Scabies in Thai orphanages

Scabies: Application of the Novel Identify-Isolate-Inform Tool for Detection and Management

Scabies is a highly contagious, globally prevalent, parasitic skin infestation caused by Sarcoptes scabiei var. hominis, also known as the itch mite. There have been outbreaks not only in the developing world, but also in the developed world among refugees and asylum seekers. Once infested with scabies mites, symptomatic patients, as well as asymptomatic carriers, quickly spread the disease through direct skin-to-skin contact. Typically, symptoms of scabies are characterized by an erythematous, papular, pruritic rash associated with burrows. Treatment of scabies involves using topical or systemic scabicides and treating secondary bacterial infections, if present. Given the prevalence and contagiousness of scabies, measures to prevent its spread are essential. Through application of the novel Identify-Isolate-Inform (3I) Tool, emergency medical providers can readily identify risk factors for exposure and important symptoms of the disease, thus limiting its spread through prompt scabicide therapy; isolate the patient until after treatment; and inform local public health authorities and hospital infection prevention, when appropriate. Ultimately, these three actions can aid public health in controlling the transmission of scabies cases, thus ensuring the protection of the general public from this highly contagious skin infestation.

Skin diseases in rural Nyala, Sudan (in a rural hospital, in 12 orphanages, and in two refugee camps)

Skin diseases are considered to be common in Nyala, Sudan. This study was carried out to verify the prevalence of skin diseases in Nyala. This prospective observational study included skin examination of a total of 1802 people: 620 patients who were evaluated in the outpatient clinics (OC) and 1182 people from orphanages and refugee camps (ORC) in Nyala, Sudan. χ² test was used. The total prevalence of skin disorders in the sample was 92.6% (1670/1802). One thousand and fifty of 1182 (88.8%) people from ORC had a skin disorder. The most common skin diseases in this community were: fungal infections (32.6%), dermatitis/eczema (10.5%), bacterial skin infections (10.3%), disorders of skin appendages (8.7%), parasitic infestations (7.7%), atrophic skin disorders (7.4%), disorders of pigmentation (7.4%), hypertrophic skin disorders (6.4%), viral infections (5.8), benign neoplasm (1.9%), dermatoses due to animal injury (0.4%), bullous dermatoses (0.1%), and malignant neoplasm (0.1%). Hypertrophic and atrophic disorders of the skin were mainly lesions of scarification (mostly atrophic) (5.7%) and keloids (5.6%). Fungal infection, bacterial infection, and parasitic infestation were more common in the ORC group, while dermatitis and eczema, disorders of skin appendages, hypertrophic and atrophic disorders of the skin, disorders of pigmentation, and benign neoplasm were more common in the OC group. The prevalence of skin diseases in the rural Nyala was more than our expectation and was dominated by infectious skin diseases. In addition, infectious skin diseases were more common in ORC rather than OC.

Scabies outbreak investigation and risk factors in Kechabira district, Southern Ethiopia: unmatched case control study

Objective

Scabies is an infection of the skin, which caused by human itch mite Sarcoptes scabiei. It is a common health problem in Ethiopia, especially during disasters, poor sanitation and overcrowded living condition. However, investigation on scabies outbreak and associated factors was absent or scarce in the country in general and in the study area in particular. Hence, this study was intended to investigate scabies outbreak, identify risk factors, and recommend preventive measures in Kechabira district, Kembata Tembaro zone, Southern Ethiopia.

Result

We identified a total of 243 scabies cases line listed with overall prevalence of 2.5% and attack rate of (AR) 20.5 per 1000 populations and no death was reported. Of the suspected cases 126 (51.9%) were males and 117 (48.1%) were females. The median age was 24 years with inter-quartile range (IQR) of 22 years. The highest cases were seen in children aged 5–14 (50.6%) years. The cases were seen in three villages and the highest incidence was in Burchana, 23.9 per 1000 population. Identified determinant factors for scabies outbreak were sharing clothes with scabies patients (AOR = 6.08, 95% CI [1.54–23.92], and households having greater than six family members AOR = 38.755, 95% CI [8.084–185.787].

Electronic supplementary material

The online version of this article (10.1186/s13104-019-4317-x) contains supplementary material, which is available to authorized users.

A systematic review of scabies transmission models and data to evaluate the cost-effectiveness of scabies interventions

Background

Scabies is a common dermatological condition, affecting more than 130 million people at any time. To evaluate and/or predict the effectiveness and cost-effectiveness of scabies interventions, disease transmission modelling can be used.

Objective

To review published scabies models and data to inform the design of a comprehensive scabies transmission modelling framework to evaluate the cost-effectiveness of scabies interventions.

Methods

Systematic literature search in PubMed, Medline, Embase, CINAHL, and the Cochrane Library identified scabies studies published since the year 2000. Selected papers included modelling studies and studies on the life cycle of scabies mites, patient quality of life and resource use. Reference lists of reviews were used to identify any papers missed through the search strategy. Strengths and limitations of identified scabies models were evaluated and used to design a modelling framework. Potential model inputs were identified and discussed.

Findings

Four scabies models were published: a Markov decision tree, two compartmental models, and an agent-based, network-dependent Monte Carlo model. None of the models specifically addressed crusted scabies, which is associated with high morbidity, mortality, and increased transmission. There is a lack of reliable, comprehensive information about scabies biology and the impact this disease has on patients and society.

Discussion

Clinicians and health economists working in the field of scabies are encouraged to use the current review to inform disease transmission modelling and economic evaluations on interventions against scabies.

Scabies is a neglected tropical disease affecting more than 130 million people, with major costs on health care systems worldwide. While effective treatments exist, it is unknown which treatment strategies result in the best outcomes against the lowest costs, and to what extent this differs between communities. Health economic modelling can help answer these questions, but has rarely been used in this disease area. This review discusses all available scabies transmission models (n = 4), and uses them to create a new, comprehensive modelling framework. This framework can be used as aid for creating a scabies transmission model, the details of which will be determined by the context (population) and the question being addressed. The current paper also reviews the data that is needed to inform scabies modelling: on scabies biology, quality of life and resource use. Unfortunately, available data is limited and particularly data on crusted scabies (associated with high morbidity and mortality rates) is rare. With this review, we hope to assist researchers and policy makers to predict and/or evaluate the cost-effectiveness of interventions against scabies in their population(s) of interest. To tackle scabies, it is key to use effective treatment strategies in a cost-effective and sustainable way. The models and data described in this review, may help researchers, clinicians and funding bodies to facilitate this.

Scabies in Resource-Poor Communities in Nasarawa State, Nigeria: Epidemiology, Clinical Features and Factors Associated with Infestation

Epidemiology and clinical features of scabies remain largely unknown in Nigeria’s rural communities. To fill this gap, we performed a cross-sectional study in three rural communities in north central Nigeria. A total of 500 individuals were included and examined for scabies infestation; a questionnaire was applied to collect socio-demographic and behavioral data. Scabies was diagnosed in 325 (65.0%) participants. Excoriations (68.6%), vesicles (61.8%), and papules (58.8%) were common skin lesions. Itching was the most common symptom (77.5%); 64% complained of sleep disturbances. Lymphadenopathy was identified in 48.3%. Lesions were most commonly encountered on the abdomen (35.5%), inguinal area (19.1%), and interdigital spaces (14.2%). Poverty-related variables, such as illiteracy (OR: 7.15; 95% CI: 3.71–13.95), low household income (7.25; 1.19–88.59), absence of a solid floor inside house (12.17; 2.83–52.34), and overcrowding (1.98; 1.08–2.81) were significantly associated with infestation. Individual behavior, such as sharing of beds/pillows (2.11; 1.42–3.14) and sharing of clothes (2.51; 1.57–3.99), was also highly significantly associated with scabies. Regular bathing habits (0.37; 0.24–0.56) and regular use of bathing soap (0.36; 0.21–0.53) were protective factors. Scabies is extremely common in the communities under study and is associated with considerable morbidity. The disease is intrinsically linked with extreme poverty.

Prevalence and drivers of human scabies among children and adolescents living and studying in Cameroonian boarding schools

Background

The dire lack of information concerning the epidemiology of human scabies in Cameroon, especially in school milieus brought us to undertake the present study which aimed to determine the prevalence and associated factors of scabies in Cameroonian boarding schools.

Methods

A cross-sectional study was conducted from February to March 2015 in four boarding schools in Yaoundé and Buea (Cameroon). Participants were students currently residing in one of the study sites, volunteering to participate in the study and whose parents or guardians had given their consent in this respect. The diagnosis was based on clinical assessment independently performed by two dermatologists.

Results

A total of 1,902 students were recruited (50.5 % boys), with a mean age of 14.3 ± 2.5 years. Overall, 338 participants (17.8 %) were diagnosed with scabies. Age ≤ 15 years, male sex, number of students in the school > 500, no access to the school infirmary, sleeping with others, sharing beddings, clothes or toilet stuffs, pruritus in the close entourage and complaining of pruritus were significantly associated with the presence of mites in univariable logistic regression analyses. On the other hand, at least two baths per day, usage of soap for baths and finger nails always cut short appeared as protective factors. After multivariable analysis, male sex (adjusted OR (aOR) 2.06, 95 % CI: 1.40–3.01, P < 0.0001), first cycle level of education (aOR 1.67, 95 % CI: 1.02–2.71, P = 0.040), number of students per dormitory ≤ 10 (aOR 6.99, 95 % CI: 3.34–14.71, P < 0.0001), no access to the school infirmary (aOR 1.62, 95 % CI: 1.12–2.32, P = 0.009) and complaining of pruritus (aOR 93.37, 95 % CI: 60.04–145.19, P < 0.0001) were the independent factors associated with scabies.

Conclusions

The prevalence of scabies was 17.8 %. The male sex, first cycle level of education, a number of students per dormitory ≤ 10, no access to the school infirmary and complaining of pruritus were the independent factors significantly impacting the occurrence of scabies.

Systems, strategies, and interventions for sustainable long-term care and protection of children with a history of living outside of family care

OBJECTIVES

This article reviews the available evidence regarding the efficacy, effectiveness, ethics, and sustainability of approaches to strengthen systems to care for and protect children living outside family care in low- and middle-income countries.

METHOD

For trafficked children, children of and on the street, children of conflict/disaster, and institutionalized children, a systems framework approach was used to organize the topic of sustainable approaches in low- and middle-income countries and addresses the following: legislation, policies, and regulations; system structures and functions (formal and informal); and continuum of care and services. The article draws on the findings of a focal group convened by the U.S. Government Evidence Summit: Protecting Children Outside of Family Care (December 12-13, 2011, Washington, DC), tasked with reviewing the literature on systems, strategies, and interventions for sustainable long-term care and protection of children with a history of living outside of family care in low- and middle-income country contexts. The specific methodology for the review is described in the commentary paper (Higgs, Zlidar, & Balster, 2012) that accompanies these papers.

RESULTS

For the most part, the evidence base in support of sustainable long-term care for the populations of interest is relatively weak, with some stronger but unreplicated studies. Some populations have been studied more thoroughly than others, and there are many gaps. Most of the existing studies identify population characteristics, needs, and consequences of a lack of systemic services to promote family-like care. There is some evidence of the effectiveness of laws and policies, as well as some evidence of service effectiveness, in improving outcomes for children outside of family care.

CONCLUSIONS

Despite the weaknesses and gaps of the existing research, there is a foundation of research for going forward, which should focus on developing and implementing systems for these most vulnerable children. The evidence reviewed indicates that child protection systems should aim for appropriate, permanent family care (including reunification, adoption, kinship care, or kafalah) for children in order to secure the best environment for a child's developmental prospects. Evidence also suggests that the quality and duration of care, including both permanent family care and alternative care, are important regardless of setting. The diversity of political, socioeconomic, historical, regional, community, and cultural contexts in which child protection systems operate need to be taken into account during programming and research design.

Scabies in the developing world--its prevalence, complications, and management

Scabies remains one of the commonest of skin diseases seen in developing countries. Although its distribution is subject to a cycle of infection, with peaks and troughs of disease prevalence, this periodicity is often less obvious in poor communities. Scabies is a condition that affects families, particularly the most vulnerable; it also has the greatest impact on young children. Largely through the association with secondary bacterial infection caused by group A streptococci and Staphylococcus aureus, the burden of disease is compounded by nephritis, rheumatic fever and sepsis in developing countries. However, with a few notable exceptions, it remains largely neglected as an important public health problem. The purpose of this review is to provide an update on the current position of scabies with regard to its complications and control in resource-poor countries.

Scabies in healthcare settings

PURPOSE OF REVIEW

In industrialized countries, epidemics of scabies are mainly described within families or in institutions such as healthcare settings. Control of institutional scabies is associated with a considerable working and economic burden, but guidelines for the management are scarce.

RECENT FINDINGS

The prevalence of institutional scabies is probably underestimated. Identified risk factors for institutional scabies outbreaks include the institution type, extensive physical contact with patients and movement of patients, the existence of crusted scabies, a long diagnostic delay and failures in implementation of infection control or treatment plans.Atypical clinical features (hyperinfestation, scabies in the elderly or in children) may be misdiagnosed. Control of institutional scabies outbreaks relies on prompt recognition of the index case, constitution of an outbreak management team, determination of the extent of the outbreak and risk factors for spread, immediate implementation of infection control practices, adequate education of all involved persons, simultaneous treatment of cases and of all exposed individuals and concomitant environmental disinfection. Prolonged surveillance is imperative to eradicate scabies.

SUMMARY

The inclusion of institutionalized patients in randomized controlled trials would be beneficial as present data concerning scabicide effectiveness are obtained from trials that recruited individual participants and do not take into account a global strategy.

The epidemiology of scabies in an impoverished community in rural Brazil: presence and severity of disease are associated with poor living conditions and illiteracy

BACKGROUND

We sought to study the epidemiology of scabies and to identify risk factors of severe disease in an impoverished rural community in northeast Brazil.

METHODS

The study was designed as a repeated cross-sectional study based on two door-to-door surveys. One survey was carried out in the rainy season, the other in the dry season. The inhabitants of the community were examined for the presence of scabies and demographic, socioeconomic, and behavioral risk factors were assessed. Risk factors were analyzed using bivariate and multivariate regression analysis.

RESULTS

The overall prevalence was 9.8% with no significant variation between seasons and the incidence was estimated to be 196/1000 person-years. The highest prevalence (18.2%) was observed in children younger than 4 years. Risk factors in the bivariate analysis were young age, presence of many children in the household, illiteracy, low family income, poor housing, sharing clothes and towels, and irregular use of shower. Age younger than 15 years, illiteracy, sharing of clothes, and living in the community for more than 6 months remained significant independent risk factors in multivariate regression analysis.

LIMITATIONS

We used a clinical case definition; specificity and sensitivity were not verified. Men were underrepresented in the study population.

CONCLUSIONS

In this impoverished community scabies is an important health problem characterized by continuous transmission throughout the year. The parasitic skin disease is embedded in a complex web of causation characterized by poor living conditions and a low level of education.

Socio-demographic characteristics of children infested with scabies in densely populated communities of residential madrashas (Islamic education institutes) in Dhaka, Bangladesh

BACKGROUND

Outbreaks of scabies in institutions and the socio-economic consequences have not been reported from overpopulated countries such as Bangladesh.

STUDY DESIGN

A community-based study among children from six residential Islamic education institutes (madrashas) in Dhaka. Multistage random sampling was used.

OBJECTIVES

To study the socio-economic profile, water-sanitation facilities, personal hygiene and living conditions of these children.

METHODOLOGY

Direct interviews were used to collect the data and clinical check up was performed in all children.

RESULTS

In total, 492 children received clinical check-ups; 92.5% were boys (mean age: 11.2+/-2.4 years). 63.4% of fathers and 98.5% of mothers were either illiterate or had only received primary education, 55.1% of fathers were in low-paid labouring jobs, and 99% of mothers were housewives. Of the 98% of children who had scabies, 71% had been re-infected (96% during the winter). Randomly assigned anti-scabies drugs revealed an average cure rate of 85.5%. Seventy-four percent of children were living in poorly ventilated buildings with overcrowded sleeping arrangements. They had poor personal hygiene: 21% shared towels; 8% shared undergarments; 30% shared bed linen; and 81% kept their used clothes on a communal line or shelf. Sanitation was also poor: 39% bathed infrequently, although 97% carried out mandatory ablution. Most children (61%) washed their clothes (including undergarments) two or three times a fortnight, 35% did so every 2-3 days, and 3.7% washed their clothes on alternative days. Disease severity and re-infection were associated with infrequent washing of clothes (P<0.001) and bed linen (P<0.001), overcrowded sleeping arrangements (P<0.001) and infrequent bathing (P<0.001) with soap (P<0.001). This was further related to household income (P<0.001 for both).

CONCLUSION

The study findings have potentially dangerous implications for public health. Immediate attention should be given to developing a sustainable long-term intervention programme to combat scabies hyperendemicity, and to save thousands of children from impending complications.

Prevalence of pediculosis and scabies in the prisoners of Bandar Abbas, Hormozgan province, Iran

The increasing prevalence of active pediculosis and scabies among prisoners prompted us to conduct a head louse and scabies prevalence survey among prisoners in the Bandar Abbas, Hormozgan province, Iran. During the study, 67 patients with skin disorders were found. Among the doubtful patients who were considered 38 patients (57%) indicated Sarcoptes scabiei, 6 patients (9%) were indicated lice and 23 patients (33%) were set aside for more studying and specialized tests. Contamination rates were 18.4, 10.5 and 10.5% in the youths, drug abusers and kitchen units, respectively. Adults, foreigners and quarantine units were contaminated 7.9, 5.3 and 5.3%, respectively. In cheque and military units, no contamination was observed because of the higher hygienic status. Morbidity rate in the individual and technical units was 2.5%. The highest and the least morbidity rates were observed among 20-29 year age group (55.2%) and over 50 year age group (2.6%). The average and the mean ages of the 38 patients that contaminated to Sarcoptes scabiei was 29 +/- 8 and 28 years, respectively. The least and the highest contamination ages were 18 and 59 years, respectively. The affirmative Sarcoptes scabiei cases in the different units indicated that the general units had the most morbidity percentage because there were many prisoners with different cultural backgrounds (26.3%).

Problems in diagnosing scabies, a global disease in human and animal populations

Scabies is a worldwide disease and a major public health problem in many developing countries, related primarily to poverty and overcrowding. In remote Aboriginal communities in northern Australia, prevalences of up to 50% among children have been described, despite the availability of effective chemotherapy. Sarcoptic mange is also an important veterinary disease engendering significant morbidity and mortality in wild, domestic, and farmed animals. Scabies is caused by the ectoparasitic mite Sarcoptes scabiei burrowing into the host epidermis. Clinical symptoms include intensely itchy lesions that often are a precursor to secondary bacterial pyoderma, septicemia, and, in humans, poststreptococcal glomerulonephritis. Although diagnosed scabies cases can be successfully treated, the rash of the primary infestation takes 4 to 6 weeks to develop, and thus, transmission to others often occurs prior to therapy. In humans, the symptoms of scabies infestations can mimic other dermatological skin diseases, and traditional tests to diagnose scabies are less than 50% accurate. To aid early identification of disease and thus treatment, a simple, cheap, sensitive, and specific test for routine diagnosis of active scabies is essential. Recent developments leading to the expression and purification of S. scabiei recombinant antigens have identified a number of molecules with diagnostic potential, and current studies include the investigation and assessment of the accuracy of these recombinant proteins in identifying antibodies in individuals with active scabies and in differentiating those with past exposure. Early identification of disease will enable selective treatment of those affected, reduce transmission and the requirement for mass treatment, limit the potential for escalating mite resistance, and provide another means of controlling scabies in populations in areas of endemicity.

Study of two main approaches-electrophoresis and chromatography as varietal identification methods in rice

Rice is a major worldwide crop that cultivated in the most areas of the north of Iran (Mazandaran and Gillan Province). An increase in the assortment of rice varieties is making it progressively more difficult to distinguish between the many cultivars by traditional visual identification methods. The more advanced identification techniques of electrophoresis and chromatography offer an effective solution to this emerging identification dilemma. This paper reviews the application of these two evaluation techniques. An Electrophoresis analysis includes gel electrophoresis and capillary electrophoresis and compares them with a popular chromatography technique, namely reversed-phase, size exclusion anion-exchange high performance liquid chromatography (HPLC). This paper will also include an interpretation of the results.

Scabies, pediculosis, bedbugs, and stinkbugs: uncommon presentations

Parasitic agents determine some of the most common skin disorders. Although well known, they could present different manifestations or be modified by individual or external factors that make their diagnosis or treatment difficult. This review will discuss some of the most prevalent parasitic infections, scabies, and pediculosis and also mention reactions determined by contact with certain insects that, although rarely found, could induce important skin reactions.