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Wu X, Yang F, Zhang R. Frequent Misdiagnosis of Scabies as Eczema in China: A Descriptive Study of 23 Cases. Int J Gen Med 2024; 17:1615-1623. [PMID: 38690199 PMCID: PMC11060170 DOI: 10.2147/ijgm.s458731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 04/10/2024] [Indexed: 05/02/2024] Open
Abstract
Objective To outline the clinical manifestations observed in patients with scabies misdiagnosed as generalized eczema, analyse the factors contributing to these misdiagnoses and explore potential reasons for the resurgence of scabies. Patients and Methods A retrospective analysis was performed to investigate the patients with scabies misdiagnosed as generalized eczema. Results We included 23 patients, with twelve (52.17%) being male and eleven (47.83%) female. The illness duration ranged from 0.5 to 7 months. Among all patients, 12 (52.17%) were residents of nursing homes, 5 (21.74%) were staff members of these facilities, 4 (17.39%) were caregivers of long-term hospitalized relatives, 1 (4.35%) was a construction worker, and 1 (4.35%) had a history of tourism. The rash predominantly affected the trunk and extremities, 12 patients (52.17%) are each involved the perineum and fingers webbings. The presentations included erythema, papules, and nodules. The main complaint of all patients was nocturnal itch. Under direct microscopy, 5 patients (21.74%) tested positive for scabies mites, and 3 (13.04%) showed histopathological features consistent with scabies. All patients were initially misdiagnosed with generalized eczema. Conclusion Over half of all patients diagnosed with scabies either resided or worked in long-term care facilities. The lack of awareness of scabies among medical staff in long-term care facilities readily led to frequent misdiagnosis. Comprehensive measures should be implemented urgently to strengthen disease management.
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Affiliation(s)
- Xumei Wu
- Department of Dermatology, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China
- Department of Dermatology, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, People’s Republic of China
| | - Feifei Yang
- Department of Dermatology, Tongzhou Maternal & Child Health Hospital of Beijing, Beijing, People’s Republic of China
| | - Ruina Zhang
- Department of Dermatology, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China
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Wang R, Zhou R, Meng Y, Zheng J, Lu W, Yang Y, Yang J, Wu Y, Shan W. Specific Detection of Phytophthora parasitica by Recombinase Polymerase Amplification Assays Based on a Unique Multicopy Genomic Sequence. PLANT DISEASE 2024; 108:987-995. [PMID: 37884481 DOI: 10.1094/pdis-04-23-0722-re] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
Phytophthora parasitica is a highly destructive oomycete plant pathogen that is capable of infecting a wide range of hosts including many agricultural cash crops, fruit trees, and ornamental garden plants. One of the most important diseases caused by P. parasitica worldwide is black shank of tobacco. Rapid, sensitive, and specific pathogen detection is crucial for early rapid diagnosis, which can facilitate effective disease management. In this study, we used a genomics approach to identify repeated sequences in the genome of P. parasitica by genome sequence alignment and identified a 203-bp P. parasitica-specific sequence, PpM34, that is present in 31 to 60 copies in the genome. The P. parasitica genome specificity of PpM34 was supported by PCR amplification of 24 genetically diverse strains of P. parasitica, 32 strains representing 12 other Phytophthora species, one Pythium species, six fungal species, and three bacterial species, all of which are plant pathogens. Our PCR and real-time PCR assays showed that the PpM34 sequence was highly sensitive in specifically detecting P. parasitica. Finally, we developed a PpM34-based high-efficiency recombinase polymerase amplification assay, which allowed us to specifically detect as little as 1 pg of P. parasitica total DNA from both pure cultures and infected Nicotiana benthamiana at 39°C using a fluorometric thermal cycler. The sensitivity, specificity, convenience, and rapidity of this assay represent a major improvement for early diagnosis of P. parasitica infection.
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Affiliation(s)
- Rongsheng Wang
- Liaoning Key Laboratory of Plant Pathology, College of Plant Protection, Shenyang Agricultural University, Shenyang 110866, Liaoning, China
- State Key Laboratory of Crop Stress Biology for Arid Areas and College of Agronomy, Northwest A&F University, Yangling 712100, Shaanxi, China
| | - Ran Zhou
- State Key Laboratory of Crop Stress Biology for Arid Areas and College of Agronomy, Northwest A&F University, Yangling 712100, Shaanxi, China
| | - Yuling Meng
- State Key Laboratory of Crop Stress Biology for Arid Areas and College of Agronomy, Northwest A&F University, Yangling 712100, Shaanxi, China
| | - Jie Zheng
- State Key Laboratory of Crop Stress Biology for Arid Areas and College of Agronomy, Northwest A&F University, Yangling 712100, Shaanxi, China
| | - Wenqin Lu
- State Key Laboratory of Crop Stress Biology for Arid Areas and College of Agronomy, Northwest A&F University, Yangling 712100, Shaanxi, China
| | - Yang Yang
- State Key Laboratory of Crop Stress Biology for Arid Areas and College of Agronomy, Northwest A&F University, Yangling 712100, Shaanxi, China
| | - Jiapeng Yang
- State Key Laboratory of Crop Stress Biology for Arid Areas and College of Agronomy, Northwest A&F University, Yangling 712100, Shaanxi, China
| | - Yuanhua Wu
- Liaoning Key Laboratory of Plant Pathology, College of Plant Protection, Shenyang Agricultural University, Shenyang 110866, Liaoning, China
| | - Weixing Shan
- State Key Laboratory of Crop Stress Biology for Arid Areas and College of Agronomy, Northwest A&F University, Yangling 712100, Shaanxi, China
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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] [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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Diagnostics to support the control of scabies–Development of two target product profiles. PLoS Negl Trop Dis 2022; 16:e0010556. [PMID: 36040928 PMCID: PMC9467343 DOI: 10.1371/journal.pntd.0010556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 09/12/2022] [Accepted: 08/08/2022] [Indexed: 11/19/2022] Open
Abstract
Background Scabies was added to the WHO NTD portfolio in 2017 and targets for the control of scabies were included in the 2021–2030 WHO NTD roadmap. A major component of scabies control efforts a strategy based on mass drug administration (MDA) with ivermectin. Currently diagnosis of scabies relies on clinical examination with a limited role for diagnostic testing. Under the recommendation of the WHO Diagnostic Technical Advisory Group (DTAG) for Neglected Tropical Diseases, a working group was assembled and tasked with agreeing on priority use cases for and developing target product profiles (TPPs) for new diagnostics tools for scabies. Methodology and principal findings The working group convened three times and established two use cases: establishing if the 10% threshold for mass drug administration had been reached and if the 2% threshold for stopping mass drug administration has been achieved. One subgroup assessed the current diagnostic landscape for scabies and a second subgroup determined the test requirements for both use cases. Draft TPPs were sent out for input from stakeholders and experts. Both TPPs considered the following parameters: product use, design, performance, configuration, cost, access and equity. The group considered the use of the tests as a single step process or as part of a two step process following initial clinical examination. When used a single step test (the ideal scenario) for starting MDA a new diagnostic required a sensitivity of ≥92% and a specificity of ≥98%. When used a single step test (the ideal scenario) for stopping MDA a new diagnostic required a sensitivity of ≥80% and a specificity of ≥99%. Conclusions The TPPs developed will provide test developers with guidance to ensure that novel diagnostic tests meet identified public health needs. Accurate diagnostic tests are needed to aid scabies control efforts. In particular they might aid decisions about when to start and stop treatment of whole communities (mass drug administration). Currently most diagnosis is based on clinical examination only and there is a need to establish what criteria new diagnostic tests should meet for them to be of public health use. To aid with this, we determined the programmatic areas of greatest need (use cases) and then developed a shortlist of product requirements (target product profiles, or TPPs) for each scenario. These TPPs can then be used by product developers to ensure that novel diagnostic tools in development are fit for purpose. There were two programmatic use cases for which scabies TPPs were developed. The first TPP focused on diagnostics to determine if the community prevalence of scabies was above 10%—the threshold at which mass drug administration is recommended. The second TPP focused on diagnostics to determine if the community prevalence of scabies is below 2%—the threshold at which mass drug administration can be stopped.
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Shehwana H, Ijaz S, Fatima A, Walton S, Sheikh ZI, Haider W, Naz S. Transcriptome Analysis of Host Inflammatory Responses to the Ectoparasitic Mite Sarcoptes scabiei var. hominis. Front Immunol 2021; 12:778840. [PMID: 34925353 PMCID: PMC8671885 DOI: 10.3389/fimmu.2021.778840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 11/02/2021] [Indexed: 11/30/2022] Open
Abstract
Scabies, a human skin infestation caused by the ectoparasitic mite Sarcoptes scabiei var. hominis, affects more than 200 million people globally. The prevailing knowledge of the disease process and host immune response mechanisms is limited. A better understanding of the host-parasite relationship is essential for the identification of novel vaccine and drug targets. Here we aimed to interrogate the transcriptomic profiles of mite-infested human skin biopsies with clinical manifestations of ordinary scabies subjects ("OS"; n = 05) and subjects naive to scabies ("control"; n = 03) using RNASeq data analysis. A combined clustering, network, and pathway mapping approach enabled us to identify key signaling events in the host immune and pro-inflammatory responses to S. scabiei infestation. The clustering patterns showed various differentially expressed genes including inflammatory responses and innate immunity genes (DEFB4A, IL-19, CXCL8, CSF3, SERPINB4, S100A7A, HRNR) and notably upregulation of the JAK-STAT pathway in scabies-infested samples. Mite-infested human skin biopsies (GSE178563) were compared with an ex-vivo porcine infested model (E-MTAB-6433) and human skin equivalents (GSE48459). Marked enrichment of immune response pathways (JAK-STAT signaling, IL-4 and IL-13 pathway, and Toll receptor cascade), chemokine ligands and receptors (CCL17, CCL18, CCL3L1, CCL3L3, CCR7), and cytokines (IL-13 and IL-20) were observed. Additionally, genes known for their role in psoriasis and atopic dermatitis were upregulated, e.g., IL-19. The detailed transcriptomic profile has provided an insight into molecular functions, biological processes, and immunological responses and increased our understanding about transcriptomic regulation of scabies in human.
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Affiliation(s)
- Huma Shehwana
- Department of Biological Sciences, National University of Medical Sciences, Rawalpindi, Pakistan
| | - Sadaf Ijaz
- Research Centre for Modelling & Simulation, National University of Science and Technology, Islamabad, Pakistan
| | - Abeera Fatima
- Research Centre for Modelling & Simulation, National University of Science and Technology, Islamabad, Pakistan
| | - Shelley Walton
- Inflammation and Healing Research Cluster, School of Health and Sport Sciences, University of the Sunshine Coast, Maroochydore, QLD, Australia
| | - Zafar Iqbal Sheikh
- Department of Dermatology, Pak-Emirates Military Hospital, Rawalpindi, Pakistan
| | - Waseem Haider
- Department of Biosciences, COMSATS University Islamabad, Islamabad, Pakistan
| | - Shumaila Naz
- Department of Biological Sciences, National University of Medical Sciences, Rawalpindi, Pakistan
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Glennie M, Gardner K, Dowden M, Currie BJ. Active case detection methods for crusted scabies and leprosy: A systematic review. PLoS Negl Trop Dis 2021; 15:e0009577. [PMID: 34297724 PMCID: PMC8336788 DOI: 10.1371/journal.pntd.0009577] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 08/04/2021] [Accepted: 06/20/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Crusted scabies is endemic in some remote Aboriginal communities in the Northern Territory (NT) of Australia and carries a high mortality risk. Improvement in active case detection (ACD) for crusted scabies is hampered by a lack of evidence about best practice. We therefore conducted a systematic review of ACD methods for leprosy, a condition with similar ACD requirements, to consider how findings could be informative to crusted scabies detection. METHODS AND PRINCIPLE FINDINGS We conducted systematic searches in MEDLINE, CINAHL, Scopus and the Cochrane Database for Systematic Reviews for studies published since 1999 that reported at least one comparison rate (detection or prevalence rate) against which the yield of the ACD method could be assessed. The search yielded 15 eligible studies from 511. Study heterogeneity precluded meta-analysis. Contact tracing and community screening of marginalised ethnic groups yielded the highest new case detection rates. Rapid community screening campaigns, and those using less experienced screening personnel, were associated with lower suspect confirmation rates. There is insufficient data to assess whether ACD campaigns improve treatment outcomes or disease control. CONCLUSION This review demonstrates the importance of ACD campaigns in communities facing the highest barriers to healthcare access and within neighbourhoods of index cases. The potential benefit of ACD for crusted scabies is not quantified, however, lessons from leprosy suggest value in follow-up with previously identified cases and their close contacts to support for scabies control and to reduce the likelihood of reinfection in the crusted scabies case. Skilled screening personnel and appropriate community engagement strategies are needed to maximise screening uptake. More research is needed to assess ACD cost effectiveness, impact on disease control, and to explore ACD methods capable of capturing the homeless and highly mobile who may be missed in household centric models.
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Affiliation(s)
- Miriam Glennie
- Public Sector Research Group, University New South Wales, Canberra, Australia
- * E-mail:
| | - Karen Gardner
- Public Sector Research Group, University New South Wales, Canberra, Australia
| | | | - Bart J. Currie
- Menzies School of Health Research, Charles Darwin University and Royal Darwin Hospital, Darwin, Australia
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