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Walker MD, Sulyok M. Internet searching on the head louse in the UK since the COVID-19 pandemic. Pediatr Dermatol 2023; 40:96-99. [PMID: 36056643 DOI: 10.1111/pde.15129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 08/16/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Wide-ranging restrictions on social and educational activities were imposed in 2020 in response to the COVID-19 pandemic. These likely influenced the population dynamics of the head louse. Close physical contact between human hosts is required for transmission of this ectoparasite. METHOD Pre- and post-pandemic internet interest in the head louse in the UK was compared using Google Trends data from March 2017 to March 2022 and modeling using the Meta Prophet package. The influence of school holidays and school attendance was also investigated. RESULTS There was a sharp decline in internet searching of the term "head louse" from March 2020 onwards coinciding with COVID-19 restrictions, and a large difference between pre- and post-pandemic search volumes. No influence of school holidays or attendance on internet searching on the head louse was found. CONCLUSION The results suggest pandemic restrictions have had a large effect on head louse incidence.
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Affiliation(s)
- Mark David Walker
- Department of the Natural and Built Environment, Sheffield Hallam University, Sheffield, UK
| | - Mihály Sulyok
- Department of Pathology, Institute of Pathology and Neuropathology, Eberhard Karls University, Tübingen, Germany
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2
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Galassi FG, Audino PG. Chemical Communication of the Head Lice with the Human Host. Curr Trop Med Rep 2022. [DOI: 10.1007/s40475-022-00279-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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3
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Aždajić MD, Bešlić I, Gašić A, Ferara N, Pedić L, Lugović-Mihić L. Increased Scabies Incidence at the Beginning of the 21st Century: What Do Reports from Europe and the World Show? Life (Basel) 2022; 12:1598. [PMID: 36295033 DOI: 10.3390/life12101598] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 09/30/2022] [Accepted: 10/09/2022] [Indexed: 11/07/2022]
Abstract
Reports from various countries have described increasing numbers of scabies cases, especially in the past two decades. The epidemiological data for various world regions showed prevalence estimates ranging from 0.2% to 71%, with the highest prevalence in the Pacific region and Latin America. Therefore, geographically, scabies occurs more commonly in the developing world, tropical climates, and in areas with a lack of access to water. According to results from specific regions of the world, the greatest burdens from scabies were recorded for East Asia, Southeast Asia, Oceania, tropical Latin America, and South Asia. Among countries with the highest rates, the top 10 were Indonesia, China, Timor-Leste, Vanuatu, Fiji, Cambodia, Laos, Myanmar, Vietnam, and the Seychelles. From Europe, available data shows an increasing trend in scabies infestation, particularly evident among populations with associated contributing factors, such as those who travel frequently, refugees, asylum seekers, those who regularly lack drinking water and appropriate hygiene and are of a younger age, etc. This increase in observed cases in the last 10–20 years has been evidenced by research conducted in Germany, France, Norway, and Croatia, among other countries. In addition, increased scabies transmission was also recorded during the COVID-19 pandemic and may have been the result of increased sexual intercourse during that time. Despite all the available treatment options, scabies commonly goes unrecognized and is therefore not treated accordingly. This trend calls for a prompt and synergistic reaction from all healthcare professionals, governmental institutions, and non-governmental organizations, especially in settings where population migration is common and where living standards are low. Furthermore, the proper education of whole populations and accessible healthcare are cornerstones of outbreak prevention. Accurate national data and proper disease reporting should be a goal for every country worldwide when developing strategic plans for preventing and controlling the community spread of scabies.
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4
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Launay T, Bardoulat I, Lemaitre M, Blanchon T, Fardet L. Effects of the Covid-19 pandemic on head lice and scabies infestation dynamics: a population based study in France. Clin Exp Dermatol 2021; 47:867-872. [PMID: 34888912 DOI: 10.1111/ced.15054] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 12/01/2021] [Accepted: 12/07/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Lockdowns and physical distancing have dramatically limited the circulation of SARS-CoV-2 and other common communicable infections. However, little is known about their impact on head lice and scabies. OBJECTIVES To assess the impact of the 2020 French National lockdowns (March 17th -May 11th , and Oct 30th -Dec 15th ) and physical distancing recommendations (from February 2020) on the head lice and scabies infestation dynamics. METHODS The weekly sales of topical head lice treatments, topical scabies treatments, and oral ivermectin were extracted from the IQVIA database (60% of all French retail pharmacies) and analysed over a 5-year period (March 2016 - December 2020). A periodic regression model was fit to drug sales before the COVID-19 period (i.e. 2016-2019) and extrapolated afterwards in order to compare the sales observed in 2020 to the expected sales. RESULTS A decrease of the sales of tracer topical treatments for head lice and scabies was observed from March 2020, synchronously with the first French national lockdown. For the period March 2020-December 2020, the mean reduction in observed versus expected sales were 44% and 14% for head lice and scabies topical treatments, respectively. On the other hand, the observed decrease of oral ivermectin sales after March 2020 was much lower (4%), probably because of studies reporting the potential positive effects of this drug on the Covid-19 infection. CONCLUSION COVID-19 lockdown and physical distancing reduce circulation of head lice and scabies in France. Further studies are needed to assess long term impact of these social behaviour changes.
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Affiliation(s)
- T Launay
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, Paris, France
| | | | | | - T Blanchon
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, Paris, France
| | - L Fardet
- Service de dermatologie, AP-HP, hôpital Henri Mondor, Créteil, France.,Université Paris Est Créteil Val de Marne, UPEC, Créteil, France
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5
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Amato E, Dansie LS, Grøneng GM, Blix HS, Bentele H, Veneti L, Stefanoff P, MacDonald E, Blystad HH, Soleng A. Increase of scabies infestations, Norway, 2006 to 2018. ACTA ACUST UNITED AC 2020; 24. [PMID: 31186078 PMCID: PMC6561015 DOI: 10.2807/1560-7917.es.2019.24.23.190020] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Between October and December 2018, several clinicians in Norway reported an increase in scabies diagnoses. We compared data from the Norwegian Syndromic Surveillance System on medical consultations for mite infestations with scabies treatment sales data to investigate this reported increase. From 2013 to 2018, consultations and sales of scabies treatments had almost increased by threefold, particularly affecting young adults 15–29 years. We recommend to increase awareness among clinicians to ensure timely diagnosis and treatment.
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Affiliation(s)
- E Amato
- European Centre for Disease Prevention and Control (ECDC) Fellowship Programme/EUPHEM, Stockholm, Sweden.,Department for Vaccine Preventable Diseases, Norwegian Institute of Public Health, Oslo, Norway
| | - L S Dansie
- Department of Drug Statistics, Norwegian Institute of Public Health, Oslo, Norway
| | - G M Grøneng
- Department of Infectious Disease Epidemiology and Modelling, Norwegian Institute of Public Health, Oslo, Norway
| | - H S Blix
- Department of Drug Statistics, Norwegian Institute of Public Health, Oslo, Norway
| | - H Bentele
- Antibiotic Resistance and Infection Prevention, Norwegian Institute of Public Health, Oslo, Norway
| | - L Veneti
- Department Zoonotic, Food- and Waterborne Infections, Norwegian Institute of Public Health, Oslo, Norway
| | - P Stefanoff
- Department Zoonotic, Food- and Waterborne Infections, Norwegian Institute of Public Health, Oslo, Norway
| | - E MacDonald
- Department Zoonotic, Food- and Waterborne Infections, Norwegian Institute of Public Health, Oslo, Norway
| | - H H Blystad
- Tuberculosis, Blood Borne and Sexually Transmitted Infections, Norwegian Institute of Public Health, Oslo, Norway
| | - A Soleng
- Department of Pest Control, Norwegian Institute of Public Health, Oslo, Norway
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Levy M, Martin L, Bursztejn A, Chiaverini C, Miquel J, Mahé E, Maruani A, Boralevi F. Ivermectin safety in infants and children under 15 kg treated for scabies: a multicentric observational study. Br J Dermatol 2019; 182:1003-1006. [DOI: 10.1111/bjd.18369] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2019] [Indexed: 11/30/2022]
Affiliation(s)
- M. Levy
- Paediatric Dermatology Unit, Children's Hospital Bordeaux University Hospital Bordeaux France
- Centre d'Investigation Clinique Pédiatrique 1401 Module Plurithématique Bordeaux University Bordeaux France
| | - L. Martin
- Department of Dermatology Angers University Hospital Angers France
| | - A.‐C. Bursztejn
- Department of Dermatology Nancy University Hospital Nancy France
| | - C. Chiaverini
- Department of Dermatology Nice University Hospital Nice France
| | - J. Miquel
- Paediatric Dermatology Unit Saint‐Pierre University Hospital Saint‐Pierre la Réunion France
| | - E. Mahé
- Department of Dermatology Hôpital Victor Dupouy Argenteuil France
| | - A. Maruani
- Department of Dermatology Tours University Hospital Tours France
| | - F. Boralevi
- Paediatric Dermatology Unit, Children's Hospital Bordeaux University Hospital Bordeaux France
- Centre d'Investigation Clinique Pédiatrique 1401 Module Plurithématique Bordeaux University Bordeaux France
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Şimşek E, Keskin A, Dağcıoğlu BF. Common and Frequently Overlooked Disease Scabies: Case Report. Ankara Medical Journal 2019. [DOI: 10.17098/amj.542208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Abstract
BACKGROUND Scabies is an intensely itchy parasitic infection of the skin. It occurs worldwide, but is particularly problematic in areas of poor sanitation, overcrowding, and social disruption. In recent years, permethrin and ivermectin have become the most relevant treatment options for scabies. OBJECTIVES To assess the efficacy and safety of topical permethrin and topical or systemic ivermectin for scabies in people of all ages. SEARCH METHODS We searched the following databases up to 25 April 2017: the Cochrane Infectious Diseases Group Specialized Register, CENTRAL, MEDLINE, Embase, LILACS, and IndMED. We searched the World Health Organization International Clinical Trials Registry Platform, the ISRCTN registry, CenterWatch Clinical Trials Listing, ClinicalTrials.gov, TrialsCentral, and the UK Department of Health National Research Register for ongoing trials. We also searched multiple sources for grey literature and checked reference lists of included studies for additional trials. SELECTION CRITERIA We included randomized controlled trials that compared permethrin or ivermectin against each other for people with scabies of all ages and either sex. DATA COLLECTION AND ANALYSIS Two review authors independently screened the identified records, extracted data, and assessed the risk of bias for the included trials.The primary outcome was complete clearance of scabies. Secondary outcomes were number of participants re-treated, number of participants with at least one adverse event, and number of participants withdrawn from study due to an adverse event.We summarized dichotomous outcomes using risk ratios (RR) with 95% confidence intervals (CI). If it was not possible to calculate the point estimate, we described the data qualitatively. Where appropriate, we calculated combined effect estimates using a random-effects model and assessed heterogeneity. We calculated numbers needed to treat for an additional beneficial outcome when we found a difference.We assessed the certainty of the evidence using the GRADE approach. We used the control rate average to provide illustrative clearance rates in the comparison groups. MAIN RESULTS Fifteen studies (1896 participants) comparing topical permethrin, systemic ivermectin, or topical ivermectin met the inclusion criteria. Overall, the risk of bias in the included trials was moderate: reporting in many studies was poor. Nearly all studies were conducted in South Asia or North Africa, where the disease is more common, and is associated with poverty.EfficacyOral ivermectin (at a standard dose of 200 μg/kg) may lead to slightly lower rates of complete clearance after one week compared to permethrin 5% cream. Using the average clearance rate of 65% in the trials with permethrin, the illustrative clearance with ivermectin is 43% (RR 0.65, 95% CI 0.54 to 0.78; 613 participants, 6 studies; low-certainty evidence). However, by week two there may be little or no difference (illustrative clearance of permethrin 74% compared to ivermectin 68%; RR 0.91, 95% CI 0.76 to 1.08; 459 participants, 5 studies; low-certainty evidence). Treatments with one to three doses of ivermectin or one to three applications of permethrin may lead to little or no difference in rates of complete clearance after four weeks' follow-up (illustrative cures with 1 to 3 applications of permethrin 93% and with 1 to 3 doses of ivermectin 86%; RR 0.92, 95% CI 0.82 to 1.03; 581 participants, 5 studies; low-certainty evidence).After one week of treatment with oral ivermectin at a standard dose of 200 μg/kg or one application of permethrin 5% lotion, there is probably little or no difference in complete clearance rates (illustrative cure rates: permethrin 73%, ivermectin 68%; RR 0.93, 95% CI 0.74 to 1.17; 120 participants, 1 study; moderate-certainty evidence). After two weeks of treatment, one dose of systemic ivermectin compared to one application of permethrin lotion may lead to similar complete clearance rates (extrapolated cure rates: 67% in both groups; RR 1.00, 95% CI 0.78 to 1.29; 120 participants, 1 study; low-certainty evidence).There is probably little or no difference in rates of complete clearance between systemic ivermectin at standard dose and topical ivermectin 1% lotion four weeks after initiation of treatment (illustrative cure rates: oral ivermectin 97%, ivermectin lotion 96%; RR 0.99, 95% CI 0.95 to 1.03; 272 participants, 2 studies; moderate-certainty evidence). Likewise, after four weeks, ivermectin lotion probably leads to little or no difference in rates of complete clearance when compared to permethrin cream (extrapolated cure rates: permethrin cream 94%, ivermectin lotion 96%; RR 1.02, 95% CI 0.96 to 1.08; 210 participants, 1 study; moderate-certainty evidence), and there is little or no difference among systemic ivermectin in different doses (extrapolated cure rates: 2 doses 90%, 1 dose 87%; RR 0.97, 95% CI 0.83 to 1.14; 80 participants, 1 study; high-certainty evidence).SafetyReporting of adverse events in the included studies was suboptimal. No withdrawals due to adverse events occurred in either the systemic ivermectin or the permethrin group (moderate-certainty evidence). Two weeks after treatment initiation, there is probably little or no difference in the proportion of participants treated with systemic ivermectin or permethrin cream who experienced at least one adverse event (55 participants, 1 study; moderate-certainty evidence). After four weeks, ivermectin may lead to a slightly larger proportion of participants with at least one adverse event (extrapolated rates: permethrin 4%, ivermectin 5%; RR 1.30, 95% CI 0.35 to 4.83; 502 participants, 4 studies; low-certainty evidence).Adverse events in participants treated with topical ivermectin were rare and of mild intensity and comparable to those with systemic ivermectin. For this comparison, it is uncertain whether there is any difference in the number of participants with at least one adverse event (very low-certainty evidence). No withdrawals due to adverse events occurred (62 participants, 1 study; moderate-certainty evidence).It is uncertain whether topical ivermectin or permethrin differ in the number of participants with at least one adverse event (very low-certainty evidence). We found no studies comparing systemic ivermectin in different doses that assessed safety outcomes. AUTHORS' CONCLUSIONS We found that for the most part, there was no difference detected in the efficacy of permethrin compared to systemic or topical ivermectin. Overall, few and mild adverse events were reported. Our confidence in the effect estimates was mostly low to moderate. Poor reporting is a major limitation.
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Affiliation(s)
- Stefanie Rosumeck
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt‐Universität zu Berlin, and Berlin Institute of HealthDivision of Evidence Based Medicine, Department of Dermatology, Venerology and AllergologyCharitéplatz 1BerlinBerlinGermany10117
| | - Alexander Nast
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt‐Universität zu Berlin, and Berlin Institute of HealthDivision of Evidence Based Medicine, Department of Dermatology, Venerology and AllergologyCharitéplatz 1BerlinBerlinGermany10117
| | - Corinna Dressler
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt‐Universität zu Berlin, and Berlin Institute of HealthDivision of Evidence Based Medicine, Department of Dermatology, Venerology and AllergologyCharitéplatz 1BerlinBerlinGermany10117
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Affiliation(s)
- J A Savin
- St Ann's, 12 York Road, North Berwick EH39 4LX, Scotland, UK.
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10
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Hsu RJ, Lin CY, Chang FW, Huang CF, Chuang HC, Liu JM. The association between scabies and myasthenia gravis: A nationwide population-based cohort study. J Clin Neurosci 2017; 45:115-20. [PMID: 28890037 DOI: 10.1016/j.jocn.2017.08.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Accepted: 08/10/2017] [Indexed: 12/24/2022]
Abstract
Scabies is an infectious inflammatory pruritic skin disease. Cytokine-mediated inflammatory processes contribute to the pathologic mechanism in scabies. Myasthenia gravis (MG) is also an autoimmune disease that is mediated by cytokines. The study aimed to investigate the association between scabies and myasthenia gravis. We conducted a nationwide population-based cohort study utilized data from the National Health Insurance Research Database (NHIRD) of Taiwan. Patients with scabies (n=5429) and control subjects without scabies (n=20,176) were enrolled. We tracked the subjects in both groups for a 7-year period to identify new onset MG. Cox regression analysis was performed to calculate the hazard ratio (HR) for MG. A total of 25,605 patients were enrolled in the study, including 5429 patients in the scabies group and 20,176 in the control group. There were 40 (0.7%) patients from the scabies group and 84 (0.4%) subjects from the control group who were newly diagnosed with MG during the 7-year follow-up period. The scabies patients had a significantly increased risk of MG, with an adjusted HR of 1.27 (95% confidence interval [CI] 1.01-1.89). As such, prompt diagnosis and treatment of scabies may decrease the risk of subsequent MG.
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Abstract
The head louse is an obligate human parasite. Evidence points to the growing resistance of head lice to nonprescription pesticides (eg, synergized pyrethrins, permethrin). To gather data, recent pharmacy graduates were surveyed about treatment failures and resistant lice. The response rate was 28.4%, with 173 of 609 surveys returned. One hundred and thirty-one pharmacists provided information that they had gathered during counseling sessions or other contacts with patients. Patients who remained infested after using either synergized pyrethrins or permethrin were encountered by 81.7% and 78.6% of pharmacists, respectively; these treatment failures occurred once or twice weekly in 58.1% of pharmacists' practices. Patients treating themselves more frequently or in higher doses with pesticides in an attempt to rid themselves of lice were reported by 62.6% of pharmacists. Patients reported the use of gasoline, kerosene, or other dangerous treatments once weekly or more in the experience of 42% of pharmacists. Resistant head lice had been a problem in their areas for 1 or 2 years for 42.8% of pharmacists. A smaller percentage (5.3%) of pharmacists had received official confirmation that resistant head lice were present in their areas. Pharmacists recommended nontoxic options (eg, combing and vacuuming) 19.8% of the time with positive results. Resistance seems to be a widespread, growing phenomenon and is not entirely related to patients' inability to use pesticides correctly. Pharmacists should consider recommending nontoxic alternatives that do not pose a threat to the patient or environment and do not contribute to resistance.
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Affiliation(s)
- W. Steven Pray
- Nonprescription Products and Devices, School of Pharmacy, Southwestern Oklahoma State University, Weatherford, OK
- Scientific Advisory Board, National Pediculosis Association (unpaid position), 1990 to present
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Liu JM, Chiu FH, Lin CY, Chang FW, Hsu RJ. Incidence of autoimmune diseases in patients with scabies: a nationwide population-based study in Taiwan. Rheumatol Int 2017; 37:1125-1134. [PMID: 28421357 DOI: 10.1007/s00296-017-3717-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 04/06/2017] [Indexed: 02/05/2023]
Abstract
Scabies is a commonly occurring infectious immune-mediated inflammatory skin disease. Immune-mediated inflammatory processes are also observed in autoimmune diseases. There have been very few previous studies; however, that have investigated the possible association between scabies and autoimmune diseases. To address this research gap, we conducted a nationwide population-based cohort study that included a total of 4481 scabies patients and 16,559 control subjects matched by gender, age, insured region, urbanization and income. We tracked both cohorts for a 7-year period to identify the incidence of autoimmune diseases in both groups during that follow-up period. Relatedly, a Cox regression analysis was performed to calculate and compare the hazard ratio (HR) for autoimmune diseases of both groups. An overall increased risk for 19 autoimmune diseases was observed in the scabies patients, with an adjusted HR (aHR) of 1.14 (95% CI 1.04-1.25). Compared with the control group, the scabies patients exhibited increased risks of hypersensitivity vasculitis (aHR 5.44, 95% CI 1.64-18.07), dermatomyositis (aHR 4.91, 95% CI 1.80-13.38), polyarteritis nodosa (aHR 2.89, 95% CI 1.46-5.73), systemic lupus erythematosus (aHR 2.73, 95% CI 1.33-5.64), psoriasis (aHR 2.31, 95% CI 1.85-2.88), myasthenia gravis (aHR 2.01, 95% CI 1.31-3.12), type 1 diabetes mellitus (aHR 1.93, 95% CI 1.53-2.44), pernicious anemia (aHR 1.92, 95% CI 1.42-2.61), and rheumatoid arthritis (aHR 1.43, 95% CI 1.12-1.83). In conclusion, the associations between scabies and a variety of autoimmune diseases may exist. Further studies are needed to clarify the shared etiologies and relationships between scabies and autoimmune diseases.
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Affiliation(s)
- Jui-Ming Liu
- Division of Urology, Department of Surgery, Taoyuan General Hospital, Ministry of Health and Welfare, No. 1492, Chung-Shan Road, Taoyuan District, Taoyuan, 330, Taiwan.,Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.,Graduate Institute of Life Sciences, National Defense Medical Center, No. 161, Sec. 6, Minquan E. Road, Neihu District, Taipei, 114, Taiwan
| | - Feng-Hsiang Chiu
- Department of Emergency Medicine, Shuang Ho Hospital, Taipei Medical University, Taipei, 235, Taiwan.,Superintendent Office, Ningbo Medical Center, Lihuili Eastern Hospital, Ningbo City, 315000, Zhejiang Province, PR China
| | - Chien-Yu Lin
- Department of Pediatrics, Hsinchu MacKay Memorial Hospital, No. 690, Sec. 2, Guangfu Road, Hsinchu, 300, Taiwan
| | - Fung-Wei Chang
- Department of Obstetrics and Gynecology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Ren-Jun Hsu
- Graduate Institute of Life Sciences, National Defense Medical Center, No. 161, Sec. 6, Minquan E. Road, Neihu District, Taipei, 114, Taiwan. .,Department of Pathology and Graduate Institute of Pathology and Parasitology, The Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan. .,Biobank Management Center of The Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
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Liu JM, Wang HW, Chang FW, Liu YP, Chiu FH, Lin YC, Cheng KC, Hsu RJ. The effects of climate factors on scabies. A 14-year population-based study in Taiwan. ACTA ACUST UNITED AC 2016; 23:54. [PMID: 27905271 PMCID: PMC5134670 DOI: 10.1051/parasite/2016065] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 11/20/2016] [Indexed: 11/27/2022]
Abstract
Scabies is a common infectious disease and can cause severe outbreaks if not controlled quickly. Besides personal contact history, environmental factors are also important. This study analyzed the effects of environmental climate factors on the incidence of scabies in Taiwan. We conducted a 14-year nationwide population-based study: a total of 14,883 patients with scabies infestation were enrolled. Monthly climate data were collected from Taiwan’s Central Weather Bureau, including data on temperature, relative humidity, total rainfall, total rain days, and total sunshine hours. The linear relationships between these climate factors and scabies infestations or other risk factors were examined by Pearson’s correlation analysis. Overall, the incidence of scabies was negatively correlated with temperature (γ = −0.152, p < 0.001), while being positively correlated with humidity (γ = 0.192, p < 0.001). This useful information may provide evidence for lowering humidity at nursing facilities, hospitals, and military camps with scabies infestations, which may help to reduce its spread and prevent outbreaks.
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Affiliation(s)
- Jui-Ming Liu
- Division of Urology, Department of Surgery, Taoyuan General Hospital, Ministry of Health and Welfare, 330 Taoyuan, Taiwan
| | - Hsiao-Wei Wang
- Division of Infectious Diseases, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, 110 Tapei, Taiwan - Division of Infection Diseases, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, 235 Tapei, Taiwan
| | - Fung-Wei Chang
- Department of Obstetrics & Gynecology, Tri-Service General Hospital, National Defense Medical Center, 114 Tapei, Taiwan
| | - Yueh-Ping Liu
- Department of Emergency Medicine, National Taiwan University Hospital, 100 Tapei, Taiwan
| | - Feng-Hsiang Chiu
- Department of Emergency Medicine, Shuang Ho Hospital, Taipei Medical University, 235 Tapei, Taiwan - Superintendent Office, Ningbo Medical Center, Lihuili Eastern Hospital, Ningbo City, 315000 Zhejiang Province, PR China
| | - Yi-Chun Lin
- Department of Internal Medicine, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, 265 Luodong, Taiwan
| | - Kuan-Chen Cheng
- Graduate Institute of Food Science and Technology, National Taiwan University, 106 Tapei, Taiwan - Institute of Biotechnology, National Taiwan University, 106 Tapei, Taiwan
| | - Ren-Jun Hsu
- Graduate Institute of Life Sciences, National Defense Medical Center, 114 Tapei, Taiwan - Department of Pathology and Graduate Institute of Pathology and Parasitology, the Tri-Service General Hospital, National Defense Medical Center, 114 Tapei, Taiwan - Biobank Management Center of the Tri-Service General Hospital, National Defense Medical Center, 114 Tapei, Taiwan
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Chen JY, Liu JM, Chang FW, Chang H, Cheng KC, Yeh CL, Wei YF, Hsu RJ. Scabies increased the risk and severity of COPD: a nationwide population-based study. Int J Chron Obstruct Pulmon Dis 2016; 11:2171-2178. [PMID: 27672322 PMCID: PMC5025009 DOI: 10.2147/copd.s114256] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Scabies is a common parasitic infectious disease, and COPD is a major pulmonary disease. However, there have been no previous studies that have investigated the relationship between scabies and COPD. Materials and methods This nationwide population-based study included a total of 3,568 patients with scabies as the study group and 14,255 patients as a control group. We followed up patients in both groups for a 5-year period to identify any new diagnoses of COPD. We then followed them up for an additional 2-year period to determine the severity of any newly diagnosed cases of COPD as indicated by acute respiratory events. Cox proportional hazard regression analyses were performed to calculate the hazard ratio (HR) of COPD during the 5-year follow-up period and COPD complication during the additional 2-year follow-up period. Results Of the 17,823 patients in the study, 2,765 (15.5%) were newly diagnosed with COPD during the 5-year follow-up period; 904 (32.7%) were from the scabies group; and 1,861 (67.3%) were from the control group. Compared to the patients without scabies, the adjusted HR (aHR) for COPD for the subjects with scabies was 1.72 (95% CI: 1.59–1.87) during the 5-year follow-up period. For those newly diagnosed with COPD, the aHR for COPD with acute exacerbation was 1.85 (95% CI: 1.67–2.06), the aHR for COPD with pneumonia was 3.29 (95% CI: 2.77–3.92), the aHR for COPD with acute respiratory failure was 4.00 (95% CI: 3.08–5.19), and the aHR for COPD with cardiopulmonary arrest was 3.95 (95% CI: 2.25–6.95) during the additional 2-year follow-up period. Conclusion The results of this study indicate a 72% increased risk for COPD among patients with scabies. The results also reveal an increased risk of severe COPD complications such as acute respiratory failure, cardiopulmonary arrest, pneumonia, and acute exacerbation among patients with scabies. This useful information may help physicians in treating scabies and remaining alert to the potential development of COPD and its severe complications.
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Affiliation(s)
- Jung-Yueh Chen
- Division of Chest Medicine, Department of Internal Medicine, E-DA Hospital, I-Shou University, Kaohsiung
| | - Jui-Ming Liu
- Division of Urology, Department of Surgery, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan
| | - Fung-Wei Chang
- Department of Obstetrics & Gynecology, Tri-Service General Hospital, National Defense Medical Center, Taipei
| | - Hung Chang
- Division of Thoracic Surgery, Department of Surgery, Taichung Armed Forces General Hospital, Taichung; Department of Physiology, National Defense Medical Center
| | - Kuan-Chen Cheng
- Graduate Institute of Food Science and Technology, National Taiwan University; Institute of Biotechnology, National Taiwan University
| | - Chia-Lun Yeh
- Division of Urology, Department of Surgery, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan
| | - Yu-Feng Wei
- Division of Chest Medicine, Department of Internal Medicine, E-DA Hospital, I-Shou University, Kaohsiung
| | - Ren-Jun Hsu
- Graduate Institute of Life Sciences, National Defense Medical Center; Department of Pathology, Graduate Institute of Pathology and Parasitology, Tri-Service General Hospital, National Defense Medical Center; Biobank Management Center, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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Kouotou EA, Nansseu JRN, Kouawa MK, Zoung-Kanyi Bissek AC. Prevalence and drivers of human scabies among children and adolescents living and studying in Cameroonian boarding schools. Parasit Vectors 2016; 9:400. [PMID: 27430556 PMCID: PMC4950090 DOI: 10.1186/s13071-016-1690-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 07/10/2016] [Indexed: 11/24/2022] Open
Abstract
Background The dire lack of information concerning the epidemiology of human scabies in Cameroon, especially in school milieus brought us to undertake the present study which aimed to determine the prevalence and associated factors of scabies in Cameroonian boarding schools. Methods A cross-sectional study was conducted from February to March 2015 in four boarding schools in Yaoundé and Buea (Cameroon). Participants were students currently residing in one of the study sites, volunteering to participate in the study and whose parents or guardians had given their consent in this respect. The diagnosis was based on clinical assessment independently performed by two dermatologists. Results A total of 1,902 students were recruited (50.5 % boys), with a mean age of 14.3 ± 2.5 years. Overall, 338 participants (17.8 %) were diagnosed with scabies. Age ≤ 15 years, male sex, number of students in the school > 500, no access to the school infirmary, sleeping with others, sharing beddings, clothes or toilet stuffs, pruritus in the close entourage and complaining of pruritus were significantly associated with the presence of mites in univariable logistic regression analyses. On the other hand, at least two baths per day, usage of soap for baths and finger nails always cut short appeared as protective factors. After multivariable analysis, male sex (adjusted OR (aOR) 2.06, 95 % CI: 1.40–3.01, P < 0.0001), first cycle level of education (aOR 1.67, 95 % CI: 1.02–2.71, P = 0.040), number of students per dormitory ≤ 10 (aOR 6.99, 95 % CI: 3.34–14.71, P < 0.0001), no access to the school infirmary (aOR 1.62, 95 % CI: 1.12–2.32, P = 0.009) and complaining of pruritus (aOR 93.37, 95 % CI: 60.04–145.19, P < 0.0001) were the independent factors associated with scabies. Conclusions The prevalence of scabies was 17.8 %. The male sex, first cycle level of education, a number of students per dormitory ≤ 10, no access to the school infirmary and complaining of pruritus were the independent factors significantly impacting the occurrence of scabies.
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Affiliation(s)
- Emmanuel Armand Kouotou
- Biyem-Assi District Hospital, Yaoundé, Cameroon.,Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon.,Yaoundé General Hospital, Yaoundé, Cameroon
| | - Jobert Richie N Nansseu
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon. .,Sickle Cell Disease Unit, Mother and Child Centre, Chantal Biya Foundation, Yaoundé, Cameroon.
| | - Michèle K Kouawa
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
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Brossier C, Morand JJ, Breton A, Gallineau C, Thauvin X, Berger F, Meynard JB, Michel R, Duron S. Scabies among the French armed forces in 2015. J Infect 2016; 73:297-300. [PMID: 27394405 DOI: 10.1016/j.jinf.2016.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 06/27/2016] [Accepted: 06/28/2016] [Indexed: 11/22/2022]
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Bernigaud C, Monsel G, Delaunay P, Do-Pham G, Foulet F, Botterel F, Chosidow O. [Main parasitic skin disorders]. Rev Med Interne 2017; 38:17-27. [PMID: 27372516 DOI: 10.1016/j.revmed.2016.05.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 05/28/2016] [Indexed: 11/23/2022]
Abstract
Cutaneous parasitic skin diseases are frequent in human pathology. There are few reliable epidemiological data on the prevalence and/or incidence of such diseases. Skin parasites are cosmopolitan but their global distribution is heterogenous; prevalence is especially high in subtropical and tropical countries. They are mainly due to arthropods (insects and mites). Many species of parasites are involved, explaining the diversity of their clinical signs. The most common are caused by ectoparasites such as scabies or pediculosis (head lice, body lice and pubic lice). Clinical signs may be related to the penetration of the parasite under the skin, its development, the inoculation of venom or allergic symptoms. Diagnosis can be easy when clinical signs are pathognomonic (e.g. burrows in the interdigital web spaces in scabies) or sometimes more difficult. Some epidemiological characteristics (diurnal or nocturnal bite, seasonality) and specific clinical presentation (single or multiple bites, linear or grouped lesions) can be a great diagnostic help. Modern non-invasive tools (dermoscopy or confocal microscopy) will play an important role in the future but the eye and experience of the specialist (dermatologist, parasitologist, infectious disease specialist or entomologist) remains for the time the best way to guide or establish a diagnosis. For most skin parasites, therapeutic proposals are rarely based on studies of high level of evidence or randomized trials but more on expert recommendations or personal experience.
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Soler B, Castellares C, Viver S, Díaz L, Gómez R, Ruíz E. [Randomised clinical trial to evaluate the efficacy and safety of a new pediculicide made with saponified olive oil in the eradication of Pediculus humanus capitis]. Semergen 2016; 43:91-99. [PMID: 27255407 DOI: 10.1016/j.semerg.2016.03.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Accepted: 03/06/2016] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The aim of the study was to evaluate the efficacy and safety of a new pediculicide in the eradication of Pediculus humanus capitis infestation. MATERIAL AND METHODS A randomised clinical trial was designed, in which children aged between 5 and 15 years diagnosed with pediculosis were selected. Treatment was administered on days 1 and 7 after selection, and they were evaluated in 4 visits (day 2, 7, 9, and 14). The product under evaluation with saponified olive oil was Inex Pediculicide Soap®, which was compared with Paranix®, with a similar mechanism of action. The primary efficacy endpoint was the eradication of the parasite by day 14 (louse-free rate), using an intention to treat analysis. RESULTS Six paediatricians from 5 Primary Health Care centres in the Community of Madrid (Spain) and one private clinic participated in the study. A total of 45 children were included, of which 75.6% were girls (n=34). The mean age was 7.1 years (95% CI 6.3-7.9). The large majority (80%) were middle class, and 82.2% had a history of previous pediculosis. The efficacy at 14 days was 76.2% (95% CI 52.8-91.8) in the group treated with Inex Pediculicide Soap® group, and 79.2% (95% CI 57.9-92.9) in Paranix® group (NNT=33.3). No adverse effects were observed with treatment. CONCLUSIONS The 2 products were effective and safe in the eradication therapy Pediculus humanus capitis, with no statistical differences.
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Affiliation(s)
- B Soler
- Departamento Médico, E-C-BIO, S. L., Madrid, España.
| | - C Castellares
- Centro de Salud Santa Mónica, Rivas-Vaciamadrid, Madrid, España
| | - S Viver
- Centro de Salud Valle de la Oliva, Majadahonda, Madrid, España
| | - L Díaz
- Clínica CEMECO, Torrelodones, Madrid, España
| | - R Gómez
- Centro de Salud Santa Mónica, Rivas-Vaciamadrid, Madrid, España
| | - E Ruíz
- Centro de Salud María Jesús Hereza Cuéllar, Leganés, Madrid, España
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Al-Quraishy S, Abdel-Ghaffar F, Mehlhorn H. Head louse control by suffocation due to blocking their oxygen uptake. Parasitol Res 2015; 114:3105-10. [DOI: 10.1007/s00436-015-4528-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 04/29/2015] [Indexed: 10/23/2022]
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21
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Hewitt KA, Nalabanda A, Cassell JA. Scabies outbreaks in residential care homes: factors associated with late recognition, burden and impact. A mixed methods study in England. Epidemiol Infect 2015; 143:1542-51. [PMID: 25195595 DOI: 10.1017/S0950268814002143] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Scabies is an important public health problem in residential care homes. Delayed diagnosis contributes to outbreaks, which may be prolonged and difficult to control. We investigated factors influencing outbreak recognition, diagnosis and treatment, and staff experiences of outbreak control, identifying areas for intervention. We carried out a semi-structured survey of managers, affected residents and staff of seven care homes reporting suspected scabies outbreaks in southern England over a 6-month period. Attack rates ranged from 2% to 50%, and most cases had dementia (37/39, 95%). Cases were diagnosed clinically by GPs (59%) or home staff (41%), none by dermatologists. Most outbreaks were attributable to avoidably late diagnosis of the index case. Participants reported considerable challenges in managing scabies outbreaks, including late diagnosis and recognition of outbreaks; logistically difficult mass treatment; distressing treatment processes and high costs. This study demonstrates the need for improved support for care homes in detecting and managing these outbreaks.
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Bécourt C, Marguet C, Balguerie X, Joly P. Treatment of scabies with oral ivermectin in 15 infants: a retrospective study on tolerance and efficacy. Br J Dermatol 2014; 169:931-3. [PMID: 23724970 DOI: 10.1111/bjd.12454] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND The incidence of scabies is increasing in Europe, and it often affects children and infants. Although numerous topical treatments have been approved for treatment of scabies in adults, they are often poorly tolerated in infants. One treatment, ivermectin, remains off label for infants weighing < 15 kg. OBJECTIVES To report our experience on the safety and efficacy of oral ivermectin in refractory scabies in infants. METHODS A retrospective study was performed in the dermatology and paediatrics departments of Rouen University Hospital between January 2009 and October 2012. Infants diagnosed with scabies were identified, and the data for those fulfilling the inclusion criteria were analysed. RESULTS Of 219 infants identified, 15 had received oral ivermectin and had been followed up for at least 3 months. All 15 patients were given two doses of ivermectin, 200 μg kg(-1), at baseline and 14 days later. Of 14 patients contacted 1 month after treatment, 12 had achieved healing. The other two were treated with ivermectin or benzyl benzoate; both healed. Overall, 3 months after the first ivermectin treatment, 13/14 patients had healed and only one had active disease. CONCLUSIONS Ivermectin is generally well tolerated in infants. The 80% rate of healing observed in infants who had failed to respond to at least two other topical treatments suggests that ivermectin could be considered for treatment of infants with recalcitrant or relapsing scabies.
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Affiliation(s)
- C Bécourt
- Department of Dermatology, Rouen University Hospitals, 1 Rue de Germont, 76000, Rouen, France
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Agrawal S, Puthia A, Kotwal A, Tilak R, Kunte R, Kushwaha A. Mass scabies management in an orphanage of rural community: An experience. Med J Armed Forces India 2012; 68:403-6. [PMID: 24532918 PMCID: PMC3862572 DOI: 10.1016/j.mjafi.2012.02.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2011] [Accepted: 02/24/2012] [Indexed: 10/28/2022] Open
Affiliation(s)
| | | | - Atul Kotwal
- Professor, Dept of Community Medicine, AFMC, Pune 40, India
| | - Rina Tilak
- Scientist ‘F’, Dept of Community Medicine, AFMC, Pune 40, India
| | - Renuka Kunte
- Associate Professor, Dept of Community Medicine, AFMC, Pune 40, India
| | - A.S. Kushwaha
- Associate Professor, Dept of Community Medicine, AFMC, Pune 40, India
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Bitar D, Thiolet J, Haeghebaert S, Castor C, Poujol I, Coignard B, Che D. La gale en France entre 1999 et 2010 : augmentation de l’incidence et implications en santé publique. Ann Dermatol Venereol 2012; 139:428-34. [DOI: 10.1016/j.annder.2012.01.023] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Revised: 01/18/2012] [Accepted: 01/31/2012] [Indexed: 11/22/2022]
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Amro A, Hamarsheh O. Epidemiology of scabies in the West Bank, Palestinian Territories (Occupied). Int J Infect Dis 2012; 16:e117-20. [DOI: 10.1016/j.ijid.2011.10.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2011] [Revised: 09/06/2011] [Accepted: 10/12/2011] [Indexed: 11/25/2022] Open
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Gallardo A, Mougabure-cueto G, Vassena C, Picollo MI, Toloza AC. Comparative efficacy of new commercial pediculicides against adults and eggs of Pediculus humanus capitis (head lice). Parasitol Res 2012; 110:1601-6. [DOI: 10.1007/s00436-011-2668-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2011] [Accepted: 09/27/2011] [Indexed: 10/17/2022]
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Abstract
BACKGROUND Scabies is a contagious parasitic infestation which causes an allergic reaction to just a few mites. OBJECTIVES To examine the epidemiology of scabies consultations in the U.K. by age, sex, region of the country and time. METHODS Data were obtained from the THIN (The Health Information Network) database provided by EPIC U.K. in which each consultation episode is coded according to a 'READ' code. Data were available for 1997-2005 inclusive (9 years) for approximately 8·5% of the U.K. population from 12 regions of the U.K. We used harmonic analysis to model the data over time and derived cycle amplitudes and phases for each region in the U.K. RESULTS There was a significantly greater infestation rate among females with a relative risk of 1·24 (P < 0·001) relative to males. The age group 10-19 years had the highest infestation rates (with rates of 4·55 per 1000 and 5·92 per 1000 for males and females, respectively). The middle age groups had the smallest infestation rates. A cycle with length of between 15 and 17 years was derived, and the phase times of the cycles for each region suggested a progression of the disease originating from the North East, spreading to Northern parts of the U.K. and then to the Midlands and the South. CONCLUSIONS The study confirms earlier studies with regard to the age/sex distribution of scabies. We suggest a contagious pattern of spread of scabies infestation in the U.K. with an epidemic cycle length of 15-17 years.
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Affiliation(s)
- S Lassa
- School of Health and Related Research, University of Sheffield, Sheffield, UK
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Abstract
Pediculosis capitis is a common problem worldwide. The aim of this study was to estimate the prevalence of pediculosis capitis in children of preschool or school age in Greece, as well as to investigate the potential risk factors. The study included children of preschool and school age from all over Greece, including urban, semi-urban, and rural areas of Greece. A questionnaire with both closed and open-type questions, which was constructed by the researcher and filled in by the children's parents, was used. A total of 5,084 questionnaires were distributed, of which 2,792 were adequately filled and subsequently evaluated. Descriptive statistics and logistic regression models were used. The median age of the children was 8 years (range: 3-13 yrs) and 54% of them were girls. Pediculosis was found to be prevalent in 12% of the tested population. The prevalence of the disease seems to be increased after the age of 10 years and the risk is higher in girls. The number of family members was correlated positively with the risk of being infected with pediculosis at least once. The children's gender, their age, and family size were correlated with the risk of infection.
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Affiliation(s)
- Vladeni Soultana
- Dermatology Clinic, Medical School, University of Thessaly, Thessaly, Greece.
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Abstract
Scabies is an ectoparasite caused by the mite Sarcoptes scabiei var hominis, an obligate human parasite. There are about 300 million cases of scabies in the world each year. Common predisposing factors are overcrowding, immigration, poor hygiene, poor nutritional status, homelessness, dementia, and sexual contact. Direct skin-to-skin contact between 15 and 20 minutes is needed to transfer the mites from one person to another. The diagnosis suspected with a clinical history of itch, worse at night, affecting other family members, clinical distribution, and appearance. Definite diagnosis relies on microscopic identification of the mites, eggs, or fecal pellets with 10% potassium hydroxide, ink enhancement, tetracycline fluorescence tests, or mineral oil; other methods include: epiluminescence light microscopy and S. scabiei DNA. The most commonly used treatment modalities are permethrin and ivermectin. Persistence of symptoms for 2-6 weeks after successful treatment is common. Most recurrences are because of reinfection from untreated contacts.
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Affiliation(s)
- Maria I Hicks
- Geisinger Dermatology, Danville, Pennsylvania 17822, USA.
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Ibarra J, Fry F, Wickenden C, Jenner M, Franks A. The impact of well-developed preventative strategies on the eradication of head lice. Perspect Public Health 2009; 129:165-73. [PMID: 19650551 DOI: 10.1177/1466424008094804] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In the 1970s Donaldson applied the principles of infectious disease surveillance to pediculosis capitis infestation with head lice. This provided a lasting insight into an effective strategy for prevention. Research in Teesside, UK, proved that the first step in breaking the chain of transmission is the engagement of parents in an intensive detection/treatment campaign. United action halved the infestation rate, even though failing lindane treatments were in use. Subsequently although effective malathion treatment was introduced, it became clear that the late detection of light cases of head lice still undermines eradication. This paper analyzes the development by the health charity, Community Hygiene Concern, of the Bug Busting programme based on this solid evidence. In the 1990s the charity solved the problem of detecting asymptomatic lice using a specially designed Bug Buster louse comb in wet, conditioned hair. It undertook the popularization of this method and the co-ordination of national detection days (Bug Busting Days) through primary schools. In 2004 this structured approach to prevention was adopted in Chester. It produced a 24% reduction in health authority spending on treatment products in the first year and appreciable savings in professional time. It is concluded that participation in the Bug Busting programme benefits community health providers and schools. Provision of dependable detection combs with the correct instructions to families at risk, empowers them to gain sustainable, cost-effective control of head lice.
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Abstract
Scabies is an infectious disease caused by Sarcoptes scabiei var. hominis. The disease is mainly transmitted by close personal contact. The primary clinical picture is characterized by burrows at typical areas as well as severe pruritus, while secondarily a rather non-specific exanthema can be observed. The detection of mites or mite products (eggs, feces) confirms the diagnosis; dermatoscopy may facilitate the diagnosis. First choice therapy for most variants of scabies is topical permethrin. Oral administration of ivermectin is recommended for some special indications. In the following article, the current knowledge about epidemiology, biology, immunology, clinical appearance, diagnostic procedures and therapy of scabies is reviewed.
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Toloza A, Vassena C, Gallardo A, González-Audino P, Picollo MI. Epidemiology of Pediculosis capitis in elementary schools of Buenos Aires, Argentina. Parasitol Res 2009; 104:1295-8. [PMID: 19148682 DOI: 10.1007/s00436-008-1324-6] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2008] [Accepted: 12/17/2008] [Indexed: 10/21/2022]
Abstract
The infestation with the human obligate ectoparasite Pediculus humanus capitis De Geer is a common public health problem affecting mainly schoolchildren worldwide. The aim of the present study was to investigate the infestation levels of head lice in elementary schools from Buenos Aires with resistant levels to permethrin >100. A total of 1,856 children aged 3-13 years old from eight selected elementary schools were examined for head lice. Pediculosis was observed in all the studied schools. The overall infestation rate was 29.7%. Girls were statistically significant more infested than boys, with infestation rate values of 36.1% and 26.7%, respectively (P < 0.0001). Only 42 of the infested girls (12%) and 23 of the infested boys (11.4%) had >10 lice on their hair. The proportions of infested children-both girls and boys-in each age group were not found to differ significantly from one another. The infestation rate among schools varied from 19.12% to 42.74%. This indicated that pediculosis is relatively common in elementary schools from Buenos Aires, and those levels are of epidemic importance. The differences of pediculosis among the studied schools could be explained by the different control strategies applied by parents or advisors to eradicate head lice.
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Affiliation(s)
- Ariel Toloza
- Centro de Investigaciones de Plagas e Insecticidas (CITEFA/CONICET), Buenos Aires, Argentina.
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Connolly M, Stafford KA, Coles GC, Kennedy CTC, Downs AMR. Control of head lice with a coconut-derived emulsion shampoo. J Eur Acad Dermatol Venereol 2009; 23:67-9. [DOI: 10.1111/j.1468-3083.2008.02829.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Feldmeier H, Jackson A, Ariza L, Calheiros CM, Soares Vde L, Oliveira FA, Hengge UR, Heukelbach J. The epidemiology of scabies in an impoverished community in rural Brazil: presence and severity of disease are associated with poor living conditions and illiteracy. J Am Acad Dermatol 2009; 60:436-43. [PMID: 19064303 DOI: 10.1016/j.jaad.2008.11.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2008] [Revised: 10/27/2008] [Accepted: 11/05/2008] [Indexed: 11/21/2022]
Abstract
BACKGROUND We sought to study the epidemiology of scabies and to identify risk factors of severe disease in an impoverished rural community in northeast Brazil. METHODS The study was designed as a repeated cross-sectional study based on two door-to-door surveys. One survey was carried out in the rainy season, the other in the dry season. The inhabitants of the community were examined for the presence of scabies and demographic, socioeconomic, and behavioral risk factors were assessed. Risk factors were analyzed using bivariate and multivariate regression analysis. RESULTS The overall prevalence was 9.8% with no significant variation between seasons and the incidence was estimated to be 196/1000 person-years. The highest prevalence (18.2%) was observed in children younger than 4 years. Risk factors in the bivariate analysis were young age, presence of many children in the household, illiteracy, low family income, poor housing, sharing clothes and towels, and irregular use of shower. Age younger than 15 years, illiteracy, sharing of clothes, and living in the community for more than 6 months remained significant independent risk factors in multivariate regression analysis. LIMITATIONS We used a clinical case definition; specificity and sensitivity were not verified. Men were underrepresented in the study population. CONCLUSIONS In this impoverished community scabies is an important health problem characterized by continuous transmission throughout the year. The parasitic skin disease is embedded in a complex web of causation characterized by poor living conditions and a low level of education.
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Abstract
Pediculosis capitis is one of the most frequent infectious diseases in childhood. If not diagnosed and treated rapidly, considerable clinical pathology may develop. The ubiquitous parasitic skin disease is characterized by a lack of sound epidemiological data, and factors which influence disease occurrence are still enigmatic. To investigate whether, in Germany, head lice infestation follows a seasonal pattern, we analyzed the weekly head lice consultations at the Health Department of Braunschweig City, Lower Saxony, for a period of 5 years, and compared the data with the units of pediculocides sold by two wholesalers to German pharmacies during a period of 2 and 3 years, respectively. The number of consultations did not show a clear seasonality, although there was a tendency of fewer consultations during school holidays, and an increase when schools opened again after Christmas, Easter, summer, and autumn holidays. In contrast, the number of packages of pediculocides sold followed a distinct seasonal rhythm with a maximum between calendar week 34 and 40, i.e., from mid September to end of October. In Germany, occurrence of pediculosis capitis varies according to the season of the year with a maximum in late summer and early autumn.
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Affiliation(s)
- Eline Bauer
- Institute of Microbiology and Hygiene, Charité-University Medicine, Campus Benjamin Franklin, Hindenburgdamm 27, 12203, Berlin, Germany
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Heukelbach J, Pilger D, Oliveira FA, Khakban A, Ariza L, Feldmeier H. A highly efficacious pediculicide based on dimeticone: randomized observer blinded comparative trial. BMC Infect Dis 2008; 8:115. [PMID: 18783606 PMCID: PMC2553415 DOI: 10.1186/1471-2334-8-115] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2008] [Accepted: 09/10/2008] [Indexed: 11/16/2022] Open
Abstract
Background Infestation with the human head louse (Pediculus humanus capitis) occurs worldwide. Existing treatment options are limited, and reports of resistance to commonly used pediculicides have been increasing. In this trial we assessed the efficacy of a product containing a high (92%) concentration of the silicone oil dimeticone (identical in composition to NYDA®), as compared to a 1% permethrin lotion. Methods Randomized, controlled, observer blinded clinical trial. Participants were recruited from a poor urban neighbourhood in Brazil where pediculosis capitis was highly prevalent. To minimize reinfestation during the trial, participants (145 children aged 5–15 years with head lice infestations) were transferred to a holiday resort outside the endemic area for a period of 9 days. Two applications of dimeticone or 1% permethrin were done, seven days apart. Outcome measures were defined as cure (absence of vital head lice) after first application and before and after second applications, degree of itching, cosmetic acceptability, and clinical pathology. Results Overall cure rates were: day 2 – dimeticone 94.5% (95% CI: 86.6% – 98.5%) and permethrin 66.7% (95% CI: 54.6% – 77.3%; p < 0.0001); day 7 – dimeticone 64.4% (95% CI: 53.3% – 75.3%) and permethrin 59.7% (95% CI: 47.5% – 71.1%; p = 0.5); day 9 – dimeticone 97.2% (95% CI: 90.3% – 99.7%) and permethrin 67.6% (95% CI: 55.4%-78.2%); p < 0.0001). Itching was reduced similarly in both groups. Cosmetic acceptability was significantly better in the dimeticone group as compared to the permethrin group (p = 0.01). Two mild product-related incidents occurred in the dimeticone group. Conclusion The dimeticone product is a safe and highly efficacious pediculicide. Due to its physical mode of action (interruption of the lice's oxygen supply of the central nervous system), development of resistance is unlikely. Trial registration Current Controlled Trials ISRCTN15117709.
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Affiliation(s)
- Jorg Heukelbach
- Department of Community Health, School of Medicine, Federal University of Ceará, Fortaleza, Brazil.
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Affiliation(s)
- Lucía Silva
- Faculdade Marechal Rondon, São Manuel, Brazil
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Karim SA, Anwar KS, Khan MAH, Mollah MAH, Nahar N, Rahman HEMR, Al Mamun M, Goni N, Hossain MM, Rahman MS, Begum HA, Das SK. Socio-demographic characteristics of children infested with scabies in densely populated communities of residential madrashas (Islamic education institutes) in Dhaka, Bangladesh. Public Health 2007; 121:923-34. [PMID: 17884117 DOI: 10.1016/j.puhe.2006.10.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2005] [Revised: 10/02/2006] [Accepted: 10/13/2006] [Indexed: 11/26/2022]
Abstract
BACKGROUND Outbreaks of scabies in institutions and the socio-economic consequences have not been reported from overpopulated countries such as Bangladesh. STUDY DESIGN A community-based study among children from six residential Islamic education institutes (madrashas) in Dhaka. Multistage random sampling was used. OBJECTIVES To study the socio-economic profile, water-sanitation facilities, personal hygiene and living conditions of these children. METHODOLOGY Direct interviews were used to collect the data and clinical check up was performed in all children. RESULTS In total, 492 children received clinical check-ups; 92.5% were boys (mean age: 11.2+/-2.4 years). 63.4% of fathers and 98.5% of mothers were either illiterate or had only received primary education, 55.1% of fathers were in low-paid labouring jobs, and 99% of mothers were housewives. Of the 98% of children who had scabies, 71% had been re-infected (96% during the winter). Randomly assigned anti-scabies drugs revealed an average cure rate of 85.5%. Seventy-four percent of children were living in poorly ventilated buildings with overcrowded sleeping arrangements. They had poor personal hygiene: 21% shared towels; 8% shared undergarments; 30% shared bed linen; and 81% kept their used clothes on a communal line or shelf. Sanitation was also poor: 39% bathed infrequently, although 97% carried out mandatory ablution. Most children (61%) washed their clothes (including undergarments) two or three times a fortnight, 35% did so every 2-3 days, and 3.7% washed their clothes on alternative days. Disease severity and re-infection were associated with infrequent washing of clothes (P<0.001) and bed linen (P<0.001), overcrowded sleeping arrangements (P<0.001) and infrequent bathing (P<0.001) with soap (P<0.001). This was further related to household income (P<0.001 for both). CONCLUSION The study findings have potentially dangerous implications for public health. Immediate attention should be given to developing a sustainable long-term intervention programme to combat scabies hyperendemicity, and to save thousands of children from impending complications.
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Affiliation(s)
- S A Karim
- Department of Dermatology, Holy Family Red Crescent Medical College Hospital, Eskaton, Dhaka 1000, Bangladesh.
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Abstract
Head lice or pediculosis is recognized as an increasing problem in medical practice (Down et al, 1999). Secondary bacterial infections can occur in patients with infestation. In neurosurgical patients, head lice infestation may be a potential risk factor for peri-operative complications. Secondary infection could further complicate neurosurgical wounds with subsequent complications. The authors discuss epidemiology, pathogenesis of potential peri-operative complications resulting from pediculosis and methodology of treatment of this common condition. The importance of early recognition and prompt treatment in patients with neurological diseases is highlighted. A simple algorithm to treat scalp pediculosis is suggested.
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Affiliation(s)
- Divyesh Sharma
- Department of Neurosurgery, Regional Neurosciences Unit, Royal Victoria Hospital, Belfast
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Affiliation(s)
- Marc Tebruegge
- Department of Paediatric Infectious Diseases, St Mary's Hospital London, UK.
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Abstract
BACKGROUND Skin problems are the commonest reason for people accessing healthcare services in Nepal but there is little information about the prevalence of skin disease. OBJECTIVES To perform a point prevalence study of skin disease in the Terai region of Nepal. METHODS Five villages were randomly selected in Bara District in the Terai region of Nepal, and 878 people were examined. RESULTS The number of individuals identified as having a skin disease was 546. The point prevalence of identifiable skin abnormalities was 62.2% (546 of 878) (with 95% exact confidence intervals 58.9-65.4%). A wide range of dermatoses was identified. The six most prevalent were dermatophyte infections (11.4%), followed by pityriasis versicolor (8.9%), acne (7.7%), melasma (6.8%), eczema (5.6%) and pityriasis alba (5.2%). Overall, treatable skin infections and infestations were by far the commonest skin diseases identified. CONCLUSIONS Our study has demonstrated a very high point prevalence (62.2%) of skin disease in rural Nepal. This study represents the first formal survey of skin disease in Nepal and demonstrates a large burden of disease, in particular treatable infections.
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Affiliation(s)
- S L Walker
- Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
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Abstract
BACKGROUND Scabies is an intensely itchy parasitic infection of the skin caused by the Sarcoptes scabiei mite. It is a common public health problem with an estimated global prevalence of 300 million cases. Serious adverse effects have been reported for some drugs used to treat scabies. OBJECTIVES To evaluate topical and systemic drugs for treating scabies. SEARCH STRATEGY In February 2007, we searched the Cochrane Infectious Diseases Group Specialized Register, CENTRAL (The Cochrane Library 2006, Issue 1), MEDLINE, EMBASE, LILACS, and INDMED. In March 2007, we also searched the grey literature and sources for registered trials. We also checked the reference lists of retrieved studies. SELECTION CRITERIA Randomized controlled trials of drug treatments for scabies. DATA COLLECTION AND ANALYSIS Two authors independently assessed trial quality and extracted data. Results were presented as relative risks with 95% confidence intervals and data combined where appropriate. MAIN RESULTS Twenty small trials involving 2392 people were included. One trial was placebo controlled, 16 compared two or more drug treatments, two compared treatment regimens, and one compared different drug vehicles.Fewer treatment failures occurred by day seven with oral ivermectin in one small trial (55 participants). Topical permethrin appeared more effective than oral ivermectin (85 participants, 1 trial), topical crotamiton (194 participants, 2 trials), and topical lindane (753 participants, 5 trials). Permethrin also appeared more effective in reducing itch persistence than either crotamiton (94 participants, 1 trial) or lindane (490 participants, 2 trials). One small trial did not detect a difference between permethrin (a synthetic pyrethroid) and a natural pyrethrin-based topical treatment (40 participants). No significant difference was detected in the number of treatment failures between crotamiton and lindane (100 participants, 1 trial), lindane and sulfur (68 participants, 1 trial), benzyl benzoate and sulfur (158 participants, 1 trial), and benzyl benzoate and natural synergized pyrethrins (240 participants, 1 trial); all were topical treatments. No trials of malathion were identified. No serious adverse events were reported. A number of trials reported skin reactions in participants randomized to topical treatments. There were occasional reports of headache, abdominal pain, diarrhoea, vomiting, and hypotension. AUTHORS' CONCLUSIONS Topical permethrin appears to be the most effective treatment for scabies. Ivermectin appears to be an effective oral treatment. More research is needed on the effectiveness of malathion, particularly when compared to permethrin, and on the management of scabies in an institutional setting and at a community level.
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Affiliation(s)
- M Strong
- University of Sheffield, School of Health and Related Research, Regent Court, 30 Regent Street, Sheffield, UK, S1 4DA.
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Abstract
A prospective survey on scabies in Ghent, Belgium was performed in 2004. Sixty-four individual cases were reported, corresponding to a crude incidence rate of 28/100,000 inhabitants. The incidence was higher in the elderly (51/100,000 in persons aged >75 years) and a higher incidence was also found in immigrants (88/100,000). More than 40% of the registered scabies patients had symptoms for more than 4 weeks at the time of presentation. In 54% of the consultations, the patient had already consulted a physician for his/her skin problem. Of this group, 44% had not yet received any scabicidal treatment, indicating that scabies was not yet diagnosed or that an inappropriate treatment was prescribed. The observations suggest that the diagnosis and/or treatment of scabies in this region can still be improved.
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Affiliation(s)
- H Lapeere
- Department of Dermatology, Ghent University, Ghent, Belgium.
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Abstract
Ectoparasites continue to be a common cause of skin disease throughout the world. The present article dissects the epidemiological profile and treatment of both Sarcoptes scabiei variant hominis and pediculosis pubis.
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Affiliation(s)
- Peter A Leone
- Department of Medicine, University of North Carolina and North Carolina STD/HIV Prevention and Care Branch, Chapel Hill, NC 27599-7030, USA.
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Abstract
Scabies is a worldwide disease and a major public health problem in many developing countries, related primarily to poverty and overcrowding. In remote Aboriginal communities in northern Australia, prevalences of up to 50% among children have been described, despite the availability of effective chemotherapy. Sarcoptic mange is also an important veterinary disease engendering significant morbidity and mortality in wild, domestic, and farmed animals. Scabies is caused by the ectoparasitic mite Sarcoptes scabiei burrowing into the host epidermis. Clinical symptoms include intensely itchy lesions that often are a precursor to secondary bacterial pyoderma, septicemia, and, in humans, poststreptococcal glomerulonephritis. Although diagnosed scabies cases can be successfully treated, the rash of the primary infestation takes 4 to 6 weeks to develop, and thus, transmission to others often occurs prior to therapy. In humans, the symptoms of scabies infestations can mimic other dermatological skin diseases, and traditional tests to diagnose scabies are less than 50% accurate. To aid early identification of disease and thus treatment, a simple, cheap, sensitive, and specific test for routine diagnosis of active scabies is essential. Recent developments leading to the expression and purification of S. scabiei recombinant antigens have identified a number of molecules with diagnostic potential, and current studies include the investigation and assessment of the accuracy of these recombinant proteins in identifying antibodies in individuals with active scabies and in differentiating those with past exposure. Early identification of disease will enable selective treatment of those affected, reduce transmission and the requirement for mass treatment, limit the potential for escalating mite resistance, and provide another means of controlling scabies in populations in areas of endemicity.
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Affiliation(s)
- Shelley F Walton
- Menzies School of Health Research, Institute of Advanced Studies, Charles Darwin University, and Department of Medicine, Royal Darwin Hospital, Casuarina NT 0811, Australia.
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Jackson A, Heukelbach J, Filho AFDS, Júnior EDBC, Feldmeier H. Clinical features and associated morbidity of scabies in a rural community in Alagoas, Brazil. Trop Med Int Health 2007; 12:493-502. [PMID: 17445140 DOI: 10.1111/j.1365-3156.2006.01809.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To describe the clinical characteristics of scabies and the associated morbidity in an impoverished rural community in northeast Brazil. METHOD A door-to-door survey was made to examine twice the population of an endemic area; first at the end of the rainy season, and a second time in the dry season 4 months later. RESULTS In total, 2005 individuals were examined. The overall prevalence of scabies was 9.8% (95% CI 8.5-11.2). Predilection sites with similar relative frequencies in all age groups were the abdomen (83.7%) and the inguinal area/inner part of the thighs (66.3%). Hands, feet, genitals and the scalp/neck/face were significantly more often affected in children <7 years (all P < 0.03). Fifty-five per cent of the patients showed scabies lesions simultaneously at > or = 12 distinct topographic areas. Papular lesions were most commonly found, followed by papular-crusted lesions. Vesicles were significantly more often observed in children (P = 0.04). Sixty-four per cent of the patients had three or more types of lesions. Local lymphadenopathy was present in 53.6% and superinfection in 36.7% of the cases. The number of topographic areas affected, as well as the proportion of superinfected lesions, was inversely correlated with age (rho = -0.22, P = 0.002 and rho = -0.358, P < 0.05, respectively). The quantity of skin surface infested, the proportion of superinfected lesions and the presence of a superinfected lesion distal to an enlarged lymphnode were predictors of lymphadenopathy. Seventy-two per cent of the patients suffered from sleep disorders, mainly because of itching. CONCLUSION Scabies is associated with considerable morbidity in this endemic community. Predilection sites, clinical presentation, quantity of skin surface affected and proportion of secondary infected lesions show a dichotomy between children and adults.
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Affiliation(s)
- Anne Jackson
- Institute of Microbiology and Hygiene, Charité-University Medicine Berlin, Berlin, Germany
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