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Simonart T, Lam Hoai XL. Escalating Threat of Drug-Resistant Human Scabies: Current Insights and Future Directions. J Clin Med 2024; 13:5511. [PMID: 39336998 PMCID: PMC11432065 DOI: 10.3390/jcm13185511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2024] [Revised: 09/12/2024] [Accepted: 09/14/2024] [Indexed: 09/30/2024] Open
Abstract
Background: Scabies is a prevalent dermatological condition with significant public health implications. The recent rise in drug-resistant scabies presents new challenges for effective disease management and control. Methods: A comprehensive literature review was conducted using PubMed, Cochrane Library, and Web of Science. Studies published from 2000 to August 2024 were considered, focusing on those reporting drug-resistant scabies and advancements in treatment approaches. Results: Clinical studies, in vitro investigations, and case reports show significant resistance of human scabies to permethrin. Main resistance mechanisms involve genetic mutations in the mites' voltage-gated sodium channels (VGSCs) and enhanced activity or expression of the detoxifying enzyme glutathione S-transferase (GST). Resistance to ivermectin and benzyle benzoate, although suggested by some authors, seems less obvious. The clinical evidence of widespread ivermectin resistance in human scabies infestations is lacking, despite indications of increased tolerance in laboratory settings and anecdotal reports of resistance in patients with crusted scabies. Benzyl benzoate resistance in scabies mites remains unconfirmed. Conclusions: Permethrin-resistant scabies is an escalating threat requiring new management strategies and updated guidelines. Infection control measures, alternative treatments, and ongoing research into new therapeutics are crucial to mitigate the impact of drug-resistant scabies.
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Affiliation(s)
- Thierry Simonart
- Department of Dermatology, Delta Hospital, CHIREC, Université Libre de Bruxelles, 1160 Bruxelles, Belgium
| | - Xuân-Lan Lam Hoai
- Department of Dermatology, St Pierre-Brugmann-HUDERF University Hospitals, Université Libre de Bruxelles, 1000 Brussels, Belgium
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2
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Salavastru CM, Cretu S, Dascalu M, Sendrea AM, Suru A, Tiplica GS. Scabies treatment with benzyl benzoate in patients younger than 2 years: A single-centre experience. J Eur Acad Dermatol Venereol 2024. [PMID: 38702971 DOI: 10.1111/jdv.20048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 04/10/2024] [Indexed: 05/06/2024]
Affiliation(s)
- C M Salavastru
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
- Paediatric Dermatology Department, Colentina Clinical Hospital, Bucharest, Romania
| | - S Cretu
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
- Dermatology Research Unit, Colentina Clinical Hospital, Bucharest, Romania
| | - M Dascalu
- Department of Computer Science, National University of Science and Technology POLITEHNICA Bucharest, Bucharest, Romania
| | - A M Sendrea
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
- Paediatric Dermatology Department, Colentina Clinical Hospital, Bucharest, Romania
- Dermatology Research Unit, Colentina Clinical Hospital, Bucharest, Romania
| | - A Suru
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
- Paediatric Dermatology Department, Colentina Clinical Hospital, Bucharest, Romania
- Dermatology Research Unit, Colentina Clinical Hospital, Bucharest, Romania
| | - G S Tiplica
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
- 2nd Dermatology Department, Colentina Clinical Hospital, Bucharest, Romania
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3
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Betlloch-Mas I, Boluda-Verdú E, Jara-Rico N, Sánchez-García V, Berbegal-De Gracia L, Chiner-Vives E. Scabies in Infants: Series of 51 Cases. CHILDREN (BASEL, SWITZERLAND) 2024; 11:443. [PMID: 38671660 PMCID: PMC11048914 DOI: 10.3390/children11040443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Revised: 04/02/2024] [Accepted: 04/03/2024] [Indexed: 04/28/2024]
Abstract
We conducted a two-year retrospective evaluation of infants aged under two years with a confirmed, clinical, or suspected diagnosis of scabies in a healthcare center in Alicante (Spain) to determine possible factors associated with diagnostic delay and poor treatment response. We collected epidemiological, clinical, diagnostic, and treatment variables. After describing our findings as mean values and percentages, we compared categorical variables using the Student's t-test and the Mann-Whitney U test, and we compared continuous variables with the Chi2 test and Pearson's correlation coefficient. We included 51 infants (19 boys and 32 girls) with a mean age of 15 months. The main source of contagion was the family; half of the infants lived with four or more people. According to the International Consensus Criteria for the Diagnosis of Scabies, confirmed scabies was diagnosed in 45% of cases and clinical scabies in 47%, and 45% of cases had a diagnostic delay. Lesions mainly affected the hands, feet, and trunk, with papules in 92% of cases and burrows in 55%. The predominant symptoms were pruritus (94%) and irritability (69%). Regarding treatment, 98% of the infants received topical permethrin and 35% received oral ivermectin. Treatment failed in 76% of infants. Living in large family units was associated with a higher risk of contagion and therapeutic failure. Diagnostic delay was associated with previous misdiagnosis.
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Affiliation(s)
- Isabel Betlloch-Mas
- Department of Clinical Medicine, Miguel Hernández University, Carretera Alicante-Valencia N-332, 03550 Sant Joan d’Alacant, Spain;
- Department of Dermatology, Dr. Balmis General University Hospital, 03010 Alicante, Spain; (N.J.-R.); (V.S.-G.); (L.B.-D.G.)
- ISABIAL Research Institute, 03010 Alicante, Spain
| | - Elena Boluda-Verdú
- Department of Clinical Medicine, Miguel Hernández University, Carretera Alicante-Valencia N-332, 03550 Sant Joan d’Alacant, Spain;
| | - Noelia Jara-Rico
- Department of Dermatology, Dr. Balmis General University Hospital, 03010 Alicante, Spain; (N.J.-R.); (V.S.-G.); (L.B.-D.G.)
- ISABIAL Research Institute, 03010 Alicante, Spain
| | - Verónica Sánchez-García
- Department of Dermatology, Dr. Balmis General University Hospital, 03010 Alicante, Spain; (N.J.-R.); (V.S.-G.); (L.B.-D.G.)
- ISABIAL Research Institute, 03010 Alicante, Spain
| | - Laura Berbegal-De Gracia
- Department of Dermatology, Dr. Balmis General University Hospital, 03010 Alicante, Spain; (N.J.-R.); (V.S.-G.); (L.B.-D.G.)
- ISABIAL Research Institute, 03010 Alicante, Spain
| | - Eusebi Chiner-Vives
- Department of Pulmonology, San Juan de Alicante University Hospital, 03010 Alicante, Spain;
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Gnesotto L, Cutrone M, Mazzatenta C, Bassi A, Piccolo V, Sechi A. Topical Ivermectin for Permethrin-Resistant Scabies: A Useful Application. Dermatol Pract Concept 2024; 14:dpc.1401a29. [PMID: 38364400 PMCID: PMC10868950 DOI: 10.5826/dpc.1401a29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2023] [Indexed: 02/18/2024] Open
Affiliation(s)
- Laura Gnesotto
- Dermatology Unit, Department of Medicine DIMED, University of Padova, Padova, Italy
| | - Mario Cutrone
- Pediatric Dermatology, Ospedale dell’Angelo Venezia, Ospedale San Bortolo Vicenza, Italy
| | | | - Andrea Bassi
- UO Dermatology-Azienda USL Toscana Nord Ovest, Lucca, Italy
| | | | - Andrea Sechi
- Pediatric Dermatology, Ospedale dell’Angelo Venezia, Ospedale San Bortolo Vicenza, Italy
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Al-Dabbagh J, Younis R, Ismail N. The current available diagnostic tools and treatments of scabies and scabies variants: An updated narrative review. Medicine (Baltimore) 2023; 102:e33805. [PMID: 37233429 PMCID: PMC10219715 DOI: 10.1097/md.0000000000033805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 04/27/2023] [Indexed: 05/27/2023] Open
Abstract
Scabies is a neglected tropical disease that continues to have global impacts and long-term health consequences. It is caused by the mite Sarcoptes scabei var. hominis, which is an obligate ectoparasite that lives in the epidermis of the human skin. Scabies is common in poor communities due to overcrowding in places like old age homes, prisons, and homeless and displaced children. However, developed countries are also susceptible to scabies infestations, such as in institutional outbreaks or small epidemics under war conditions or during natural disasters. The diagnosis of scabies may be assisted by invasive and noninvasive tools; However, the history and examination findings are usually adequate to confirm the clinical suspicion. Here, we present an updated review of scabies by focusing on the diagnostic approaches, treatment, and prevention of scabies.
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Affiliation(s)
| | - Razan Younis
- Faculty of Medicine, Tartous University, Tartous, Syria
| | - Nemat Ismail
- Faculty of Medicine, Tishreen University, Latakia, Syria
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Bourkas AN, Pope E. Oral ivermectin treatment for an infant with crusted scabies. CMAJ 2023; 195:E334. [PMID: 36878546 PMCID: PMC9987233 DOI: 10.1503/cmaj.221385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
Affiliation(s)
- Adrienn N Bourkas
- Division of Dermatology, Department of Paediatrics (Bourkas, Pope), The Hospital for Sick Children, University of Toronto, Toronto, Ont.; Queen's University School of Medicine (Bourkas), Kingston, Ont
| | - Elena Pope
- Division of Dermatology, Department of Paediatrics (Bourkas, Pope), The Hospital for Sick Children, University of Toronto, Toronto, Ont.; Queen's University School of Medicine (Bourkas), Kingston, Ont.
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Long K. Bugs, Bumps, and Bacteria: The Role of Virtual Collaborative Learning Network in Pediatric Dermatology. MISSOURI MEDICINE 2023; 120:59-65. [PMID: 36860597 PMCID: PMC9970329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
Patients in rural and underserved areas face significant barriers in accessing specialty care due to unavailability of services, geographic isolation, travel burden, and other cultural and socioeconomic factors.1 Pediatric dermatology is among the top three subspecialties that provides routine care for pediatric patients, however, shortage and maldistribution of pediatric dermatologists have remained a major hurdle for those living in remote and isolated areas.2 Pediatric dermatologists cluster in urban areas with high-patient volume and estimated wait times for new patients that often exceed 13 weeks, making access one of the major drivers of inequity for rural patients.2-4.
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Rasti S, Talaee R, Abdoli A. Disseminated scabies in a 2-month-old infant. Clin Case Rep 2022; 10:e6334. [PMID: 36110337 PMCID: PMC9465694 DOI: 10.1002/ccr3.6334] [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: 04/28/2022] [Revised: 06/17/2022] [Accepted: 08/25/2022] [Indexed: 11/13/2022] Open
Abstract
Scabies is a skin disease caused by the mite Sarcoptes scabiei. We report disseminated scabies in a 2-month-old girl as well as eczematoid lesions in her mother. The diagnosis was made by skin scraping and microscopic examination of the crusts. The patients were successfully treated with permethrin cream (5%).
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Affiliation(s)
- Sima Rasti
- Department of Parasitology and Mycology and Infectious Diseases Research Center, Faculty of MedicineKashan University of Medical SciencesKashanIran
| | - Rezvan Talaee
- Department of Dermatology, Autoimmune Diseases Research Center, Faculty of MedicineKashan University of Medical SciencesKashanIran
| | - Amir Abdoli
- Zoonoses Research CenterJahrom University of Medical SciencesJahromIran
- Department of Parasitology and MycologyJahrom University of Medical SciencesJahromIran
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Comparison of Permethrin-Based Treatment Strategies against Scabies in Infants and Young Children. J Pediatr 2022; 245:184-189. [PMID: 35176310 DOI: 10.1016/j.jpeds.2022.02.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/22/2022] [Accepted: 02/09/2022] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To optimize the permethrin-based therapies for scabies infestations in infants and young children, the efficacies of 3 different regimens were evaluated. STUDY DESIGN The retrospective analysis encompassed 85 infants and children aged <4 years with scabies. The children had received either topical permethrin 5% on the entire body on days 1/8, on days 1/8/15, on days 1/8/15 plus interim applications restricted to hands and feet on days 2/3/4//9/10/11, or alternative treatments. RESULTS The intensified regimen, consisting of full-body permethrin applied on days 1/8/15 and hands/feet on days 2/3/4//9/10/11, resulted in cure of scabies in 73.5% of the cases. The cure rates were significantly greater compared with full-body permethrin given on days 1/8, which led to eradication in 44%, and were greater compared with the clearance in children who had received full-body permethrin on days 1/8/15 (53.8%) or alternative treatments (60%). For patients in whom permethrin had previously been applied, the intensified regimen resulted in eradication of scabies in 71.4% of the cases, compared with 30% and 55.6% after full-body permethrin on days 1/8 and 1/8/15, respectively. CONCLUSIONS The intensified regimen of full-body permethrin plus interim applications on hands/feet, which aims at reducing the number of mites present on the frequently heavily infested palmoplantar sites in addition to the standard entire body application, appears efficacious in curing scabies in young children.
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Jiang Y, Zhan AT, Qiu F, Fan YM. Serial dermoscopic monitoring of subungal scabies mites in an infant with crusted scabies. J Eur Acad Dermatol Venereol 2022; 36:e492-e494. [PMID: 35143082 DOI: 10.1111/jdv.17994] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 12/21/2021] [Accepted: 02/04/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Ying Jiang
- Department of Dermatology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - An-Ting Zhan
- Department of Dermatology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Fang Qiu
- Department of Dermatology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Yi-Ming Fan
- Department of Dermatology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
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Sartorio MUA, Munari AM, Carlucci P, Erba P, Calcaterra V, Fabiano V. MRSA Femoral Osteomyelitis from Superinfected Scabies Lesions: A Pediatric Case Report. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19021007. [PMID: 35055830 PMCID: PMC8775834 DOI: 10.3390/ijerph19021007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 01/13/2022] [Accepted: 01/15/2022] [Indexed: 02/01/2023]
Abstract
Scabies is a skin infestation from the Sarcoptes scabiei. It is considered a public health issue causing concern in developing countries and is considered a “neglected tropical disease” by the World Health Organization (WHO). Scabies skin lesions may cause severe itching and can be the portal of entry for opportunistic and pathogenic bacteria, which can cause serious systemic infections. We report the case of a 3-year-old boy with recurrent scabies infections who presented to the emergency department because of a fever and refusal to walk. Blood tests showed neutrophilic leukocytosis and significantly increased C reactive protein (CRP) and procalcitonin. Upon medical examination, his right thigh was extremely painful upon palpation, knee flexion was lost and he was unable to stand, so magnetic resonance imaging (MRI) was performed. MRI showed osteomyelitis of metaphysis and distal diaphysis of the right femur with associated subperiosteal purulent collection and concomitant pyomyositis and fasciitis of the distal right thigh. Blood cultures were positive for methicillin-resistant Staphylococcus aureus (MRSA). The patient received a long course of intravenous antibiotic therapy and his condition slowly improved. Follow-up femur X-ray showed a mixed pattern of erosion and sclerosis at the meta-diaphyseal region and periosteal reaction at the diaphyseal region. This case highlights the importance of early scabies diagnosis even in Western countries where poverty and household overcrowding are uncommon. Early diagnosis, timely initiation of proper treatment and evidence of clinical resolution are important elements to prevent recurrence of infection and serious systemic superinfections even from multi-drug resistant bacteria. Clinical consequences from unrecognized disease or inadequate eradication are preventable.
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Affiliation(s)
- Marco Ugo Andrea Sartorio
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, University of Milan, Via Castelvetro 32, 20154 Milan, Italy; (P.C.); (P.E.); (V.C.); (V.F.)
- Correspondence:
| | - Alice Marianna Munari
- Pediatric Radiology and Neuroradiology, Vittore Buzzi Children’s Hospital, 20154 Milan, Italy;
| | - Patrizia Carlucci
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, University of Milan, Via Castelvetro 32, 20154 Milan, Italy; (P.C.); (P.E.); (V.C.); (V.F.)
| | - Paola Erba
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, University of Milan, Via Castelvetro 32, 20154 Milan, Italy; (P.C.); (P.E.); (V.C.); (V.F.)
| | - Valeria Calcaterra
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, University of Milan, Via Castelvetro 32, 20154 Milan, Italy; (P.C.); (P.E.); (V.C.); (V.F.)
- Pediatrics and Adolescentology Unit, Department of Internal Medicine and Therapeutics, University of Pavia, 27100 Pavia, Italy
| | - Valentina Fabiano
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, University of Milan, Via Castelvetro 32, 20154 Milan, Italy; (P.C.); (P.E.); (V.C.); (V.F.)
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