oscillating populations) with wombat population far below carrying capacity. Empirical evidence exists for the first two of these outcomes, with the third highly likely to occur in nature, and the fourth plausible at least until wombat populations succumb to Allee effects. These potential outcomes are examined to inform treatment programs for wombat populations. Through this theoretical exploration of a relatively well understood empirical system, this study supports general learning across environmentally transmitted wildlife pathogens, increasing understanding of how pathogen dynamics may cause crashes in some populations and not others.


Assuntos
Marsupiais/parasitologia , Modelos Teóricos , Escabiose/transmissão , Animais , Animais Selvagens , Infestações por Ácaros/terapia , Infestações por Ácaros/transmissão , Ácaros/patogenicidade , Escabiose/terapia
16.
Biosci Rep ; 38(6)2018 12 21.
Artigo em Inglês | MEDLINE | ID: mdl-30291217

RESUMO

The present study was designed to investigate the use of specific biomarkers, such as albumin, serum total protein, aspartate amino transferase (AST), globulin, alanine amino transferase (ALT), serum cortisol and alkaline phosphatase (ALP), as predictive tools for sarcoptic mange in rabbits. A total of 40 naturally infested rabbits were equally divided into four groups.Thirty infested rabbits were administered with three different treatments (propolis,ivermectin, and propolis with ivermectin) and were compared to10 infested un-treated rabbits. The impact of treatment was assessed via microscopic examination of skin scrapings, clinical signs, and blood measurements relating to the liver. The present study demonstrated that topical application of 10% propolis ointment resulted in complete recovery from clinical signs and complete absence of mites based on microscopic examination after 10-15 days of treatment. Moreover, AST, ALP, ALT, and cortisol were determined to be acceptable biomarkers to track the response of diseased rabbits to the therapeutic use of propolis.


Assuntos
Apiterapia , Própole/uso terapêutico , Coelhos/parasitologia , Escabiose/veterinária , Animais , Apiterapia/métodos , Biomarcadores/análise , Feminino , Prognóstico , Escabiose/diagnóstico , Escabiose/patologia , Escabiose/terapia , Pele/parasitologia , Pele/patologia
17.
Lancet Infect Dis ; 18(8): 894-902, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-30068499

RESUMO

BACKGROUND: Scabies outbreaks in residential and nursing care homes for elderly people are common, subject to diagnostic delay, and hard to control. We studied clinical features, epidemiology, and outcomes of outbreaks in the UK between 2014 and 2015. METHODS: We did a prospective observational study in residential care homes for elderly people in southeast England that reported scabies outbreaks to Public Health England health protection teams. An outbreak was defined as two or more cases of scabies (in either residents or staff) at a single care home. All patients who provided informed consent were included; patients with dementia were included if a personal or nominated consultee (ie, a family member or nominated staff member) endorsed participation. Dermatology-trained physicians examined residents at initial clinical visits, which were followed by two mass treatments with topical scabicide as per local health protection team guidance. Follow-up clinical visits were held 6 weeks after initial visits. Scabies was diagnosed through pre-defined case definitions as definite, probable, or possible with dermatoscopy and microscopy as appropriate. FINDINGS: 230 residents were examined in ten outbreaks between Jan 23, 2014, and April 13, 2015. Median age was 86·9 years (IQR 81·5-92·3), 174 (76%) were female, and 157 (68%) had dementia. 61 (27%) residents were diagnosed with definite, probable, or possible scabies, of whom three had crusted scabies. Physical signs differed substantially from classic presentations. 31 (51%) of the 61 people diagnosed with scabies were asymptomatic, and only 25 (41%) had burrows. Mites were visualised with dermatoscopy in seven (11%) patients, and further confirmed by microscopy in three (5%). 35 (57%) cases had signs of scabies only on areas of the body that would normally be covered. Dementia was the only risk factor for a scabies diagnosis that we identified (odds ratio 2·37 [95% CI 1·38-4·07]). At clinical follow-up, 50 people who were initially diagnosed with scabies were examined. No new cases of scabies were detected, but infestation persisted in ten people. INTERPRETATION: Clinical presentation of scabies in elderly residents of care homes differs from classic descriptions familiar to clinicians. This difference probably contributes to delayed recognition and suboptimal management in this vulnerable group. Dermatoscopy and microscopy were of little value. Health-care workers should be aware of the different presentation of scabies in elderly people, and should do thorough examinations, particularly in people with dementia. FUNDING: Public Health England and British Skin Foundation.


Assuntos
Diagnóstico Tardio , Instituições Residenciais , Sarcoptes scabiei , Escabiose/epidemiologia , Escabiose/terapia , Idoso de 80 Anos ou mais , Animais , Surtos de Doenças/prevenção & controle , Inglaterra , Feminino , Humanos , Masculino , Casas de Saúde , Estudos Prospectivos , Sarcoptes scabiei/fisiologia , Escabiose/diagnóstico , Escabiose/parasitologia , Pele , Resultado do Tratamento
19.
Prim Care ; 45(3): 409-421, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30115331

RESUMO

Patients with suspected bites or skin rashes regularly present to their primary care physician. Common mite infections encountered in the primary care office include scabies, chiggers, grain itch, and allergic responses from dust mites. In fact, scabies is one of the 50 most prevalent diseases worldwide. Bed bugs are also becoming increasingly common, living in dark crevices, such as mattresses, feeding at night, and causing a maculopapular immune mediated allergic skin response in humans. Proper identification of the mite or bed bug is essential to guide treatment and eradication.


Assuntos
Percevejos-de-Cama , Infestações por Ácaros/diagnóstico , Animais , Dermatite/parasitologia , Humanos , Infestações por Ácaros/parasitologia , Infestações por Ácaros/terapia , Pyroglyphidae , Escabiose/diagnóstico , Escabiose/terapia , Trombiculidae
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