Hookworm-related cutaneous larva migrans in patients living in an endemic community in Brazil: immunological patterns before and after ivermectin treatmen

Travel- and migration-associated epidermal parasitic skin diseases. A review

Epidermal parasitic skin diseases are a family of parasitic diseases which occur globally or are frequent in special settings. Epidermal parasitic skin diseases occur in travelers and migrants, although epidemiology and/or clinical manifestations differ between these groups. The objective of this study is to summarize the existing knowledge concerning tungiasis, hookworm-related cutaneous larva migrans, scabies, pediculosis capitis and pediculosis corporis in the context of travel and migration, and to identify risk factors for infection. The PUBMED database was searched using the terms tungiasis, cutaneous larva migrans, scabies, pediculosis capitis, pediculosis corporis in combination with travel, migrant, or refugee from 2000 to 2022. Tungiasis and cutaneous larva migrans were the epidermal parasitic skin diseases most commonly reported in travelers. Outbreaks with up to 36 cases occurred in groups of adventure-travelers. The clinical manifestation differed from those in inhabitants of endemic areas and were usually circumscript and moderate. Scabies was very rarely reported in travelers but causes a high disease burden in migrants and refugees. The infestation of refugees with body and head lice caused louse-borne relapsing fever in refugees arriving by boat from Africa. Travel advice concerning prevention of epidermal parasitic skin diseases requires knowledge on their epidemiology in the settings they are endemic.

Questionnaire Modifications and Alternative Scoring Methods of the Dermatology Life Quality Index: A Systematic Review

OBJECTIVES

Dermatology Life Quality index (DLQI) is the most widely used health-related quality of life questionnaire in dermatology. Little is known about existing questionnaire or scoring modifications of the DLQI. We aimed to systematically review, identify, and categorize all modified questionnaire versions and scoring methods of the DLQI.

METHODS

We performed a systematic literature search in PubMed, Web of Science, CINAHL, and PsychINFO. Methodologic quality and evidence of psychometric properties were assessed using the Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) and Terwee checklists.

RESULTS

The included 81 articles reported on 77 studies using 59 DLQI modifications. Modifications were used for a combined sample of 25 509 patients with 47 different diagnoses and symptoms from 28 countries. The most frequently studied diseases were psoriasis, hirsutism, acne, alopecia, and bromhidrosis. The modifications were categorized into the following nonmutually exclusive groups: bolt-ons or bolt-offs (48%), disease, symptom, and body part specifications (42%), changes in existing items (34%), scoring modifications (27%), recall period changes (19%), response scale modifications (15%), and illustrations (3%). The evidence concerning the quality of measurement properties was heterogeneous: 4 of 13 studies were rated positive on internal consistency, 1 of 3 on reliability, 3 of 5 on content validity, 9 of 22 on construct validity, 6 of 6 on criterion validity, and 1 of 1 on responsiveness.

CONCLUSION

An exceptionally large number of DLQI modifications have been used that may indicate an unmet need for adequate health-related quality of life instruments in dermatology. The psychometric overview of most questionnaire modifications is currently incomplete, and additional efforts are needed for proper validation.

Involvement of Hookworm Co-Infection in the Pathogenesis and Progression of Podoconiosis: Possible Immunological Mechanism

Podoconiosis is an endemic, non-infectious, geochemical and non-filarial inflammatory cause of tropical elephantiasis. The immunology of podoconiosis is not yet expressly understood. In spite of this, co-infection and co-morbidity with the infectious, soil-transmitted hookworm disease that causes iron deficiency anemia has been found to be predominant among affected individuals living in co-endemic settings, thus creating a more complex immunological interplay that still has not been investigated. Although deworming and iron-rich nutrient supplementation have been suggested in podoconiosis patients living under resource-poor conditions, and it is thought that hookworm infection may help to suppress inflammatory responses, the undisputed link that exists between a non-infectious and an infectious disease may create a scenario whereby during a co-infection, treatment of one exacerbates the other disease condition or is dampened by the debilitation caused by the other. In this paper, we elaborate on the immunopathogenesis of podoconiosis and examine the possible immunological dynamics of hookworm co-infection in the immunopathology of podoconiosis, with a view toward improved management of the disease that will facilitate its feasible elimination.