Abstract
Scabies is an important predisposing factor for impetigo but its role in more serious skin and soft tissue infections (SSTIs) is not well understood. Information is limited on incidence of SSTIs in the presence of endemic scabies. We conducted a prospective study of hospital admissions for SSTIs in the Northern Division of Fiji (population: 131,914). Prospective surveillance for admissions with impetigo, abscess, cellulitis, wound infection, pyomyositis, necrotizing fasciitis, infected scabies, and crusted scabies was conducted at the Division’s referral hospital between 2018 to 2019. Information was collected on demographic characteristics, clinical features, microbiology, treatment and outcomes. Over the study period, 788 SSTI admissions were recorded corresponding to a population incidence 647 per 100,000 person-years (95%CI 571–660). Incidence was highest at the extremes of age with peak incidence in children aged <5 years (908 per 100,000) and those aged ≥65 years (1127 per 100,000). Incidence was 1.7 times higher among the Indigenous Fijian population (753 per 100,000) compared to other ethnicities (442 per 100,000). Overall case fatality rate was 3.3%, and 10.8% for those aged ≥65 years. Scabies was diagnosed concurrently in 7.6% of all patients and in 24.6% of admitted children <5 years. There is a very high burden of hospital admissions for SSTIs in Fiji compared to high-income settings especially among the youngest, oldest and indigenous population which is concordant with scabies and impetigo distribution in this population. Our findings highlight the need for strategies to reduce the burden of SSTIs in Fiji and similar settings.
Highlights
Scabies is a pruritic skin disease caused by the mite Sarcoptes scabiei var. hominis with global prevalence estimated at 200 million in 2015. [1]Available studies have found high levels of prevalence in diverse, resource-limited settings including Pacific islands countries, parts of Latin America and some remote Aboriginal communities in Australia.[1]
We conducted a prospective study of the incidence of hospitalizations for soft tissue infections (SSTIs) in 2018 and 2019 at the referral centre for the Northern Division of Fiji where community scabies prevalence is very high
We measured the incidence of admissions for abscesses, cellulitis, impetigo, wound infections, pyomyositis, necrotizing fasciitis and crusted scabies
Summary
Scabies is a pruritic skin disease caused by the mite Sarcoptes scabiei var. hominis with global prevalence estimated at 200 million in 2015. [1]Available studies have found high levels of prevalence in diverse, resource-limited settings including Pacific islands countries, parts of Latin America and some remote Aboriginal communities in Australia.[1]. [1]Available studies have found high levels of prevalence in diverse, resource-limited settings including Pacific islands countries, parts of Latin America and some remote Aboriginal communities in Australia.[1] Scabies has a well described association with impetigo,[2,3,4] as breaches in skin from scratching facilitate acquisition of secondary bacterial infection, predominantly caused by Staphylococcus aureus and Group A Streptococcus (GAS).[5] A 2007 national survey in Fiji reported impetigo prevalence at 19.6% across all ages, and 34.2% in children aged 5 to 9 years.[2] Impetigo is understood to be a pathway by which more severe skin and soft tissue infections (SSTIs) and systemic infection can arise the frequency of this progression is not well defined. The Fiji Ministry of Health and Medical Services 2016 Health Status Report stated that SSTIs were the fifth most common cause of mortality nationally.[7]
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