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Hermann Feldmeier - One of the best experts on this subject based on the ideXlab platform.
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Tungíase: doença negligenciada causando patologia grave em uma favela de Fortaleza, Ceará Tungiasis: a neglected Disease causing severe morbidity in a shantytown in Fortaleza, State of Ceará
2020Co-Authors: Liana Ariza, Hermann Feldmeier, Martin Seidenschwang, John Buckendahl, Marcia Gomide, Jorg HeukelbachAbstract:The Parasitic Skin Disease tungiasis, caused by the jigger flea Tunga penetrans, is endemic in low-income communities in Brazil. In this study, inhabitants of a shantytown in Fortaleza, northeastern Brazil, who had an elevated parasite load, were identified. The number of lesions, localization, staging and associated Diseases were recorded. The 142 individuals identified were living in extremely precarious housing conditions. A total of 3,445 lesions located on the feet were counted (median = 17 lesions; maximum = 98 lesions). Almost without exception, the individuals had nail deformation and edema, and more than 70% presented with pain and fissures. There was nail loss in 46%; deformation of the digits in 25%; abscesses in 42%; and complaints of walking difficulty in 59%. Our data show that tungiasis in this low-income urban community typical of northeastern Brazil was associated with severe morbidity. Tungiasis needs to be recognized as a public health problem in this study area and other similar endemic areas.
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Tungiasis: a neglected Disease causing severe morbidity in a shantytown in Fortaleza, State of Ceará
Revista Da Sociedade Brasileira De Medicina Tropical, 2020Co-Authors: Liana Ariza, Hermann Feldmeier, Martin Seidenschwang, John Buckendahl, Marcia Gomide, Jorg HeukelbachAbstract:The Parasitic Skin Disease tungiasis, caused by the jigger flea Tunga penetrans, is endemic in low-income communities in Brazil. In this study, inhabitants of a shantytown in Fortaleza, northeastern Brazil, who had an elevated parasite load, were identified. The number of lesions, localization, staging and associated Diseases were recorded. The 142 individuals identified were living in extremely precarious housing conditions. A total of 3,445 lesions located on the feet were counted (median = 17 lesions; maximum = 98 lesions). Almost without exception, the individuals had nail deformation and edema, and more than 70% presented with pain and fissures. There was nail loss in 46%; deformation of the digits in 25%; abscesses in 42%; and complaints of walking difficulty in 59%. Our data show that tungiasis in this low-income urban community typical of northeastern Brazil was associated with severe morbidity. Tungiasis needs to be recognized as a public health problem in this study area and other similar endemic areas.
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Very severe tungiasis in Amerindians in the Amazon lowland of Colombia: A case series.
PLOS Neglected Tropical Diseases, 2019Co-Authors: Hollman Miller, Jovana Ocampo, Alvaro Ayala, Julian Trujillo, Hermann FeldmeierAbstract:Background Tungiasis is a Parasitic Skin Disease caused by penetrating female sand fleas. By nature, tungiasis is a self-limiting infection. However, in endemic settings re-infection is the rule and parasite load gradually accumulates over time. Intensity of infection and degree of morbidity are closely related. Methodology/principal findings This case series describes the medical history, the clinical pathology, the socio-economic and the environmental characteristics of very severe tungiasis in five patients living in traditional Amerindian communities in the Amazon lowland of Colombia. Patients had between 400 and 1,300 penetrated sand fleas. The feet were predominantly affected, but clusters of embedded sand fleas also occurred at the ankles, the knees, the elbows, the hands, the fingers and around the anus. The patients were partially or totally immobile. Patients 1 and 3 were cachectic, patient 2 presented severe malnutrition. Patient 3 needed a blood transfusion due to severe anemia. All patients showed a characteristic pattern of pre-existing medical conditions and culture-dependent behavior facilitating continuous re-infection. In all cases intradomiciliary transmission was very likely. Conclusion/significance Although completely ignored in the literature, very severe tungiasis occurs in settings where patients do not have access to health care and are stricken in a web of pre-existing illness, poverty and neglect. If not treated, very severe tungiasis may end in a fatal Disease course.
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In Situ Diagnosis of Scabies Using a Handheld Digital Microscope in Resource-Poor Settings-A Proof-of-Principle Study in the Amazon Lowland of Colombia.
Tropical Medicine and Infectious Disease, 2018Co-Authors: Hollman Miller, Julián Trujillo-trujillo, Hermann FeldmeierAbstract:Scabies is a neglected tropical Disease associated with important morbidity. The Disease occurs worldwide and is particularly common in resource-poor communities in the Global South. A validated technique for the diagnosis of scabies in resource-poor settings does not exist. The objective of the study was to determine the practicability and accuracy of handheld digital microscopy in three indigenous communities in the Amazon lowland of Colombia, where scabies is the most common Parasitic Skin Disease. One-hundred-and-eleven children and adults from three indigenous communities with a presumptive diagnosis of scabies were examined clinically by using a handheld digital microscope placed directly on the Skin. The microscopical identification of a mite was verified by an “experienced mother”, a woman who had acquired the skills to diagnose scabies as part of traditional Amerindian medicine. The “experienced mother” removed the parasite with a fine needle and placed it on a flat surface in order to enable its direct examination with the digital microscope. Using digital microscopy, scabies was diagnosed in 24 out of 111 participants and confirmed by the extraction of a Sarcoptes mites from the acarine eminence. A characteristic tunnel (burrow) with or without mite could be clearly identified irrespective of the degree of pigmentation of the Skin. Besides, digital microscopy revealed pathological characteristics of scabies hitherto unknown and impossible to be seen in dermoscopy, such as partially or totally obliterated tunnels, tunnels with multiple entry or exit points, circumscribed hyperpigmentation around obliterated tunnels and mites secluded in a nodule. This proof-of-principle study demonstrated the accurate diagnosis of scabies by handheld digital microscopy in patients with pigmented Skin and the feasibility of this technique in resource-poor settings.
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Epidemiology and morbidity of hookworm-related cutaneous larva migrans (HrCLM): Results of a cohort study over a period of six months in a resource-poor community in Manaus, Brazil.
PLOS Neglected Tropical Diseases, 2018Co-Authors: Felix Reichert, Daniel Pilger, Angela Schuster, Hannah Lesshafft, Silas Guedes De Oliveira, Ralf Ignatius, Hermann FeldmeierAbstract:Background Hookworm-related cutaneous larva migrans (HrCLM) is a neglected Parasitic Skin Disease, widespread in resource-poor communities in tropical and subtropical countries. Incidence and risk factors have never been investigated in a cohort study. Methodology/Principal findings To understand the seasonal epidemiology of HrCLM, an open cohort of 476 children in a resource-poor community in Manaus, Brazil was examined for HrCLM monthly over a period of 6 months. Monthly prevalence and intensity of infection were correlated with the amount of monthly precipitation. Multivariable Cox regression analysis indicated male sex (hazard ratio [HR] 3.29; 95% confidence interval [CI] 1.95–5.56), walking barefoot on sandy ground (HR 2.30; 95% CI 1.03–5.16), poverty (HR 2.13; 95% CI 1.09–4.17) and age between 10 and 14 years (HR 1.87; 95% CI 1.01–3.46) as predictors of HrCLM. Monthly incidence rates ranged between 0.21 and 1.05 cases per person-year with an overall incidence of 0.52 per person-year. Conclusions/Significance HrCLM is a frequent Parasitic Skin Disease in this resource-poor community. Every second child theoretically becomes infected during one year. Boys, 10 to 14 years old, belonging to the poorest households of the community, are the most vulnerable population group. Even in the tropical monsoonal climate of Amazonia there is a considerable seasonal variation with monthly incidence and number of lesions peaking in the rainy season.
Jorg Heukelbach - One of the best experts on this subject based on the ideXlab platform.
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Revision on tungiasis: treatment options and prevention.
Expert Review of Anti-infective Therapy, 2020Co-Authors: Jorg HeukelbachAbstract:The Parasitic Skin Disease tungiasis occurs in many resource-poor communities in Latin America, the Caribbean and sub-Saharan Africa. The sand flea, Tunga penetrans, most commonly penetrates into the Skin of the feet. Many individuals harbor a large number of embedded parasites and show significant morbidity. Standard treatment consists of surgical extraction of the flea and application of a topical antibiotic. There are no drugs available with proven effectiveness. Clinical trials performed in the last few years did not show very promising results. Thus, surgical extraction still remains the treatment of choice in patients with a low parasite load, such as tourists returning from endemic areas. Probably the best approach to reduce tungiasis-associated morbidity in heavily affected individuals is the application of a repellent to prevent the penetration of sand fleas. In the future, we should see new exciting data on the biology, epidemiology, therapy and control of tungiasis.
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Tungiasis: a neglected Disease causing severe morbidity in a shantytown in Fortaleza, State of Ceará
Revista Da Sociedade Brasileira De Medicina Tropical, 2020Co-Authors: Liana Ariza, Hermann Feldmeier, Martin Seidenschwang, John Buckendahl, Marcia Gomide, Jorg HeukelbachAbstract:The Parasitic Skin Disease tungiasis, caused by the jigger flea Tunga penetrans, is endemic in low-income communities in Brazil. In this study, inhabitants of a shantytown in Fortaleza, northeastern Brazil, who had an elevated parasite load, were identified. The number of lesions, localization, staging and associated Diseases were recorded. The 142 individuals identified were living in extremely precarious housing conditions. A total of 3,445 lesions located on the feet were counted (median = 17 lesions; maximum = 98 lesions). Almost without exception, the individuals had nail deformation and edema, and more than 70% presented with pain and fissures. There was nail loss in 46%; deformation of the digits in 25%; abscesses in 42%; and complaints of walking difficulty in 59%. Our data show that tungiasis in this low-income urban community typical of northeastern Brazil was associated with severe morbidity. Tungiasis needs to be recognized as a public health problem in this study area and other similar endemic areas.
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Tungíase: doença negligenciada causando patologia grave em uma favela de Fortaleza, Ceará Tungiasis: a neglected Disease causing severe morbidity in a shantytown in Fortaleza, State of Ceará
2020Co-Authors: Liana Ariza, Hermann Feldmeier, Martin Seidenschwang, John Buckendahl, Marcia Gomide, Jorg HeukelbachAbstract:The Parasitic Skin Disease tungiasis, caused by the jigger flea Tunga penetrans, is endemic in low-income communities in Brazil. In this study, inhabitants of a shantytown in Fortaleza, northeastern Brazil, who had an elevated parasite load, were identified. The number of lesions, localization, staging and associated Diseases were recorded. The 142 individuals identified were living in extremely precarious housing conditions. A total of 3,445 lesions located on the feet were counted (median = 17 lesions; maximum = 98 lesions). Almost without exception, the individuals had nail deformation and edema, and more than 70% presented with pain and fissures. There was nail loss in 46%; deformation of the digits in 25%; abscesses in 42%; and complaints of walking difficulty in 59%. Our data show that tungiasis in this low-income urban community typical of northeastern Brazil was associated with severe morbidity. Tungiasis needs to be recognized as a public health problem in this study area and other similar endemic areas.
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Canine tungiasis: High prevalence in a tourist region in Bahia state, Brazil
Preventive Veterinary Medicine, 2017Co-Authors: Tatiani Vitor Harvey, Jorg Heukelbach, Maíra Siles Assunção, Thalna Magalhães Fernandes, Christiane Maria Barcellos Magalhães Da Rocha, Renata Santiago Alberto CarlosAbstract:Abstract Tungiasis is a Parasitic Skin Disease neglected by authorities, health professionals, and the general population. Its occurrence is significantly associated with poverty. A cross-sectional study was conducted to describe the prevalence of tungiasis, associated clinical signs and risk factors of the canine population at a tourist site in the city of Ilheus, Bahia (northeast Brazil). All village households were visited and dogs inspected after authorization by owners. A semi-structured questionnaire was administered. Of the 114 dogs included in the study, 71 (62.3%) were infested; all of them had lesions on their pads. An ectopic lesion on the nose was observed in one dog (1.4%). The number of manipulated lesions outnumbered the number of vital and avital lesions with an average of 88.3%. Edema (95.8%) and hyperkeratosis (85.9%) were the most prevalent clinical signs. Behavioral disorders such as excessive licking (6/71; 8.5%), disobedience (1/71; 1.4%) and prostration (2/71; 2.8%) were reported. In the multi-variate analysis, semi-restricted condition of the dogs (adjusted OR = 8.58; 95% CI = 2.47–29.76) and the presence of sand on the compound (adjusted OR = 14.23, 95% CI = 2.88–70.28) were significantly associated with infestation. We concluded that, infestation with Tunga spp. is highly endemic in the canine population of the village. The low level of restrictions on dogs and the presence of sand in areas most frequented by the animals are perpetuating factors of infestation in the community, subject to integrated and multidisciplinary intervention measures.
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Tungiasis - A Neglected Disease with Many Challenges for Global Public Health
PLOS Neglected Tropical Diseases, 2014Co-Authors: Hermann Feldmeier, Jorg Heukelbach, Uade Samuel Ugbomoiko, Elizabeth Sentongo, Pamela Sabina Mbabazi, Georg Von Samson-himmelstjerna, Ingela KrantzAbstract:Tungiasis (sand flea Disease) is a Parasitic Skin Disease with origins in South America. It was introduced into sub-Saharan Africa in the 19th century [1]–[3]. Sand flea Disease is a zoonosis caused by the penetration of female sand fleas into the Skin. In humans, tungiasis predominantly affects marginalized populations. Children and elderly people are especially susceptible to severe Disease. Sand flea Disease is the most frequent Parasitic infection in many resource-poor communities. In animals like dogs, pigs, or ruminants, the infection has severe consequences with, for example, reduced milk production when the Skin of the udder is affected. Despite the substantial Disease burden caused by embedded sand fleas, tungiasis is basically neglected by health care providers, policy makers, the scientific community, the pharmaceutical industry, and funding institutions [4]. Although not included in WHO's list of neglected tropical Diseases (NTDs), tungiasis bears all the hallmarks of an NTD to merit apprehension from the public health sector [5]–[7]. It occurs in resource-poor communities, causing considerable morbidity and loss of quality of life. Systematic data on Disease occurrence are not available.
Birke Walter - One of the best experts on this subject based on the ideXlab platform.
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Impaired quality of life in adults and children with scabies from an impoverished community in Brazil.
International Journal of Dermatology, 2012Co-Authors: Christine Worth, Birke Walter, Gernot Fengler, Jorg Heukelbach, Oliver Liesenfeld, Hermann FeldmeierAbstract:Background Scabies is highly prevalent in resource-poor communities in developing countries and is associated with considerable morbidity in this setting. How the Parasitic Skin Disease impairs the quality of life of patients has rarely been investigated. Methodology A modified Dermatology Life Quality Index (mDLQI) was developed to assess the quality of life in adults and children with scabies living in an urban slum in Fortaleza, capital of Ceara State, Brazil. A total of 105 patients with scabies (58 children and 57 adults) were included in the study. The diagnosis was made by dermatoscopy, Skin scraping, and adhesive film test. Results Feelings of shame was the restriction most frequently noted (adults 77.2% and children 46.6%). Other types of quality of life impairment were the need to dress differently (35.1 vs. 29.3%), restriction on leisure activities (24.6 vs. 36.8%), social exclusion (24.6 vs. 17.9%), stigmatization (21.1 vs. 25.0%), teasing (only children: 26.3%), and problems with sexual partners (only adults: 10.9%). Women and girls perceived more restrictions than men and boys. mDLQI scores indicated that 13.9% of the patients noticed a large or very large effect on their life, 65.2% considered their quality of life lightly or moderately reduced by scabies, and 20.9% did not feel any restrictions. The degree of impairment increased parallel to the degree of itching and severity of scabies (P = 0.003). Limitations Owing to active case finding, most of the patients were in an early phase of scabies, and clinical pathology was not very pronounced. Conclusion Scabies considerably impaired the quality of life in adults and children living in poverty in an urban slum. Females particularly suffered from restrictions.
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comparison of dermoscopy Skin scraping and the adhesive tape test for the diagnosis of scabies in a resource poor setting
Archives of Dermatology, 2011Co-Authors: Birke Walter, Gernot Fengler, Christine Worth, Ulrich Hengge, Jorg Heukelbach, Hermann FeldmeierAbstract:Background Scabies is a Parasitic Skin Disease endemic in resource-poor communities in low-income countries. The best ways to diagnose scabies in this setting have not been investigated. Objective To compare the diagnostic properties of dermoscopy, the microscopic examination of a Skin scraping, and the adhesive tape test in 125 patients with a presumptive diagnosis of scabies. Design A prospective evaluator-blinded study. Results The sensitivity of dermoscopy was 0.83 (95% confidence interval [CI], 0.70-0.94) and significantly higher than the sensitivity of the adhesive tape test (0.68; 95% CI, 0.52-0.81; P P Limitations Because of active case finding, the duration of the infestation was short and the severity of Disease was rather low in most patients. The rather short duration of the infestation might have affected the diagnostic properties of each test in different ways. Conclusions When trained personnel are available, dermoscopy is a valid tool for diagnosing scabies in a resource-poor setting. The adhesive tape test is easy to perform and, because it has high positive and negative predictive values, the test is ideal for screening purposes. Skin scraping cannot be recommended as a diagnostic tool in this setting.
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Comparison of Dermoscopy, Skin Scraping, and the Adhesive Tape Test for the Diagnosis of Scabies in a Resource-Poor Setting
Archives of Dermatology, 2011Co-Authors: Birke Walter, Gernot Fengler, Christine Worth, Ulrich Hengge, Jorg Heukelbach, Hermann FeldmeierAbstract:BACKGROUND: Scabies is a Parasitic Skin Disease endemic in resource-poor communities in low-income countries. The best ways to diagnose scabies in this setting have not been investigated. OBJECTIVE: To compare the diagnostic properties of dermoscopy, the microscopic examination of a Skin scraping, and the adhesive tape test in 125 patients with a presumptive diagnosis of scabies. DESIGN: A prospective evaluator-blinded study. RESULTS: The sensitivity of dermoscopy was 0.83 (95% confidence interval [CI], 0.70-0.94) and significantly higher than the sensitivity of the adhesive tape test (0.68; 95% CI, 0.52-0.81; P < .001). The sensitivity of Skin scraping was low (0.46; 95% CI, 0.31-0.62). The specificity of dermoscopy was 0.46 (95% CI, 0.34-0.58); by definition, it was 1.00 for Skin scraping and the adhesive tape test. The negative predictive value was identical for dermoscopy and the adhesive tape test (0.85; 95% CI, 0.69-0.94 and 0.75-0.91, respectively) but significantly lower for Skin scraping (0.77; 95% CI, 0.67-0.84; P < .001). The sensitivity of dermoscopy increased with the severity of the Disease, whereas the sensitivity of the adhesive tape test did not depend on this characteristic. Limitations Because of active case finding, the duration of the infestation was short and the severity of Disease was rather low in most patients. The rather short duration of the infestation might have affected the diagnostic properties of each test in different ways. CONCLUSIONS: When trained personnel are available, dermoscopy is a valid tool for diagnosing scabies in a resource-poor setting. The adhesive tape test is easy to perform and, because it has high positive and negative predictive values, the test is ideal for screening purposes. Skin scraping cannot be recommended as a diagnostic tool in this setting.
Ulrich Hengge - One of the best experts on this subject based on the ideXlab platform.
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comparison of dermoscopy Skin scraping and the adhesive tape test for the diagnosis of scabies in a resource poor setting
Archives of Dermatology, 2011Co-Authors: Birke Walter, Gernot Fengler, Christine Worth, Ulrich Hengge, Jorg Heukelbach, Hermann FeldmeierAbstract:Background Scabies is a Parasitic Skin Disease endemic in resource-poor communities in low-income countries. The best ways to diagnose scabies in this setting have not been investigated. Objective To compare the diagnostic properties of dermoscopy, the microscopic examination of a Skin scraping, and the adhesive tape test in 125 patients with a presumptive diagnosis of scabies. Design A prospective evaluator-blinded study. Results The sensitivity of dermoscopy was 0.83 (95% confidence interval [CI], 0.70-0.94) and significantly higher than the sensitivity of the adhesive tape test (0.68; 95% CI, 0.52-0.81; P P Limitations Because of active case finding, the duration of the infestation was short and the severity of Disease was rather low in most patients. The rather short duration of the infestation might have affected the diagnostic properties of each test in different ways. Conclusions When trained personnel are available, dermoscopy is a valid tool for diagnosing scabies in a resource-poor setting. The adhesive tape test is easy to perform and, because it has high positive and negative predictive values, the test is ideal for screening purposes. Skin scraping cannot be recommended as a diagnostic tool in this setting.
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Comparison of Dermoscopy, Skin Scraping, and the Adhesive Tape Test for the Diagnosis of Scabies in a Resource-Poor Setting
Archives of Dermatology, 2011Co-Authors: Birke Walter, Gernot Fengler, Christine Worth, Ulrich Hengge, Jorg Heukelbach, Hermann FeldmeierAbstract:BACKGROUND: Scabies is a Parasitic Skin Disease endemic in resource-poor communities in low-income countries. The best ways to diagnose scabies in this setting have not been investigated. OBJECTIVE: To compare the diagnostic properties of dermoscopy, the microscopic examination of a Skin scraping, and the adhesive tape test in 125 patients with a presumptive diagnosis of scabies. DESIGN: A prospective evaluator-blinded study. RESULTS: The sensitivity of dermoscopy was 0.83 (95% confidence interval [CI], 0.70-0.94) and significantly higher than the sensitivity of the adhesive tape test (0.68; 95% CI, 0.52-0.81; P < .001). The sensitivity of Skin scraping was low (0.46; 95% CI, 0.31-0.62). The specificity of dermoscopy was 0.46 (95% CI, 0.34-0.58); by definition, it was 1.00 for Skin scraping and the adhesive tape test. The negative predictive value was identical for dermoscopy and the adhesive tape test (0.85; 95% CI, 0.69-0.94 and 0.75-0.91, respectively) but significantly lower for Skin scraping (0.77; 95% CI, 0.67-0.84; P < .001). The sensitivity of dermoscopy increased with the severity of the Disease, whereas the sensitivity of the adhesive tape test did not depend on this characteristic. Limitations Because of active case finding, the duration of the infestation was short and the severity of Disease was rather low in most patients. The rather short duration of the infestation might have affected the diagnostic properties of each test in different ways. CONCLUSIONS: When trained personnel are available, dermoscopy is a valid tool for diagnosing scabies in a resource-poor setting. The adhesive tape test is easy to perform and, because it has high positive and negative predictive values, the test is ideal for screening purposes. Skin scraping cannot be recommended as a diagnostic tool in this setting.
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The epidemiology of scabies in an impoverished community in rural Brazil: Presence and severity of Disease are associated with poor living conditions and illiteracy
Journal of The American Academy of Dermatology, 2008Co-Authors: Hermann Feldmeier, Ulrich Hengge, Anne Jackson, Cláudia Maria Lins Calheiros, Valquiria De Lima Soares, Liana Ariza, Fabíola A. Oliveira, Jorg HeukelbachAbstract:Background We sought to study the epidemiology of scabies and to identify risk factors of severe Disease in an impoverished rural community in northeast Brazil. Methods The study was designed as a repeated cross-sectional study based on two door-to-door surveys. One survey was carried out in the rainy season, the other in the dry season. The inhabitants of the community were examined for the presence of scabies and demographic, socioeconomic, and behavioral risk factors were assessed. Risk factors were analyzed using bivariate and multivariate regression analysis. Results The overall prevalence was 9.8% with no significant variation between seasons and the incidence was estimated to be 196/1000 person-years. The highest prevalence (18.2%) was observed in children younger than 4 years. Risk factors in the bivariate analysis were young age, presence of many children in the household, illiteracy, low family income, poor housing, sharing clothes and towels, and irregular use of shower. Age younger than 15 years, illiteracy, sharing of clothes, and living in the community for more than 6 months remained significant independent risk factors in multivariate regression analysis. Limitations We used a clinical case definition; specificity and sensitivity were not verified. Men were underrepresented in the study population. Conclusions In this impoverished community scabies is an important health problem characterized by continuous transmission throughout the year. The Parasitic Skin Disease is embedded in a complex web of causation characterized by poor living conditions and a low level of education.
Gernot Fengler - One of the best experts on this subject based on the ideXlab platform.
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Impaired quality of life in adults and children with scabies from an impoverished community in Brazil.
International Journal of Dermatology, 2012Co-Authors: Christine Worth, Birke Walter, Gernot Fengler, Jorg Heukelbach, Oliver Liesenfeld, Hermann FeldmeierAbstract:Background Scabies is highly prevalent in resource-poor communities in developing countries and is associated with considerable morbidity in this setting. How the Parasitic Skin Disease impairs the quality of life of patients has rarely been investigated. Methodology A modified Dermatology Life Quality Index (mDLQI) was developed to assess the quality of life in adults and children with scabies living in an urban slum in Fortaleza, capital of Ceara State, Brazil. A total of 105 patients with scabies (58 children and 57 adults) were included in the study. The diagnosis was made by dermatoscopy, Skin scraping, and adhesive film test. Results Feelings of shame was the restriction most frequently noted (adults 77.2% and children 46.6%). Other types of quality of life impairment were the need to dress differently (35.1 vs. 29.3%), restriction on leisure activities (24.6 vs. 36.8%), social exclusion (24.6 vs. 17.9%), stigmatization (21.1 vs. 25.0%), teasing (only children: 26.3%), and problems with sexual partners (only adults: 10.9%). Women and girls perceived more restrictions than men and boys. mDLQI scores indicated that 13.9% of the patients noticed a large or very large effect on their life, 65.2% considered their quality of life lightly or moderately reduced by scabies, and 20.9% did not feel any restrictions. The degree of impairment increased parallel to the degree of itching and severity of scabies (P = 0.003). Limitations Owing to active case finding, most of the patients were in an early phase of scabies, and clinical pathology was not very pronounced. Conclusion Scabies considerably impaired the quality of life in adults and children living in poverty in an urban slum. Females particularly suffered from restrictions.
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comparison of dermoscopy Skin scraping and the adhesive tape test for the diagnosis of scabies in a resource poor setting
Archives of Dermatology, 2011Co-Authors: Birke Walter, Gernot Fengler, Christine Worth, Ulrich Hengge, Jorg Heukelbach, Hermann FeldmeierAbstract:Background Scabies is a Parasitic Skin Disease endemic in resource-poor communities in low-income countries. The best ways to diagnose scabies in this setting have not been investigated. Objective To compare the diagnostic properties of dermoscopy, the microscopic examination of a Skin scraping, and the adhesive tape test in 125 patients with a presumptive diagnosis of scabies. Design A prospective evaluator-blinded study. Results The sensitivity of dermoscopy was 0.83 (95% confidence interval [CI], 0.70-0.94) and significantly higher than the sensitivity of the adhesive tape test (0.68; 95% CI, 0.52-0.81; P P Limitations Because of active case finding, the duration of the infestation was short and the severity of Disease was rather low in most patients. The rather short duration of the infestation might have affected the diagnostic properties of each test in different ways. Conclusions When trained personnel are available, dermoscopy is a valid tool for diagnosing scabies in a resource-poor setting. The adhesive tape test is easy to perform and, because it has high positive and negative predictive values, the test is ideal for screening purposes. Skin scraping cannot be recommended as a diagnostic tool in this setting.
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Comparison of Dermoscopy, Skin Scraping, and the Adhesive Tape Test for the Diagnosis of Scabies in a Resource-Poor Setting
Archives of Dermatology, 2011Co-Authors: Birke Walter, Gernot Fengler, Christine Worth, Ulrich Hengge, Jorg Heukelbach, Hermann FeldmeierAbstract:BACKGROUND: Scabies is a Parasitic Skin Disease endemic in resource-poor communities in low-income countries. The best ways to diagnose scabies in this setting have not been investigated. OBJECTIVE: To compare the diagnostic properties of dermoscopy, the microscopic examination of a Skin scraping, and the adhesive tape test in 125 patients with a presumptive diagnosis of scabies. DESIGN: A prospective evaluator-blinded study. RESULTS: The sensitivity of dermoscopy was 0.83 (95% confidence interval [CI], 0.70-0.94) and significantly higher than the sensitivity of the adhesive tape test (0.68; 95% CI, 0.52-0.81; P < .001). The sensitivity of Skin scraping was low (0.46; 95% CI, 0.31-0.62). The specificity of dermoscopy was 0.46 (95% CI, 0.34-0.58); by definition, it was 1.00 for Skin scraping and the adhesive tape test. The negative predictive value was identical for dermoscopy and the adhesive tape test (0.85; 95% CI, 0.69-0.94 and 0.75-0.91, respectively) but significantly lower for Skin scraping (0.77; 95% CI, 0.67-0.84; P < .001). The sensitivity of dermoscopy increased with the severity of the Disease, whereas the sensitivity of the adhesive tape test did not depend on this characteristic. Limitations Because of active case finding, the duration of the infestation was short and the severity of Disease was rather low in most patients. The rather short duration of the infestation might have affected the diagnostic properties of each test in different ways. CONCLUSIONS: When trained personnel are available, dermoscopy is a valid tool for diagnosing scabies in a resource-poor setting. The adhesive tape test is easy to perform and, because it has high positive and negative predictive values, the test is ideal for screening purposes. Skin scraping cannot be recommended as a diagnostic tool in this setting.
