Infected Scabies Research Articles

Bacteriological Etiologic Diagnosis, Mode of Infection and Management of Chronic Osteomyelitis: A Prospective Hospital-Based Study in Bangladesh

Background: There are different factors responsible for chronic osteomyelitis. Objective: The purpose of the present study was to find out the bacteriological aetiology of chronic osteomyelitis patients. Methodology: This prospective hospital-based study was conducted in the Department of Orthopaedic and Traumatology at Cox’s Bazar Medical College Hospital, Cox’s bazar, Bangladesh from January 2019 to June 2022 for a period of three and half years. Eligible patients for enrolment in the present study had to sustain an osseous infectious process confirmed by radiological findings lasting more than 2 weeks without acute symptomatology or few contributory laboratory results. The bacteriological aetiology were recorded and the antimicrobial sensitivity testing were performed by dis diffusion test. Results: A total number of 89 cases of osteomyelitis patients were recruited for this study. The mean age with the SD of study population was 11.5±7.89 years with the range of 1 to 42 years. Infected scabies was the most common cause osteomyelitis among the study population which was 42.0% cases in children group; however, there was no cases in adult group. Otitis media, rhinitis dental caries were also found among the children which were 25.0% cases, 5.0% cases, 18.0% cases respectively. Among adult group implant surgery was the most common cause of osteomyelitis which was 65.0% cases. Most common bacterial isolate was Staphylococcus aureus which was 29(32.6%) cases. Coagulase Negative Staphylococcus (CoNS) and Proteus species were the second most common isolated bacteria which was 17(19.1%) cases in each. Gram negative bacteria like Escherichia coli and Pseudomonas species were the most common isolated bacteria which were 11(12.4%) cases and 9(10.1%) cases respectively. Conclusion: In conclusion implant surgery is the most common cause of osteomyelitis and Staphylococcus aureus is the most common isolated bacteria. Bangladesh Journal of Medical Microbiology, January 2022;16(1):8-13

Etiology of Kidney Diseases With Proteinuria in the Gambia/West Africa.

In West Africa, kidney diseases are frequently seen, but diagnostic and therapeutic options are poor due to limited access to specialized facilities. To unravel the etiology and develop clinical guidelines, we collected clinical data and results of kidney biopsies in 121 pediatric and mostly young adult patients with edema and proteinuria in The Gambia. Workup included clinical examination, urine and serum analysis, and kidney biopsy findings. Selected cases were treated with steroids.ResultsThe median age was 14.9 years (range 1.8–52.0) at presentation. The most frequent underlying histologies were post-infectious glomerulonephritis (PIGN) in 38%, focal-segmental glomerulosclerosis (FSGS) in 30%, minimal change nephrotic syndrome (MCNS) in 15%, and membranous glomerulonephritis (MGN) in 10% of cases. Patients with PIGN were significantly younger and had less proteinuria and higher serum albumin levels than the other three. Infected scabies was seen more often in cases with PIGN. Clinical parameters could not distinguish patients with FSGS, MCNS, and MGN. Steroid response was prompt in patients with MCNS (remission in 10/10 cases) compared to FSGS (4/19) and MGN (0/4). In summary, the clinical histopathological correlation allows a better approach to therapy and can be the basis for urgently needed interventional studies in steroid-resistant cases.

Mite is right: A case of infected scabies masquerading as a blistering disorder.

Scabies classically presents with itching and skin lesions in the interdigital spaces of hands, trunk, and genitals. Rarely, non‐classical skin lesions can result in misdiagnosis and inappropriate management of patients.

Hospital admissions for skin and soft tissue infections in a population with endemic scabies: A prospective study in Fiji, 2018-2019.

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.

The prevalence of scabies in Monrovia, Liberia: A population-based survey.

Scabies is known to be a public health problem in many settings but the majority of recent data is from rural settings in the Pacific. There is a need for high quality data from sub-Saharan Africa and peri-urban settings to inform scale up of scabies control efforts. There have been anecdotal reports of scabies being a public health problem in Liberia but robust data are lacking. We conducted a cross-sectional cluster-randomised prevalence survey for scabies in a peri-urban community in Monrovia, Liberia in February-March 2020. Participants underwent a standardised examination conducted by trained local health care workers. Health related quality of life (HRQoL) was assessed using age-appropriate versions of the dermatology life quality index (DLQI). Prevalence estimates were calculated accounting for clustering at community and household levels and associations with key demographic variables assessed through multivariable random-effects logistic regression. 1,318 participants from 477 households were surveyed. The prevalence of scabies was 9.3% (95% CI: 6.5–13.2%), across 75 (19.7%) households; impetigo or infected scabies prevalence was 0.8% (95% CI: 0.4–1.9%). The majority (52%) of scabies cases were classified as severe. Scabies prevalence was lower in females and higher in the youngest age group; no associations were found with other collected demographic or socio-economic variables. DLQI scores indicated a very or extremely large effect on HRQoL in 29% of adults and 18% of children diagnosed with scabies. Our study indicates a substantial burden of scabies in this peri-urban population in Liberia. This was associated with significant impact on quality of life, highlighting the need for action to control scabies in this population. Further work is needed to assess the impact of interventions in this context on both the prevalence of scabies and quality of life.

A 8- year Bangladeshi girl with disseminated histoplasmosis, presented as chronic liver disease with portal hypertension: a rare case report

BackgroundHistoplasmosis is a rare infectious condition with mainly pulmonary involvement. Disseminated histoplasmosis may occur in immunocompromised condition. It can present in different ways but jaundice and ascites is very uncommon.Case presentationA 8- year old girl visited to department of pediatric gastroenterology & nutrition, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. Child presented with fever, jaundice and abdominal distension for 2 ½ months. There was no history of contact with tuberculosis patient and travelling to kala-azar, malaria endemic zone and no history of previous jaundice, blood or blood product transfusion, history of sib death, family history of jaundice or neuropsychiatric disorder, significant weight loss. On general examination she was fretful, febrile, moderately icteric, mildly pale, vitally stable, severely wasted and moderately stunted, skin survey revealed infected scabies, BCG vaccine mark was absent, generalized lymphadenopathy, hepato-splenomegaly and ascites present. After evaluating the physical findings, several investigations was done including lymphnode biopsy, then the case was finally diagnosed as Disseminated histoplasmosis with portal hypertension. Child was treated with injectable Deoxycholate Amphotericin B for 28 days and improved on follow up.ConclusionWe suggest that children presenting with fever, jaundice, lymphadenopathy and hepatosplenomegaly and portal hypertension, disseminated histoplasmosis can be one differential.

Outbreak of scabies among preschool children, Accra, Ghana, 2017

BackgroundScabies occurs worldwide with a prevalence between 0.3 and 46.0%. In Ghana, even though a 5.1% proportion of scabies was reported in a retrospective review of skin diseases at the Korle Bu Teaching Hospital, the nationwide prevalence of scabies is unknown. Overall, its burden is higher in tropical regions. Scabies outbreaks mostly occur among children, the elderly in nursing homes, and prison inmates. Even though primary scabies hardly results in mortalities, the pain, itch, and systemic complications from secondary bacterial infections account for about 1.5 million years lived with disabilities. We investigated a scabies outbreak among school children in Ghana to determine its magnitude, stop the outbreak, and institute preventive measures to minimize risks of future outbreaks.MethodsThe investigation was conducted between March 14 and May 17, 2017 among pupils of Presbyterian Secondary Staff Basic School in Accra. We defined a case as a school child who on clinical examination, had an intensely pruritic rash on at least one typical predilection site with or without a burrow, or positive skin scrapings on microscopy. We screened and line listed cases, performed laboratory investigations on skin scrapings and wound swaps, and conducted an environmental assessment. We performed descriptive statistics on data, and calculated attack rate ratios (ARR) at 95% confidence level.ResultsOf 823 preschool children screened, 92 were cases. Median age of cases was 4 years (range 2–7 years) and their modal age was 3 years. The overall attack rate was 11.2% (92/823). The sex specific attack rate was 11.5% for males, and 10.8% for females (ARR: 0.93; CI: 0.67–1.28). Compared with the least affected class (crèche), the nursery one class was worst affected (ARR: 5.14; CI: 3.44–7.50). On microscopy, all skin scrapings were negative for scabies. Staphylococcus aureus and Streptococcus spp. were isolated from secondarily infected scabies lesions.ConclusionsA scabies outbreak with a propagated source occurred among preschool children. The 3-year-old pupils were most affected. It was controlled by mass treatment with benzyl benzoate and health education. Classrooms and sleeping mats were disinfected. We recommended the decongestion of classrooms and discouraged sharing of sleeping mats.

A clinico-bacteriological study of pyodermas in pediatric population

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Pyodermas are frequently confronted skin infections by dermatologists in pediatric population. While treating them recurrence and resistance to commonly used antibiotics are the major concerns.&lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;456 cases of pyodermas in pediatric population attending dermatology outpatient department of Sri Guru Ram Das Medical College over the period of 8 months from February 2016- October 2016 were evaluated. Samples were collected with sterile swab and sent for gram staining, culture and sensitivity&lt;/span&gt;.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Majority of cases of pyodermas in pediatric population were due to impetigo and secondarily infected scabies. Most cases were seen in the age group of 4-7 years. &lt;em&gt;Staphylococcus aureus&lt;/em&gt; (49.5%) was the most frequently isolated organism from these cases followed by streptococcus (29.8%). Majority of these gram positive organisms were sensitive to antibiotics like amoxiclav, ampicillin and linezolid. &lt;em&gt;E. coli&lt;/em&gt; and &lt;em&gt;enterococcus&lt;/em&gt; were predominantly encountered gram negative isolates with high susceptibility to aminoglycosides and ceftriaxone. &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Bacteriological study of pyodermas and knowledge of their susceptibility pattern is imperative for appropriate management. It also helps in prevention of emergence of resistant strains.&lt;/span&gt;&lt;/p&gt;

Clinical and bacteriological aspects of pyoderma.

Pyoderma is one of the commonest clinical conditions encountered in dermatological practice.[1] Primary pyodermas are impetigo, follicultis, furuncle, carbuncle, ecthyma, erthyrasma, and sycosis barbae. Secondary pyodermas constitute tropic ulcer, infected pemphigus, infected contact dermatitis, infected scabies, and various other dermatoses infected with organisms. Various factors like poverty, malnutrition, overcrowding, and poor hygiene have been stated to be responsible for its higher incidence in the lower socio-economic class. Climatic conditions also play a major role.[2] Changing trends are being noted in the etiological aspects of primary pyoderma, and the problem of emergence of drug resistance strains is an even increasing one. Most common organism usually isolated in pyoderma is Staphyloccus aureus, which may be either methicilllin-sensitive (MSSA) or methicilllin-resistant (MRSA). MRSA is an important health care associated pathogen. Many of these isolates are becoming multidrug resistant. All β-lactams including carbapenams and high-end cephalosporins, piperacillin, tazobactum etc. are ineffective against MRSA. Knowledge of prevalence of MRSA and their current anti-microbial profile becomes necessary in the selection of appropriate empirical treatment of these infections.[3] Here, we report the clinical and bacteriological aspects of the pyodermas to guide for the selection of appropriate antibiotics and to prevent the emergence of resistant organisms. We found that the incidence of impetigo was maximum among pyoderma. The primary pyoderma cases were maximum in the age group of < 10 years, and prevalence rate was higher in male patients. Among the various diseases, scabies was found to be the commonest to be associated with primary pyoderma. Most common isolated organism was Staphylococcus aureus. Pyodermas are a common cause of skin infection in children and are associated with many multidrug-resistant organisms such as MRSA. A correct anti-microbial policy based on the knowledge of resistance patterns of the commonly isolated organisms is mandatory to prevent unnecessary medication and further emergence of drug-resistant organisms.

A Regional Initiative to Reduce Skin Infections amongst Aboriginal Children Living in Remote Communities of the Northern Territory, Australia

BackgroundLinked to extreme rates of chronic heart and kidney disease, pyoderma is endemic amongst Aboriginal children in Australia's Northern Territory (NT). Many of those with pyoderma will also have scabies. We report the results of a community-based collaboration within the East Arnhem Region, which aimed to reduce the prevalence of both skin infections in Aboriginal children.Methodology/Principal FindingsCommencing September 2004, we conducted an ecological study that included active surveillance for skin infections amongst children aged <15 years in five remote East Arnhem communities over a three year period. Screening was undertaken by trained local community workers, usually accompanied by another project team member, using a standard data collection form. Skin infections were diagnosed clinically with the aid of a pictorial flip chart developed for the purpose. Topical 5% permethrin was provided for age-eligible children and all household contacts whenever scabies was diagnosed, whilst those with pyoderma were referred to the clinic for treatment in accordance with current guidelines. In addition, annual mass scabies treatment (5% permethrin cream) was offered to all community residents in accordance with current guidelines but was not directly observed. Pyoderma and scabies prevalence per month was determined from 6038 skin assessments conducted on 2329 children. Pyoderma prevalence dropped from 46.7% at baseline to a median of 32.4% (IQR 28.9%–41.0%) during the follow-up period – an absolute reduction of 14.7% (IQR 4.7%–16.8%). Compared to the first 18 months of observation, there was an absolute reduction in pyoderma prevalence of 18 cases per 100 children (95%CI −21.0, −16.1, p≤0.001) over the last 18 months. Treatment uptake increased over the same period (absolute difference 13.4%, 95%CI 3.3, 23.6). While scabies prevalence was unchanged, the prevalence of infected scabies (that is with superimposed pyoderma) decreased from 3.7% (95%CI 2.4, 4.9) to 1.5% (95%CI 0.7, 2.2), a relative reduction of 59%.ConclusionAlthough pyoderma prevalence remained unacceptably high, there was a substantial reduction overall with improvements in treatment uptake a critical factor. More acceptable alternatives, such as cotrimoxazole for pyoderma and ivermectin as a community-wide scabicide, warrant further investigation in these settings. We are encouraged by progress made through this work, where local action was led by local community members and primary health care providers with external training and support.Trial RegistrationClinicalTrials.gov NCT00884728

Infected wound healing and antimicrobial effects of Chenopodium ambrosioides and Mitracarpus scaber

Chenopodium ambrosioides Linn. (Chenopdiaceae) and Mitracarpus scaber Zucc. (Rubiaceae) are herbal medicinal plants. They are commonly used in Togolese folk medicine to treat skin infections such as infected wounds, dermatoses, and scabies. The aim of this work was to evaluate the wound healing and antimicrobial properties of the two plants. Firstly, we evaluated the infected wound healing property of the two plants. We induced and treated infected wound in Wistar rats as follows. We inserted a sterile needle under the skin of the animal previously anesthetized by ether. Along the needle, we made an incision of 2 cm of length. The wound was infected with 24 hours colonies of P.aeruginosa . One infected wound was created per animal. 0.5 g of ointments prepared form C. ambrosioides and M. scabe r leaf extracts, was applied twice a day. Secondly, we conducted antimicrobial assays with extracts prepared with the leaves of the plants. Staphylococcus aureus, Pseudomonas aeruginosa, Candida albcans, Escherichia coli and Salmonella sp. were used in this study. Infected wound in control group healed in 12.6±0.245 days. The ointment from C. ambrosioides or M. scaber leaf extracts, significantly and respectively reduced this mean time to 07.04±0.245 (P C. ambrosioides and M. scaber possess wound healing and antimicrobial properties. These findings support their traditional use in treatment of skin infections. Keywords: antimicrobial activity, Chenopodium ambrosioides, Mitracarpus scabe r, ointments, skin infected wounds.

Validation of an Integrated Management of Childhood Illness algorithm for managing common skin conditions in Fiji

To assess the sensitivity of an Integrated Management of Childhood Illness (IMCI) algorithm to detect common skin conditions in children in Fiji. We collected data from the assessments of children aged between 2 months and 5 years who presented to one of two health clinics. Every child was assessed by a nurse trained in the use of the IMCI algorithm and also an expert paediatrician. We used a kappa statistic to measure agreement between the nurse/algorithm assessment method and the paediatrician's diagnosis. High sensitivity for identifying skin problems (sensitivity: 98.7%; 95% confidence interval, CI: 95.5-99.9) was found for the algorithm applied by IMCI-trained nurses, who were able to identify the one child with a severe skin infection and all three children with periorbital cellulitis. Sensitivity was high for the classification of abscess/cellulitis (sensitivity: 95%; 95% CI: 75.1-99.9) and infected scabies (sensitivity: 89.1%; 95% CI: 77.8-95.9), but lower for identification of impetigo, fungal infection and, in particular, non-infected scabies. The IMCI skin algorithm is a robust tool that should be incorporated into the IMCI after some modifications relating to scabies and impetigo. Its use by primary health-care workers will reduce the burden of skin diseases in children in Fiji through improved case identification and management. The algorithm should be considered in other countries where skin diseases in children are a priority, particularly in the Pacific region.

Exit site infection due to Zygomycosis resulting in abdominal wall necrosis in a continuous ambulatory peritoneal dialysis patient

Keywords: continuous ambulatory peritoneal dialysis;exit site infection; zygomycosisA 52-year-old gentleman, type 2 diabetic andhypertensive was initiated on continuous ambulatoryperitoneal dialysis (CAPD) in August 2004. He waspartially blind in both eyes owing to diabeticretinopathy. He had also been confined to bed forthe past 2 months, due to severe sensorimotorperipheral neuropathy. His wife and son were perform-ing the exchanges, three per day with 2.5% dextrosesolution of Dianeal (Baxter India Pvt Ltd, New Delhi).He had Kt/V of 1.8 per week and a urine output of350–500ml/day. He had suffered an episode ofperitonitis in September 2005. Methicillin-sensitivecoagulase negative staphylococci was identified atthat time. He was injected with vancomycin 1g IPonce in every 5 days (three doses were given) and withceftriaxone 1g IP in the longest CAPD exchange for 14days. In December, the dermatologist of our Institutediagnosed him with infected scabies, when hepresented with complaints of overall body itching.He had burrows and infected scratch marks all over hisbody. He was prescribed permethrin, liquid paraffinand gamma benzene hexachloride soap. In the lastweek of the same month, he presented to us witherythema and blackening of the skin, starting initiallyaround the exit site and the tunnel and spreading to theentire anterior abdominal wall in a week, resulting infull thickness necrosis and sloughing, exposing therectus and other anterior abdominal muscles (Figure 1and 2). He also complained of abdominal pain, cloudyeffluent of 1-day duration, vomiting of 3-day duration.The results of investigations done were: haemoglobin,7.1g/dl; blood urea, 91mg/dl; creatinine, 5.1mg/dl;serum proteins, 5.6g/dl; serum albumin, 1.7g/dl. TheCAPD catheter was removed. The catheter tip cultureshowed the growth of zygomycetes. The histopathol-ogy of the specimen from wound tissue also revealedthe growth of zygomycetes. Detailed mycologicalidentification was not possible at our institute. Thepatient was initiated on haemodialysis and twice a daycleaning and dressing of the wound with EdinburghUniversity solution of lime (EUSOL), as is the practiceat our institute, and amphotericin. EUSOL isa solution of calcium hypochlorite containing notless than 0.25% w/v of available chlorine bufferedwith boric acid to a pH of 7.5–8.5. After 3 weeks oftreatment, the signs of peritonitis subsided. When theplastic surgeon contemplated thorough debridementunder general anaesthesia, the patient’s general condi-tion was so deteriorated owing to malnourishmentthat his son refused further treatment and he left theInstitute against medical advice.There are very few reports [1–4] of peritonitis andexit site infection due to zygomycosis. In all instances,the catheter had been removed. Mortality related tozygomycosis has been reported as 57% [5].The human infection is rare, despite ampleexposure to zygomycosis, due to efficacy of theimmune system. Underlying factors include diabetic

An outbreak of acute post‐streptococcal glomerulonephritis in remote Far North Queensland

To observe and record an outbreak of acute post-streptococcal glomerulonephritis (APSGN) in the Lockhart River community in 2005 and the steps taken by health workers to contain the epidemic. A descriptive study of cases of APSGN and children aged from 2 to 12 years involved in the screening program. A remote indigenous community in Far North Queensland. All children aged from 2 to 12 years in the Lockhart River community. Eighty-seven children were screened. And 46% were found to have infected scabies. There were 11 confirmed cases of APSGN over four months from February to May. Infected scabies was the main preceding finding in these children.

Outcome of an interventional program for scabies in an Indigenous community.

To implement an intervention program for reducing the prevalence of scabies in a large Northern Territory Aboriginal community. Prospective, longitudinal screening, intervention and follow-up study. All children aged 5 years and under in one of the largest Aboriginal communities in the Northern Territory, total population, approximately 2,200 (95% Indigenous). A decrease in prevalence of scabies, infected scabies and non-scabies pyoderma over seven months. The number of children aged 5 years and under screened intially and at the three follow-up screenings ranged from 201 to 242 (more than 98% of those eligible on each occasion). The prevalences of scabies, infected scabies and non-scabies pyoderma before intervention were 35%, 12% and 11%, respectively. At 6 weeks postintervention these had decreased to 3%, 1% and 4%, respectively; low prevalences were maintained at four and seven months. This intervention, which was based on community motivation, involvement and control, successfully reduced the prevalence of scabies. Continuing community health education and regular screening will be crucial in controlling scabies. The methods and results of this study may be helpful in developing a coordinated program for all remote Aboriginal communities in the area.

Clinico-bacteriological study of pyodermas in children.

One hundred cases of pyodermas in children were investigated clinically and bacteriologically. Nasal and throat swabs from all cases were subjected to bacteriological examination. Most of the children (42%) were in the 1-4 year age group. The majority (58%) belonged to lower socio-economic groups with poor standards of hygiene. A history of over-crowding was obtained from 87% of cases, 82% were undernourished. Most of the children (68%) reported during the hot and humid months of June, July, August, and September. Primary pyodermas were observed in 72% of the children, and secondary pyodermas in 28%. Impetigo was the commonest primary pyoderma (48.61%); among secondary pyodermas, infected scabies was noted predominantly (42.86%). The face and legs were more commonly involved. Bacteriological cultures from pyoderma lesions revealed a single microorganism in the majority of the patients (84%). Staphylococcus aureus was isolated in pure culture from 48% and pure beta-hemolytic streptococci from 36%. A combination of both was obtained from 16%. No other organism was isolated from any case. A similar pattern was also observed in cultures from the nose and throat. Only 46 out of the 64 strains (84.3%) of Staphylococcus aureus isolated from pyoderma were typable. The majority (39.1%) showed a mixed pattern of phages; the second commonest was the non-allocated phage type (30.4%). Nasal flora had more of the non-allocated phage type (50%); two out of the three strains (66.6%) isolated from the throat showed a mixed pattern. All the strains of beta hemolytic streptococci, isolated either from lesions of pyoderma, nose, or throat belonged to group A. Staphylococcus aureus and showed a high sensitivity to netilmycin (100%), ofloxacin (98.4%), amoxycillin/clavulanic acid (96.9%), ciprofloxacin (89.1%) and gentamycin (84.4%) but a high resistance to penicillin (85.9%). A greater correlation was noted between nasal flora and organisms causing pyodermas. A change in the pattern of organisms causing pyodermas in children and their antibiotic sensitivities in this part of the globe has been observed in this study. The role of endogenous nasal and throat flora in the causation of pyodermas has also been highlighted.

Microbiology of secondary bacterial infection in scabies lesions.

Aerobic and anaerobic bacteria were grown from specimens obtained from 30 children with secondarily infected scabies lesions. Aerobic or facultative bacteria only were present in 14 (47%) patients, anaerobic bacteria only were present in 6 (20%) patients, and a mixed anaerobic-aerobic flora was present in 10 (33%) patients. Fifty isolates were recovered (1.7 per specimen); 27 were aerobic or facultative bacteria and 23 were strict anaerobes. The predominant aerobic and facultative bacteria were Staphylococcus aureus (nine isolates), group A streptococci (five isolates), and Pseudomonas aeruginosa (three isolates). The predominant anaerobes were Peptostreptococcus sp. (nine isolates) and pigmented Prevotella and Porphyromonas spp. (four isolates). Single bacterial isolates were recovered from nine (30%) patients; five of these were S. aureus. Sixteen organisms isolated from 12 (40%) patients produced the enzyme beta-lactamase. Organisms that resided in the mucous membranes close to or in contact with the lesions predominated in those infections. Enteric gram-negative rods were recovered in leg and trunk lesions. Group A streptococci and S. aureus predominated in finger and hand lesions. Bacteroides fragilis group and Clostridium sp. were isolated from leg lesions, and pigmented Prevotella sp. and Porphyromonas and Fusobacterium spp. were recovered from finger lesions. The polymicrobial etiology of secondarily infected scabies lesions in children and the association of bacterial flora with the anatomical sites of the lesions are demonstrated.

Post-streptococcal acute glomerulonephritis : A clinical, bacteriological and serological study

Eight hundred and sixty four children were admitted with Acute post-streptococcal glomerulonephritis (APSGN) at the Institute for Child Health, Madras, during the period January 1981 to January 1983. Majority of the cases followed infected scabies or impetigo. 135 children were investigated and followed up for a period of 1-2 years. The disease had an excellent prognosis in these children. None of those examined 2 years after discharge had proteinuria or hypertension. Group A beta hemolytic streptococcus (BHS) was isolated in 13.4% of patients and 11.25% of skin infection controls. Eight different T types were identified in patients and 6 T types in pyoderma cases. All patients and 87% of skin infection controls had elevated anti-D Nase B titres, while ASO titres were not significantly raised.

Bacterial Skin Infections in Preschool and School Children in Coastal Tanzania

In coastal Tanzania, 1,855 preschool and school children were studied for pyoderma (superficial bacterial infections of the skin exclusive of secondarily infected scabies) and for scabies. The predisposing personal, socleoeconomic, and hygienic variables for both conditions were studied also. Pyoderma lesions and some secondarily infected scabies were cultured aerobically for bacterial isolates and the predisposing factors were determined by interviews, home visits, and physical examinations. Pyoderma was present in 6.9% and scabies in 16.6% of the children; both combined totalled 23.5% of the children. Both conditions were more common in rural than in urban environments, but scabies was most common in populations with poor socioeconomic and hygienic conditions. The predisposing factors included trauma, insect bites, hot and damp coastal weather, and poor socioeconomic and hygienic conditions.

Letter: Scabies and bullae.

To the Editor.— The recent article (230:878, 1974) regarding the association of scabies and bullae states that widespread and extensive bullae may on occasion be a part of the clinical spectrum of scabies in children. Whereas it is true that large bullae are sometimes seen in association with scabies, I believe these are a secondary complication of Sarcoptes infestation rather than a primary feature, as seems implied in the article. In most cases, the bullae are most likely due to Staphylococcus aureus superinfection causing bullous impetigo. This seems attested to in the case cited, since an antibiotic was used because of secondary bacterial infection. Most reports of secondarily infected scabies mention only the clinical nature of such infection as erythema, crusting, pustules, and bullae, but do not specify the particular infecting organism(s). Nowhere have I found a reference mentioning specifically S aureus , phage type 71, as the infecting organism in