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Yu WM, Palmer TM, Miller D, Storm S. Impetigo Surgical Site Infection Following Open Reduction and Internal Fixation of a Patella Fracture. Cureus 2024; 16:e52259. [PMID: 38352090 PMCID: PMC10863628 DOI: 10.7759/cureus.52259] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 01/13/2024] [Indexed: 02/16/2024] Open
Abstract
Impetigo is a pediatric skin infection characterized by the presence of pathognomonic "honey-crusted" lesions caused by either Staphylococcus aureus or Streptococcus pyogenes. The diagnosis of impetigo is largely based on clinical judgment, confirmatory skin cultures, and Gram staining. Surgical site infections following patellar surgery are a relatively uncommon occurrence, with the most common causative organisms being Staphylococcus aureus, Streptococcus pyogenes, Pseudomonas aeruginosa, and other gram-negative bacilli. Surgical site infections have a range of risk factors that largely depend on patient characteristics and surgical logistics. We report the first documented case in the literature of a surgical impetigo infection with diagnostic skin lesions following open reduction and internal fixation of a patellar fracture in a 24-year-old female.
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Affiliation(s)
- Westin M Yu
- Surgery, Lake Erie College of Osteopathic Medicine, Erie, USA
| | | | - Drew Miller
- Orthopaedic Surgery, LECOM Health Millcreek Community Hospital, Erie, USA
| | - Shawn Storm
- Orthopaedic Surgery, LECOM Health Millcreek Community Hospital, Erie, USA
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2
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Thornley S, Sundborn G, Engelman D, Roskvist R, Pasay C, Marshall R, Long W, Dugu N, Hopoi N, Moritsuka S, McCarthy J, Morris AJ. Children's scabies survey indicates high prevalence and misdiagnosis in Auckland educational institutions. J Paediatr Child Health 2023; 59:1296-1303. [PMID: 37920140 DOI: 10.1111/jpc.16512] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 10/16/2023] [Accepted: 10/19/2023] [Indexed: 11/04/2023]
Abstract
AIM Here, we present results of a survey of scabies prevalence in childcare centres and primary schools in Auckland. METHODS Children whose parents agreed to take part in participating centres in the Auckland region were examined for scabies by general practitioners and given questionnaires of relevant symptoms. Diagnoses of clinical or suspected scabies were made according to the International Alliance for the Control of Scabies (IACS) criteria. The survey was a stratified random sample of schools and early childcare centres. A quantitative polymerase chain reaction (PCR) test was also used to complement the IACS criteria. RESULTS A total of 181 children were examined, with 145 children with history information, 16 of whom (11.0%) met the criteria for 'clinical' or 'suspected' scabies. Weighted analysis, accounting for the survey design, indicated that the prevalence of scabies in early childcare centres was 13.2% (95% CI: 4.3 to 22.1), with no school-aged children fulfilling these criteria. A higher proportion had clinical signs of scabies with 23 (12.7%) having typical scabies lesions and a further 43 (23.8%) had atypical lesions. A total of 64 PCR tests were taken and 15 (23%) were positive. None of these cases were receiving treatment for scabies. Five were undergoing topical skin treatment: three with topical steroid and two with calamine lotion. CONCLUSIONS The prevalence of children with scabies is high in early childcare centres in Auckland. Misdiagnosis is suggested by several PCR positive cases being treated by topical agents used to treat other skin conditions.
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Affiliation(s)
- Simon Thornley
- Section of Epidemiology and Biostatistics, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Gerhard Sundborn
- Section of Pacific Health, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Daniel Engelman
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Rachel Roskvist
- Department of Primary Care, The University of Auckland, Auckland, New Zealand
| | - Cielo Pasay
- QIMR Berghoffer Medical Research Institute, Brisbane, Queensland, Australia
| | - Roger Marshall
- Section of Epidemiology and Biostatistics, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Wei Long
- Auckland Family Medical Centre, Auckland, New Zealand
| | - Noela Dugu
- Conifer Gardens Medical Centre, Auckland, New Zealand
| | | | - Shunsuke Moritsuka
- Section of Pacific Health, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - James McCarthy
- Doherty Institute, The University of Melbourne, Melbourne, Victoria, Australia
| | - Arthur J Morris
- LabPLUS, Auckland District Health Board, Auckland, New Zealand
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Anderson BJ, Wilz L, Peterson A. The Identification and Treatment of Common Skin Infections. J Athl Train 2023; 58:502-510. [PMID: 35984712 PMCID: PMC10496455 DOI: 10.4085/1062-6050-0142.22] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Skin conditions are a common problem addressed by medical providers. Up to 25% of individuals in the United States will seek attention for these conditions each year. The same problem occurs in the athletic training room, where athletes with infectious skin conditions can be seen. Most conditions are simple and can be treated without concern for spread to susceptible athletes. However, others can be quite serious and spread rapidly through a team and opponents during competition. Knowledge of the different types of skin infections is necessary to help treat these athletes and prevent spread to others. With proper diagnosis and treatment, certified athletic trainers can keep the athlete off the field of play for a minimum period and prevent transmission.
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Affiliation(s)
- B. J. Anderson
- Boynton Health Service, University of Minnesota, Minneapolis
- Medical Director of Sports Medicine, Augsburg University, Minneapolis, MN
| | - Logan Wilz
- Department of Family Medicine, University of Iowa Hospitals and Clinics, Iowa City
| | - Andrew Peterson
- Carver College of Medicine, University of Iowa, Iowa City
- Stead Family Department of Pediatrics, University of Iowa, Iowa City
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City
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Neri I, Miraglia del Giudice M, Novelli A, Ruggiero G, Pappagallo G, Galli L. Ideal Features of Topical Antibiotic Therapy for the Treatment of Impetigo: An Italian Expert Consensus Report. Curr Ther Res Clin Exp 2022; 98:100690. [PMID: 36712177 PMCID: PMC9881045 DOI: 10.1016/j.curtheres.2022.100690] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 12/16/2022] [Indexed: 12/25/2022]
Abstract
Background A group of Italian experts in impetigo medical care sought to define 10 statements to describe the ideal characteristics of the best local antibiotic treatments, and to provide relevant information re- garding their appropriate use and prescription that should be considered in clinical practice for impetigo management. Objective A group of Italian experts in impetigo medical care sought to define 10 statements to describe the ideal characteristics of the best local antibiotic treatments, and to provide relevant information regarding their appropriate use and prescription that should be considered in clinical practice for impetigo management. Methods A consensus on ideal features of antibiotic therapy for the treatment of impetigo was appraised by an online Delphi-based method, based on a panel of 61 infectious disease specialists, pediatricians, and dermatologists coordinated by a scientific committee of 5 experts specializing in impetigo management. Results Full or very high consensus was reached on the 10 statements identified to describe the characteristics of the best hypothetic antibiotic therapy for impetigo together with indications for appropriate antibiotics use. Conclusions Several criteria have to be considered when selecting topical antibacterial therapy for impetigo. Beyond efficacy and safety, antimicrobial susceptibility and pharmacological characteristics of the agent are essential points. Formulation of the antimicrobial product is fundamental, as well as patient and caregiver preference, to facilitate therapeutic adherence, to achieve the infection control, and to obtain the best benefit from treatment (Curr Ther Res Clin Exp. 2023; 84:XXXXXX).
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Affiliation(s)
- Iria Neri
- Dermatology Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy
| | - Michele Miraglia del Giudice
- Department of Woman and Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Andrea Novelli
- Department of Health Sciences, Clinical Pharmacology and Oncology Section, University of Florence, Italy
| | - Giuseppe Ruggiero
- Dermatology Study Group of the Italian Federation Italian of Pediatricians, Rome, Italy
| | - Giovanni Pappagallo
- School of Clinical Research Methodology, IRCCS Sacro Cuore - Don Calabria Hospital, Negrar di Valpolicella VR, Italy
| | - Luisa Galli
- Department of Health Sciences, University of Florence, Florence, Italy,Paediatric Infectious Diseases Unit, Meyer Children's Hospital, Florence, Italy,Address correspondence to: Luisa Galli, Paediatric Infectious Diseases Unit, University Hospital Meyer, Azienda Ospedaliero Universitaria Meyer, Viale Pieraccini 24, Florence IT-50131, Italy
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5
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Taylor S, Walther D, Fernando DD, Swe-Kay P, Fischer K. Investigating the Antibacterial Properties of Prospective Scabicides. Biomedicines 2022; 10:biomedicines10123287. [PMID: 36552044 PMCID: PMC9776028 DOI: 10.3390/biomedicines10123287] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 12/02/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022] Open
Abstract
Scabies is a dermatological disease found worldwide. Mainly in tropical regions, it is also the cause of significant morbidity and mortality due to its association with potentially severe secondary bacterial infections. Current treatment strategies for scabies do not consider the role of opportunistic bacteria, and here we investigate whether current and emerging scabicides can offer any anti-bacterial protection. Using the broth microdilution method, we examined antimicrobial potential of the current scabicide ivermectin and emerging scabies treatments: abametapir, mānuka oil, and its individual β-triketones. Our results demonstrate that the two novel scabicides abametapir and mānuka oil have antimicrobial properties against common scabies-associated bacteria, specifically Staphylococcus aureus, Streptococcus pyogenes, Streptococcus dysgalactiae subsp. equisimilis and Acinetobacter baumannii. The current scabicide ivermectin offers some antimicrobial activity and is capable of inhibiting the growth aforementioned bacteria. This research is important as it could help to inform future best treatment options of scabies, and scabies-related impetigo.
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Lake SJ, Kaldor JM, Hardy M, Engelman D, Steer AC, Romani L. Mass drug administration for the control of scabies: a systematic review and meta-analysis. Clin Infect Dis 2022; 75:959-967. [PMID: 35088849 PMCID: PMC9522411 DOI: 10.1093/cid/ciac042] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Scabies is a neglected tropical disease of the skin that can lead to impetigo, serious secondary bacterial infections and immune-mediated diseases. Mass drug administration (MDA) has been reported in several studies to reduce the prevalence of scabies and impetigo. We aimed to assess the efficacy of MDA for scabies on scabies and impetigo. METHODS We conducted a systematic review and meta-analysis of reports on the impact of MDA on scabies and impetigo. We included randomised control trials and observational evaluations reported from January 1970 to April 2021 and involving human participants. We searched PubMed, Ovid Medline, Embase and Cochrane. We considered MDA as treatment intended for the whole population, regardless of individual infection status or symptoms. The main outcome assessed was the change in scabies and impetigo prevalence following MDA. This review is registered with PROSPERO (CRD42020169839). RESULTS We identified 1110 records, of which 11 met inclusion criteria for the review and 9 were deemed suitable for meta-analysis for scabies and four for impetigo. Most studies were in small populations. There was a high degree of heterogeneity between studies (I 2 value 96·19%). The overall relative reduction of the impact of MDA on scabies prevalence was 79%. The effect size was comparable for MDA based on ivermectin and permethrin. MDA for scabies also led to a reduction in impetigo prevalence with a relative reduction of 66%. CONCLUSIONS MDA for scabies is highly effective in reducing the prevalence of scabies and impetigo. Further research is needed to determine the durability of impact, and the effectiveness of MDA regimens in larger populations.
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Affiliation(s)
- Susanna J Lake
- Tropical Diseases Research Group, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Melbourne Children's Global Health, Melbourne, Australia
| | - John M Kaldor
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - Myra Hardy
- Tropical Diseases Research Group, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Melbourne Children's Global Health, Melbourne, Australia
| | - Daniel Engelman
- Tropical Diseases Research Group, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Melbourne Children's Global Health, Melbourne, Australia
| | - Andrew C Steer
- Tropical Diseases Research Group, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Melbourne Children's Global Health, Melbourne, Australia
| | - Lucia Romani
- Tropical Diseases Research Group, Murdoch Children's Research Institute, Melbourne, Australia.,Kirby Institute, University of New South Wales, Sydney, Australia
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Abstract
BACKGROUND Impetigo is a common superficial skin infection that affects people worldwide and is usually treated with antibiotics; therefore, its management has implications for global antibiotic stewardship. OBJECTIVE This systematic review and narrative synthesis compares and contrasts international impetigo management guidelines. METHODS Guidelines for treatment of impetigo that were produced by a national authority; available to primary care physicians; and published since 2008 were included. Following a comprehensive search strategy, data extraction from eligible studies was performed independently in duplicate. Details of antiseptic and antibiotic treatment; methicillin-resistant Staphylococcus aureus treatment; and conservative management and preventative measures were tabulated and analysed descriptively. RESULTS Fifty-one guidelines were included from 42 different countries. All guidelines recommended systemic antibiotics, 78% of these only for widespread lesions or failure of topical antibiotic treatment. The first-line systemic antibiotic treatment was restricted to narrow-spectrum options in 21 (41%) whilst 7 (14%) recommended only broad-spectrum antibiotics first-line. Thirty-four (67%) guidelines included recommendations for topical antibiotic use. Twenty guidelines (39%) did not mention antiseptic treatment for impetigo. Guidelines did not always provide clear indications for different treatment options. CONCLUSIONS Despite potentially equal efficacy to systemic antibiotics, only two-thirds of guidelines include topical antibiotic options. Many fail to include recommendations for non-antibiotic treatments such as antiseptics, preventative measures and conservative management, despite potential for antibiotic-sparing. Provision of clear definitions of disease severity and indications for treatment would enhance the ability of clinicians to adhere to recommendations. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42018117770.
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Affiliation(s)
- Leanne M Hall
- College of Medicine and Dentistry, James Cook University, Mackay Clinical School, Mackay, QLD, Australia
| | - Hilary J Gorges
- College of Medicine and Dentistry, James Cook University, Mackay Clinical School, Mackay, QLD, Australia
| | - Mieke van Driel
- Primary Care Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Parker Magin
- Discipline of General Practice, University of Newcastle, Callaghan, NSW, Australia.,GP Synergy Regional Training Organisation, NSW & ACT Research and Evaluation Unit, Mayfield, Australia
| | - Nick Francis
- School of Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | - Clare F Heal
- College of Medicine and Dentistry, James Cook University, Mackay Clinical School, Mackay, QLD, Australia
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Barbieri E, Porcu G, Dona' D, Falsetto N, Biava M, Scamarcia A, Cantarutti L, Cantarutti A, Giaquinto C. Non-bullous Impetigo: Incidence, Prevalence, and Treatment in the Pediatric Primary Care Setting in Italy. Front Pediatr 2022; 10:753694. [PMID: 35433549 PMCID: PMC9008221 DOI: 10.3389/fped.2022.753694] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 03/07/2022] [Indexed: 11/24/2022] Open
Abstract
UNLABELLED Impetigo is a common skin infection in children. The worldwide prevalence in children is estimated to be 12%, but this may be lower since high-income countries are under-represented. This research aims to evaluate the incidence, prevalence, and management of children with non-bullous impetigo (NBI) residing in Italy. This retrospective cohort study included children up to 14 years of age enrolled in the Pedianet database from January 2004 to June 2018. Events were identified searching ICD9-CM codes (684 and 694.3) and free text fields for a diagnosis of NBI reported during a primary care visit. Diagnoses were manually validated, and events registered within 30-days after the index date were considered follow-ups. Incidence (IR) and prevalence (PR) rates of NBI were stratified by sex, age group, and calendar year. Topical and systemic antibiotic treatments were grouped based on ATC codes. 15,136 NBI episodes occurred in a total cohort of 225,979 children. The overall IR of NBI was 9.5 per 1,000 person-years, and children aged 1-4 years had the highest IR (13.2 per 1,000 person-years). A significant decrease in NBI IR from 13 per 1,000 person-years in 2004 to 7.46 per 1,000 person-years in 2018 (p < 0.0001) was noted. Most of the episodes were treated; systemic antibiotics were preferred over topical. CONCLUSION The prevalence of NBI in children in Italy is less than one third than the global estimate and the trend in time is decreasing. Over prescriptions of systemic antibiotics pose a threat to the diffusion of antimicrobial resistance.
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Affiliation(s)
- Elisa Barbieri
- Division of Pediatric Infectious Diseases, Department for Woman and Child Health, University of Padua, Padua, Italy
| | - Gloria Porcu
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy.,National Centre for Healthcare Research and Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Daniele Dona'
- Division of Pediatric Infectious Diseases, Department for Woman and Child Health, University of Padua, Padua, Italy
| | | | | | | | | | - Anna Cantarutti
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy.,National Centre for Healthcare Research and Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy.,Società Servizi Telematici - Pedianet, Padua, Italy
| | - Carlo Giaquinto
- Division of Pediatric Infectious Diseases, Department for Woman and Child Health, University of Padua, Padua, Italy.,Società Servizi Telematici - Pedianet, Padua, Italy
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Russell ER, Tripathi R, Carroll BT. Emergency department utilization for impetigo among the pediatric population: A retrospective study of the national emergency department sample 2013-2015. Pediatr Dermatol 2021; 38:1111-1117. [PMID: 34338362 DOI: 10.1111/pde.14729] [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] [Indexed: 11/28/2022]
Abstract
BACKGROUND Despite the large burden of impetigo in childhood and high frequency of pediatric emergency department (ED) visits for skin conditions, limited information exists on the use of EDs for impetigo among US children. OBJECTIVE Our study aimed to generate national estimates of ED utilization and to identify sociodemographic predictors of impetigo-related ED visits. METHODS This was a retrospective, cross-sectional study of children ages 1-17 presenting to EDs with a primary diagnosis of impetigo using years 2013-2015 of the Nationwide Emergency Department Sample. RESULTS Impetigo accounted for 163 909 of the 71 488, 511 pediatric ED visits and was the fourth most common presenting skin diagnosis. Controlling for sociodemographic factors, patients presenting to the ED with impetigo were most likely to be 6-11 years old, male, and from lower-income quartiles. Patients were most likely to be uninsured and most likely to present on weekends in the summer. CONCLUSION This study provided national-level estimates of ED use for impetigo among US children. Ultimately, the identification of factors associated with increased ED utilization may help in developing targeted interventions to reduce the use of emergency care for impetigo.
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Affiliation(s)
- Emma R Russell
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Raghav Tripathi
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Bryan T Carroll
- Case Western Reserve University School of Medicine, Cleveland, OH, USA.,University Hospitals Cleveland Medical Center Department of Dermatology, Cleveland, OH, USA
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Galli L, Novelli A, Ruggiero G, Stefani S, Fortina AB. Pediatric impetigo: an expert panel opinion about its main controversies. J Chemother 2021; 34:279-285. [PMID: 34405763 DOI: 10.1080/1120009x.2021.1961185] [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] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Bacterial impetigo is one of the most common skin infection in childhood. Uncertainty exists about its management. This article offers practical suggestions, given the existing evidence and experts' opinions, for correctly managing pediatric impetigo in both hospital and ambulatory settings. Italian physicians with an expertise on pediatric impetigo appointed a working group. A preliminary literature search using Pubmed/MEDLINE and Cochrane Library databases has been performed. The most common controversial issues about pediatric impetigo have been identified and then discussed from multidisciplinary perspectives, according to the 'structured controversy' methodology, a technique discovered and designed to get engaged in a controversy and then guide participants to seek consensus. The expert panels identified 10 main controversies about pediatric impetigo. All of them have been discussed from dermatological, pediatric, pharmacological and microbiological points of view reaching consensus. Each controversy has been revised thus giving practical issues for an easy use in clinical practice. Based on clinical experts' opinion, local epidemiology and literature review this article offers practical suggestions for the management of pediatric impetigo trying to reduce uncertainty in this setting of care.
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Affiliation(s)
- Luisa Galli
- Department of Health Sciences, University of Florence, Paediatric Infectious Diseases Division, Anna Meyer Children's University Hospital, Florence, Italy
| | - Andrea Novelli
- Department of Health Sciences, Clinical Pharmacology and Oncology Section, University of Florence, Florence, Italy
| | - Giuseppe Ruggiero
- National Head of the Dermatology Study Group of the Italian Federation of General Pediatricians, Rome, Italy
| | - Stefania Stefani
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
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Aquino TM, Calvarido MG, North JP. Interleukin 36 expression in psoriasis variants and other dermatologic diseases with psoriasis-like histopathologic features. J Cutan Pathol 2021; 49:123-132. [PMID: 34346097 DOI: 10.1111/cup.14115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 04/02/2021] [Revised: 05/30/2021] [Accepted: 07/14/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Elevated epidermal interleukin (IL)-36 expression distinguishes psoriasis from eczematous dermatitis, but other psoriasiform dermatitides (PDs) have not been thoroughly investigated for IL-36 expression. In this study, we assess the IL-36 staining pattern (IL36-SP) in psoriasis variants and other PDs including lichen simplex chronicus (LSC), prurigo nodularis (PN), lichen planus (LP), tinea, pityriasis rubra pilaris (PRP), mycosis fungoides (MF), pemphigus foliaceus (PF), acute generalized exanthematous pustulosis (AGEP), impetigo (IMP), and syphilis (SY). METHODS IL-36 immunostaining was performed on 307 cases of psoriasis and various PDs. IL36-SP in the upper epidermis was graded on a scale of 0-4. RESULTS High IL36-SP occurred in all variants of psoriasis, as well as in AGEP, PRP, PN, tinea, IMP, and LP (P > 0.05). SY, PF, LSC, and MF showed a lower IL36-SP (P ≤ 0.05) compared with psoriasis. CONCLUSION All variants of psoriasis exhibit high IL36-SP. IL-36 staining can assist in differentiating MF, PF, SY, and LSC from psoriasis, particularly MF and LSC, which have consistent low IL-36 expression. AGEP, PRP, tinea, IMP, PN, and LP exhibit high IL-36 expression similar to psoriasis, indicating Th17 activation in these diseases.
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Gahlawat G, Tesfaye W, Bushell M, Abrha S, Peterson GM, Mathew C, Sinnollareddy M, McMillan F, Samarawickrema I, Calma T, Chang AY, Engelman D, Steer A, Thomas J. Emerging Treatment Strategies for Impetigo in Endemic and Nonendemic Settings: A Systematic Review. Clin Ther 2021; 43:986-1006. [PMID: 34053699 DOI: 10.1016/j.clinthera.2021.04.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 01/26/2021] [Revised: 03/31/2021] [Accepted: 04/20/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE Impetigo affects approximately 162 million children worldwide at any given time. Lack of consensus on the most effective treatment strategy for impetigo and increasing antibiotic resistance continue to drive research into newer and alternative treatment options. We conducted a systematic review to assess the effectiveness of new treatments for impetigo in endemic and nonendemic settings. METHODS We searched PubMed, MEDLINE, CINAHL, Web of Science, and Embase via Scopus for studies that explored treatments for bullous, nonbullous, primary, and secondary impetigo published between August 1, 2011, and February 29, 2020. We also searched online trial registries and hand-searched the reference lists of the included studies. We used the revised Cochrane risk of bias (version 2.0) tool for randomized trials and the National Heart, Lung, and Blood Institute for nonrandomized uncontrolled studies to assess the risk of bias. FINDINGS We included 10 studies that involved 6651 participants and reported on 9 treatments in the final analysis. Most clinical trials targeted nonbullous impetigo or did not specify this. The risk of bias varied among the studies. In nonendemic settings, ozenoxacin 1% cream appeared to have the strongest evidence base compared with retapamulin and a new minocycline formulation. In endemic settings, oral co-trimoxazole and benzathine benzylpenicillin G injection were equally effective in the treatment of severe impetigo. Mass drug administration intervention emerged as a promising public health strategy to reduce the prevalence of impetigo in endemic settings. IMPLICATIONS This review highlights the limited research into new drugs used for the treatment of impetigo in endemic and nonendemic settings. Limited recent evidence supports the use of topical ozenoxacin or retapamulin for impetigo treatment in nonendemic settings, whereas systemic antibiotics and the mass drug administration strategy have evidence for use in endemic settings. Given the troubling increase in resistance to existing treatments, there is a clear need to ensure the judicious use of antibiotics and to develop new treatments and alternative strategies; this is particularly important in endemic settings. PROSPERO identifier: CRD42020173042.
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Affiliation(s)
- Garima Gahlawat
- Faculty of Health, University of Canberra, Canberra, Australia
| | - Wubshet Tesfaye
- Faculty of Health, University of Canberra, Canberra, Australia
| | - Mary Bushell
- Faculty of Health, University of Canberra, Canberra, Australia
| | - Solomon Abrha
- Faculty of Health, University of Canberra, Canberra, Australia; Mekelle University, Mekelle, Ethiopia
| | - Gregory M Peterson
- Faculty of Health, University of Canberra, Canberra, Australia; University of Tasmania, Hobart, Tasmania, Australia
| | - Cynthia Mathew
- Faculty of Health, University of Canberra, Canberra, Australia
| | | | - Faye McMillan
- School of Nursing, Midwifery and Indigenous Health, Charles Sturt University, Bathurst, Australia
| | | | - Tom Calma
- Faculty of Health, University of Canberra, Canberra, Australia
| | | | - Daniel Engelman
- Murdoch Children's Research Institute, University of Melbourne, Melbourne, Australia
| | - Andrew Steer
- Murdoch Children's Research Institute, University of Melbourne, Melbourne, Australia
| | - Jackson Thomas
- Faculty of Health, University of Canberra, Canberra, Australia.
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13
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Abstract
Scabies is an infestation of the skin caused by the mite Sarcoptes scabiei. In 2017, scabies was recognised by the World Health Organisation as a disease of public importance and was consequently added to the list of neglected tropical diseases. An estimated 200 million people currently have scabies worldwide. Scabies is endemic in many developing countries, with the highest prevalence being in hot, humid climates such as the Pacific and Latin American regions. Scabies causes a host immune response which is intensely itchy. Scratching of the lesions can lead to secondary bacterial infections of the skin, such as impetigo, most commonly caused by Streptococcus pyogenes or Staphylococcus aureus. This can have fatal consequences, such as septicaemia, glomerulonephritis, and rheumatic heart disease. Advances over the past 5 years indicate that mass drug administration is an effective strategy to treat scabies. This review will outline advances in the mite biology, epidemiological understanding, diagnosis, and treatment of scabies.
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Affiliation(s)
- Emily Welch
- St Vincent’s Hospital, University of New South Wales, Sydney, Australia
| | | | - Margot J Whitfeld
- St Vincent’s Hospital, University of New South Wales, Sydney, Australia
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14
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Hoffmann TC, Peiris R, Glasziou P, Cleo G, Mar CD. Natural history of non-bullous impetigo: a systematic review of time to resolution or improvement without antibiotic treatment. Br J Gen Pract 2021; 71:e237-42. [PMID: 33558328 DOI: 10.3399/bjgp20X714149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 09/12/2020] [Indexed: 11/20/2022] Open
Abstract
Background Non-bullous impetigo is typically treated with antibiotics. However, the duration of symptoms without their use has not been established, which hampers informed decision making about antibiotic use. Aim To determine the natural history of non-bullous impetigo. Design and setting Systematic review. Method The authors searched PubMed up to January 2020, as well as reference lists of articles identified in the search. Eligible studies involved participants with impetigo in either the placebo group of randomised trials, or in single-group prognostic studies that did not use antibiotics and measured time to resolution or improvement. A modified version of a risk of bias assessment for prognostic studies was used. Outcomes were percentage of participants who had either symptom resolution, symptom improvement, or failed to improve at any timepoint. Adverse event data were also extracted. Results Seven randomised trials (557 placebo group participants) were identified. At about 7 days, the percentage of participants classified as resolved ranged from 13% to 74% across the studies, whereas the percentage classified as ‘failure to improve’ ranged from 16% to 41%. The rate of adverse effects was low. Incomplete reporting of some details limited assessment of risk of bias. Conclusion Although some uncertainty around the natural history of non-bullous impetigo remains, symptoms resolve in some patients by about 7 days without using antibiotics, with about one-quarter of patients not improving. Immediate antibiotic use may not be mandatory, and discussions with patients should include the expected course of untreated impetigo and careful consideration of the benefits and harms of antibiotic use.
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15
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Mahesh S, Kozymenko T, Kolomiiets N, Vithoulkas G. Antimonium crudum in pediatric skin conditions: A classical homeopathic case series. Clin Case Rep 2021; 9:818-824. [PMID: 33598251 PMCID: PMC7869354 DOI: 10.1002/ccr3.3674] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 11/28/2020] [Accepted: 12/04/2020] [Indexed: 11/16/2022] Open
Abstract
Homeopathic Antimonium crudum may be useful in many pediatric skin conditions if prescribed on symptom similarity. It may especially be helpful in reducing the use of antibiotics and steroids in this age-group if proven to be effective through larger scientific studies.
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Affiliation(s)
- Seema Mahesh
- School of MedicineFaculty of Health and Medical SciencesTaylor’s UniversitySelangorMalaysia
| | - Tamara Kozymenko
- Private Higher Educational EstablishmentKyiv Medical UniversityKyivUkraine
| | | | - George Vithoulkas
- Postgraduate Doctors’ Training InstituteHealth Care Ministry of the Chuvash RepublicCheboksaryRussia
- International Academy of Classical HomeopathyAlonissosGreece
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16
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Marks M, Romani L, Sokana O, Neko L, Harrington R, Nasi T, Wand H, Whitfeld MJ, Engelman D, Solomon AW, Kaldor JM, Steer AC. Prevalence of Scabies and Impetigo 3 Years After Mass Drug Administration With Ivermectin and Azithromycin. Clin Infect Dis 2021; 70:1591-1595. [PMID: 31131410 PMCID: PMC7145994 DOI: 10.1093/cid/ciz444] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 04/08/2019] [Accepted: 05/24/2019] [Indexed: 12/01/2022] Open
Abstract
Background Ivermectin-based mass drug administration has emerged as a promising strategy for the control of scabies and impetigo in settings where the diseases are endemic. Current follow-up data are limited to 12 months for the majority of studies. Longer-term data are vital to inform the sustainability of interventions. Methods We conducted a prevalence survey for scabies and impetigo in 10 villages in Choiseul Province of the Solomon Islands 36 months after a single round of ivermectin and azithromycin mass drug coadministration. In the primary analysis, we compared the prevalence of scabies and impetigo at 36 months to the prevalence at baseline. Results At 36 months, the prevalence of scabies was 4.7% (95% confidence interval [CI], 3.6–6.1), which was significantly lower than at baseline (18.7%; relative reduction, 74.9%; 95% CI, 61.5%–87.7%; P < .001). The prevalence of impetigo was 9.6% (95% CI, 8.1%–11.4%), significantly lower than at baseline (24.7%; relative reduction, 61.3%; 95% CI, 38.7%–100%; P < .001). The highest prevalence of scabies was among children aged <5 years (12.5%; adjusted odds ratio, 33.2; 95% CI, 6.6–603.2), and the highest prevalence of impetigo was among children aged 5–9 years (16.4%; adjusted odds ratio, 8.1; 95% CI, 3.6–21.8). Conclusions There was a sustained impact of a single round of ivermectin and azithromycin mass drug coadministration on the prevalence of scabies and impetigo 3 years after the intervention. Our data provide further support to adopt this intervention as a central component of global scabies control efforts. Clinical Trials Registration Australian and New Zealand Trials Registry (ACTRN12615001199505).
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Affiliation(s)
- Michael Marks
- Clinical Research Department, Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom.,Hospital for Tropical Diseases, London, United Kingdom
| | - Lucia Romani
- Kirby Institute, University of New South Wales, Sydney.,Murdoch Children's Research Institute, Melbourne, Australia
| | | | - Lazarus Neko
- Ministry of Health and Medical Services, Choiseul
| | | | - Titus Nasi
- Ministry of Health and Medical Services, Honiara
| | - Handan Wand
- Kirby Institute, University of New South Wales, Sydney
| | | | - Daniel Engelman
- Murdoch Children's Research Institute, Melbourne, Australia.,Centre for International Child Health, University of Melbourne, Melbourne, Australia
| | - Anthony W Solomon
- Clinical Research Department, Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom.,Hospital for Tropical Diseases, London, United Kingdom
| | - John M Kaldor
- Kirby Institute, University of New South Wales, Sydney
| | - Andrew C Steer
- Kirby Institute, University of New South Wales, Sydney.,Centre for International Child Health, University of Melbourne, Melbourne, Australia
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17
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van den Boogaard J, Hahné SJ, Te Wierik MJ, Knol MJ, Balasegaram S, de Gier B. Out-of-season increase of puerperal fever with group A Streptococcus infection: a case-control study, Netherlands, July to August 2018. ACTA ACUST UNITED AC 2021; 25. [PMID: 33034283 PMCID: PMC7545820 DOI: 10.2807/1560-7917.es.2020.25.40.1900589] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We observed an increase in notifications of puerperal group A Streptococcus (GAS) infections in July and August 2018 throughout the Netherlands without evidence for common sources. General practitioners reported a simultaneous increase in impetigo. We hypothesised that the outbreak of puerperal GAS infections resulted from increased exposure via impetigo in the community.We conducted a case-control study to assess peripartum exposure to possible, non-invasive GAS infections using an online questionnaire. Confirmed cases were recruited through public health services while probable cases and controls were recruited through social media. We calculated odds ratios (OR) and 95% confidence intervals (95% CI) with logistic regression analysis.We enrolled 22 confirmed and 23 probable cases, and 2,400 controls. Contact with persons with impetigo were reported by 8% of cases and 2% of controls (OR: 3.26, 95% CI: 0.98-10.88) and contact with possible GAS infections (impetigo, pharyngitis or scarlet fever) by 28% and 9%, respectively (OR: 4.12, 95% CI: 1.95-8.68). In multivariable analysis, contact with possible GAS infections remained an independent risk factor (aOR: 4.28, 95% CI: 2.02-9.09).We found an increased risk of puerperal fever after community contact with possible non-invasive GAS infections. Further study of this association is warranted.
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Affiliation(s)
- Jossy van den Boogaard
- European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden.,National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Susan Jm Hahné
- National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Margreet Jm Te Wierik
- National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Mirjam J Knol
- National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Sooria Balasegaram
- Public Health England, London, United Kingdom.,European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Brechje de Gier
- National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
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18
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Ghosh P, Tesfaye W, Manandhar A, Calma T, Bushell M, Oguoma VM, Kosari S, McMillan F, Peterson G, Thomas J. Mass drug administration campaigns for scabies and impetigo: protocol for a systematic review and meta-analysis. BMJ Paediatr Open 2021; 5:e001132. [PMID: 34263086 PMCID: PMC8245437 DOI: 10.1136/bmjpo-2021-001132] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 05/27/2021] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Scabies is recognised as a neglected tropical disease, disproportionately affecting the most vulnerable populations around the world. Impetigo often occurs secondarily to scabies. Several studies have explored mass drug administration (MDA) programmes, with some showing positive outcomes-but a systematic evaluation of such studies is yet to be reported. The main aim of this systematic review is to generate comprehensive evidence on the effect and feasibility of MDA programmes in reducing the burden of scabies and impetigo. METHODS AND ANALYSIS A systematic review and meta-analysis will be conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis statement. Electronic databases to be searched will include CINAHL EBSCOhost, Medline Ovid, ProQuest, Science Direct, PubMed and SCOPUS. In addition, grey literature will be explored via the Australian Institute of Health and Welfare, Australian Indigenous HealthInfoNet, Informit, OaIster database and WHO. No language restrictions will be applied. All treatment studies following an MDA protocol, including randomised/quasi-controlled trials, and prospective before-after interventional studies, will be considered. The main outcome is the change in prevalence of scabies and impetigo The Cochrane collaboration risk of bias assessment tool will be used for assessing the methodological quality of studies. A random-effect restricted maximum likelihood meta-analysis will be performed to generate pooled effect (OR) using STATA V.16. Appropriate statistical tests will be carried out to quantify heterogeneity between studies and publication bias. ETHICS AND DISSEMINATION Ethical approval is not required since data will be extracted from published works. The findings will be communicated to the scientific community through a peer-reviewed journal publication. This systematic review will present an evidence on the effect of MDA interventions on scabies and impetigo, which is instrumental to obtain a clear understanding of the treatments widely used in these programmes. PROSPERO REGISTRATION NUMBER CRD42020169544.
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Affiliation(s)
- Pousali Ghosh
- Health, University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Wubshet Tesfaye
- Health Research Institute, University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Avilasha Manandhar
- Health, University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Thomas Calma
- Health, University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Mary Bushell
- Health, University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Victor M Oguoma
- Health Research Institute, University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Sam Kosari
- Health, University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Faye McMillan
- School of Public Health and Community Medicine, The University of New South Wales, Kensington, New South Wales, Australia
| | - Greg Peterson
- Health, University of Canberra, Canberra, Australian Capital Territory, Australia.,School of Pharmacy and Pharmacology, University of Tasmania, Hobart, Tasmania, Australia
| | - Jackson Thomas
- Health, University of Canberra, Canberra, Australian Capital Territory, Australia
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19
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Abrha S, Tesfaye W, Thomas J. Intolerable Burden of Impetigo in Endemic Settings: A Review of the Current State of Play and Future Directions for Alternative Treatments. Antibiotics (Basel) 2020; 9:E909. [PMID: 33333955 PMCID: PMC7765423 DOI: 10.3390/antibiotics9120909] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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] [Received: 11/21/2020] [Revised: 12/11/2020] [Accepted: 12/14/2020] [Indexed: 01/22/2023] Open
Abstract
Impetigo (school sores) is a common superficial bacterial skin infection affecting around 162 million children worldwide, with the highest burden in Australian Aboriginal children. While impetigo itself is treatable, if left untreated, it can lead to life-threatening conditions, such as chronic heart and kidney diseases. Topical antibiotics are often considered the treatment of choice for impetigo, but the clinical efficacy of these treatments is declining at an alarming rate due to the rapid emergence and spread of resistant bacteria. In remote settings in Australia, topical antibiotics are no longer used for impetigo due to the troubling rise of antimicrobial resistance, demanding the use of oral and injectable antibiotic therapies. However, widespread use of these agents not only contributes to existing resistance, but also associated with adverse consequences for individuals and communities. These underscore the urgent need to reinvigorate the antibiotic discovery and alternative impetigo therapies in these settings. This review discusses the current impetigo treatment challenges in endemic settings in Australia and explores potential alternative antimicrobial therapies. The goals are to promote intensified research programs to facilitate effective use of currently available treatments, as well as developing new alternatives for impetigo.
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Affiliation(s)
- Solomon Abrha
- Faculty of Health, University of Canberra, Canberra, ACT 2617, Australia; (S.A.); (W.T.)
- Department of Pharmaceutics, School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle 7000, Ethiopia
| | - Wubshet Tesfaye
- Faculty of Health, University of Canberra, Canberra, ACT 2617, Australia; (S.A.); (W.T.)
| | - Jackson Thomas
- Faculty of Health, University of Canberra, Canberra, ACT 2617, Australia; (S.A.); (W.T.)
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20
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Davino G, D'Alvano T, Esposito S. The Use of Ozenoxacin in Pediatric Patients: Clinical Evidence, Efficacy and Safety. Front Pharmacol 2020; 11:559708. [PMID: 33364940 PMCID: PMC7751750 DOI: 10.3389/fphar.2020.559708] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 10/09/2020] [Indexed: 11/30/2022] Open
Abstract
Impetigo is the most common childhood skin infection in the world. There are two patterns of impetigo: nonbullous (or impetigo contagiosa) and bullous. The nonbullous type is due to Staphylococcus aureus and group A beta-haemolytic Streptococcus and occurs in 70% of impetigo cases. Impetigo is often a self-limited disease, but complications can sometimes occur. Therapy depends on the extent and site of the lesions and on the presence of systemic symptoms. The increase in multidrug resistance pathogens, such as methicillin-resistant Staphylococcus aureus, mupirocin-resistant Staphylococcus aureus or quinolone-resistant Staphylococcus aureus, requires the development of new antibiotics against these agents. The aim of this review is to evaluate the efficacy and safety of ozenoxacin in children compared to those of other approved topical antimicrobial therapies. The bactericidal activity against both susceptible and resistant organisms is a relevant feature of ozenoxacin because the bacterial strain and potential for resistance are generally not known at the beginning of therapy. Additionally, its minimal dermal absorption and its capability to reach high concentrations in the upper layers of the epidermidis agrees with the recommended practice aimed at avoiding the emergence of bacterial resistance in presence of a good safety profile. Further studies with real-life analyses and pharmacoeconomic evaluation are needed to confirm its role as first-line and second-line therapy in children with impetigo.
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Affiliation(s)
- Giusy Davino
- Pediatric Clinic, Department of Medicine and Surgery, Pietro Barilla Children's Hospital, University of Parma, Parma, Italy
| | - Tiziana D'Alvano
- Pediatric Clinic, Department of Medicine and Surgery, Pietro Barilla Children's Hospital, University of Parma, Parma, Italy
| | - Susanna Esposito
- Pediatric Clinic, Department of Medicine and Surgery, Pietro Barilla Children's Hospital, University of Parma, Parma, Italy
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21
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Abrha S, Bartholomaeus A, Tesfaye W, Thomas J. Impetigo Animal Models: A Review of Their Feasibility and Clinical Utility for Therapeutic Appraisal of Investigational Drug Candidates. Antibiotics (Basel) 2020; 9:E694. [PMID: 33066386 DOI: 10.3390/antibiotics9100694] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/06/2020] [Accepted: 10/07/2020] [Indexed: 01/12/2023] Open
Abstract
Impetigo (school sores), a superficial skin infection commonly seen in children, is caused by the gram-positive bacteria Staphylococcus aureus and/or Streptococcus pyogenes. Antibiotic treatments, often topical, are used as the first-line therapy for impetigo. The efficacy of potential new antimicrobial compounds is first tested in in vitro studies and, if effective, followed by in vivo studies using animal models and/or humans. Animal models are critical means for investigating potential therapeutics and characterizing their safety profile prior to human trials. Although several reviews of animal models for skin infections have been published, there is a lack of a comprehensive review of animal models simulating impetigo for the selection of therapeutic drug candidates. This review critically examines the existing animal models for impetigo and their feasibility for testing the in vivo efficacy of topical treatments for impetigo and other superficial bacterial skin infections.
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22
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Affiliation(s)
- Qian Yu
- Department of Medical Mycology, Shanghai Dermatology Hospital, Shanghai, People's Republic of China
| | - Wei Li
- Department of Medical Cosmetology, Shanghai Dermatology Hospital, Shanghai, People's Republic of China
| | - Lianjuan Yang
- Department of Medical Mycology, Shanghai Dermatology Hospital, Shanghai, People's Republic of China
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23
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Salatin S, Lotfipour F, Jelvehgari M. Preparation and characterization of a novel thermosensitive and bioadhesive cephalexin nanohydrogel: a promising platform for topical antibacterial delivery. Expert Opin Drug Deliv 2020; 17:881-893. [PMID: 32441175 DOI: 10.1080/17425247.2020.1764530] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Impetigo is a common and highly contagious bacterial skin infection that mostly affects young children and infants. Herein, we report the development of a thermosensitive and bioadhesive in-situ hydrogel-forming system containing cephalexin-loaded nanoparticles (NPs) suitable for antibacterial drug delivery. METHODS The nanohydrogel was formulated using drug-loaded NPs and characterized by its physicochemical characteristics. Antibacterial activities of the cephalexin NPs and nanohydrogel were examined in vitro against Staphylococcus aureus (S. aureus). The ex vivo drug permeation study was performed using rat skin. Finally, this formulation was tested for in vivo antibacterial activity using superficial skin infections in rats. RESULTS The mean size and entrapment efficiency of the NPs were found to be 178 nm and 58%, respectively. The transmission electron microscopy analysis verified the formation of spherical NPs. The drug-loaded NPs showed an enhanced eradication effect against S. aureus according to the declined MIC values in comparison with the untreated drug. The ex vivo permeation profile of the cephalexin nanohydrogel showed a slow release pattern for 8 h. When applied on rat skin for 6 days, the nanohydrogel exhibited a superior antibacterial activity with normal hair growth and skin appearance as compared to the plain drug hydrogel. CONCLUSIONS These findings suggested that the nanohydrogel could serve as a valuable drug delivery platform against superficial bacterial infections.
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Affiliation(s)
- Sara Salatin
- Department of Pharmaceutics, Faculty of Pharmacy, Tabriz University of Medical Sciences , Tabriz, Iran.,Student Research Committee, Tabriz University of Medical Sciences , Tabriz, Iran
| | - Farzaneh Lotfipour
- Department of Pharmaceutical and Food Control, Faculty of Pharmacy, Tabriz University of Medical Sciences , Tabriz, Iran.,Food and Drug Safety Research Center, Tabriz University of Medical Sciences , Tabriz, Iran
| | - Mitra Jelvehgari
- Department of Pharmaceutics, Faculty of Pharmacy, Tabriz University of Medical Sciences , Tabriz, Iran
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24
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Marks M, Toloka H, Baker C, Kositz C, Asugeni J, Puiahi E, Asugeni R, Azzopardi K, Diau J, Kaldor JM, Romani L, Redman-MacLaren M, MacLaren D, Solomon AW, Mabey DCW, Steer AC. Randomized Trial of Community Treatment With Azithromycin and Ivermectin Mass Drug Administration for Control of Scabies and Impetigo. Clin Infect Dis 2020; 68:927-933. [PMID: 29985978 PMCID: PMC6399435 DOI: 10.1093/cid/ciy574] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [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: 04/09/2018] [Accepted: 07/06/2018] [Indexed: 12/14/2022] Open
Abstract
Background Scabies is a public health problem in many countries, with impetigo and its complications important consequences. Ivermectin based mass drug administration (MDA) reduces the prevalence of scabies and, to a lesser extent, impetigo. We studied the impact of co-administering azithromycin on the prevalence of impetigo and antimicrobial resistance. Methods Six communities were randomized to receive either ivermectin-based MDA or ivermectin-based MDA co-administered with azithromycin. We measured scabies and impetigo prevalence at baseline and 12 months. We collected impetigo lesions swabs at baseline, 3 and 12 months to detect antimicrobial resistance. Results At baseline, scabies and impetigo prevalences were 11.8% and 10.1% in the ivermectin-only arm and 9.2% and 12.1% in the combined treatment arm. At 12 months, the prevalences had fallen to 1.0% and 2.5% in the ivermectin-only arm and 0.7% and 3.3% in the combined treatment arm. The proportion of impetigo lesions containing Staphylococcus aureus detected did not change (80% at baseline vs 86% at 12 months; no significant difference between arms) but the proportion containing pyogenic streptococci fell significantly (63% vs 23%, P < .01). At 3 months, 53% (8/15) of S. aureus isolates were macrolide-resistant in the combined treatment arm, but no resistant strains (0/13) were detected at 12 months. Conclusions Co-administration of azithromycin with ivermectin led to similar decreases in scabies and impetigo prevalence compared to ivermectin alone. The proportion of impetigo lesions containing pyogenic streptococci declined following MDA. There was a transient increase in the proportion of macrolide-resistant S. aureus strains following azithromycin MDA. Clinical Trials Registration clinicaltrials.gov (NCT02775617).
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Affiliation(s)
- Michael Marks
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, United Kingdom.,Hospital for Tropical Diseases, University College London Hospitals NHS Trust, United Kingdom
| | - Hilary Toloka
- Atoifi Adventist Hospital, Malaita Province, Solomon Islands
| | - Ciara Baker
- Group A Streptococcal Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Christian Kositz
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, United Kingdom
| | - James Asugeni
- Atoifi Adventist Hospital, Malaita Province, Solomon Islands
| | - Elliot Puiahi
- National Referral Hospital, Honiara, Solomon Islands
| | - Rowena Asugeni
- Atoifi Adventist Hospital, Malaita Province, Solomon Islands
| | - Kristy Azzopardi
- Group A Streptococcal Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Jason Diau
- Atoifi Adventist Hospital, Malaita Province, Solomon Islands
| | - John M Kaldor
- Kirby Institute, University of New South Wales, Sydney
| | - Lucia Romani
- Kirby Institute, University of New South Wales, Sydney
| | | | - David MacLaren
- College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
| | - Anthony W Solomon
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, United Kingdom.,Hospital for Tropical Diseases, University College London Hospitals NHS Trust, United Kingdom
| | - David C W Mabey
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, United Kingdom.,Hospital for Tropical Diseases, University College London Hospitals NHS Trust, United Kingdom
| | - Andrew C Steer
- National Referral Hospital, Honiara, Solomon Islands.,Centre for International Child Health, University of Melbourne, Victoria, Australia.,Department of General Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia
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25
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Gorges H, Heal C, van Driel M, Tapley A, Davis J, Davey A, Holliday E, Ball J, Najib N, Spike N, Fitzgerald K, Magin P. Prevalence and Associations of General Practice Registrars' Management of Impetigo: A Cross-Sectional Analysis From the Registrar Clinical Encounters in Training (ReCEnT) Study. Dermatol Pract Concept 2020; 10:e2020043. [PMID: 32363105 DOI: 10.5826/dpc.1002a43] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2020] [Indexed: 10/31/2022] Open
Abstract
Background Impetigo is a mild bacterial skin infection of childhood that is usually managed empirically in primary care. Objective To establish the prevalence and associations of impetigo in general practice (GP) registrars' consultations. Methods Cross-sectional analysis of the Registrar Clinical Encounters in Training (ReCEnT) study data. Results Impetigo was managed in 0.24% of problems and 0.43% of consultations. Patient variables associated with impetigo presentations were younger age and impetigo as a new problem, while patients with non-English-speaking backgrounds were less likely to present with impetigo. Associated registrar variables were being new to the registrar and practicing in outer regional/remote locations. Compared with all other problems/diagnoses, impetigo more often involved information seeking, ordering pathology, and prescription of medication, but less often involved follow-up or referral. Conclusions Impetigo accounts for 0.43 per 100 GP registrar consultations in Australia. Association with outer regional/remote areas may reflect climate and socioeconomic factors that predispose to impetigo. Associated pathology requests may reflect a lack of confidence in GP registrars' management of impetigo. Cultural differences may exist regarding health-seeking behavior relating to impetigo.
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Affiliation(s)
- Hilary Gorges
- Mackay Clinical School, College of Medicine and Dentistry, James Cook University, Mackay, Australia
| | - Clare Heal
- Mackay Clinical School, College of Medicine and Dentistry, James Cook University, Mackay, Australia
| | - Mieke van Driel
- Primary Care & General Practice, Faculty of Medicine, University of Queensland, Australia
| | | | - Joshua Davis
- Global and Tropical Health Division, Menzies School of Health Research School of Medicine, Darwin, Australia
| | | | - Elizabeth Holliday
- Biostatistics, School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Jean Ball
- Clinical Research Design and Statistics, Hunter Medical Research Institute, New Lambston Heights, Australia
| | | | - Neil Spike
- Department of General Practice, The University of Melbourne, Notting Hill, Australia
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Heal C, Gorges H, van Driel ML, Tapley A, Davis J, Davey A, Holliday L, Ball J, Najib N, Spike N, FitzGerald K, Magin P. Antibiotic stewardship in skin infections: a cross-sectional analysis of early-career GP's management of impetigo. BMJ Open 2019; 9:e031527. [PMID: 31662391 PMCID: PMC6830714 DOI: 10.1136/bmjopen-2019-031527] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To establish the prevalence and associations of systemic antibiotic prescription for impetigo by early-career general practitioners (GPs) (GP registrars in their first 18 months in general practice). DESIGN A cross-sectional analysis of data from the Registrar Clinical Encounters in Training (ReCEnT) study. SETTING ReCEnT is an ongoing multisite cohort study of Australian registrars' in-consultation clinical practice across five Australian states. PARTICIPANTS Registrars participating in ReCEnT from 2010 to 2017. OUTCOME MEASURES Management of impetigo with systemic antibiotics. RESULTS 1741 registrars (response rate 96%) provided data from 384 731 problems identified in 246 434 consultations. Impetigo, on first presentation or follow-up, was managed in 930 (0.38%, 95% CI 0.35 to 0.40) consultations and comprised 0.24% (95% CI 0.23 to 0.26) of problems. 683 patients presented with a new diagnosis of impetigo of which 38/683 (5.6%) were not prescribed antibiotics; 239/683 (35.0%) were prescribed solely topical antibiotics; 306/683 (44.8%) solely systemic antibiotics and 100/683 (14.6%) both systemic and topical antibiotics. The most common systemic antibiotic prescribed was cephalexin (53.5%). Variables independently associated with prescription of systemic antibiotics were an inner regional (compared with major city) location (OR 1.82, 95% CI 1.06 to 3.13; p=0.028), seeking in-consultation information or advice (OR 2.17, 95% CI 1.47 to 3.23; p<0.001) and ordering pathology (OR 2.13, 95% CI 1.37 to 3.33; p=0.01). CONCLUSIONS Australian early-career GPs prescribe systemic antibiotics (the majority broad-spectrum) for a high proportion of initial impetigo presentations. Impetigo guidelines should clearly specify criteria for systemic antibiotic prescription and individual antibiotic choice. The role of non-antibiotic management and topical antiseptics needs to be explored further.
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Affiliation(s)
- Clare Heal
- School of Medicine and Dentistry, James Cook University, Mackay, Queensland, Australia
| | - Hilary Gorges
- Department of General Practice and Rural Medicine, James Cook University, Mackay, Queensland, Australia
| | - Mieke L van Driel
- Academic Discipline of General Practice, University of Queensland, Brisbane, Queensland, Australia
| | - Amanda Tapley
- NSW & ACT Research and Evaluation Unit, GP Synergy Ltd - Newcastle, Newcastle, New South Wales, Australia
- Discipline of General Practice, School of Medicine & Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Josh Davis
- Global and Tropical Health Division, Menzies School of Health Research, Casuarina, New South Wales, Australia
| | - Andrew Davey
- GP Synergy Ltd, Liverpool Westfield, New South Wales, Australia
| | - L Holliday
- The University of Newcastle, Newcastle, New South Wales, Australia
| | - Jean Ball
- Clinical Research Design and Statistics, The University of Newcastle Hunter Medical Research Institute, New Lambton, New South Wales, Australia
| | - Nashwa Najib
- GP Synergy Ltd, Liverpool Westfield, New South Wales, Australia
| | - Neil Spike
- Eastern Victoria General Practice Training, Melbourne, Victoria, Australia
- University of Melbourne, Melbourne, Victoria, Australia
| | | | - Parker Magin
- Discipline of General Practice, University of Newcastle, Callaghan, New South Wales, Australia
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Mullane MJ, Barnett TC, Cannon JW, Carapetis JR, Christophers R, Coffin J, Jones MA, Marsh JA, Mc Loughlin F, O'Donnell V, Pavlos R, Smith B, Steer AC, Tong SYC, Walker R, Bowen AC. SToP (See, Treat, Prevent) skin sores and scabies trial: study protocol for a cluster randomised, stepped-wedge trial for skin disease control in remote Western Australia. BMJ Open 2019; 9:e030635. [PMID: 31551385 PMCID: PMC6773324 DOI: 10.1136/bmjopen-2019-030635] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION Skin is important in Australian Aboriginal culture informing kinship and identity. In many remote Aboriginal communities, scabies and impetigo are very common. Untreated skin infections are painful, itchy and frequently go untreated due to under-recognition and lack of awareness of their potential serious complications. We hypothesise that the skin infection burden in remote Aboriginal communities can be reduced by implementing streamlined training and treatment pathways integrated with environmental health and health promotion activities, tested in the See, Treat, Prevent (SToP skin sores and scabies) trial. METHODS AND ANALYSIS SToP will evaluate a skin control programme using a stepped-wedge, cluster randomised trial design with three intervention components (the 'SToP activities'): (1) seeing skin infections (development of training resources implemented within a community dermatology model); (2) treating skin infections (employing the latest evidence for impetigo, and scabies treatment); and (3) preventing skin infections (embedded, culturally informed health promotion and environmental health activities). Four community clusters in the remote Kimberley region of Western Australia will participate. Following baseline data collection, two clusters will be randomly allocated to the SToP activities. At 12 months, the remaining two clusters will transition to the SToP activities. The primary outcome is the diagnosis of impetigo in children (5-9 years) at school-based surveillance. Secondary outcome measures include scabies diagnosis, other child health indicators, resistance to cotrimoxazole in circulating pathogenic bacteria, determining the economic burden of skin disease and evaluating the cost effectiveness of SToP activities. ETHICS AND DISSEMINATION This study protocol was approved by the health ethics review committees at the Child and Adolescent Health Service (Approval number RGS0000000584), the Western Australian Aboriginal Health Ethics Committee (Reference number: 819) and the University of Western Australia (Reference RA/4/20/4123). Study findings will be shared with community members, academic and medical communities via publications and presentations, and in reports to funders. Authorship for all publications based on this study will be determined in line with the Uniform Requirements for Manuscripts Submitted to Biomedical Journals published by the International Committee of Medical Journal Editors. Sharing results with organisations and communities who contributed to the study is paramount. The results of the SToP trial will be shared with participants in a suitable format, such as a single summary page provided to participants or presentations to communities, the Kimberly Aboriginal Health Planning Forum Research Subcommittee and other stakeholders as appropriate and as requested. Communication and dissemination will require ongoing consultation with Aboriginal communities to determine appropriate formats. TRIAL REGISTRATION NUMBER ACTRN12618000520235.
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Affiliation(s)
- Marianne J Mullane
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia
| | - Timothy C Barnett
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia
| | - Jeffrey W Cannon
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia
| | - Jonathan R Carapetis
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia
- Faculty of Health and Medical Sciences, University of Western Australia, Crawley, Western Australia, Australia
- Department of Paediatric Infectious Diseases, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Ray Christophers
- Nirrumbuk Environmental Health & Services, Nirrumbuk Aboriginal Corporation, Broome, Western Australia, Australia
| | - Juli Coffin
- Aboriginal Health, Telethon Kids Kimberley, Telethon Kids Institute, University of Western Australia, Broome, Western Australia, Australia
- Nulungu Research Institute, University of Notre Dame, Broome, Western Australia, Australia
| | - Mark A Jones
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia
| | - Julie A Marsh
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia
| | - Frieda Mc Loughlin
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia
| | - Vicki O'Donnell
- Kimberley Aboriginal Medical Services, Broome, Western Australia, Australia
| | - Rebecca Pavlos
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia
| | - Bec Smith
- Western Australian Country Health Services-Kimberley, Broome, Western Australia, Australia
| | - Andrew C Steer
- Tropical Diseases Research Group, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
- Department of General Paediatrics, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Steven Y C Tong
- Peter Doherty Institute for Infection and Immunity, Royal Melbourne Hospital and The University of Melbourne, Melbourne, Victoria, Australia
- Menzies School of Health Research, Casuarina, Northern Territory, Australia
| | - Roz Walker
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia
| | - Asha C Bowen
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia
- Faculty of Health and Medical Sciences, University of Western Australia, Crawley, Western Australia, Australia
- Department of Paediatric Infectious Diseases, Perth Children's Hospital, Nedlands, Western Australia, Australia
- Menzies School of Health Research, Casuarina, Northern Territory, Australia
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Amgarth-Duff I, Hendrickx D, Bowen A, Carapetis J, Chibawe R, Samson M, Walker R. Talking skin: attitudes and practices around skin infections, treatment options, and their clinical management in a remote region in Western Australia. Rural Remote Health 2019; 19:5227. [PMID: 31540550 DOI: 10.22605/rrh5227] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Skin infections including scabies and impetigo have a high burden and cause significant morbidity in remote Aboriginal communities in Australia. Nevertheless, there is limited knowledge about community, healthcare practitioner and service provider perspectives on skin infections and treatment preferences. An increased understanding of their respective knowledge, attitudes and practices will contribute to improving healthcare seeking behaviour, improved diagnosis, treatment acceptability and quality of care within remote Aboriginal communities. The aim of this study was to explore Aboriginal parent/carer, healthcare practitioner, and service provider attitudes and practices regarding skin infections in Aboriginal communities in remote communities in the Pilbara, Western Australia. The study documents their perspectives and preferences regarding treatments for skin infections, as well as the perceived barriers and enablers to treatment uptake for scabies and impetigo amongst Aboriginal families in this region. METHODS A qualitative study consisting of semi-structured interviews and focus group discussions was conducted with parents/carers, healthcare practitioners and community service providers in four remote communities in Western Australia. All interviews and focus group discussions were voice recorded and data were analysed using NVivo software and thematic analysis. RESULTS Despite the high burden, skin infections were considered normal in these communities, and their impact on child health was under-recognised. Common themes identified by all participants included the inadequacy of health services, the pain of the benzathine penicillin G injection, uncertainty regarding the use of oral antibiotics and topical creams, and the need for health practitioner training and improved communication and resources. CONCLUSION Documenting carer, service provider and healthcare practitioner perspectives on skin infections provides a more informed understanding of the context in which treatment decisions are made. The ongoing need for culturally appropriate targeted, translational health education; improved treatment guidelines and feasible, painless treatments; and potential for the use of bush medicines for skin infections were themes that emerged.
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Affiliation(s)
- Ingrid Amgarth-Duff
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), University of Technology Sydney, 235 Jones Street, Ultimo, NSW, 2007, Australia
| | - David Hendrickx
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute and Division of Paediatrics, School of Medicine, University of Western Australia, Northern Entrance, Perth Children's Hospital, 15 Hospital Avenue, Nedlands, WA 6009, Australia
| | - Asha Bowen
- Department of Infectious Disease, Perth Children's Hospital, 15 Hospital Avenue, Nedlands, WA 6009; Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, 15 Hospital Avenue, Nedlands, WA 6009; Division of Paediatrics, School of Medicine, University of Western Australia, Nedlands, WA 6009; and Menzies School of Health Research, Charles Darwin University, NT 0810, Australia
| | - Jonathan Carapetis
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, 15 Hospital Avenue, Nedlands, WA 6009; Division of Paediatrics, School of Medicine, University of Western Australia, Nedlands, WA 6009; Department of Infectious Disease, Perth Children's Hospital, 15 Hospital Avenue, Nedlands, WA 6009, Australia
| | - Robby Chibawe
- Puntukurnu Aboriginal Medical Service Unit 5, 15, Iron Ore Parade, Newman, WA 6753, Australia
| | - Margaret Samson
- Jigalong Community Council, Pmb 8, Newman, WA 6753, Australia
| | - Roz Walker
- Telethon Kids Institute, Centre for Child Health, The University of Western Australia, Nedlands, WA 6009, Australia
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Duldulao PM, Ortega AE, Delgadillo X. Mycotic and Bacterial Infections. Clin Colon Rectal Surg 2019; 32:333-339. [PMID: 31507342 DOI: 10.1055/s-0039-1687828] [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] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This article reviews the salient clinical features, evaluation, and treatment of mycotic and bacterial infections of the perianal and contiguous zones of the human body.
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Affiliation(s)
- Phillip M Duldulao
- Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Adrián E Ortega
- Keck School of Medicine of the University of Southern California, Los Angeles, California
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30
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Imanishi I, Uchiyama J, Tsukui T, Hisatsune J, Ide K, Matsuzaki S, Sugai M, Nishifuji K. Therapeutic Potential of an Endolysin Derived from Kayvirus S25-3 for Staphylococcal Impetigo. Viruses 2019; 11:v11090769. [PMID: 31443379 PMCID: PMC6784202 DOI: 10.3390/v11090769] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 08/16/2019] [Accepted: 08/20/2019] [Indexed: 12/31/2022] Open
Abstract
Impetigo is a contagious skin infection predominantly caused by Staphylococcus aureus. Decontamination of S. aureus from the skin is becoming more difficult because of the emergence of antibiotic-resistant strains. Bacteriophage endolysins are less likely to invoke resistance and can eliminate the target bacteria without disturbance of the normal microflora. In this study, we investigated the therapeutic potential of a recombinant endolysin derived from kayvirus S25-3 against staphylococcal impetigo in an experimental setting. First, the recombinant S25-3 endolysin required an incubation period of over 15 minutes to exhibit efficient bactericidal effects against S. aureus. Second, topical application of the recombinant S25-3 endolysin decreased the number of intraepidermal staphylococci and the size of pustules in an experimental mouse model of impetigo. Third, treatment with the recombinant S25-3 endolysin increased the diversity of the skin microbiota in the same mice. Finally, we revealed the genus-specific bacteriolytic effect of recombinant S25-3 endolysin against staphylococci, particularly S. aureus, among human skin commensal bacteria. Therefore, topical treatment with recombinant S25-3 endolysin can be a promising disease management procedure for staphylococcal impetigo by efficient bacteriolysis of S. aureus while improving the cutaneous bacterial microflora.
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Affiliation(s)
- Ichiro Imanishi
- Laboratory of Veterinary Internal Medicine, Division of Animal Life Science, Institute of Agriculture, Graduate School, Tokyo University of Agriculture and Technology, 3-5-8 Saiwai-cho, Fuchu, Tokyo 183-8509, Japan
| | - Jumpei Uchiyama
- Laboratory of Veterinary Microbiology I, School of Veterinary Medicine, Azabu University, 1-17-71 Fuchinobe, Chuo-ku, Sagamihara, Kanagawa 252-5201, Japan
| | - Toshihiro Tsukui
- Nippon Zenyaku Kogyo Co. Ltd., 1-1 Tairanoue, Sasagawa, Asaka-machi, Koriyama, Fukushima 963-0196, Japan
| | - Junzo Hisatsune
- Department of Bacteriology, Graduate school of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8553, Japan
| | - Kaori Ide
- Laboratory of Veterinary Internal Medicine, Division of Animal Life Science, Institute of Agriculture, Graduate School, Tokyo University of Agriculture and Technology, 3-5-8 Saiwai-cho, Fuchu, Tokyo 183-8509, Japan
| | - Shigenobu Matsuzaki
- Department of Ophthalmology and Visual Science, Kochi Medical School, Kochi University, 185-1 Kohasu, Oko-cho, Nankoku, Kochi 783-8505, Japan
| | - Motoyuki Sugai
- Department of Bacteriology, Graduate school of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8553, Japan
| | - Koji Nishifuji
- Laboratory of Veterinary Internal Medicine, Division of Animal Life Science, Institute of Agriculture, Graduate School, Tokyo University of Agriculture and Technology, 3-5-8 Saiwai-cho, Fuchu, Tokyo 183-8509, Japan.
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Nikolic P, Mudgil P, Whitehall J. Formaldehyde as an alternative to antibiotics for treatment of refractory impetigo and other infectious skin diseases. Expert Rev Anti Infect Ther 2019; 17:681-687. [PMID: 31393185 DOI: 10.1080/14787210.2019.1654376] [Citation(s) in RCA: 2] [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] [Indexed: 12/26/2022]
Abstract
Introduction: Antibiotic-resistant strains of bacteria are an increasing problem in hospitals and in the community. This has resulted in bacterial infections such as impetigo becoming difficult to treat. Alternative treatment options are needed. Areas covered: In this paper, a past study that assessed the health burden of scabies in North Queensland is described and from it, the potential for formaldehyde as an alternative antimicrobial treatment is discussed. In doing so, antibiotic resistance, impetigo, permethrin, and formaldehyde are introduced and the current understanding and limitations of the effects of formaldehyde on humans are outlined. The limited cases of formaldehyde resistance in bacteria are also discussed. Expert opinion: Formaldehyde is currently used as a preservative in cosmetics and medicinal creams due to its antibacterial activity. It, therefore, has the potential to be used as an alternative antibacterial treatment for infections with antibiotic-resistant bacteria. The harmful side effects of airborne formaldehyde and exposure in allergic individuals have been extensively studied. Significantly less research has been conducted on formaldehyde skin contact in healthy individuals. If formaldehyde is safe for topical use in humans, it has the potential to assist with combating antibiotic resistance.
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Affiliation(s)
- Philip Nikolic
- School of Medicine, Western Sydney University , Campbelltown , NSW , Australia
| | - Poonam Mudgil
- School of Medicine, Western Sydney University , Campbelltown , NSW , Australia
| | - John Whitehall
- School of Medicine, Western Sydney University , Campbelltown , NSW , Australia
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Abstract
BACKGROUND There is a lack of recently published data on impetigo presentation incidence and treatment practices in the routine Western European primary care setting. OBJECTIVES To investigate impetigo incidence, treatments and recurrence in primary care in the Netherlands. METHODS A retrospective, observational study. Electronic records of patients treated for impetigo in 2015 at 29 general practices in Utrecht and surrounds were reviewed. An episode of impetigo was defined as one or more patient-doctor contacts within 8 weeks of the index consultation. Within an episode, patient demographics and prescribing patterns were analysed including number of treatments, and the category and sequence of individual medicines. RESULTS A total of 1761 impetigo episodes were managed, with an incidence rate of 13.6 per 1000 person years. Impetigo peaked in summer. Most patients, the majority children, experienced a single episode (93%), and 25% had eczema as comorbidity. Topical antibiotics (primarily fusidic acid) were the most prescribed initial treatments (85%), followed by oral antibiotics (14%). Topical antibiotics were progressively used less over subsequent treatments, while there was an inverse increase in oral antibiotic use. Topical fusidic acid as the most common first line treatment seemed satisfactory as only 12% of initial treatments with this drug received further therapy. Repeat treatments generally occurred within 7 days. CONCLUSION This study of impetigo prescribing patterns in primary care highlighted that Dutch general practitioners were generally adherent to national treatment guidelines. Topical treatment, and if needed systemic small-spectrum antibiotic treatment, appeared satisfactory; these findings aid in antimicrobial stewardship.
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Affiliation(s)
- Madelyn E N Loadsman
- School of Medicine, Griffith University, Brisbane, Australia.,Logan Hospital, Queensland Health, Queensland, Australia
| | - Theo J M Verheij
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Alike W van der Velden
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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Thomas C, Coates SJ, Engelman D, Chosidow O, Chang AY. Ectoparasites: Scabies. J Am Acad Dermatol 2019; 82:533-548. [PMID: 31310840 DOI: 10.1016/j.jaad.2019.05.109] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [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: 02/22/2019] [Revised: 05/16/2019] [Accepted: 05/22/2019] [Indexed: 12/26/2022]
Abstract
Scabies is an ectoparasitic dermatosis caused by Sarcoptes scabiei var. hominis and is a public health issue in all countries regardless of socioeconomic status. In high-income countries, delays in diagnosis can lead to institutional outbreaks; in low- and middle-income countries, poor access to health care contributes to disease undertreatment and long-term systemic sequelae. With scabies now recognized as a neglected tropical disease by the World Health Organization, increased awareness and systematic efforts are addressing gaps in diagnosis and treatment that impede scabies control. This review summarizes the available data and provides an update on scabies epidemiology, clinical features, diagnosis, management, and public health considerations.
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Affiliation(s)
- Cristina Thomas
- Departments of Dermatology and Internal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sarah J Coates
- Department of Dermatology, University of California, San Francisco, San Francisco, California
| | - Daniel Engelman
- International Alliance for the Control of Scabies, Parkville, Australia; Tropical Diseases, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Department of General Medicine, Royal Children's Hospital, Melbourne, Australia
| | - Olivier Chosidow
- International Alliance for the Control of Scabies, Parkville, Australia; Department of Dermatology, Assistance Publique - Hôpitaux de Paris, University Paris-Est Créteil, Créteil, France
| | - Aileen Y Chang
- Department of Dermatology, University of California, San Francisco, San Francisco, California; International Alliance for the Control of Scabies, Parkville, Australia.
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Ozenoxacin 1% cream (Xepi) for impetigo. Med Lett Drugs Ther 2019; 61:63-4. [PMID: 31169810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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Sasai N, Nakaminami H, Iwasaki M, Iwao M, Misegawa K, Hasui M, Sato M, Yamamoto S, Yoshida T, Asano T, Senoue M, Ikeda M, Noguchi N. Clonal change of methicillin-resistant Staphylococcus aureus isolated from patients with impetigo in Kagawa, Japan. J Dermatol 2019; 46:301-307. [PMID: 30803017 DOI: 10.1111/1346-8138.14820] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 10/30/2018] [Accepted: 01/21/2019] [Indexed: 11/29/2022]
Abstract
Recently, the USA300 clone, which is a Panton-Valentine leukocidin (PVL)-positive clonal complex 8-staphylococcal cassette chromosome mec type IV (CC8-IV) community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) strain, emerged in community and hospital settings in Japan. Hence, clonal types of CA-MRSA strains are predicted to be changing. Nonetheless, long-term surveillance of CA-MRSA has not been conducted in Japan. Here, we investigated the transition and current status of CA-MRSA strains isolated from outpatients with impetigo; the samples were collected between 2007 and 2016 in Kagawa, Japan. The detection rate (22.8%, 488/2139 strains) of MRSA slightly decreased in these 10 years. Molecular epidemiological analyses showed that the prevalence of the CC89-II clone, which is a typical CA-MRSA genotype of causative agents of impetigo, significantly decreased from 48.0% (48/100 strains) in 2007-2009 to 21.9% (16/73 strains) in 2013-2016. By contrast, a non-USA300 CC8-IV clone, which is a highly pathogenic CA-MRSA/J clone, significantly increased in prevalence from 9.0% (9/100 strains) to 32.9% (24/73 strains). The prevalence of PVL-positive CA-MRSA strains increased annually from 2012 (0%) to 2015 (6.7%), whereas only one of these strains turned out to be the USA300 clone. Antibiotic susceptibility data revealed that the rates of resistance to gentamicin and clindamycin among CA-MRSA strains decreased along with the decreased prevalence of the CC89-II clone and increased prevalence of the CA-MRSA/J clone. Our data strongly suggest that the clonal types and antibiotic susceptibility of CA-MRSA isolated from patients with impetigo dramatically changed during the last 10 years in Japan.
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Affiliation(s)
- Nao Sasai
- Department of Microbiology, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, Tokyo, Japan
| | - Hidemasa Nakaminami
- Department of Microbiology, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, Tokyo, Japan
| | - Manami Iwasaki
- Department of Microbiology, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, Tokyo, Japan
| | - Miku Iwao
- Department of Microbiology, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, Tokyo, Japan
| | - Kotaro Misegawa
- Department of Microbiology, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, Tokyo, Japan
| | - Mikiko Hasui
- Takamatsu Dermatological Research Group, Takamatsu, Japan
| | - Minoru Sato
- Takamatsu Dermatological Research Group, Takamatsu, Japan
| | | | - Tomoko Yoshida
- Takamatsu Dermatological Research Group, Takamatsu, Japan
| | - Takashi Asano
- Takamatsu Dermatological Research Group, Takamatsu, Japan
| | - Mitsura Senoue
- Takamatsu Dermatological Research Group, Takamatsu, Japan
| | - Masami Ikeda
- Takamatsu Dermatological Research Group, Takamatsu, Japan.,Department of Dermatology, Takamatsu Red Cross Hospital, Takamatsu, Japan
| | - Norihisa Noguchi
- Department of Microbiology, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, Tokyo, Japan
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Galli L, Venturini E, Bassi A, Gattinara GC, Chiappini E, Defilippi C, Diociaiuti A, Esposito S, Garazzino S, Giannattasio A, Krzysztofiak A, Latorre S, Lo Vecchio A, Marchisio P, Montagnani C, Nicolini G, Novelli A, Rossolini GM, Tersigni C, Villani A, El Hachem M, Neri I; Italian Pediatric Infectious Diseases Society., Italian Pediatric Dermatology Society. Common Community-acquired Bacterial Skin and Soft-tissue Infections in Children: an Intersociety Consensus on Impetigo, Abscess, and Cellulitis Treatment. Clin Ther 2019; 41:532-551.e17. [PMID: 30777258 DOI: 10.1016/j.clinthera.2019.01.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 12/20/2018] [Accepted: 01/16/2019] [Indexed: 11/22/2022]
Abstract
PURPOSE The main objective of this article was to offer practical suggestions, given the existing evidence, for identifying and managing bacterial impetigo, abscess, and cellulitis in ambulatory and hospital settings. METHODS Five Italian pediatric societies appointed a core working group. In selected conditions, specially trained personnel evaluated quality assessment of treatment strategies according to the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. Only randomized controlled trials (RCTs) and observational studies were included for quality assessment according to the GRADE methodology. MEDLINE, Ovid MEDLINE, EMBASE, and Cochrane Library databases were searched with a strategy combining MeSH and free text terms. FINDINGS The literature review included 364 articles focusing on impetigo, skin abscess, and cellulitis/orbital cellulitis. The articles included for quality assessment according to the GRADE methodology for impetigo comprised 5 RCTs and 1 observational study; for skin abscess, 10 RCTs and 3 observational studies were included; for cellulitis and erysipelas, 5 RCTs and 5 observational studies were included; and for orbital cellulitis, 8 observational studies were included. Recommendations were formulated according to 4 grades of strength for each specific topic (impetigo, skin abscesses, cellulitis, and orbital cellulitis). Where controversies arose and expert opinion was considered fundamental due to lack of evidence, agreement according to Delphi consensus recommendations was included. IMPLICATIONS Based on a literature review and on local epidemiology, this article offers practical suggestions for use in both ambulatory and hospital settings for managing the most common bacterial SSTIs.
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Vila J, Hebert AA, Torrelo A, López Y, Tato M, García-Castillo M, Cantón R. Ozenoxacin: a review of preclinical and clinical efficacy. Expert Rev Anti Infect Ther 2019; 17:159-168. [PMID: 30686133 DOI: 10.1080/14787210.2019.1573671] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Impetigo is the most common bacterial skin infection in children. Treatment is becoming complicated due to the development of antimicrobial resistance, especially in the main pathogen, Staphylococcus aureus. Ozenoxacin, a novel non-fluorinated topical quinolone antimicrobial, has demonstrated efficacy in impetigo. Areas covered: This article reviews the microbiology, pharmacodynamic and pharmacokinetic properties of ozenoxacin, and its clinical and microbiological efficacy in impetigo. Expert opinion: In an environment of increasing antimicrobial resistance and concurrent slowdown in antimicrobial development, the introduction of a new agent is a major event. Ozenoxacin is characterized by simultaneous affinity for DNA gyrase and topoisomerase IV, appears to be impervious to certain efflux pumps that confer bacterial resistance to other quinolones, shows low selection of resistant mutants, and has a mutant prevention concentration below its concentration in skin. These mechanisms protect ozenoxacin against development of resistance, while the absence of a fluorine atom in its structure confers a better safety profile versus fluoroquinolones. In vitro studies have demonstrated high potency of ozenoxacin against staphylococci and streptococci including resistant strains of S. aureus. Clinical trials of ozenoxacin in patients with impetigo reported high clinical and microbiological success rates. Preserving the activity and availability of ozenoxacin through antimicrobial stewardship is paramount.
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Affiliation(s)
- Jordi Vila
- a Red Española de Investigación en Patología Infecciosa (REIPI) , Madrid , Spain.,b Servei de Microbiología , Centre de Diagnòstic Biomèdic, Hospital Clinic , Barcelona , Spain.,c ISGlobal - Hospital Clinic , Universitat de Barcelona , Barcelona , Spain
| | - Adelaide A Hebert
- d Departments of Dermatology and Pediatrics , UT Health McGovern Medical School , Houston , TX , USA
| | - Antonio Torrelo
- e Departament of Dermatology , Hospital del Niño Jesús , Madrid , Spain
| | - Yuly López
- c ISGlobal - Hospital Clinic , Universitat de Barcelona , Barcelona , Spain
| | - Marta Tato
- f Servicio de Microbiología , Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS) , Madrid , Spain
| | - María García-Castillo
- f Servicio de Microbiología , Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS) , Madrid , Spain
| | - Rafael Cantón
- a Red Española de Investigación en Patología Infecciosa (REIPI) , Madrid , Spain.,f Servicio de Microbiología , Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS) , Madrid , Spain
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May PJ, Tong SYC, Steer AC, Currie BJ, Andrews RM, Carapetis JR, Bowen AC. Treatment, prevention and public health management of impetigo, scabies, crusted scabies and fungal skin infections in endemic populations: a systematic review. Trop Med Int Health 2019; 24:280-293. [PMID: 30582783 PMCID: PMC6850630 DOI: 10.1111/tmi.13198] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 11/25/2022]
Abstract
We conducted a systematic review of the treatment, prevention and public health control of skin infections including impetigo, scabies, crusted scabies and tinea in resource‐limited settings where skin infections are endemic. The aim is to inform strategies, guidelines and research to improve skin health in populations that are inequitably affected by infections of the skin and the downstream consequences of these. The systematic review is reported according to the PRISMA statement. From 1759 titles identified, 81 full text studies were reviewed and key findings outlined for impetigo, scabies, crusted scabies and tinea. Improvements in primary care and public health management of skin infections will have broad and lasting impacts on overall quality of life including reductions in morbidity and mortality from sepsis, skeletal infections, kidney and heart disease.
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Affiliation(s)
- Philippa J May
- Northern Territory Centre for Disease Control, Casuarina, Australia
| | - Steven Y C Tong
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, The University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Parkville, Australia.,Menzies School of Health Research, Charles Darwin University, Casuarina, Australia
| | - Andrew C Steer
- Royal Children's Hospital, Parkville, Australia.,Murdoch Children's Research Institute, University of Melbourne, Parkville, Australia
| | - Bart J Currie
- Menzies School of Health Research, Charles Darwin University, Casuarina, Australia.,Royal Darwin Hospital, Casuarina, Australia
| | - Ross M Andrews
- Menzies School of Health Research, Charles Darwin University, Casuarina, Australia.,National Centre for Epidemiology & Population Health, Australian National University, Canberra, Australia
| | - Jonathan R Carapetis
- Perth Children's Hospital, Nedlands, Australia.,Wesfarmers Centre for Vaccines and Infectious Diseases, University of Western Australia, Nedlands, Australia.,School of Medicine, University of Western Australia, Nedlands, Australia
| | - Asha C Bowen
- Menzies School of Health Research, Charles Darwin University, Casuarina, Australia.,Perth Children's Hospital, Nedlands, Australia.,Wesfarmers Centre for Vaccines and Infectious Diseases, University of Western Australia, Nedlands, Australia.,School of Medicine, University of Western Australia, Nedlands, Australia.,University of Notre Dame Australia, Fremantle, Australia
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Abstract
Scabies is a neglected tropical disease of the skin, causing severe itching and stigmatizing skin lesions. Further, scabies leads to impetigo, severe bacterial infections, and post-infectious complications. Around 200 million people are affected, particularly among disadvantaged populations living in crowded conditions in tropical areas. After almost 50 years, research into scabies control has shown great promise, particularly in highly-endemic island settings, but these findings have not been widely adopted. Newer approaches, utilizing ivermectin-based mass drug administration, appear feasible and highly effective. Inclusion of scabies in the WHO portfolio of neglected tropical diseases in 2017 may facilitate renewed opportunities and momentum toward global control. However, further operational research is needed to develop evidence-based strategies for control in a range of settings, and monitor their impact. Several enabling factors are required for successful implementation, including availability of affordable drug supply. Integration with existing health programs may provide a cost-effective approach to control.
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Affiliation(s)
- Daniel Engelman
- Tropical Diseases, Murdoch Children's Research Institute, Parkville VIC 3052, Australia.
- Department of Paediatrics, University of Melbourne, Parkville VIC 3052, Australia.
- Department of General Medicine, Royal Children's Hospital, Parkville VIC 3052, Australia.
- International Alliance for the Control of Scabies, Parkville VIC 3052, Australia.
| | - Andrew C Steer
- Tropical Diseases, Murdoch Children's Research Institute, Parkville VIC 3052, Australia.
- Department of Paediatrics, University of Melbourne, Parkville VIC 3052, Australia.
- Department of General Medicine, Royal Children's Hospital, Parkville VIC 3052, Australia.
- International Alliance for the Control of Scabies, Parkville VIC 3052, Australia.
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Canton R, Chouinard L, Tarragó C. A review of the antibacterial activity of ozenoxacin. Future Microbiol 2018; 13:1-2. [PMID: 29745241 DOI: 10.2217/fmb-2018-0069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Rafael Canton
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal & Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain.,Red Española de Investigación en Patología Infecciosa (REIPI), Madrid, Spain
| | - Luc Chouinard
- Charles River Laboratories Montreal ULC., Senneville, Canada
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Nasiri S, Bidari Zerehpoosh F, Dadkhahfar S, Mortazavi N, Mozafari N. An infant with diffuse bullous lesions. Arch Dis Child 2018; 103:335. [PMID: 28550148 DOI: 10.1136/archdischild-2017-312704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/25/2017] [Indexed: 11/03/2022]
Affiliation(s)
- Soheila Nasiri
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farahnaz Bidari Zerehpoosh
- Department of Pathology, Shahid Beheshti University of Medical Sciences, Loghman-Hakim Hospital, Tehran, Iran
| | - Sahar Dadkhahfar
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nafiseh Mortazavi
- Department of Pathology, Shahid Beheshti University of Medical Sciences, Loghman-Hakim Hospital, Tehran, Iran
| | - Nikoo Mozafari
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Coughlin P, Bradford C, Montali RJ, Bronson E. PUSTULAR DERMATITIS CAUSED BY IMPETIGO IN RED-TAILED MONKEYS ( CERCOPITHECUS ASCANIUS). J Zoo Wildl Med 2018; 49:206-9. [PMID: 29517455 DOI: 10.1638/2012-0293R1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Impetigo is a bacterial infection of the superficial layer of the epidermis with crusting or bullae caused by Streptococcus spp., Staphylococcus spp., or both. A 14-yr-old red-tailed monkey ( Cercopithecus ascanius) presented with recurrent scabbing and ulceration under the nares over an 8-yr period. Repeated cultures and biopsy samples led to a presumptive diagnosis of impetigo, later confirmed on necropsy. Multiple antibiotic regimens were employed with varying success during multiple episodes, while lesions resolved on their own at other times. This condition has not been previously reported in a nonhuman primate, although it is not uncommon in humans.
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43
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Bowen AC, Carapetis JR, Currie BJ, Fowler V, Chambers HF, Tong SYC. Sulfamethoxazole-Trimethoprim (Cotrimoxazole) for Skin and Soft Tissue Infections Including Impetigo, Cellulitis, and Abscess. Open Forum Infect Dis 2017; 4:ofx232. [PMID: 29255730 PMCID: PMC5730933 DOI: 10.1093/ofid/ofx232] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [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] [Received: 07/02/2017] [Accepted: 10/23/2017] [Indexed: 01/28/2023] Open
Abstract
Skin and soft tissue infections (SSTI) affect millions of people globally, which represents a significant burden on ambulatory care and hospital settings. The role of sulfamethoxazole-trimethoprim (SXT) in SSTI treatment, particularly when group A Streptococcus (GAS) is involved, is controversial. We conducted a systematic review of clinical trials and observational studies that address the utility of SXT for SSTI treatment, caused by either GAS or Staphylococcus aureus, including methicillin-resistant (MRSA). We identified 196 studies, and 15 underwent full text review by 2 reviewers. Observational studies, which mainly focused on SSTI due to S aureus, supported the use of SXT when compared with clindamycin or β-lactams. Of 10 randomized controlled trials, 8 demonstrated the efficacy of SXT for SSTI treatment including conditions involving GAS. These findings support SXT use for treatment of impetigo and purulent cellulitis (without an additional β-lactam agent) and abscess and wound infection. For nonpurulent cellulitis, β-lactams remain the treatment of choice.
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Affiliation(s)
- Asha C Bowen
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth.,Princess Margaret Hospital for Children, Perth, Western Australia.,Menzies School of Health Research, Charles Darwin University, North Territory, Australia
| | - Jonathan R Carapetis
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth.,Princess Margaret Hospital for Children, Perth, Western Australia
| | - Bart J Currie
- Menzies School of Health Research, Charles Darwin University, North Territory, Australia.,Royal Darwin Hospital, North Territory, Australia
| | - Vance Fowler
- Duke University Division of Infectious Diseases, Durham, North Carolina
| | - Henry F Chambers
- Division of Infectious Disease, Department of Medicine, San Francisco General Hospital, California
| | - Steven Y C Tong
- Menzies School of Health Research, Charles Darwin University, North Territory, Australia.,Victorian Infectious Disease Service, The Royal Melbourne Hospital, and The University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Victoria, Australia
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44
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Williamson DA, Carter GP, Howden BP. Current and Emerging Topical Antibacterials and Antiseptics: Agents, Action, and Resistance Patterns. Clin Microbiol Rev 2017; 30:827-60. [PMID: 28592405 DOI: 10.1128/CMR.00112-16] [Citation(s) in RCA: 185] [Impact Index Per Article: 26.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Bacterial skin infections represent some of the most common infectious diseases globally. Prevention and treatment of skin infections can involve application of a topical antimicrobial, which may be an antibiotic (such as mupirocin or fusidic acid) or an antiseptic (such as chlorhexidine or alcohol). However, there is limited evidence to support the widespread prophylactic or therapeutic use of topical agents. Challenges involved in the use of topical antimicrobials include increasing rates of bacterial resistance, local hypersensitivity reactions (particularly to older agents, such as bacitracin), and concerns about the indiscriminate use of antiseptics potentially coselecting for antibiotic resistance. We review the evidence for the major clinical uses of topical antibiotics and antiseptics. In addition, we review the mechanisms of action of common topical agents and define the clinical and molecular epidemiology of antimicrobial resistance in these agents. Moreover, we review the potential use of newer and emerging agents, such as retapamulin and ebselen, and discuss the role of antiseptic agents in preventing bacterial skin infections. A comprehensive understanding of the clinical efficacy and drivers of resistance to topical agents will inform the optimal use of these agents to preserve their activity in the future.
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45
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Wei EY, Coghlin DT. Beyond Folliculitis: Recognizing Herpes Gladiatorum in Adolescent Athletes. J Pediatr 2017; 190:283. [PMID: 28728810 DOI: 10.1016/j.jpeds.2017.06.062] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 06/19/2017] [Accepted: 06/26/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Elizabeth Y Wei
- Hasbro Children's Hospital The Warren Alpert Medical School of Brown University Providence, Rhode Island
| | - Daniel T Coghlin
- Hasbro Children's Hospital The Warren Alpert Medical School of Brown University Providence, Rhode Island
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46
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D'Cunha NM, Peterson GM, Baby KE, Thomas J. Impetigo: A need for new therapies in a world of increasing antimicrobial resistance. J Clin Pharm Ther 2017; 43:150-153. [PMID: 29063621 DOI: 10.1111/jcpt.12639] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [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: 09/06/2017] [Accepted: 09/17/2017] [Indexed: 11/29/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Impetigo is a highly contagious bacterial skin infection and is one of the most common skin infections in children. Antibiotics are the first-line treatment when multiple lesions exist, but with an increasing prevalence of antibiotic-resistant bacteria the successful management of impetigo in the future is an area of concern. COMMENT Current treatment options that favour the use of oral antibiotic therapy are increasingly problematic. Widespread use of these agents contributes to antimicrobial resistance and has adverse consequences for individuals and communities. There is a need for new topical antimicrobials and antiseptics as an alternative treatment strategy. WHAT IS NEW AND CONCLUSION To successfully treat impetigo into the future and ensure that therapy does not contribute to bacterial resistance, additional research is required to ascertain the usefulness of alternative agents, including new topical antimicrobials and antiseptics.
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Affiliation(s)
- N M D'Cunha
- Faculty of Health, University of Canberra, Bruce, ACT, Australia
| | - G M Peterson
- Faculty of Health, University of Tasmania, Hobart, TAS, Australia
| | - K E Baby
- The Canberra Hospital, Yamba Drive, Garran, ACT, Australia
| | - J Thomas
- Faculty of Health, University of Canberra, Bruce, ACT, Australia
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Rouchon CN, Ly AT, Noto JP, Luo F, Lizano S, Bessen DE. Incremental Contributions of FbaA and Other Impetigo-Associated Surface Proteins to Fitness and Virulence of a Classical Group A Streptococcal Skin Strain. Infect Immun 2017; 85:e00374-17. [PMID: 28808160 DOI: 10.1128/IAI.00374-17] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 08/08/2017] [Indexed: 12/26/2022] Open
Abstract
Group A streptococci (GAS) are highly prevalent human pathogens whose primary ecological niche is the superficial epithelial layers of the throat and/or skin. Many GAS strains with a strong tendency to cause pharyngitis are distinct from strains that tend to cause impetigo; thus, genetic differences between them may confer host tissue-specific virulence. In this study, the FbaA surface protein gene was found to be present in most skin specialist strains but largely absent from a genetically related subset of pharyngitis isolates. In an ΔfbaA mutant constructed in the impetigo strain Alab49, loss of FbaA resulted in a slight but significant decrease in GAS fitness in a humanized mouse model of impetigo; the ΔfbaA mutant also exhibited decreased survival in whole human blood due to phagocytosis. In assays with highly sensitive outcome measures, Alab49ΔfbaA was compared to other isogenic mutants lacking virulence genes known to be disproportionately associated with classical skin strains. FbaA and PAM (i.e., the M53 protein) had additive effects in promoting GAS survival in whole blood. The pilus adhesin tip protein Cpa promoted Alab49 survival in whole blood and appears to fully account for the antiphagocytic effect attributable to pili. The finding that numerous skin strain-associated virulence factors make slight but significant contributions to virulence underscores the incremental contributions to fitness of individual surface protein genes and the multifactorial nature of GAS-host interactions.
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48
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Oliver SJ, Cush J, Ward JE. Community-Based Prescribing for Impetigo in Remote Australia: An Opportunity for Antimicrobial Stewardship. Front Public Health 2017; 5:158. [PMID: 28748178 PMCID: PMC5506077 DOI: 10.3389/fpubh.2017.00158] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 06/19/2017] [Indexed: 11/17/2022] Open
Abstract
Background To support antibiotic prescribing for both hospital and community-based health professionals working in remote North Western Australia, a multidisciplinary Antimicrobial Stewardship (AMS) Committee was established in 2013. This Committee is usually focused on hospital-based prescribing. A troubling increase in sulfamethoxazole/trimethoprim resistance in Staphylococcus aureus antibiograms from 9 to 18% over 1 year prompted a shift in gaze to community prescribing. What we did Finding a paucity of relevant research, we first investigated contextual factors influencing local prescribing. We also designed a systematic survey of experts with experience relevant to our setting using a structured response survey (12 questions) to better understand specific AMS risks. Using these findings, recommendations were formulated for the AMS Committee. What we learned Prescribing recommendations in a regional Skin Infections Protocol had previously been altered in December 2014. From 15 experts, we received 9 comprehensive responses (60%) about AMS risks in community prescribing. If feasible, prescribing audits also would have been valuable. Ten recommendations regarding specific antibiotic recommendations were submitted to the AMS Committee. Strengthening AMS in remote settings As AMS Committees in Australia usually focus on hospital-based prescribing, novel methods such as external expert opinion could inform deliberations about community-based prescribing. Our approach meant that this AMS Committee was able to intervene in the 2017 organizational review of the regional Skin Infections Protocol used by prescribers likely unaware of AMS risks. This experience demonstrates the value of incorporating AMS principles in community-based prescribing in context of a remote setting.
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Affiliation(s)
- Stefanie Jane Oliver
- Pharmacy Department, Western Australia Country Health Service (WACHS)-Kimberley, Broome, WA, Australia
| | - James Cush
- Paediatrics Department, Western Australia Country Health Service (WACHS)-Kimberley, Broome, WA, Australia
| | - Jeanette E Ward
- Kimberley Population Health Unit, Western Australia Country Health Service (WACHS)-Kimberley, Broome, WA, Australia.,Nulungu Research Institute, University of Notre Dame Australia, Broome, WA, Australia
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49
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Doudoulakakis A, Spiliopoulou I, Spyridis N, Giormezis N, Kopsidas J, Militsopoulou M, Lebessi E, Tsolia M. Emergence of a Staphylococcus aureus Clone Resistant to Mupirocin and Fusidic Acid Carrying Exotoxin Genes and Causing Mainly Skin Infections. J Clin Microbiol 2017; 55:2529-37. [PMID: 28592549 DOI: 10.1128/JCM.00406-17] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 05/30/2017] [Indexed: 11/20/2022] Open
Abstract
Skin and soft tissue infections (SSTIs) caused by mupirocin-resistant Staphylococcus aureus strains have recently increased in number in our settings. We sought to evaluate the characteristics of these cases over a 43-month period. Data for all community-acquired staphylococcal infections caused by mupirocin-resistant strains were retrospectively reviewed. Genes encoding products producing high-level resistance (HLR) to mupirocin (mupA), fusidic acid resistance (fusB), resistance to macrolides and lincosamides (ermC and ermA), Panton-Valentine leukocidin (PVL) (lukS/lukF-PV), exfoliative toxins (eta and etb), and fibronectin binding protein A (fnbA) were investigated by PCRs in 102 selected preserved strains. Genotyping was performed by SCCmec and agr typing, whereas clonality was determined by pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST). A total of 437 cases among 2,137 staphylococcal infections were recorded in 2013 to 2016; they were all SSTIs with the exception of 1 case of primary bacteremia. Impetigo was the predominant clinical entity (371 cases [84.9%]), followed by staphylococcal scalded skin syndrome (21 cases [4.8%]), and there were no abscesses. The number of infections detected annually increased during the study years. All except 3 isolates were methicillin susceptible. The rates of HLR to mupirocin and constitutive resistance to clindamycin were 99% and 20.1%, respectively. Among the 102 tested strains, 100 (98%) were mupA positive and 97 (95%) were fusB positive, 26/27 clindamycin-resistant strains (96.3%) were ermA positive, 83 strains (81.4%) were lukS/lukF positive, 95 (93%) carried both eta and etb genes, and 99 (97%) were fnbA positive. Genotyping of methicillin-sensitive S. aureus (MSSA) strains revealed that 96/99 (96.7%) belonged to one main pulsotype, pulsotype 1, classified as sequence type 121 (ST121). The emergence of a single MSSA clone (ST121) causing impetigo was documented. Resistance to topical antimicrobials and a rich toxinogenic profile confer to this clone adaptability for spread in the community.
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50
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Patrizi A, Neri I, Ricci G, Cipriani F, Ravaioli GM. Advances in pharmacotherapeutic management of common skin diseases in neonates and infants. Expert Opin Pharmacother 2017; 18:717-725. [PMID: 28429969 DOI: 10.1080/14656566.2017.1316371] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION neonatal and infantile skin diseases are frequently encountered in the clinical practice and represent worldwide a socioeconomic issue. They encompass a wide range of acquired or congenital conditions, including infections, vascular lesions and inflammatory diseases and can present with different degrees of severity, leading in some cases to dramatic complications. Areas covered: In this paper we report the most recent evidences on the management of some common skin diseases in neonates and infants. Hemangiomas, viral, fungal and bacterial infections, omphalitis, atopic and seborrhoeic dermatitis, napkin disease will be treated and discussed. Expert opinion: The majority of the dermatologic alterations in neonates are physiological, transient and do not require any treatment, thus the parents can be reassured about the good prognosis. However, in some cases, serious conditions must be excluded. In particular neonatal and infantile infections should be promptly recognized and properly managed, to avoid severe complications. The therapeutic options include traditional and, although few, innovative medical treatments, which will be carefully taken into consideration by the expert Dermatologists and Paediatricians.
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Affiliation(s)
- Annalisa Patrizi
- a Dermatology, Department of Experimental, Diagnostic and Specialty Medicine , Sant'Orsola-Malpighi Hospital, University of Bologna , Bologna , Italy
| | - Iria Neri
- a Dermatology, Department of Experimental, Diagnostic and Specialty Medicine , Sant'Orsola-Malpighi Hospital, University of Bologna , Bologna , Italy
| | - Giampaolo Ricci
- b Division of Pediatrics, Department of Medical and Surgical Sciences , Sant'Orsola-Malpighi Hospital, University of Bologna , Bologna , Italy
| | - Francesca Cipriani
- b Division of Pediatrics, Department of Medical and Surgical Sciences , Sant'Orsola-Malpighi Hospital, University of Bologna , Bologna , Italy
| | - Giulia Maria Ravaioli
- a Dermatology, Department of Experimental, Diagnostic and Specialty Medicine , Sant'Orsola-Malpighi Hospital, University of Bologna , Bologna , Italy
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