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Asha C Bowen - One of the best experts on this subject based on the ideXlab platform.
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scabies and Impetigo in timor leste a school screening study in two districts
PLOS Neglected Tropical Diseases, 2018Co-Authors: Laura M Korte, Asha C Bowen, Anthony D K Draper, Kim Davis, Annette Steel, Ines Teodora, Ivonia Mascarenhas, Benjamin Dingle, Joshua R FrancisAbstract:Introduction Scabies and Impetigo are common and important skin conditions which are often neglected in developing countries. Limited data have been published on the prevalence of scabies and Impetigo in Timor-Leste. Sequelae including cellulitis, bacteraemia, nephritis, acute rheumatic fever and rheumatic heart disease contribute significantly to the burden of disease. Methods School students were recruited from schools in Dili (urban) and Ermera (rural) in Timor-Leste for an epidemiological study in October 2016. A standard questionnaire was used to record demographics, anthropometry and skin examination results. Impetigo and scabies were diagnosed based on clinical examination of exposed surfaces, and clinical photographs were reviewed for correlation by an infectious diseases paediatrician. Prevalence of scabies and Impetigo were calculated and binary risk factor associations were described using relative risks and 95% confidence intervals. Adjusted odds ratios were calculated using logistic regression multivariate analysis. Continuous variables were analysed for associations using the Mann-Whitney Rank Sum test. Results The study enrolled 1396 students; median age 11 years (interquartile range (IQR) 9–15). The prevalence of scabies was 22.4% (95% CI 20.2–24.7%) and active Impetigo 9.7% (95% CI 8.3–11.4%); 68.2% of students had evidence of either active or healed Impetigo. Students in Ermera were more likely than those in Dili to have scabies (prevalence 32.0% vs 5.2%, aOR 8.1 (95% CI 5.2–12.4), p<0.01). There was no difference in the prevalence of active Impetigo between urban and rural sites. More than a third of participants were moderately or severely underweight. Stunting was markedly more common in the rural district of Ermera. Conclusion Scabies and Impetigo are common in Timor-Leste, with very high prevalence of scabies in the rural district of Ermera. Improvements in prevention and treatment are needed, with prioritised activities in the rural areas where prevalence is highest.
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Scabies and Impetigo in Timor-Leste: A school screening study in two districts.
PLoS neglected tropical diseases, 2018Co-Authors: Laura M Korte, Asha C Bowen, Anthony D K Draper, Kim Davis, Annette Steel, Ines Teodora, Ivonia Mascarenhas, Benjamin Dingle, Joshua R FrancisAbstract:Introduction Scabies and Impetigo are common and important skin conditions which are often neglected in developing countries. Limited data have been published on the prevalence of scabies and Impetigo in Timor-Leste. Sequelae including cellulitis, bacteraemia, nephritis, acute rheumatic fever and rheumatic heart disease contribute significantly to the burden of disease. Methods School students were recruited from schools in Dili (urban) and Ermera (rural) in Timor-Leste for an epidemiological study in October 2016. A standard questionnaire was used to record demographics, anthropometry and skin examination results. Impetigo and scabies were diagnosed based on clinical examination of exposed surfaces, and clinical photographs were reviewed for correlation by an infectious diseases paediatrician. Prevalence of scabies and Impetigo were calculated and binary risk factor associations were described using relative risks and 95% confidence intervals. Adjusted odds ratios were calculated using logistic regression multivariate analysis. Continuous variables were analysed for associations using the Mann-Whitney Rank Sum test. Results The study enrolled 1396 students; median age 11 years (interquartile range (IQR) 9–15). The prevalence of scabies was 22.4% (95% CI 20.2–24.7%) and active Impetigo 9.7% (95% CI 8.3–11.4%); 68.2% of students had evidence of either active or healed Impetigo. Students in Ermera were more likely than those in Dili to have scabies (prevalence 32.0% vs 5.2%, aOR 8.1 (95% CI 5.2–12.4), p
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Scabies and Impetigo in Timor-Leste: A school screening study in two districts.
Public Library of Science (PLoS), 2018Co-Authors: Laura M Korte, Asha C Bowen, Anthony D K Draper, Kim Davis, Annette Steel, Ines Teodora, Ivonia Mascarenhas, Benjamin Dingle, Joshua R FrancisAbstract:Scabies and Impetigo are common and important skin conditions which are often neglected in developing countries. Limited data have been published on the prevalence of scabies and Impetigo in Timor-Leste. Sequelae including cellulitis, bacteraemia, nephritis, acute rheumatic fever and rheumatic heart disease contribute significantly to the burden of disease.School students were recruited from schools in Dili (urban) and Ermera (rural) in Timor-Leste for an epidemiological study in October 2016. A standard questionnaire was used to record demographics, anthropometry and skin examination results. Impetigo and scabies were diagnosed based on clinical examination of exposed surfaces, and clinical photographs were reviewed for correlation by an infectious diseases paediatrician. Prevalence of scabies and Impetigo were calculated and binary risk factor associations were described using relative risks and 95% confidence intervals. Adjusted odds ratios were calculated using logistic regression multivariate analysis. Continuous variables were analysed for associations using the Mann-Whitney Rank Sum test.The study enrolled 1396 students; median age 11 years (interquartile range (IQR) 9-15). The prevalence of scabies was 22.4% (95% CI 20.2-24.7%) and active Impetigo 9.7% (95% CI 8.3-11.4%); 68.2% of students had evidence of either active or healed Impetigo. Students in Ermera were more likely than those in Dili to have scabies (prevalence 32.0% vs 5.2%, aOR 8.1 (95% CI 5.2-12.4), p
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The importance of scabies coinfection in the treatment considerations for Impetigo
Pediatric Infectious Disease Journal, 2016Co-Authors: Tasani M, Carapetis, Ross M Andrews, Steven Y C Tong, Deborah C Holt, Bart J. Currie, Asha C BowenAbstract:Skin infections account for a high disease burden in indigenous children living in northern Australia. Although the relationship between Impetigo and scabies is recognized, the prevalence of scabies in children with Impetigo is not well reported. We report the prevalence, demographics and treatment success outcomes of Impetigo and scabies coinfection in indigenous children who were participants in a randomized controlled trial of Impetigo treatment conducted in remote communities of the Northern Territory, Australia.Of 1715 screening episodes for Impetigo, 508 children were randomized to receive intramuscular benzathine benzylpenicillin (BPG), twice daily co-trimoxazole (SXT) for 3 days (4 mg/kg trimethoprim plus 20 mg/kg sulfamethoxazole per dose) or once daily SXT for 5 days (8 mg/kg trimethoprim plus 40 mg/kg sulfamethoxazole per dose). A clinical diagnosis of scabies; tinea of the skin, scalp or nail; and head lice was made on all children. Scabies presence was not confirmed using diagnostic scrapings. In a post-hoc analysis, we determined whether coinfection with scabies had an impact on treatment success for Impetigo.Of children randomized to receive treatment for Impetigo, 84 of 508 (16.5%) had scabies. The presence of scabies ranged from 14.3% to 20.0% in the 3 treatment groups. Treatment success for Impetigo with and without scabies coinfection, independent of the treatment groups, was 75.9% and 86.6%, respectively, absolute difference 10.7% [95% confidence interval (CI): +1% to +21%]. Treatment success for Impetigo with and without scabies coinfection in the BPG group was 69.6% and 88.0%, respectively, absolute difference 18.4% (95% CI: -1% to +38%). In the pooled SXT groups, the treatment success for Impetigo with and without scabies coinfection was 78.6% and 86.0%, respectively, with absolute difference 7.4% (95% CI: -4% to +18%). Treatment success in the pooled SXT group with scabies (78.6%) was higher than in the BPG group (69.6%) with scabies, absolute difference 9.0% (95% CI: +0.1% to +18%). Prediction of treatment success for Impetigo is dependent on the presence or absence of scabies and for scabies coinfected Impetigo it was higher in the group treated with SXT.The burden of scabies in an Impetigo trial for Indigenous children was high. Treatment success for scabies coinfection was lower than for Impetigo overall, with a higher success seen in the SXT group than the BPG group.
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The Importance of Scabies Coinfection in the Treatment Considerations for Impetigo.
The Pediatric infectious disease journal, 2016Co-Authors: Monika Tasani, Ross M Andrews, Steven Y C Tong, Deborah C Holt, Bart J. Currie, Jonathan R. Carapetis, Asha C BowenAbstract:Background Skin infections account for a high disease burden in indigenous children living in northern Australia. Although the relationship between Impetigo and scabies is recognized, the prevalence of scabies in children with Impetigo is not well reported. We report the prevalence, demographics and treatment success outcomes of Impetigo and scabies coinfection in indigenous children who were participants in a randomized controlled trial of Impetigo treatment conducted in remote communities of the Northern Territory, Australia. Methods Of 1715 screening episodes for Impetigo, 508 children were randomized to receive intramuscular benzathine benzylpenicillin (BPG), twice daily co-trimoxazole (SXT) for 3 days (4 mg/kg trimethoprim plus 20 mg/kg sulfamethoxazole per dose) or once daily SXT for 5 days (8 mg/kg trimethoprim plus 40 mg/kg sulfamethoxazole per dose). A clinical diagnosis of scabies; tinea of the skin, scalp or nail; and head lice was made on all children. Scabies presence was not confirmed using diagnostic scrapings. In a post-hoc analysis, we determined whether coinfection with scabies had an impact on treatment success for Impetigo. Results Of children randomized to receive treatment for Impetigo, 84 of 508 (16.5%) had scabies. The presence of scabies ranged from 14.3% to 20.0% in the 3 treatment groups. Treatment success for Impetigo with and without scabies coinfection, independent of the treatment groups, was 75.9% and 86.6%, respectively, absolute difference 10.7% [95% confidence interval (CI): +1% to +21%]. Treatment success for Impetigo with and without scabies coinfection in the BPG group was 69.6% and 88.0%, respectively, absolute difference 18.4% (95% CI: -1% to +38%). In the pooled SXT groups, the treatment success for Impetigo with and without scabies coinfection was 78.6% and 86.0%, respectively, with absolute difference 7.4% (95% CI: -4% to +18%). Treatment success in the pooled SXT group with scabies (78.6%) was higher than in the BPG group (69.6%) with scabies, absolute difference 9.0% (95% CI: +0.1% to +18%). Prediction of treatment success for Impetigo is dependent on the presence or absence of scabies and for scabies coinfected Impetigo it was higher in the group treated with SXT. Conclusions The burden of scabies in an Impetigo trial for Indigenous children was high. Treatment success for scabies coinfection was lower than for Impetigo overall, with a higher success seen in the SXT group than the BPG group.
Jonathan R. Carapetis - One of the best experts on this subject based on the ideXlab platform.
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The Importance of Scabies Coinfection in the Treatment Considerations for Impetigo.
The Pediatric infectious disease journal, 2016Co-Authors: Monika Tasani, Ross M Andrews, Steven Y C Tong, Deborah C Holt, Bart J. Currie, Jonathan R. Carapetis, Asha C BowenAbstract:Background Skin infections account for a high disease burden in indigenous children living in northern Australia. Although the relationship between Impetigo and scabies is recognized, the prevalence of scabies in children with Impetigo is not well reported. We report the prevalence, demographics and treatment success outcomes of Impetigo and scabies coinfection in indigenous children who were participants in a randomized controlled trial of Impetigo treatment conducted in remote communities of the Northern Territory, Australia. Methods Of 1715 screening episodes for Impetigo, 508 children were randomized to receive intramuscular benzathine benzylpenicillin (BPG), twice daily co-trimoxazole (SXT) for 3 days (4 mg/kg trimethoprim plus 20 mg/kg sulfamethoxazole per dose) or once daily SXT for 5 days (8 mg/kg trimethoprim plus 40 mg/kg sulfamethoxazole per dose). A clinical diagnosis of scabies; tinea of the skin, scalp or nail; and head lice was made on all children. Scabies presence was not confirmed using diagnostic scrapings. In a post-hoc analysis, we determined whether coinfection with scabies had an impact on treatment success for Impetigo. Results Of children randomized to receive treatment for Impetigo, 84 of 508 (16.5%) had scabies. The presence of scabies ranged from 14.3% to 20.0% in the 3 treatment groups. Treatment success for Impetigo with and without scabies coinfection, independent of the treatment groups, was 75.9% and 86.6%, respectively, absolute difference 10.7% [95% confidence interval (CI): +1% to +21%]. Treatment success for Impetigo with and without scabies coinfection in the BPG group was 69.6% and 88.0%, respectively, absolute difference 18.4% (95% CI: -1% to +38%). In the pooled SXT groups, the treatment success for Impetigo with and without scabies coinfection was 78.6% and 86.0%, respectively, with absolute difference 7.4% (95% CI: -4% to +18%). Treatment success in the pooled SXT group with scabies (78.6%) was higher than in the BPG group (69.6%) with scabies, absolute difference 9.0% (95% CI: +0.1% to +18%). Prediction of treatment success for Impetigo is dependent on the presence or absence of scabies and for scabies coinfected Impetigo it was higher in the group treated with SXT. Conclusions The burden of scabies in an Impetigo trial for Indigenous children was high. Treatment success for scabies coinfection was lower than for Impetigo overall, with a higher success seen in the SXT group than the BPG group.
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the global epidemiology of Impetigo a systematic review of the population prevalence of Impetigo and pyoderma
PLOS ONE, 2015Co-Authors: Asha C Bowen, Ross M Andrews, Steven Y C Tong, Andrew C Steer, Jonathan R. Carapetis, A MaheAbstract:Objective We conducted a comprehensive, systematic review of the global childhood population prevalence of Impetigo and the broader condition pyoderma. Methods PubMed was systematically searched for Impetigo or pyoderma studies published between January 1 1970 and September 30 2014. Two independent reviewers extracted data from each relevant article on the prevalence of Impetigo. Findings Sixty-six articles relating to 89 studies met our inclusion criteria. Based on population surveillance, 82 studies included data on 145,028 children assessed for pyoderma or Impetigo. Median childhood prevalence was 12·3% (IQR 4·2–19·4%). Fifty-eight (65%) studies were from low or low-middle income countries, where median childhood prevalences were 8·4% (IQR 4·2–16·1%) and 14·5% (IQR 8·3–20·9%), respectively. However, the highest burden was seen in underprivileged children from marginalised communities of high-income countries; median prevalence 19·4%, (IQR 3·9–43·3%). Conclusion Based on data from studies published since 2000 from low and low-middle income countries, we estimate the global population of children suffering from Impetigo at any one time to be in excess of 162 million, predominantly in tropical, resource-poor contexts. Impetigo is an under-recognised disease and in conjunction with scabies, comprises a major childhood dermatological condition with potential lifelong consequences if untreated.
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The microbiology of Impetigo in Indigenous children: associations between Streptococcus pyogenes, Staphylococcus aureus,scabies, and nasal carriage
BMC Infectious Diseases, 2014Co-Authors: Asha C Bowen, Steven Y C Tong, Mark D Chatfield, Jonathan R. CarapetisAbstract:Background Impetigo is caused by both Streptococcus pyogenes and Staphylococcus aureus ; the relative contributions of each have been reported to fluctuate with time and region. While S. aureus is reportedly on the increase in most industrialised settings, S. pyogenes is still thought to drive Impetigo in endemic, tropical regions. However, few studies have utilised high quality microbiological culture methods to confirm this assumption. We report the prevalence and antimicrobial resistance of Impetigo pathogens recovered in a randomised, controlled trial of Impetigo treatment conducted in remote Indigenous communities of northern Australia. Methods Each child had one or two sores, and the anterior nares, swabbed. All swabs were transported in skim milk tryptone glucose glycogen broth and frozen at –70°C, until plated on horse blood agar. S. aureus and S. pyogenes were confirmed with latex agglutination. Results From 508 children, we collected 872 swabs of sores and 504 swabs from the anterior nares prior to commencement of antibiotic therapy. S. pyogenes and S. aureus were identified together in 503/872 (58%) of sores; with an additional 207/872 (24%) sores having S. pyogenes and 81/872 (9%) S. aureus , in isolation. Skin sore swabs taken during episodes with a concurrent diagnosis of scabies were more likely to culture S. pyogenes (OR 2.2, 95% CI 1.1 – 4.4, p = 0.03). Eighteen percent of children had nasal carriage of skin pathogens. There was no association between the presence of S. aureus in the nose and skin. Methicillin-resistance was detected in 15% of children who cultured S. aureus from either a sore or their nose. There was no association found between the severity of Impetigo and the detection of a skin pathogen. Conclusions S. pyogenes remains the principal pathogen in tropical Impetigo; the relatively high contribution of S. aureus as a co-pathogen has also been confirmed. Children with scabies were more likely to have S. pyogenes detected. While clearance of S. pyogenes is the key determinant of treatment efficacy, co-infection with S. aureus warrants consideration of treatment options that are effective against both pathogens where Impetigo is severe and prevalent. Trial registration This trial is registered; ACTRN12609000858291 .
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the microbiology of Impetigo in indigenous children associations between streptococcus pyogenes staphylococcus aureus scabies and nasal carriage
BMC Infectious Diseases, 2014Co-Authors: Asha C Bowen, Steven Y C Tong, Jonathan R. Carapetis, Mark D ChatfieldAbstract:Impetigo is caused by both Streptococcus pyogenes and Staphylococcus aureus; the relative contributions of each have been reported to fluctuate with time and region. While S. aureus is reportedly on the increase in most industrialised settings, S. pyogenes is still thought to drive Impetigo in endemic, tropical regions. However, few studies have utilised high quality microbiological culture methods to confirm this assumption. We report the prevalence and antimicrobial resistance of Impetigo pathogens recovered in a randomised, controlled trial of Impetigo treatment conducted in remote Indigenous communities of northern Australia. Each child had one or two sores, and the anterior nares, swabbed. All swabs were transported in skim milk tryptone glucose glycogen broth and frozen at –70°C, until plated on horse blood agar. S. aureus and S. pyogenes were confirmed with latex agglutination. From 508 children, we collected 872 swabs of sores and 504 swabs from the anterior nares prior to commencement of antibiotic therapy. S. pyogenes and S. aureus were identified together in 503/872 (58%) of sores; with an additional 207/872 (24%) sores having S. pyogenes and 81/872 (9%) S. aureus, in isolation. Skin sore swabs taken during episodes with a concurrent diagnosis of scabies were more likely to culture S. pyogenes (OR 2.2, 95% CI 1.1 – 4.4, p = 0.03). Eighteen percent of children had nasal carriage of skin pathogens. There was no association between the presence of S. aureus in the nose and skin. Methicillin-resistance was detected in 15% of children who cultured S. aureus from either a sore or their nose. There was no association found between the severity of Impetigo and the detection of a skin pathogen. S. pyogenes remains the principal pathogen in tropical Impetigo; the relatively high contribution of S. aureus as a co-pathogen has also been confirmed. Children with scabies were more likely to have S. pyogenes detected. While clearance of S. pyogenes is the key determinant of treatment efficacy, co-infection with S. aureus warrants consideration of treatment options that are effective against both pathogens where Impetigo is severe and prevalent. This trial is registered; ACTRN12609000858291 .
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high burden of Impetigo and scabies in a tropical country
PLOS Neglected Tropical Diseases, 2009Co-Authors: Andrew C Steer, Adam Jenney, Joseph Kado, Michael R Batzloff, Sophie La Vincente, Lepani Waqatakirewa, Kim E Mulholland, Jonathan R. CarapetisAbstract:Background Impetigo and scabies are endemic diseases in many tropical countries; however the epidemiology of these diseases is poorly understood in many areas, particularly in the Pacific. Methodology/Principal Findings We conducted three epidemiological studies in 2006 and 2007 to determine the burden of disease due to Impetigo and scabies in children in Fiji using simple and easily reproducible methodology. Two studies were performed in primary school children (one study was a cross-sectional study and the other a prospective cohort study over ten months) and one study was performed in infants (cross-sectional). The prevalence of active Impetigo was 25.6% (95% CI 24.1–27.1) in primary school children and 12.2% (95% CI 9.3–15.6) in infants. The prevalence of scabies was 18.5% (95% CI 17.2–19.8) in primary school children and 14.0% (95% CI 10.8–17.2) in infants. The incidence density of active Impetigo, group A streptococcal (GAS) Impetigo, Staphylococcus aureus Impetigo and scabies was 122, 80, 64 and 51 cases per 100 child-years respectively. Impetigo was strongly associated with scabies infestation (odds ratio, OR, 2.4, 95% CI 1.6–3.7) and was more common in Indigenous Fijian children when compared with children of other ethnicities (OR 3.6, 95% CI 2.7–4.7). The majority of cases of active Impetigo in the children in our study were caused by GAS. S. aureus was also a common cause (57.4% in school aged children and 69% in infants). Conclusions/Significance These data suggest that the Impetigo and scabies disease burden in children in Fiji has been underestimated, and possibly other tropical developing countries in the Pacific. These diseases are more than benign nuisance diseases and consideration needs to be given to expanded public health initiatives to improve their control.
Andrew C Steer - One of the best experts on this subject based on the ideXlab platform.
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community perspectives on scabies Impetigo and mass drug administration in fiji a qualitative study
PLOS Neglected Tropical Diseases, 2020Co-Authors: Elke Mitchell, Andrew C Steer, Mike Kama, Stephen Bell, Li Jun Thean, Aalisha Sahukhan, Aminiasi Koroivueti, John M KaldorAbstract:Scabies is endemic in Fiji and is a significant cause of morbidity. Little is known about the sociocultural beliefs and practices that affect the occurrence of scabies and Impetigo, or community attitudes towards the strategy of mass drug administration that is emerging as a public health option for scabies and Impetigo control in Fiji and other countries. Data were collected during semi-structured interviews with 33 community members in four locations in Fiji's Northern Division. Thematic analysis examined participants' lived experiences of scabies and Impetigo; community knowledge and perceptions about scabies and Impetigo aetiology and transmission; community-based treatment and prevention measures; and attitudes towards mass drug administration. Many indigenous Fijian (iTaukei) participants noted extensive and ongoing experience of scabies and Impetigo among children in their families and communities, but only one participant of Indian descent (Indo-Fijian) identified personal childhood experience of scabies. Scabies and Impetigo were perceived as diseases affecting children, impacting on school attendance and families' quality of sleep. Awareness of scabies and Impetigo was considerable, but there were major misconceptions around disease causation and transmission. Traditional remedies were preferred for scabies treatment, followed by biomedicines provided by local health centres and hospitals. Treatment of close household contacts was not prioritised. Attitudes towards mass drug administration to control scabies were mostly positive, although some concerns were noted about adverse effects and hesitation to participate in the planned scabies elimination programme. Findings from this first study to document perspectives and experiences related to scabies and Impetigo and their management in the Asia Pacific region illustrate that a community-centred approach to scabies and Impetigo is needed for the success of control efforts in Fiji, and most likely in other affected countries. This includes community-based health promotion messaging on the social dynamics of scabies transmission, and a campaign of education and community engagement prior to mass drug administration.
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Prevalence of scabies and Impetigo in the Solomon Islands: a school survey.
BMC infectious diseases, 2019Co-Authors: Millicent H. Osti, Andrew C Steer, Margot J Whitfeld, Michael Marks, John M Kaldor, Oliver Sokana, Sophie L Phelan, Christina Gorae, Daniel T EngelmanAbstract:Scabies, a parasitic disease of the skin, is a major public health problem, largely affecting children. Scabies is often complicated by Impetigo which can result in serious complications including invasive infections and immune mediated diseases. Scabies and Impetigo are reported to have high prevalence in tropical settings including the Solomon Islands. We conducted a cross-sectional prevalence survey at Gizo Primary School in the Western Province of the Solomon Islands in August 2018. The diagnosis of scabies was based on criteria developed by the International Alliance for the Control of Scabies in 2018. Population attributable risk was calculated to determine the effect of scabies on the prevalence of Impetigo, and both adjusted and unadjusted risk ratios were calculated to identify differences between sexes and age groups. A total of 324 students were assessed (47.5% of those enrolled at the school). The prevalence of scabies was 54.3% (95% confidence interval [CI] 48.7–59.8) and most disease was mild (68.8%). The prevalence was higher in males (63.5%; adjusted risk ratio [ARR] 1.4, 95% CI 1.1–1.7), and in those aged 10–12 years (61.4%; ARR 1.8, 95% CI 1.1–2.9 when compared to those aged 4–6 years). The prevalence of Impetigo was 32.1%, with males more likely to be affected (41.7%, ARR 1.7, 95% CI 1.2–2.4) but with no significant differences between age groups. 63.5% of those with Impetigo had scabies, corresponding to a population attributable risk of 11.8%. There is a very high burden of scabies and Impetigo among primary school students in Gizo. There is a critical need for the development and implementation of control programs in areas where scabies is endemic.
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the global epidemiology of Impetigo a systematic review of the population prevalence of Impetigo and pyoderma
PLOS ONE, 2015Co-Authors: Asha C Bowen, Ross M Andrews, Steven Y C Tong, Andrew C Steer, Jonathan R. Carapetis, A MaheAbstract:Objective We conducted a comprehensive, systematic review of the global childhood population prevalence of Impetigo and the broader condition pyoderma. Methods PubMed was systematically searched for Impetigo or pyoderma studies published between January 1 1970 and September 30 2014. Two independent reviewers extracted data from each relevant article on the prevalence of Impetigo. Findings Sixty-six articles relating to 89 studies met our inclusion criteria. Based on population surveillance, 82 studies included data on 145,028 children assessed for pyoderma or Impetigo. Median childhood prevalence was 12·3% (IQR 4·2–19·4%). Fifty-eight (65%) studies were from low or low-middle income countries, where median childhood prevalences were 8·4% (IQR 4·2–16·1%) and 14·5% (IQR 8·3–20·9%), respectively. However, the highest burden was seen in underprivileged children from marginalised communities of high-income countries; median prevalence 19·4%, (IQR 3·9–43·3%). Conclusion Based on data from studies published since 2000 from low and low-middle income countries, we estimate the global population of children suffering from Impetigo at any one time to be in excess of 162 million, predominantly in tropical, resource-poor contexts. Impetigo is an under-recognised disease and in conjunction with scabies, comprises a major childhood dermatological condition with potential lifelong consequences if untreated.
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streptococcal skin infection and rheumatic heart disease
Current Opinion in Infectious Diseases, 2012Co-Authors: Tom Parks, Pierre R Smeesters, Andrew C SteerAbstract:In resource-limited tropical settings, both Impetigo and rheumatic disease are endemic. The major cause of Impetigo in these regions is the group A streptococcus and there is a growing body of opinion implicating Impetigo in the pathogenesis of rheumatic fever and rheumatic heart disease (RHD). This potentially has major implications for control of these neglected diseases, which account for at least 350 000 deaths worldwide, annually. In this review, we summarize recent advances in the epidemiology of group A streptococcal skin disease and examine evidence for the relationship between group A streptococcal skin disease and rheumatic fever.
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high burden of Impetigo and scabies in a tropical country
PLOS Neglected Tropical Diseases, 2009Co-Authors: Andrew C Steer, Adam Jenney, Joseph Kado, Michael R Batzloff, Sophie La Vincente, Lepani Waqatakirewa, Kim E Mulholland, Jonathan R. CarapetisAbstract:Background Impetigo and scabies are endemic diseases in many tropical countries; however the epidemiology of these diseases is poorly understood in many areas, particularly in the Pacific. Methodology/Principal Findings We conducted three epidemiological studies in 2006 and 2007 to determine the burden of disease due to Impetigo and scabies in children in Fiji using simple and easily reproducible methodology. Two studies were performed in primary school children (one study was a cross-sectional study and the other a prospective cohort study over ten months) and one study was performed in infants (cross-sectional). The prevalence of active Impetigo was 25.6% (95% CI 24.1–27.1) in primary school children and 12.2% (95% CI 9.3–15.6) in infants. The prevalence of scabies was 18.5% (95% CI 17.2–19.8) in primary school children and 14.0% (95% CI 10.8–17.2) in infants. The incidence density of active Impetigo, group A streptococcal (GAS) Impetigo, Staphylococcus aureus Impetigo and scabies was 122, 80, 64 and 51 cases per 100 child-years respectively. Impetigo was strongly associated with scabies infestation (odds ratio, OR, 2.4, 95% CI 1.6–3.7) and was more common in Indigenous Fijian children when compared with children of other ethnicities (OR 3.6, 95% CI 2.7–4.7). The majority of cases of active Impetigo in the children in our study were caused by GAS. S. aureus was also a common cause (57.4% in school aged children and 69% in infants). Conclusions/Significance These data suggest that the Impetigo and scabies disease burden in children in Fiji has been underestimated, and possibly other tropical developing countries in the Pacific. These diseases are more than benign nuisance diseases and consideration needs to be given to expanded public health initiatives to improve their control.
Steven Y C Tong - One of the best experts on this subject based on the ideXlab platform.
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The importance of scabies coinfection in the treatment considerations for Impetigo
Pediatric Infectious Disease Journal, 2016Co-Authors: Tasani M, Carapetis, Ross M Andrews, Steven Y C Tong, Deborah C Holt, Bart J. Currie, Asha C BowenAbstract:Skin infections account for a high disease burden in indigenous children living in northern Australia. Although the relationship between Impetigo and scabies is recognized, the prevalence of scabies in children with Impetigo is not well reported. We report the prevalence, demographics and treatment success outcomes of Impetigo and scabies coinfection in indigenous children who were participants in a randomized controlled trial of Impetigo treatment conducted in remote communities of the Northern Territory, Australia.Of 1715 screening episodes for Impetigo, 508 children were randomized to receive intramuscular benzathine benzylpenicillin (BPG), twice daily co-trimoxazole (SXT) for 3 days (4 mg/kg trimethoprim plus 20 mg/kg sulfamethoxazole per dose) or once daily SXT for 5 days (8 mg/kg trimethoprim plus 40 mg/kg sulfamethoxazole per dose). A clinical diagnosis of scabies; tinea of the skin, scalp or nail; and head lice was made on all children. Scabies presence was not confirmed using diagnostic scrapings. In a post-hoc analysis, we determined whether coinfection with scabies had an impact on treatment success for Impetigo.Of children randomized to receive treatment for Impetigo, 84 of 508 (16.5%) had scabies. The presence of scabies ranged from 14.3% to 20.0% in the 3 treatment groups. Treatment success for Impetigo with and without scabies coinfection, independent of the treatment groups, was 75.9% and 86.6%, respectively, absolute difference 10.7% [95% confidence interval (CI): +1% to +21%]. Treatment success for Impetigo with and without scabies coinfection in the BPG group was 69.6% and 88.0%, respectively, absolute difference 18.4% (95% CI: -1% to +38%). In the pooled SXT groups, the treatment success for Impetigo with and without scabies coinfection was 78.6% and 86.0%, respectively, with absolute difference 7.4% (95% CI: -4% to +18%). Treatment success in the pooled SXT group with scabies (78.6%) was higher than in the BPG group (69.6%) with scabies, absolute difference 9.0% (95% CI: +0.1% to +18%). Prediction of treatment success for Impetigo is dependent on the presence or absence of scabies and for scabies coinfected Impetigo it was higher in the group treated with SXT.The burden of scabies in an Impetigo trial for Indigenous children was high. Treatment success for scabies coinfection was lower than for Impetigo overall, with a higher success seen in the SXT group than the BPG group.
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The Importance of Scabies Coinfection in the Treatment Considerations for Impetigo.
The Pediatric infectious disease journal, 2016Co-Authors: Monika Tasani, Ross M Andrews, Steven Y C Tong, Deborah C Holt, Bart J. Currie, Jonathan R. Carapetis, Asha C BowenAbstract:Background Skin infections account for a high disease burden in indigenous children living in northern Australia. Although the relationship between Impetigo and scabies is recognized, the prevalence of scabies in children with Impetigo is not well reported. We report the prevalence, demographics and treatment success outcomes of Impetigo and scabies coinfection in indigenous children who were participants in a randomized controlled trial of Impetigo treatment conducted in remote communities of the Northern Territory, Australia. Methods Of 1715 screening episodes for Impetigo, 508 children were randomized to receive intramuscular benzathine benzylpenicillin (BPG), twice daily co-trimoxazole (SXT) for 3 days (4 mg/kg trimethoprim plus 20 mg/kg sulfamethoxazole per dose) or once daily SXT for 5 days (8 mg/kg trimethoprim plus 40 mg/kg sulfamethoxazole per dose). A clinical diagnosis of scabies; tinea of the skin, scalp or nail; and head lice was made on all children. Scabies presence was not confirmed using diagnostic scrapings. In a post-hoc analysis, we determined whether coinfection with scabies had an impact on treatment success for Impetigo. Results Of children randomized to receive treatment for Impetigo, 84 of 508 (16.5%) had scabies. The presence of scabies ranged from 14.3% to 20.0% in the 3 treatment groups. Treatment success for Impetigo with and without scabies coinfection, independent of the treatment groups, was 75.9% and 86.6%, respectively, absolute difference 10.7% [95% confidence interval (CI): +1% to +21%]. Treatment success for Impetigo with and without scabies coinfection in the BPG group was 69.6% and 88.0%, respectively, absolute difference 18.4% (95% CI: -1% to +38%). In the pooled SXT groups, the treatment success for Impetigo with and without scabies coinfection was 78.6% and 86.0%, respectively, with absolute difference 7.4% (95% CI: -4% to +18%). Treatment success in the pooled SXT group with scabies (78.6%) was higher than in the BPG group (69.6%) with scabies, absolute difference 9.0% (95% CI: +0.1% to +18%). Prediction of treatment success for Impetigo is dependent on the presence or absence of scabies and for scabies coinfected Impetigo it was higher in the group treated with SXT. Conclusions The burden of scabies in an Impetigo trial for Indigenous children was high. Treatment success for scabies coinfection was lower than for Impetigo overall, with a higher success seen in the SXT group than the BPG group.
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the global epidemiology of Impetigo a systematic review of the population prevalence of Impetigo and pyoderma
PLOS ONE, 2015Co-Authors: Asha C Bowen, Ross M Andrews, Steven Y C Tong, Andrew C Steer, Jonathan R. Carapetis, A MaheAbstract:Objective We conducted a comprehensive, systematic review of the global childhood population prevalence of Impetigo and the broader condition pyoderma. Methods PubMed was systematically searched for Impetigo or pyoderma studies published between January 1 1970 and September 30 2014. Two independent reviewers extracted data from each relevant article on the prevalence of Impetigo. Findings Sixty-six articles relating to 89 studies met our inclusion criteria. Based on population surveillance, 82 studies included data on 145,028 children assessed for pyoderma or Impetigo. Median childhood prevalence was 12·3% (IQR 4·2–19·4%). Fifty-eight (65%) studies were from low or low-middle income countries, where median childhood prevalences were 8·4% (IQR 4·2–16·1%) and 14·5% (IQR 8·3–20·9%), respectively. However, the highest burden was seen in underprivileged children from marginalised communities of high-income countries; median prevalence 19·4%, (IQR 3·9–43·3%). Conclusion Based on data from studies published since 2000 from low and low-middle income countries, we estimate the global population of children suffering from Impetigo at any one time to be in excess of 162 million, predominantly in tropical, resource-poor contexts. Impetigo is an under-recognised disease and in conjunction with scabies, comprises a major childhood dermatological condition with potential lifelong consequences if untreated.
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The microbiology of Impetigo in Indigenous children: associations between Streptococcus pyogenes, Staphylococcus aureus,scabies, and nasal carriage
BMC Infectious Diseases, 2014Co-Authors: Asha C Bowen, Steven Y C Tong, Mark D Chatfield, Jonathan R. CarapetisAbstract:Background Impetigo is caused by both Streptococcus pyogenes and Staphylococcus aureus ; the relative contributions of each have been reported to fluctuate with time and region. While S. aureus is reportedly on the increase in most industrialised settings, S. pyogenes is still thought to drive Impetigo in endemic, tropical regions. However, few studies have utilised high quality microbiological culture methods to confirm this assumption. We report the prevalence and antimicrobial resistance of Impetigo pathogens recovered in a randomised, controlled trial of Impetigo treatment conducted in remote Indigenous communities of northern Australia. Methods Each child had one or two sores, and the anterior nares, swabbed. All swabs were transported in skim milk tryptone glucose glycogen broth and frozen at –70°C, until plated on horse blood agar. S. aureus and S. pyogenes were confirmed with latex agglutination. Results From 508 children, we collected 872 swabs of sores and 504 swabs from the anterior nares prior to commencement of antibiotic therapy. S. pyogenes and S. aureus were identified together in 503/872 (58%) of sores; with an additional 207/872 (24%) sores having S. pyogenes and 81/872 (9%) S. aureus , in isolation. Skin sore swabs taken during episodes with a concurrent diagnosis of scabies were more likely to culture S. pyogenes (OR 2.2, 95% CI 1.1 – 4.4, p = 0.03). Eighteen percent of children had nasal carriage of skin pathogens. There was no association between the presence of S. aureus in the nose and skin. Methicillin-resistance was detected in 15% of children who cultured S. aureus from either a sore or their nose. There was no association found between the severity of Impetigo and the detection of a skin pathogen. Conclusions S. pyogenes remains the principal pathogen in tropical Impetigo; the relatively high contribution of S. aureus as a co-pathogen has also been confirmed. Children with scabies were more likely to have S. pyogenes detected. While clearance of S. pyogenes is the key determinant of treatment efficacy, co-infection with S. aureus warrants consideration of treatment options that are effective against both pathogens where Impetigo is severe and prevalent. Trial registration This trial is registered; ACTRN12609000858291 .
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the microbiology of Impetigo in indigenous children associations between streptococcus pyogenes staphylococcus aureus scabies and nasal carriage
BMC Infectious Diseases, 2014Co-Authors: Asha C Bowen, Steven Y C Tong, Jonathan R. Carapetis, Mark D ChatfieldAbstract:Impetigo is caused by both Streptococcus pyogenes and Staphylococcus aureus; the relative contributions of each have been reported to fluctuate with time and region. While S. aureus is reportedly on the increase in most industrialised settings, S. pyogenes is still thought to drive Impetigo in endemic, tropical regions. However, few studies have utilised high quality microbiological culture methods to confirm this assumption. We report the prevalence and antimicrobial resistance of Impetigo pathogens recovered in a randomised, controlled trial of Impetigo treatment conducted in remote Indigenous communities of northern Australia. Each child had one or two sores, and the anterior nares, swabbed. All swabs were transported in skim milk tryptone glucose glycogen broth and frozen at –70°C, until plated on horse blood agar. S. aureus and S. pyogenes were confirmed with latex agglutination. From 508 children, we collected 872 swabs of sores and 504 swabs from the anterior nares prior to commencement of antibiotic therapy. S. pyogenes and S. aureus were identified together in 503/872 (58%) of sores; with an additional 207/872 (24%) sores having S. pyogenes and 81/872 (9%) S. aureus, in isolation. Skin sore swabs taken during episodes with a concurrent diagnosis of scabies were more likely to culture S. pyogenes (OR 2.2, 95% CI 1.1 – 4.4, p = 0.03). Eighteen percent of children had nasal carriage of skin pathogens. There was no association between the presence of S. aureus in the nose and skin. Methicillin-resistance was detected in 15% of children who cultured S. aureus from either a sore or their nose. There was no association found between the severity of Impetigo and the detection of a skin pathogen. S. pyogenes remains the principal pathogen in tropical Impetigo; the relatively high contribution of S. aureus as a co-pathogen has also been confirmed. Children with scabies were more likely to have S. pyogenes detected. While clearance of S. pyogenes is the key determinant of treatment efficacy, co-infection with S. aureus warrants consideration of treatment options that are effective against both pathogens where Impetigo is severe and prevalent. This trial is registered; ACTRN12609000858291 .
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scabies and Impetigo in timor leste a school screening study in two districts
PLOS Neglected Tropical Diseases, 2018Co-Authors: Laura M Korte, Asha C Bowen, Anthony D K Draper, Kim Davis, Annette Steel, Ines Teodora, Ivonia Mascarenhas, Benjamin Dingle, Joshua R FrancisAbstract:Introduction Scabies and Impetigo are common and important skin conditions which are often neglected in developing countries. Limited data have been published on the prevalence of scabies and Impetigo in Timor-Leste. Sequelae including cellulitis, bacteraemia, nephritis, acute rheumatic fever and rheumatic heart disease contribute significantly to the burden of disease. Methods School students were recruited from schools in Dili (urban) and Ermera (rural) in Timor-Leste for an epidemiological study in October 2016. A standard questionnaire was used to record demographics, anthropometry and skin examination results. Impetigo and scabies were diagnosed based on clinical examination of exposed surfaces, and clinical photographs were reviewed for correlation by an infectious diseases paediatrician. Prevalence of scabies and Impetigo were calculated and binary risk factor associations were described using relative risks and 95% confidence intervals. Adjusted odds ratios were calculated using logistic regression multivariate analysis. Continuous variables were analysed for associations using the Mann-Whitney Rank Sum test. Results The study enrolled 1396 students; median age 11 years (interquartile range (IQR) 9–15). The prevalence of scabies was 22.4% (95% CI 20.2–24.7%) and active Impetigo 9.7% (95% CI 8.3–11.4%); 68.2% of students had evidence of either active or healed Impetigo. Students in Ermera were more likely than those in Dili to have scabies (prevalence 32.0% vs 5.2%, aOR 8.1 (95% CI 5.2–12.4), p<0.01). There was no difference in the prevalence of active Impetigo between urban and rural sites. More than a third of participants were moderately or severely underweight. Stunting was markedly more common in the rural district of Ermera. Conclusion Scabies and Impetigo are common in Timor-Leste, with very high prevalence of scabies in the rural district of Ermera. Improvements in prevention and treatment are needed, with prioritised activities in the rural areas where prevalence is highest.
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Scabies and Impetigo in Timor-Leste: A school screening study in two districts.
PLoS neglected tropical diseases, 2018Co-Authors: Laura M Korte, Asha C Bowen, Anthony D K Draper, Kim Davis, Annette Steel, Ines Teodora, Ivonia Mascarenhas, Benjamin Dingle, Joshua R FrancisAbstract:Introduction Scabies and Impetigo are common and important skin conditions which are often neglected in developing countries. Limited data have been published on the prevalence of scabies and Impetigo in Timor-Leste. Sequelae including cellulitis, bacteraemia, nephritis, acute rheumatic fever and rheumatic heart disease contribute significantly to the burden of disease. Methods School students were recruited from schools in Dili (urban) and Ermera (rural) in Timor-Leste for an epidemiological study in October 2016. A standard questionnaire was used to record demographics, anthropometry and skin examination results. Impetigo and scabies were diagnosed based on clinical examination of exposed surfaces, and clinical photographs were reviewed for correlation by an infectious diseases paediatrician. Prevalence of scabies and Impetigo were calculated and binary risk factor associations were described using relative risks and 95% confidence intervals. Adjusted odds ratios were calculated using logistic regression multivariate analysis. Continuous variables were analysed for associations using the Mann-Whitney Rank Sum test. Results The study enrolled 1396 students; median age 11 years (interquartile range (IQR) 9–15). The prevalence of scabies was 22.4% (95% CI 20.2–24.7%) and active Impetigo 9.7% (95% CI 8.3–11.4%); 68.2% of students had evidence of either active or healed Impetigo. Students in Ermera were more likely than those in Dili to have scabies (prevalence 32.0% vs 5.2%, aOR 8.1 (95% CI 5.2–12.4), p
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Scabies and Impetigo in Timor-Leste: A school screening study in two districts.
Public Library of Science (PLoS), 2018Co-Authors: Laura M Korte, Asha C Bowen, Anthony D K Draper, Kim Davis, Annette Steel, Ines Teodora, Ivonia Mascarenhas, Benjamin Dingle, Joshua R FrancisAbstract:Scabies and Impetigo are common and important skin conditions which are often neglected in developing countries. Limited data have been published on the prevalence of scabies and Impetigo in Timor-Leste. Sequelae including cellulitis, bacteraemia, nephritis, acute rheumatic fever and rheumatic heart disease contribute significantly to the burden of disease.School students were recruited from schools in Dili (urban) and Ermera (rural) in Timor-Leste for an epidemiological study in October 2016. A standard questionnaire was used to record demographics, anthropometry and skin examination results. Impetigo and scabies were diagnosed based on clinical examination of exposed surfaces, and clinical photographs were reviewed for correlation by an infectious diseases paediatrician. Prevalence of scabies and Impetigo were calculated and binary risk factor associations were described using relative risks and 95% confidence intervals. Adjusted odds ratios were calculated using logistic regression multivariate analysis. Continuous variables were analysed for associations using the Mann-Whitney Rank Sum test.The study enrolled 1396 students; median age 11 years (interquartile range (IQR) 9-15). The prevalence of scabies was 22.4% (95% CI 20.2-24.7%) and active Impetigo 9.7% (95% CI 8.3-11.4%); 68.2% of students had evidence of either active or healed Impetigo. Students in Ermera were more likely than those in Dili to have scabies (prevalence 32.0% vs 5.2%, aOR 8.1 (95% CI 5.2-12.4), p
