Clinical Scabies Research Articles

Scabies in Infants: Series of 51 Cases.

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.

Prevalence and determinants of impetigo in Ghana: a cross-sectional study

IntroductionSkin diseases such as impetigo pose a significant public health challenge in low resource settings. Despite this, there is a dearth of epidemiological data on the prevalence of this condition in Ghana.MethodsWe conducted a cross sectional study in three settings in Ghana: community members in East Mamprusi district in the North East region, a secondary school in Sekyere East district, and inmates of the Kumasi central prisons both in the Ashanti region. Following a period of training, we performed a standardised skin examination on each participant to assess for scabies and impetigo. We calculated the prevalence of each skin condition and investigated determinants of impetigo.Results/ findingsOf the 1327 participants [males 64.1% and median age 22 (16–29) years], 746 (56.2%) had scabies and 186 (14%) had impetigo which was usually very mild or mild in severity. Most participants with impetigo also had scabies (161/186, 86.6%). Having an itch [RR 6.05 (95% CI 2.53–14.47)], presence of scabies burrows [RR 1.99 (95% CI 1.54–2.59)], clinical scabies [RR 3.15 (2.11–4.72)] or being in preschool [RR 4.56 (1.78–11.67)] increased the risk for impetigo. A combination of the presence of clinical scabies, age, sex and itch most accurately predicted the odds of having impetigo.ConclusionsThere is substantial burden of impetigo and scabies in Ghana. There is a need to institute measures to improve detection and control of these common dermatoses as part of Universal Health Coverage package to reduce the scourge of the diseases in this setting.

Cat Scabies Prevalence at Animal Health Center Pemalang

Scabies in cats is an infectious skin disease caused by the mite Sarcoptes scabiei that attacks the stratum corneum layer of the cat's skin at all ages and is zoonotic. The purpose of this study is to determine the prevalence of scabies using cat patient data from the Pemalang Animal Health Center from May 13th to July 15th, 2022, as well as morphological information of S. scabiei. The scabies diagnosis method employs two stages, namely the examination of clinical and laboratory symptoms. Purposive sampling was used to select laboratory examination samples. Cats with clinical scabies use the skin scraping technique, which involves scraping the skin in the area around the lesion, placing it on an object glass, dripping with 10% KOH, covering it with a cover glass, and examining it under a 400x microscope. The prevalence of scabies in cat patients at the Pemalang Health Center was 33.19%, and S. scabiei was found on the legs of cat patients.

Failure of scabies treatment: a systematic review andmeta-analysis.

Treatment failure is considered to be an important factor in relation to the increase in scabies incidence over the last decade. However, the regional and temporal differences, in addition to the predictors of therapy failure, are unclear. We aimed to conduct a systematic review of the prevalence of treatment failure in patients with scabies and investigation of associated factors. We searched MEDLINE, EMBASE, CINAHL, Web of Science, Scopus, Global Health and the Cochrane Central Register of Controlled Trials from inception to August 2021 for randomized and quasi-randomized trials, in addition to observational studies that enrolled children or adults diagnosed with confirmed or clinical scabies treated with permethrin, ivermectin, crotamiton, benzyl benzoate, malathion, sulfur or lindane, and measured treatment failure or factors associated with treatment failure. We performed a random effects meta-analysis for all outcomes reported by at least two studies. A total of 147 studies were eligible for inclusion in the systematic review. The overall prevalence of treatment failure was 15.2% [95% confidence interval (CI) 12.9-17.6; I2 = 95.3%, moderate-certainty evidence] with regional differences between World Health Organization regions (P = 0.003) being highest in the Western Pacific region (26.9%, 95% CI 14.5-41.2). Oral ivermectin (11.8%, 95% CI 8.4-15.4), topical ivermectin (9.3%, 95% CI 5.1-14.3) and permethrin (10.8%, 95% CI 7.5-14.5) had relatively lower failure prevalence compared with the overall prevalence. Failure prevalence was lower in patients treated with two doses of oral ivermectin (7.1%, 95% CI 3.1-12.3) compared with those treated with one dose (15.2%, 95% CI 10.8-20.2; P = 0.021). Overall and permethrin treatment failure prevalence in the included studies (1983-2021) increased by 0.27% and 0.58% per year, respectively. Only three studies conducted a multivariable risk factor analysis; no studies assessed resistance. A second dose of ivermectin showed lower failure prevalence than single-dose ivermectin, which should be considered in all guidelines. The increase in treatment failure over time hints at decreasing mite susceptibility for several drugs, but reasons for failure are rarely assessed. Ideally, scabicide susceptibility testing should be implemented in future studies.

Scabies: Clinical Signs, Diagnosis and Current Treatment

Scabies is a parasitic disease caused by Sarcoptes scabiei var hominis. It can spread through indirect contact with contaminated objects as well as direct skin-to-skin contact. Widespread itching that gets worse at night can be present along with a variety of lesions, including papules, vesicles, nodules and excoriations. Mites, eggs, or faeces should be visualised using an additional tool for a definitive diagnosis. Only the patient's history and physical examination are used to diagnose clinical scabies or suspected clinical scabies. It is included in the differential diagnosis with other itchy skin diseases. Although other topical treatments like benzyl benzoate, sulphur, and lindane are available, permethrin is still the top option. Oral ivermectin is used as an efficient, secure, and affordable treatment for scabies in many countries despite not having FDA approval for this use. Current search for treatment continues, and there are studies on moxidectin and isoxazoline derivative drugs. Application errors, skipping treatment repetitions, inadequate environmental cleaning, not receiving treatment from the patient's relatives, and not providing the patient with the necessary precautions in writing are all reasons why treatments fail. It is known that good results can be obtained in the treatment of scabies, which continues to be a global public health problem, if physicians have sufficient knowledge and can manage their patients appropriately. By summarising the information that is currently available, this review aims to provide an update on the clinical characteristics, diagnosis, treatment, and management of scabies.

Community Scabies Outbreak Investigation and Risk Factors in Katondo Health Post, Kasenengwa District of Eastern Province: Unmatched Case Control Study

Scabies is a parasitic infestation caused by <i>Sarcoptes scabiei var hominis</i> which is a microscopic mite that burrows into the skin and lays eggs. Prevalence of the condition range from 0.2% to 71% globally. This study was therefore conducted to investigate the suspected community scabies outbreak in Katondo Health Post of Kasenengwa District and bring out the significant associated factors. Unmatched case control study was conducted (1:2 case control ratio). Suspected outbreak was identified through weekly notifiable report. Desk review of the Out Patient Register (OPD) was done to determine additional suspected cases. Structured questionnaire was administered to collect risk factors data. Total study participants were therefore cases with clinical signs of symptoms unmatched to controls within the area. Frequency tables were used to present demographic variables. Attack rate was used to measure morbidity. Odds Ratio (OR) with 95% confidence interval (CI) was used to determine risk factors. Total of 64 clinical scabies cases were recorded giving an attack rate of 1/100 people. Mandondo zone which was the index case zone recorded the highest attack rate of 3/100 people. Mean age of the cases was 18 with range of 11-56 years. Statistically significant factors associated with the outbreak were Low education ((OR=4.9, 95% CI=1.34-6.45, P-Value=0.014), record of exchanging clothes (OR=2.1, 95%CI=1.45-5.34, P value 0.001), Skin contact with suspected case (OR=2.5, 95% CI=0.74-8.68, P Value=0.012), bathing less than 3 times per week (OR=5.4, 95% CI=2.38-14.43, P value: 0.000). Protective factors were, use of soap for bathing (OR=0.34, 95% CI=0.21-2.71, P value=0.003), family member less than 5 (OR=0.12, 95% CI= 0.12-0.06, P Value=0.000). From the results, it can be deduced that scabies outbreak occurred in Katondo Health Facility. Low education, record of exchanging clothes, bathing less than 3 times per week, and skin contact with the suspected case were the risk factors associated with outbreak. Epidemic protective factors were, use of soap for bathing and belonging to a household with family members less than 5. Providing risk factors-based health education on prevention and controls especially, at health facility and community level were recommended.

Scabies infection among boarding school students in Medan, Indonesia: Epidemiology, Risk Factors, and Recommended Prevention.

Introduction:Scabies has been a continuous health concern in residential institutions including boarding schools in Indonesia. The disease easily spreads in overcrowding residences. Using one of several boarding schools in Medan, Indonesia, as study site, we conducted this study to better understand the underlying factors behind scabies incidence in boarding schools. We hoped to be able to promote more effective preventive measures toward the disease.Materials and Methods:We included all of 220 students (115 males and 105 females) in a cross-sectional descriptive analytical study, whose ages were ranging from 10 to 18 years. The diagnosis of scabies was made based on interview and physical examination. Skin scraping followed by microscopic assessment was carried out upon finding scabies-related lesion. Data on risk factors were collected using a set of pretested questionnaire and direct observation. Data were analyzed using bivariate and multivariate analysis the with Chi square and logistic regression.Results:We found a high prevalence clinical scabies, i.e., 81 (36.8%) students, yet only one came out positive with skin scraping and microscopic examination. The factors associated with the infection were found to be younger age (odds ratio [OR]: 2.95, 95% confidence interval [CI] 0.97–6.09), sharing clothes (OR: 8.22, 95% CI 2.37–28.48), sharing bed (OR: 17.53, 95% CI 5.55–56.02), and unhygienic bedroom condition (OR: 8.18, 95% CI 3.30–20.28).Conclusions:The results imply the need for better strategies to prevent the transmission of astigmatid mites within the risky populations. We promote six recommendations for a more applicable approach toward scabies prevention in boarding schools and other institutional facilities alike.

Spatial modeling of the spread of scabies and environmental sanitation as a risk factor among schoolchildren: a case-control study

BACKGROUND Scabies is a World Health Organization neglected tropical disease common in children in low-and middle-income countries. The prevalence of scabies, especially in tropical countries, is still quite high at more than 200 million cases per year. Transmission of scabies is predominantly via skin-to-skin contact. The purpose of the study was to determine the epidemiology of clinical scabies among schoolchildren and spatial modeling using geographic information systems (GIS).METHODSA study of unmatched case-control design with a ratio of 1: 1 was performed to identify specific risk factors of scabies. Cases were patients with clinical scabies and controls were healthy people in the area. A total of 100 students were involved in the study. Simple and multiple logistic regression was used to test any association between the variables. Geographical Information Systems (GIS) modeling was used to determine the spatial distribution of clinical scabies based on 69 cases.RESULTThere was a significant association between the level of environmental sanitation and the prevalence of clinical scabies (OR = 2.53;95% C.I. 1.11-5.74). Multivariate analysis showed that the level of environmental sanitation was significant (AOR = 3.05;95% C.I. 1.19-7.81). Risk factors for developing clinical scabies increased to 3 times after considering other risk factors, namely gender, age group and respondent education level. Analysis of average nearest neighbor distance showed that the spatial distribution of clinical scabies was clustered. CONCLUSIONSThe distribution of clinical scabies was spatial clustering, and prediction of transmission in a clockwise direction with Southeast and Northwest ellipses.

Diagnostic value of the molecular detection of Sarcoptes scabieifrom a skin scraping in patients with suspected scabies.

Scabies is a highly contagious parasitic disease associated with long-term residence in nursing homes, and it is a public health burden worldwide. However, atypical skin manifestations are frequent and the widely used diagnostic test based on microscopic examinations has limited sensitivity. We evaluated the diagnostic value of polymerase chain reaction (PCR) from skin scraping in patients with suspected scabies. Adult patients with suspected scabies, unrelated diseases or healthy volunteers were enrolled at a tertiary hospital, in Seoul, South Korea, from December 2017 through October 2018. We classified participants based on the consensus criteria established by the International Alliance for the Control of Scabies in 2018; confirmed (microscopic mite detection), clinical (scabies burrow or typical lesions with two history features including itch and close contact with scabies patients), suspected scabies (typical lesion with one history feature or atypical lesion with two history features), or no scabies. PCR was performed on the skin scrapings to target the cytochrome c oxidase subunit 1 (cox1) gene of Sarcoptes scabiei. A total of 47 participants, 33 with suspected scabies, 10 with unrelated diseases, and 4 healthy volunteers were enrolled. Of the 33 patients, 22 were classified as confirmed scabies, 2 as clinical scabies, 6 as suspected scabies, and 3 as no scabies. The sensitivities of the microscopic examination were 100%, 92%, and 73% in confirmed scabies; confirmed and clinical scabies; and confirmed, clinical, and suspected scabies, respectively (p = 0.006). The sensitivities of PCR were 86%, 83%, and 80% in confirmed scabies; confirmed and clinical scabies; and confirmed, clinical, and suspected scabies, respectively (p = 0.59). The specificity of the scabies PCR in the no scabies control was 100% (95% CI = 80-100).PCR testing for scabies may be helpful in the improvement of sensitivity for the diagnosis of scabies by clinical criteria.

The 2020 International Alliance for the Control of Scabies Consensus Criteria for the Diagnosis of Scabies.

SummaryBackgroundScabies is a common parasitic skin condition that causes considerable morbidity globally. Clinical and epidemiological research for scabies has been limited by a lack of standardization of diagnostic methods.ObjectivesTo develop consensus criteria for the diagnosis of common scabies that could be implemented in a variety of settings.MethodsConsensus diagnostic criteria were developed through a Delphi study with international experts. Detailed recommendations were collected from the expert panel to define the criteria features and guide their implementation. These comments were then combined with a comprehensive review of the available literature and the opinion of an expanded group of international experts to develop detailed, evidence‐based definitions and diagnostic methods.ResultsThe 2020 International Alliance for the Control of Scabies (IACS) Consensus Criteria for the Diagnosis of Scabies include three levels of diagnostic certainty and eight subcategories. Confirmed scabies (level A) requires direct visualization of the mite or its products. Clinical scabies (level B) and suspected scabies (level C) rely on clinical assessment of signs and symptoms. Evidence‐based, consensus methods for microscopy, visualization and clinical symptoms and signs were developed, along with a media library.ConclusionsThe 2020 IACS Criteria represent a pragmatic yet robust set of diagnostic features and methods. The criteria may be implemented in a range of research, public health and clinical settings by selecting the appropriate diagnostic levels and subcategories. These criteria may provide greater consistency and standardization for scabies diagnosis. Validation studies, development of training materials and development of survey methods are now required. What is already known about this topic? The diagnosis of scabies is limited by the lack of accurate, objective tests. Microscopy of skin scrapings can confirm the diagnosis, but it is insensitive, invasive and often impractical.Diagnosis usually relies on clinical assessment, although visualization using dermoscopy is becoming increasingly common.These diagnostic methods have not been standardized, hampering the interpretation of findings from clinical research and epidemiological surveys, and the development of scabies control strategies. What does this study add? International consensus diagnostic criteria for common scabies were developed through a Delphi study with global experts.The 2020 International Alliance for the Control of Scabies (IACS) Criteria categorize diagnosis at three levels of diagnostic certainty (confirmed, clinical and suspected scabies) and eight subcategories, and can be adapted to a range of research and public health settings.Detailed definitions and figures are included to aid training and implementation. The 2020 IACS Criteria may facilitate the standardization of scabies diagnosis.

Efficacy of ivermectin mass-drug administration to control scabies in asylum seekers in the Netherlands: A retrospective cohort study between January 2014 - March 2016.

Scabies is a skin infestation with the mite Sarcoptes scabiei causing itch and rash and is a major risk factor for bacterial skin infections and severe complications. Here, we evaluated the treatment outcome of 2866 asylum seekers who received (preventive) scabies treatment before and during a scabies intervention programme (SIP) in the main reception centre in the Netherlands between January 2014 and March 2016. A SIP was introduced in the main national reception centre based on frequent observations of scabies and its complications amongst Eritrean and Ethiopian asylum seekers in the Netherlands. On arrival, all asylum seekers from Eritrea or Ethiopia were checked for clinical scabies signs and received ivermectin/permethrin either as prevention or treatment. A retrospective cohort study was conducted to compare the reinfestations and complications of scabies in asylum seekers who entered the Netherlands before and during the intervention and who received ivermectin/permethrin. In total, 2866 asylum seekers received treatment during the study period (January 2014 –March 2016) of which 1359 (47.4%) had clinical signs of scabies. During the programme, most of the asylum seekers with scabies were already diagnosed on arrival as part of the SIP screening (580 (64.7%) of the 897). Asylum seekers with more than one scabies episode reduced from 42.0% (194/462) before the programme to 27.2% (243/897) during the programme (RR = 0.64, 95% CI = 0.55–0.75). Development of scabies complications later in the asylum procedure reduced from 12.3% (57/462) to 4.6% (41/897). A scabies prevention and treatment programme at start of the asylum procedure was feasible and effective in the Netherlands; patients were diagnosed early and risk of reinfestations and complications reduced. To achieve a further decrease of scabies, implementation of the programme in multiple asylum centres may be needed.

Description and epidemiological implications of S. scabiei infection in roe deer (Capreolus capreolus) originating from chamois (Rupicapra rupicapra)

The authors describe a case of Sarcoptes scabiei transmission from a chamois (Rupicapra rupicapra) kid to three roe deer (Capreolus capreolus) fawns kept in captive cohabitation in a wildlife rehabilitation centre for approximately 4 months. Symptoms in the two male fawns started developing 1 week after skin lesions were noticed in the kid, whereas a delayed (75 days later) appearance of scabies signs was observed in the female fawn. A severe generalised form of scabies rapidly developed in a male fawn, but lesions in the other two healed after triple inoculation of ivermectin at 15 days intervals. These roe deer were monitored for specific anti-S. scabiei antibodies with an immunoblotting technique. The strongest antibody response was exhibited during the clinical phase of the infection and then rapidly declined post-treatment. Interestingly, the female fawn developed immunoglobulin G to S. scabiei proteins more than 2 months before the onset of clinical scabies. Since all captive roe deer appeared sensitive to infection with S. scabiei var. rupicaprae, the authors hypothesise that the sporadic frequency of spontaneous scabies in this Cervid host may be attributed to avoidance of direct contacts with moribund or recently dead scabietic chamois, and/or to a self-limiting (and therefore difficult to detect) course of the disease after infrequent infectious contacts and/or exposure to lower infectious doses than in the described episode.

The development of symptoms, parasitic infection and immunity in human scabies

1. Scabies is usually transmitted by intimate personal contact.2. The young, newly fertilized adult female Sarcoptes is the stage usually responsible for transmission.3. Patients with a high parasite rate (over 100 adult female mites) are much more likely to spread scabies than those with few parasites.4. The distribution of the parasites in clinical scabies gives no clue to the original sites of infection.5. When a volunteer is infected for the first time he gives no reaction for about a month. During this period he may be quite unaware that the parasites are burrowing in his cuticle.6. After a month the patient becomes sensitized, itching and other symptoms develop.7. In a first infection the mites increase in numbers far less rapidly than is theoretically possible. A parasite rate of about 25 may be reached in 50 days and of up to 500 in 100 days; after this the number of mites decreases rapidly.8. The second time an individual has scabies he itches at the sites of infection within 24 hr. His mite population seldom rises to a fraction of the height reached in his first infection.9. Reinfection of cured cases is much more difficult than infection for the first time.10. Sarcoptes causes antibody function in man. This causes a partial immunity.11. The mechanism of immunity is due to three reactions: (a) scratching by the host which removes the parasites mechanically; (b) oedema renders the cuticle unsuitable for colonization and causes the mites to vacate their burrows; (c) scratching produces sepsis which is fatal to Sarcoptes.12. The partial immunity obtained may account for fluctuations in the incidence of the disease.