Scabies and pediculosis: neglected diseases to highlight

The Impact of the COVID-19 Pandemic on the Prevalence of Head Lice Infestation among Children Attending Schools and Kindergartens in Poland

Pediculosis capitis predominantly affects child populations. During the COVID-19 pandemic, various types of social limitations such as social isolation and limitations on educational facilities' functionalities were introduced worldwide, including in Poland. The impact of these pandemic restrictions on the prevalence of pediculosis capitis has not been extensively investigated so far. Existing data on this topic are limited mainly to indirect evaluation methods, such as online surveys or Internet analysis. In this study, we directly examined a cohort of over five thousand children to assess the influence of COVID-19 pandemic restrictions on the prevalence of head lice infestation among school and kindergarten attendees in Poland. Our findings demonstrate that the restrictions imposed during the COVID-19 pandemic led to a decrease in the number of children infested with head lice compared to pre-pandemic data. These results confirm that head lice infestations remain an ongoing epidemiological concern and warrant continued monitoring.

Molecular analysis of mitochrondrial cytb of Pediculus humanus capitis in Thailand revealed potential historical connection with South Asia

Background

Pediculus humanus capitis or head louse is an obligate ectoparasite and its infestation remains a major public health issue worldwide. Molecular analysis divides head lice into six clades and intra-clade genetic differences have been identified. Several hypotheses have been formulated to elucidate the discrepancies of the variety of head lice among different regions of the world. It is currently concluded that head lice distribution might be associated with human migration history. This study aims to investigate genetic data of human head lice in Thailand. We believe that the analysis could help establish the correlation between local and global head lice populations.

Method

We investigated mitochondrial cytochrome b (cytb) gene of the collected 214 head lice to evaluate genetic diversity from 15 provinces among 6 regions of Thailand. The head lice genes were added to the global pool for the phylogenetic tree, Bayesian tree, Skyline plot, and median joining network construction. The biodiversity, neutrality tests, and population genetic differentiation among the 6 Thailand geographic regions were analyzed by DNAsp version 6.

Results

The phylogenetic tree analysis of 214 collected head lice are of clade A and clade C accounting for roughly 65% and 35% respectively. The Bayesian tree revealed a correlation of clade diversification and ancient human dispersal timeline. In Thailand, clade A is widespread in the country. Clade C is confined to only the Central, Southern, and Northeastern regions. We identified 50 novel haplotypes. Statistical analysis showed congruent results between genetic differentiation and population migration especially with South Asia.

Conclusions

Pediculosis remains problematic among children in the rural areas in Thailand. Cytb gene analysis of human head lice illustrated clade distribution and intra-clade diversity of different areas. Our study reported novel haplotypes of head lice in Thailand. Moreover, the statistic calculation provided a better understanding of their relationship with human, as an obligate human parasite and might help provide a better insight into the history of human population migration. Determination of the correlation between phylogenetic data and pediculicide resistance gene as well as residing bacteria are of interest for future studies.

Itch in Scabies-What Do We Know?

Scabies is a common parasitic skin infestation characterized by severe itch and a heterogenous clinical presentation. Itch, as the cardinal symptom of scabies, is imposing a high burden on affected patients and is often difficult to manage. Decreased life quality and secondary complications, caused by an itch-related disruption of the epidermal barrier and subsequent superinfections, illustrate the need to treat scabies and to understand the underlying mechanisms of itch in respective patients. This review summarizes available data on itch in scabies with a special focus on the clinical aspects and its underlying pathomechanisms.

Assessing knowledge of scabies among physicians working in primary health care setting

Background:

Outbreaks of scabies have been documented in 2018 among school children in Western and Central regions of Saudi Arabia. There have been concerns about the awareness of healthcare providers.

Objective:

The objective of the current study was to evaluate the knowledge of primary health care physicians about scabies diagnosis and management, as well as the factors influencing such knowledge.

Methods:

An observational cross-sectional study was conducted between September and October 2019. The target population was physicians working in primary care centers in Riyadh. Filling either hard or soft copies of the study questionnaire was used for data collection. The knowledge score was calculated from the answers for 16 knowledge questions.

Results:

A total of 216 physicians were included in the final analysis, mainly general practitioners (56.5%) and registrars (31.5%). The overall knowledge score was 67.5%± 13.9%. The highest level of knowledge was associated with age susceptibility (80.6%), followed by clinical presentation and diagnosis (78.1%), mode of transmission (75.8%), pathogen cause & incubation period (66.9%), and finally management (61.7%). In multivariate logistic regression models, a shorter time since last time information about scabies was reviewed was significantly associated with better knowledge (defined as score > median), with odds ratio = 5.84 (95% confidence interval = 2.43–14.01). Similarly, older age and higher qualification were significantly associated with better knowledge.

Discussion:

As expected, the knowledge about scabies among primary care physicians was generally inadequate. The current findings highlight the need for educational and training programs lead by health care authorities, targeting these physicians.

A Proteomic Analysis of Sarcoptes scabiei (Acari: Sarcoptidae)

The pruritic skin disease scabies is caused by the burrowing of the itch mite Sarcoptes scabiei (De Geer). It is difficult to diagnose this disease because its symptoms often resemble those of other skin diseases. No reliable blood or molecular diagnostic test is available. The aim of this project was to begin to characterize the scabies proteome to identify scabies mite proteins, including those that may be useful in the development of a diagnostic test or vaccine. Various scabies mite extracts were separated by two-dimensional electrophoresis, and 844 Coomassie Blue-stained protein spots were excised, subjected to trypsin digestion, and analyzed by Matrix Assisted Laser Desorption/Ionization Time-Of-Flight/Time-Of-Flight (MALDI-TOF/TOF) mass spectrometry (MS). Tryptic fragment sequences determined by MS were searched against the recently completed S. scabiei annotated genome, leading to the identification of >150 proteins. Only 10 proteins hit to previously identified scabies proteins including actin, tropomyosin, and several ABC transporters. Thirteen proteins had homology to dust mite allergens (members of groups 8, 10, 13, 17, 20, 25, and 28). Most other sequences showed some homology to proteins in other mites and ticks including homologs of calmodulin, calreticulin, lipocalin, and glutathione-S-transferase. These data will now allow the identification of the proteins to which scabies patients produce antibodies, including those that may be good candidates for inclusion in a diagnostic test and vaccine.

Impact of an Ivermectin Mass Drug Administration on Scabies Prevalence in a Remote Australian Aboriginal Community

Background

Scabies is endemic in many Aboriginal and Torres Strait Islander communities, with 69% of infants infected in the first year of life. We report the outcomes against scabies of two oral ivermectin mass drug administrations (MDAs) delivered 12 months apart in a remote Australian Aboriginal community.

Methods

Utilizing a before and after study design, we measured scabies prevalence through population census with sequential MDAs at baseline and month 12. Surveys at months 6 and 18 determined disease acquisition and treatment failures. Scabies infestations were diagnosed clinically with additional laboratory investigations for crusted scabies. Non-pregnant participants weighing ≥15 kg were administered a single 200 μg/kg ivermectin dose, repeated after 2–3 weeks if scabies was diagnosed, others followed a standard alternative algorithm.

Principal Findings

We saw >1000 participants at each population census. Scabies prevalence fell from 4% at baseline to 1% at month 6. Prevalence rose to 9% at month 12 amongst the baseline cohort in association with an identified exposure to a presumptive crusted scabies case with a higher prevalence of 14% amongst new entries to the cohort. At month 18, scabies prevalence fell to 2%. Scabies acquisitions six months after each MDA were 1% and 2% whilst treatment failures were 6% and 5% respectively.

Conclusion

Scabies prevalence reduced in the six months after each MDA with a low risk of acquisition (1–2%). However, in a setting where living conditions are conducive to high scabies transmissibility, exposure to presumptive crusted scabies and population mobility, a sustained reduction in prevalence was not achieved.

Clinical Trial Registration

Australian New Zealand Clinical Trial Register (ACTRN—12609000654257).

Scabies is endemic in many Australian Aboriginal and Torres Strait Islander communities, with 69% of infants infected in the first year of life. Previous mass drug administration (MDA) programs using topical acaricides to decrease scabies prevalence have had varying degrees of success in Australia. We were invited by one community in eastern Arnhem Land to develop and deliver an oral-ivermectin MDA. Utilizing a before and after study design, we measured scabies prevalence through population census with sequential MDAs at baseline and month 12. Scabies prevalence fell from 4% at baseline to 1% at month 6, rising to 9% at month 12 in association with an identified exposure to a presumptive crusted scabies case. For new entries to the cohort at month 12 scabies prevalence was higher at 14%. We were able to demonstrate a reduction in scabies prevalence in the six months after each MDA with a low risk of acquisition (1–2%); however, a sustained reduction was not achieved.

Isolated itching of the genitals

A 38-year-old man, returned from Ivory Coast 2 months ago and presented with a 3-month history of pruritus exclusively on the scrotum. Itching was continuous during the day and no pruritus was described in his wife and son. Clinical examination of the genitals revealed several nodules on the scrotum, a chancrous lesion was seen on the penis, and multiple excoriations were noted. Dermoscopy exam with a dermatoscope of the whole body was performed and no papules, nodules, or burrow were found. Microscopic examination of several superficial skin samples obtained by scraping in the peri-genital area revealed one adult of Sarcoptes scabiei. The patient and his relatives were successfully treated with Ivermectin 200 μg/kg with a second dose 2 weeks later. Very rare cases are described on localized scabies (scalp, feet) and they mainly occurred in an immunocompromised patient unlike this patient who does not have any immunosuppression.