In Situ Diagnosis of Scabies Using a Handheld Digital Microscope in Resource-Poor Settings-A Proof-of-Principle Study in the Amazon Lowland of Colombia

Parasitological prevalence of scabies and secondary bacterial infections among scabies suspected patients at Borumeda General Hospital, Northeast Ethiopia

BACKGROUND

Scabies disproportionately affects people in resource-poor areas. Clinical diagnosis risks misdiagnosis due to resemblance to other skin diseases, but laboratory confirmation improves accuracy. Scabies allow for secondary bacterial infections. Associated bacteria exacerbate scabies and antibiotic resistance. Ethiopian scabies diagnosis relies solely on clinical exams without confirming parasites or investigating secondary bacterial infections. This study aims to identify parasites via scraping, isolate secondary bacteria, and evaluate their antibiotic susceptibility profiles.

METHODS

A hospital based cross-sectional study was conducted from September 2022 to July 2023 among scabies suspected patients who visited the dermatology clinic at Borumeda General Hospital in Northeast Ethiopia. A systematic random sampling technique was used to select 422 study participants. Socio-demographic, hygiene, and clinical characteristics data were collected via face-to-face interviews and observation. Skin scrapings for parasitological investigations and swab samples for microbiological investigations were collected and transported for analysis and drug susceptibility testing. Descriptive statistics and logistic regression analysis were employed to assess risk factors.

RESULT

Among 422 skin scraping samples, 156 (37.0%) cases of scabies were microscopically confirmed. Bed-sharing and having contact history were independent predictors of microscopically confirmed scabies. The prevalence of secondary bacterial infections among scabies-confirmed patients was 35.9% (56/156). The most prevalent bacterial species were Staphylococcus aureus, coagulase-negative staphylococci, and Streptococcus pyogenes. Tetracycline for Gram-positive bacteria and ampicillin for Gram-negative bacteria showed the highest rate of resistance. In both Gram-positive and Gram-negative strains, multidrug resistance was also observed.

CONCLUSION

This study found that over one-third of skin scrapings tested positive for scabies. Additionally, more than one-third of scabies cases were complicated by secondary bacterial infections. Improved scabies diagnosis and consideration of secondary bacterial infections are important for better controlling this neglected tropical disease.

Scabies in French Guiana: Quantitative and qualitative factors associated with therapeutic failure

BACKGROUND

Strategies for the control of scabies should be adapted to local settings. Traditional communities in French Guiana have non-Western conceptions of disease and health.

OBJECTIVES

The objectives for this study were to explore knowledge, attitudes and practices to identify potential factors associated with the failure of scabies treatment in these communities.

METHODS

Patients with a clinical diagnosis of scabies, seen at either the Cayenne Hospital or one of 13 health centres between 01 April 2021 and 31 August 2021, were included as participants, and were seen again after 6 weeks to check for persistence of lesions. Factors associated with treatment failure were looked for both at inclusion and at 6 weeks. Semi-structured interviews were conducted with a diversified subsample of participants.

RESULTS

In total, 164 participants were included in the quantitative component, and 21 were interviewed for the qualitative component. Declaring that the second treatment dose had been taken was associated with therapeutic success. Western treatments were not always affordable. Better adherence was observed with topical treatments than with oral ivermectin, whereas permethrin monotherapy was associated with failure. Scabies-associated stigma was high among Amerindians and Haitians but absent in Ndjuka Maroons. Participants reported environmental disinfection as being very complex.

CONCLUSIONS

The treatment of scabies in traditional Guianan communities may vary depending on local perceptions of galenic formulations, disease-associated stigma and differences in access to health care. These factors should be taken into account when devising strategies for the control of scabies aimed at traditional communities living in remote areas, and migrant populations.

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

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

[Overview of infectious and non-infectious diseases in French Guiana in 2022]

Source of many myths, French Guiana represents an exceptional territory due to the richness of its biodiversity and the variety of its communities. The only European territory in Amazonia, surrounded by the Brazilian giant and the little-known Suriname, Ariane 6 rockets are launched from Kourou while 50% of the population lives below the poverty line. This paradoxical situation is a source of health problems specific to this territory, whether they be infectious diseases with unknown germs, intoxications or chronic pathologies.Some infectious diseases such as Q fever, toxoplasmosis, cryptococcosis or HIV infection are in common with temperate countries, but present specificities leading to sometimes different management and medical reasoning. In addition to these pathologies, many tropical diseases are present in an endemic and / or epidemic mode such as malaria, leishmaniasis, Chagas disease, histoplasmosis or dengue. Besides, Amazonian dermatology is extremely varied, ranging from rare but serious pathologies (Buruli ulcer, leprosy) to others which are frequent and benign such as agouti lice (mites of the family Trombiculidae) or papillonitis. Envenomations by wild fauna are not rare, and deserve an appropriate management of the incriminated taxon. Obstetrical, cardiovascular and metabolic cosmopolitan pathologies sometimes take on a particular dimension in French Guiana that must be taken into account in the management of patients. Finally, different types of intoxication are to be known by practitioners, especially due to heavy metals.European-level resources offer diagnostic and therapeutic possibilities that do not exist in the surrounding countries and regions, thus allowing the management of diseases that are not well known elsewhere.Thanks to these same European-level resources, research in Guyana occupies a key place within the Amazon region, despite a smaller population than in the surrounding countries. Thus, certain pathologies such as histoplasmosis of the immunocompromised patient, Amazonian toxoplasmosis or Q fever are hardly described in neighboring countries, probably due to under-diagnosis linked to more limited resources. French Guiana plays a leading role in the study of these diseases.The objective of this overview is to guide health care providers coming to or practicing in French Guiana in their daily practice, but also practitioners taking care of people returning from French Guiana.

Laboratory-based diagnosis of scabies: a review of the current status

Scabies is a neglected tropical disease (NTD) of the skin that is caused by the mite Sarcoptes scabiei. It is considered to be an important public health problem in many regions. The disease is at its most prevalent in low-resource countries where there are overcrowded living conditions coupled with poor hygiene. In some regions, mass drug administration using ivermectin is a key population-based approach to the control of scabies. Before starting a patient on specific treatment, confirming the diagnosis by accurate and rapid identification of the organism is critical. Different laboratory-based techniques for scabies have been developed in the last few decades. These include direct microscopy and histopathology. More recently, serological testing, dermoscopy and different molecular techniques have been developed as diagnostic methods for scabies. To date, none of these, apart from microscopy and dermoscopy, has been translated into routine clinical laboratory practice. A simple point-of-care or laboratory test would provide a rapid and confirmed diagnosis and early institution of effective treatment. In this review we present an update on the laboratory techniques currently in use for the identification of scabies.

Estimating the global burden of scabies: what else do we need?

Scabies is one of the most common disorders identified in any estimate of global skin disease prevalence. Furthermore, quantifying its impact on individuals and societies has been problematic. There has been a lack of clear case definitions and laboratory tests. There have been few epidemiological studies, particularly those focusing on low-income countries, variation in prevalence within high-income countries, or estimates of the effect of scabies on health beyond the skin, such as renal disease or mental wellbeing. Economic studies are also lacking. However, the new strategy of integrating surveillance for skin Neglected Tropical Diseases may well produce advancements on these issues, in addition to providing an overarching structure for health improvement and disease control.

The public health control of scabies: priorities for research and action

Scabies is a parasitic disease of the skin that disproportionately affects disadvantaged populations. The disease causes considerable morbidity and leads to severe bacterial infection and immune-mediated disease. Scientific advances from the past 5 years suggest that scabies is amenable to population-level control, particularly through mass drug administration. In recognition of these issues, WHO added scabies to the list of neglected tropical diseases in 2017. To develop a global control programme, key operational research questions must now be addressed. Standardised approaches to diagnosis and methods for mapping are required to further understand the burden of disease. The safety of treatments for young children, including with ivermectin and moxidectin, should be investigated. Studies are needed to inform optimum implementation of mass treatment, including the threshold for intervention, target, dosing, and frequency. Frameworks for surveillance, monitoring, and evaluation of control strategies are also necessary.