1
|
Fernando DD, Mounsey KE, Bernigaud C, Surve N, Estrada Chávez GE, Hay RJ, Currie BJ, Chosidow O, Fischer K. Scabies. Nat Rev Dis Primers 2024; 10:74. [PMID: 39362885 DOI: 10.1038/s41572-024-00552-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/22/2024] [Indexed: 10/05/2024]
Abstract
Scabies is one of the most common and highest-burden skin diseases globally. Estimates suggest that >200 million people worldwide have scabies at any one time, with an annual prevalence of 455 million people, with children in impoverished and overcrowded settings being the most affected. Scabies infection is highly contagious and leads to considerable morbidity. Secondary bacterial infections are common and can cause severe health complications, including sepsis or necrotizing soft-tissue infection, renal damage and rheumatic heart disease. There is no vaccine or preventive treatment against scabies and, for the past 30 years, only few broad-spectrum antiparasitic drugs (mainly topical permethrin and oral ivermectin) have been widely available. Treatment failure is common because drugs have short half-lives and do not kill all developmental stages of the scabies parasite. At least two consecutive treatments are needed, which is difficult to achieve in resource-poor and itinerant populations. Another key issue is the lack of a practical, rapid, cheap and accurate diagnostic tool for the timely detection of scabies, which could prevent the cycle of exacerbation and disease persistence in communities. Scabies control will require a multifaceted approach, aided by improved diagnostics and surveillance, new treatments, and increased public awareness.
Collapse
Affiliation(s)
- Deepani D Fernando
- Scabies Laboratory, Infection and Inflammation Program, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Kate E Mounsey
- School of Health, University of the Sunshine Coast, Sippy Downs, Queensland, Australia
| | - Charlotte Bernigaud
- Research Group Dynamic, EA7380, Faculté de Santé de Créteil, USC ANSES, Université Paris-Est Créteil, Créteil, France
| | - Nuzhat Surve
- Department of Microbiology, Seth G S Medical College and KEM Hospital, Parel, Mumbai, India
| | - Guadalupe E Estrada Chávez
- State Institute of Cancer "Dr. Arturo Beltrán Ortega", Faculty of Medicine, Universidad Autónoma de Guerrero, Community Dermatology Mexico, Acapulco, Guerrero, Mexico
| | - Roderick J Hay
- St Johns Institute of Dermatology, King's College London, London, UK
| | - Bart J Currie
- Global and Tropical Health, Menzies School of Health Research, Charles Darwin University and Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Olivier Chosidow
- Hôpital Universitaire La Pitié-Salpêtrière, AP-HP, Paris, France
| | - Katja Fischer
- Scabies Laboratory, Infection and Inflammation Program, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.
| |
Collapse
|
2
|
Mbuagbaw L, Sadeghirad B, Morgan RL, Mertz D, Motaghi S, Ghadimi M, Babatunde I, Zani B, Pasumarthi T, Derby M, Kothapudi VN, Palmer NR, Aebischer A, Harder T, Reichert F. Failure of scabies treatment: a systematic review and meta-analysis. Br J Dermatol 2024; 190:163-173. [PMID: 37625798 DOI: 10.1093/bjd/ljad308] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 08/18/2023] [Accepted: 08/20/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND Treatment failure is considered to be an important factor in relation to the increase in scabies incidence over the last decade. However, the regional and temporal differences, in addition to the predictors of therapy failure, are unclear. OBJECTIVES We aimed to conduct a systematic review of the prevalence of treatment failure in patients with scabies and investigation of associated factors. METHODS We searched MEDLINE, EMBASE, CINAHL, Web of Science, Scopus, Global Health and the Cochrane Central Register of Controlled Trials from inception to August 2021 for randomized and quasi-randomized trials, in addition to observational studies that enrolled children or adults diagnosed with confirmed or clinical scabies treated with permethrin, ivermectin, crotamiton, benzyl benzoate, malathion, sulfur or lindane, and measured treatment failure or factors associated with treatment failure. We performed a random effects meta-analysis for all outcomes reported by at least two studies. RESULTS A total of 147 studies were eligible for inclusion in the systematic review. The overall prevalence of treatment failure was 15.2% [95% confidence interval (CI) 12.9-17.6; I2 = 95.3%, moderate-certainty evidence] with regional differences between World Health Organization regions (P = 0.003) being highest in the Western Pacific region (26.9%, 95% CI 14.5-41.2). Oral ivermectin (11.8%, 95% CI 8.4-15.4), topical ivermectin (9.3%, 95% CI 5.1-14.3) and permethrin (10.8%, 95% CI 7.5-14.5) had relatively lower failure prevalence compared with the overall prevalence. Failure prevalence was lower in patients treated with two doses of oral ivermectin (7.1%, 95% CI 3.1-12.3) compared with those treated with one dose (15.2%, 95% CI 10.8-20.2; P = 0.021). Overall and permethrin treatment failure prevalence in the included studies (1983-2021) increased by 0.27% and 0.58% per year, respectively. Only three studies conducted a multivariable risk factor analysis; no studies assessed resistance. CONCLUSIONS A second dose of ivermectin showed lower failure prevalence than single-dose ivermectin, which should be considered in all guidelines. The increase in treatment failure over time hints at decreasing mite susceptibility for several drugs, but reasons for failure are rarely assessed. Ideally, scabicide susceptibility testing should be implemented in future studies.
Collapse
Affiliation(s)
- Lawrence Mbuagbaw
- Biostatistics Unit/The Research Institute, St Joseph's Healthcare, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, and Impact
- Department of Anesthesia
| | - Behnam Sadeghirad
- Department of Health Research Methods, Evidence, and Impact
- Department of Anesthesia
- Michael G. DeGroote National Pain Centre
| | - Rebecca L Morgan
- Department of Health Research Methods, Evidence, and Impact
- Evidence Foundation, Cleveland Heights, OH, USA
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Dominik Mertz
- Department of Health Research Methods, Evidence, and Impact
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | | | - Maryam Ghadimi
- Department of Health Research Methods, Evidence, and Impact
| | | | - Babalwa Zani
- Knowledge Translation Unit, University of Cape Town Lung Institute, Rondebosch, South Africa
| | | | | | | | | | | | - Thomas Harder
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Felix Reichert
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| |
Collapse
|
3
|
Hesari R, Schur N, Tyndall N, Chuchla T, Gazy N. The Itchy Truth About Scabies: A Case of Asymptomatic Carrier Transmission and Treatment Failure. Cureus 2023; 15:e50744. [PMID: 38239556 PMCID: PMC10794788 DOI: 10.7759/cureus.50744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 12/18/2023] [Indexed: 01/22/2024] Open
Abstract
Scabies, a common and highly contagious skin infestation, is caused by the mite Sarcoptes scabiei var. hominis. Identifying individuals with scabies often poses a diagnostic challenge, as its clinical features resemble other dermatologic conditions such as drug reactions, atopic dermatitis, and contact dermatitis. Furthermore, the cutaneous manifestations arise from delayed-type immunologic reactions to the mites and their byproducts, allowing some individuals to carry the mite without showing symptoms. The significant transmissibility of scabies, along with the potential for asymptomatic carriers, creates multiple treatment hurdles for cohabiting individuals, as the failure to treat all close contacts can result in re-infestation. This report presents the case of a 46-year-old Vietnamese male who suffered from a worsening erythematous, scaly, and pruritic rash for four months. Despite being prescribed topical corticosteroids by three different dermatologists, his rash persisted. Upon thorough evaluation, scabies was diagnosed. The patient was treated with scabicidal agents, which initially alleviated his symptoms; however, three weeks later, his symptoms resurfaced. Further investigation revealed that his wife was an asymptomatic carrier who had not received treatment. This case highlights the clinical features, pathogenesis, and treatment options for scabies while emphasizing the importance of promptly identifying and treating all close contacts.
Collapse
Affiliation(s)
- Roksana Hesari
- Osteopathic Medicine, Lake Erie College of Osteopathic Medicine, Bradenton, USA
| | - Nina Schur
- Osteopathic Medicine, Lake Erie College of Osteopathic Medicine, Bradenton, USA
| | - Nicholas Tyndall
- Osteopathic Medicine, Lake Erie College of Osteopathic Medicine, Bradenton, USA
| | - Thaddeus Chuchla
- Osteopathic Medicine, Lake Erie College of Osteopathic Medicine, Bradenton, USA
| | - Nicky Gazy
- Dermatology, Western University of Health Sciences, Pomona, USA
- Dermatology, Beaumont Hospital, Trenton, USA
| |
Collapse
|