A systematic review of epidemiologic studies on scabies in the Philippines

Background and Objective@#Scabies is the second most common cause of disability due to skin disease in the Philippines. However, there were no cited studies in Global Burden of Disease 2019 and the disability-adjusted life years (DALY) computations were most likely based on statistical modelling. The Philippine Department of Health has embarked on a program to estimate the disease burden of priority diseases in the country, which include scabies. The last nationwide prevalence survey was 23 years ago. This systematic review aimed to estimate the prevalence or incidence of scabies in the Philippines. @*Methods@#We searched PubMed, Scopus, Herdin, and Philippine Health Research Registry (search date October 2022) for studies on prevalence/incidence (including systematic reviews, cross-sectional studies, cohort studies, case series, registry or census studies) of patients diagnosed with scabies in the Philippines. We excluded narrative reviews, commentaries, and conference proceedings or abstracts. Two reviewers independently screened titles and abstracts, assessed full text reports for eligibility, appraised the quality of included studies, and collected data using a pretested data extraction form. We did not pool studies due to clinical heterogeneity but plotted the individual studies in a forest plot with prevalence estimates and confidence intervals. We reported the median and interquartile range for entire group or relevant subgroups (age, setting) of studies. We used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to assess the certainty of evidence.@*Results@#We included nine studies (N=79,065). Most were clinic-based prevalence studies, retrospective chart reviews, conducted in dermatology outpatient clinics, Metro Manila area, and on pediatric populations. Prevalence of scabies was moderate (i.e., between 2 and 10%), ranging from 2.75% (national prevalence survey) to 6.8% (communitybased review), to high (> 10%) among pediatric patients in clinic-based retrospective chart reviews (29 to 36%) and institution-based surveys (39.0% to 45%), and a tertiary government university training hospital dermatology clinic (22.9%). The most affected age group was from 0 to 14 y/o, while males tended to have a higher prevalence than females. The cooler month of January had higher prevalence than the hotter month of June in one study. @*Conclusion@#Scabies is common in the Philippines, especially among children and elderly in institutional settings, and during the month of January. There is a need to do a national prevalence survey to identify high-risk areas and to monitor the prevalence of scabies, especially in crowded settings and vulnerable populations. This information can be used for estimating the burden of disease for scabies and guide appropriate health resource allocation.

Scabies in the Philippines: A secondary analysis of local patient registries

Background@#Scabies is the second most common cause of disability among skin diseases in the Philippines as of 2019. There is no large nationwide study describing the epidemiologic profile of scabies in the country. Objective. This study aimed to describe the demographic, seasonal, and geographic profile of scabies in the Philippines.@*Methods@# We compared secondary data of two local patient registries (Philippine Dermatological Society, PDS, 2010 to 2021; and Philippine Pediatric Society, PPS, 2009 to 2021) for reported cases of scabies in the Philippines. We reported the frequency and percentage distribution according to age, sex, month, year, and type of diagnosis, and region. @*Results@#The median annual frequency of scabies cases (mostly outpatient) for PDS (from year 2010) was 4087 (range ([QR], 342-6422 [3271.5]), while it was 183 (range [IQR], 64-234 [96.5]) (all inpatient) for PPS (from year 2009). There was a reduction to one-third (PDS) and one-fourth (PPS) of pre-pandemic numbers during the pandemic years (2020- 2021). The peak months for scabies cases were the cooler months: January (median, 12.1% of annual cases; range [IQR], 2.6%-31.4% [3.6%]) to February (median, 10.0% of annual cases; range [IQR], 1.5%-27.8% [2.5%]) based on PDS data, and November (median, 10.0% of annual cases; range [IQR], 0.0%-24.3% [7.0%]) to January (median, 9.0% of annual cases; range [IQR], 0.0%-24.3% [6.6%]) for PPS data. Overall, for PDS, age 1-4 years is the most affected age group (median, PDS, 17.5% of annual cases; range [IQR], 11.9%-25.4% [8.1%]), while it was the less than 1-yearolds (median annual cases, 48.9%; range [IQR], 29.1%-67.3% [13.20%]) among PPS pediatric population aged 0 to 18 years. Males (median, 53.9% of annual cases; range [IQR], 45.0%-67.2% [8.8%]) were more affected than females in PPS. While for PDS during earlier years (prior to 2015), males (median, 51.6% of annual cases from 2010 to 2014; range [IQR], 47.4%-52.9% [0.2%]) were more affected than females. However, males became less affected than females with median, 44.7% of annual cases from 2015 onwards (range [IQR], 43.4%-46.5% [1.2%]). NCR was the region with the highest frequency of cases in PPS (median, 52.6% of annual cases; range [IQR], 22.7%-75.0% [20.4%]). The 2nd most affected regions were Central/Eastern Visayas (34.2%, 2009-2013; range [IQR], 17.9%-54.1% [5.3%]), Bicol region (12%; 2014 to 2018; range [IQR], 17.9%-54.1% [7.4%]), Central Luzon (18%; 2019), Central/Eastern Visayas (29%, 2020), and Northern/Central Mindanao (17%, 2021). @*Conclusion@#Scabies was commonly seen in the younger age group, slightly more in females in the PDS, while slightly more among males in the PPS, in the cooler months of the year, and in the urbanized NCR.

Economic evaluation of oral ivermectin, alone or in combination with permethrin, versus permethrin, in the treatment of classic scabies in the Philippine Setting

Background and Objective@#Oral ivermectin is recommended as an alternative to topical permethrin in Japanese, European, and CDC-STI guidelines for treating classic scabies. The combination of oral ivermectin and topical permethrin is also used in some settings. Partial economic evaluations conducted in India and Egypt have conflicting results, and no cost-effectiveness analysis in the Philippines has compared ivermectin-based regimens to permethrin for scabies treatment. We aimed to determine the cost-effectiveness of oral ivermectin, alone or in combination with permethrin, compared to permethrin, in the treatment of Filipino adult patients with classic scabies.@*Methods@#We used a decision tree model to estimate the cost-effectiveness of two regimens, oral ivermectin alone or in combination with permethrin, compared with permethrin to treat adults and children aged five years and older with classic scabies in the outpatient setting from the household perspective in the Philippines. We estimated total costs and disability-adjusted life years (DALYs) over a one-month follow-up. Input parameters were obtained from secondary data, such as effect estimates for probabilities of clinical outcomes from a network meta-analysis, DALYs from the Global Burden of Disease 2019, and prevailing market cost in the Philippines (DPRI 2022 with recommended markup by DOH, and leading drugstores) as of August 2022. We computed for incremental cost-effectiveness ratio (ICER) and net monetary benefit (NMB) to determine which of the interventions are cost-effective. Univariate and probabilistic sensitivity analyses, and scenario analyses were conducted to assess the impact of parameter and structural uncertainty.@*Results@#Ivermectin-based regimens are suggested to be likely cost-saving compared to permethrin in the Philippine outpatient setting. Base case analysis showed that oral ivermectin had higher cost-savings (change in cost, -1,039.31; change in DALYS, 0.00027), while combination oral ivermectin/permethrin had higher DALYs averted (change in cost, PhP -1,019.78; change in DALYs, 0.00045), compared to permethrin. Combination oral ivermectin/permethrin (56%) was the most cost-effective, followed by oral ivermectin (44%) compared to permethrin (0%) through probabilistic sensitivity analysis. Estimates for ivermectin were sensitive to risk of cure for ivermectin vs permethrin using 1-way deterministic sensitivity analysis. Oral ivermectin was favored over combination oral ivermectin/permethrin at all thresholds based on the cost-effectiveness acceptability curve.@*Conclusion@#Both ivermectin-based regimens seem to be cost-saving compared to permethrin in the treatment of classic scabies in the Philippine outpatient setting. Clinicians may consider oral ivermectin, alone or in combination with permethrin as an alternative first-line or second-line treatment depending on patient preference, adverse event risk profile, availability, and economic capacity. This needs to be confirmed using primary data from Filipino patients to enhance the robustness of the findings and support evidence-based local decision-making in different settings. Less uncertainty in modelled parameters can give greater confidence in the results, which can be adopted for budget impact analysis and allow more rational resource allocation. Value of information analysis can be done to determine whether the expense of future RCTs or surveys in Filipinos to collect primary data is worth it. The cost of reducing uncertainty, if deemed worth the cost of further studies, may facilitate population-level decision-making and budget planning. Findings may further inform practice guideline development, coverage decisions, and national control program planning by providing the most cost-effective scabies intervention.

Healthcare users' knowledge and experiences regarding the management of scabies in the Deder district, Ethiopia

Background. Scabies is an ectoparasitic, highly contagious skin disease caused by a human itch mite infes tation of the skin, and it is the leading cause of morbidity and disease burden in developing countries. The purpose of this study was to investigate healthcare users' current knowledge and experiences with scabies management provided at primary healthcare facilities. Materials and Methods. A qualitative research design was used to address the research objectives. Focus group interviews with 58 health care users were used to collect data. Thematic analysis was performed on the verbatim transcriptions using Tesch's approach. Results. The findings showed that the knowledge of healthcare users who participated in the study on scabies, its management, prevention, and control was limited. Health care users experience different chal lenges regarding scabies and the management thereof. Five themes emerged after data analysis. These were knowledge regarding scabies, knowledge regarding the management of scabies, knowledge regarding the prevention of scabies, perceptions regarding receiving treatment for scabies, and recommendations regarding the availability of materials and medication. Conclusions. Healthcare users in the area had limited knowledge and experienced different challenges regarding scabies and their management. These challenges contribute to low quality health services with undesir able health outcomes. To narrow this gap, consistent and programed health education was provided to the community through different modalities by using the existing health system to increase awareness regarding scabies. Following the implementation of community awareness, each commu nity member was positioned to prevent and control scabies.

Endomarketing para la adherencia al tratamiento de enfermedades dermatológicas estigmatizantes / Endomarketing for adherence to the treatment of stigmatizing dermatological diseases

Las enfermedades cutáneas son una amplia gama de afecciones que afectan la piel, de origen bacteriano, viral, fúngica, reacción alérgica, cáncer, parásito, hereditarias, ideopáticas; por sus sintomatologías pueden generar estigma. Por tal motivo, la Organización Mundial para la Salud, alienta a los Estados miembros a que se involucren en actividades de promoción para aumentar la concienciación con el fin de combatir la discriminación que perciben los pacientes con enfermedades dermatológicas estigmatizantes (EDE), tanto por la comunidad y en los establecimientos de salud, pudiendo repercutir negativamente en la adherencia del tratamiento. El objetivo de este estudio fue valorar el uso de endomarketing para la adherencia al tratamiento de EDE. Se realizó una investigación cuantitativa. Se les aplicó encuesta de endomarketing a 279 participantes; además con 147 pacientes con EDE se indago la percepción de actitudes estigmatizantes. Los resultados mostraron un alcance sobre el endomarketing de 0,62 en personal de atención directa y 0,45 para atención indirecta; los pacientes con mayor percepción de actitudes estigmatizantes fueron los que presentaban afecciones en piel tipo infecciosas, mayormente proveniente de la atención indirecta. Se infiere que el conocimiento sobre las EDE disminuye las expresiones de rechazos. Como alternativas para la formación del personal con una mayor satisfacción en el trabajo, competencia para gestionar y elevado sentido de espiritualidad corporativa, que garantice atención humanitaria a estos pacientes, se sugiere el uso de endomarketing, para conciliar los objetivos e intereses del recurso humano interno a las necesidades y expectativas de los pacientes con EDE(AU)

Skin diseases are a wide range of conditions that affect the skin, of bacterial, viral, fungal origin, allergic reaction, cancer, parasite, hereditary, idiopathic; due to their symptoms they can generate stigma. For this reason, the World Health Organization encourages Member States to engage in promotional activities to raise awareness in order to combat the discrimination perceived by patients with stigmatizing dermatological diseases (SDD), both for the community and in health establishments, which may have a negative impact on adherence to treatment. The objective of this study was to assess the use of endomarketing for adherence to DTS treatment. A quantitative investigation was carried out. An endomarketing survey was applied to 279 participants; In addition, with 147 patients with EDE, the perception of stigmatizing attitudes was investigated. The results showed a reach on endomarketing of 0.62 in direct attention personnel and 0.45 for indirect attention; The patients with the highest perception of stigmatizing attitudes were those who presented infectious-type skin conditions, mostly from indirect care. It is inferred that knowledge about DTS decreases the expressions of rejections. As alternatives for the training of personnel with greater job satisfaction, competence to manage and a high sense of corporate spirituality, which guarantees humanitarian attention to these patients, the use of endomarketing is suggested, to reconcile the objectives and interests of internal human resources. to the needs and expectations of patients with DTS(AU)

First description of sarcoptic mange in a wild coati (Nasua narica), in Ecuador, and cooccurrence of canine distemper virus / Primeira descrição da sarna sarcóptica em um coati selvagem (Nasua narica), no Equador, e coocorrência do vírus distemper canino

Abstract We present a case of Sarcoptes and canine distemper virus (CDV) infection in a white-nosed coati (Nasua narica) that was trapped in the dry tropical forest of Cerro Blanco reserve, located in the coastal region of Ecuador. Sarcoptic mange is a highly contagious and zoonotic disease with worldwide distribution that causes epidemics. Mange is produced by Sarcoptes mites that causes severe epidermal damage. Secondary infections and physiological constrictions without treatment can lead to death of the host. In addition, cooccurrence of canine distemper virus was detected via iiRT-PCR from serum samples. Physical analyses showed that 90% of the skin was affected by severe alopecia due to the sarcoptic mange infection. The presence of mites and histopathological analyses confirmed the diagnosis of infection. This coati was taken to a veterinary clinic and was fed every day, but it died after four days. This is the first report of sarcoptic mange and the first report of CDV in white-nosed coatis in South America. Further studies are needed in this region, to seek out other suspected cases, given the high capacity for disease transmission. Preventive actions to avoid epidemic and zoonotic episodes are needed.

Resumo Apresentamos um caso de Sarcoptes e infecção pelo vírus da cinomose canina (CDV) em um quati-do-nariz-branco (Nasua narica) que ficou preso na floresta tropical seca da reserva de Cerro Blanco, localizada na região costeira do Equador. A sarna sarcóptica é uma doença altamente contagiosa e zoonótica de distribuição mundial que causa epidemias. A sarna é produzida por ácaro do gênero Sarcoptes que causa graves danos epidérmicos. Infecções secundárias e constrições fisiológicas sem tratamento podem levar à morte do organismo. Além disso, a coocorrência do vírus da cinomose canina foi detectada, via iiRT-PCR, a partir de amostras de soro. As análises físicas mostraram que 90% da pele estava afetada por alopecia severa devido à infecção pelo ácaro da sarna sarcóptica. A presença de ácaros e análises histopatológicas confirmaram o diagnóstico de infecção. Esse quati foi levado a uma clínica veterinária e foi alimentado todos os dias, mas morreu após quatro dias. Esse é o primeiro relato de sarna sarcóptica e o primeiro relato de CDV em quatis-de-nariz-branco na América do Sul. São necessários mais estudos nessa região, para buscar outros casos suspeitos, dada a alta capacidade de transmissão da doença. Ações preventivas para evitar episódios epidêmicos e zoonóticos, são necessárias.

Sarna costrosa: revisión sobre aspectos clínicos de una ectoparasitosis desatendida y de presentación infrecuente / Crusty scabies: review of the clinical aspects of a neglected and infrequent ectoparasitosis

En esta revisión de la literatura se describen aspectos epidemiológicos, fisiopatológicos, clínicos y terapéuticos sobre una presentación atípica y grave de escabiosis, la sarna costrosa o noruega. Esta presentación de escabiosis destaca por afectar principalmente a personas con condiciones de inmunodepresión o sociales que las hacen susceptibles de una alta carga parasitaria, además se asocia a un peor pronóstico y a riesgo de complicaciones. Desde el punto de vista terapéutico, sus estrategias difieren del manejo de la escabiosis clásica.(AU)

This literature review describes epidemiological, pathophysiological, clinical and therapeutic aspects of an atypical and severe presentation of scabies, Norwegian or crusty scabies. This presentation of scabies stands out because it mainly affects people with immunosuppressive or social conditions that make them susceptibleto a high parasite load, it is also associated with a worse prognosis and risk of complications. From a therapeutic point of view, their strategies differ from the management of classic scabies.(AU)

Intervención educativa para la prevención de la escabiosis dirigida a representantes de preescolares de 5-6 años / Educational intervention for the prevention of scabiosis Aimed at representatives of preschoolers of 5-6 years / Intervenção educativa para a prevenção da escabiose dirigida a representantes de crianças pré-escolares de 5 a 6 anos

INTRODUCCIÓN: la escabiosis constituye un problema de salud pública en especial en los niños, es una infestación cutánea, altamente pruriginosa y contagiosa endémica en países en vías de desarrollo, afecta a todos los grupos socioeconómicos y a todas las edades es causa la alta morbilidad OBJETIVO: determinar la información sobre prevención de escabiosis que poseen los representantes de preescolares de 5-6 años de la comunidad de la Peña posterior a una intervención educativa MATERIALES Y MÉTODOS: investigación cuasi experimental de pre test y post test de las intervenciones educativas. El universo estuvo conformado por 143 representantes de preescolares, la muestra intencionada fue de 86 personas, el instrumento fue un cuestionario conformado por ítems de respuestas dicotómicas que se administró a los representantes antes de la intervención educativa y posterior a la misma. RESULTADOS: antes de la intervención existía muy baja información acerca de la prevención de la escabiosis lo que representaba el 67.4 %. Posterior a la misma se incrementa el número de representantes que mejoran su nivel de información hasta llegar a 73.2%. CONCLUSIÓN: El desarrollo y aplicación de la intervención educativa logro elevar los conocimientos sobre que es la escabiosis identificar cuáles son los factores de riesgo.

INTRODUCTION: scabies is a public health problem, especially in children. It is a highly pruritic and contagious skin infestation endemic in developing countries. It affects all socioeconomic groups and causes high morbidity at all ages. OBJECTIVE: to determine the information on the prevention of scabies that the representatives of preschool children aged 5-6 years from the Peña community have after an educational intervention. MATERIALS AND METHODS: quasiexperimental pre-test and post-test research of educational interventions. The universe was made up of 143 preschool representatives, the intended sample was 86 people, and the instrument was a questionnaire made up of items of dichotomous responses that were administered to the representatives before and after the educational intervention. RESULTS: before the intervention, there was very little information about the prevention of scabies, which represented 67.4%. After the same, the number of representatives that improve their level of information increases to 73.2%. CONCLUSION: the development and application of the educational intervention managed to raise the knowledge about what scabies is, to identify which are the risk factors.

INTRODUÇÃO: a escabiose constitui um problema de saúde pública principalmente em crianças, é uma infestação cutânea altamente pruriginosa e contagiosa, endêmica em países em desenvolvimento, afeta todos os grupos socioeconômicos e é causa de alta morbidade em todas as idades OBJETIVO: determinar as informações sobre prevenção de sarna que os representantes de crianças pré-escolares de 5-6 anos da comunidade La Peña têm após uma intervenção educativa MATERIAIS E MÉTODOS: pesquisa quase experimental de pré-teste e pós-teste de intervenções educativas. O universo foi constituído por 143 representantes da pré-escola, a amostra pretendida foi de 86 pessoas, o instrumento foi um questionário composto por itens de resposta dicotómicos que foi aplicado aos representantes antes e após a intervenção educativa. RESULTADOS: antes da intervenção havia muito pouca informação sobre a prevenção da escabiose, o que representava 67,4%. Depois disso, o número de representantes que melhoraram seu nível de informação aumentou para 73,2%. CONCLUSÃO: o desenvolvimento e aplicação da intervenção educativa foi capaz de aumentar o conhecimento sobre o que é sarna para identificar quais são os fatores de risco.

Digital dermoscopy: a complementary method in the diagnosis of scabies

Abstract Scabies is an ectoparasitosis caused by Sarcoptes scabiei var. hominis, characterized clinically by pruritic lesions in typical locations; the crusted form is a rare manifestation. The diagnosis is usually established based on the clinical picture, but dermoscopy can be an important complementary method, as it allows the observation of a brownish triangular structure with a hang-glider appearance. A case of crusted scabies is reported; the magnification of the images obtained by digital dermoscopy allowed the demonstration of a structure usually observed only with videodermoscopy.

Escabiose mascarada por mastocitose sistêmica / Scabies masked by systemic mastocytosis

Paciente do sexo feminino, com 59 anos de idade, portadora de mastocitose sistêmica há 20 anos. A mastocitose é doença rara, caracterizada pela proliferação excessiva e o subsequente acúmulo de mastócitos em órgãos e tecidos, principalmente na medula óssea, pele e no trato gastrointestinal. Há 1 mês, relatava história de novas lesões cutâneas caracterizadas por pápulas e placas eritemato-edematosas com escoriação e intenso prurido. Feito o raspado da pele com confirmação diagnóstica de escabiose.

A 59-year-old female patient had a diagnosis of systemic mastocytosis for 20 years. Mastocytosis is a rare disease characterized by excessive proliferation and accumulation of mast cells in organs and tissues, especially in the bone marrow, skin and gastrointestinal tract. She reported new skin lesions characterized by erythematous papules and plaques with excoriation and intense itching for one month. Skin scraping confirmed the diagnosis of scabies.

Crusted (Norwegian) scabies in an infant: A case report

@#INTRODUCTION: Norwegian or crusted scabies is a rare and highly contagious form of skin parasitosis caused by Sarcoptes scabiei var. hominis. Individuals maffffinly affected are considered to be immunocompromised such as those on prolonged glucocorticosteroid therapy, with AIDS or organ transplant patients. This disease presents as a hyperkeratotic dermatosis with an acral distribution. CASE REPORT: This is a case of a 2-month-old healthy Filipino male, who was previously managed as a case of miliaria rubra and treated with clobetasol 0.05% – ketoconazole 2% cream for 1 week. The papules and plaques became widespread. Consult with a pediatrician revealed widespread scabies and for which patient was prescribed topical permethrin with no improvement. On examination, patient presented with multiple erythematous papules and plaques with crusts on the face, trunk, extremities, palms and soles. Thickened yellowish plaques were observed on the palms and soles. Both parents also presented with widespread papules most prominent on the flexural areas accompanied by nocturnal pruritus. On dermoscopy, numerous mites and burrows were seen in a “jet with contrail pattern.” Prominent yellowish scales were also noted. Patient was admitted due to fever and superimposed bacterial infection and was given IV oxacillin, paracetamol, 8% precipitated sulfur in a hypoallergenic lotion applied twice daily and sodium fusidate ointment. On the 4th hospital day, the patient was afebrile and the lesions were noted to decrease in both erythema and crusting. Follow-up dermoscopy revealed absence scales, burrows and mites. CONCLUSION: Prolonged, unsupervised use of topical corticosteroids in our case most likely induced an immunocompromised state thus predisposing the patient to develop Norwegian scabies. In countries were cases of Norwegian scabies have been unresponsive to permethrin and when ivermectin is not available, the use of precipitated sulfur may still be the best therapeutic and safest option for infants.

Éxito terapéutico con esquema de ivermectina oral en sarna costrosa / Therapeutic success with oral ivermectin regimen in crusted scabies

Se expone el caso de una paciente obesa inmunodeprimida que presentó una sarna costrosa. Luego de la sospecha clínica se confirmó el diagnóstico mediante acarotest. La paciente sufrió algunas complicaciones asociadas a su condición general, como sobreinfección de sus lesiones cutáneas, epistaxis e insuficiencia renal aguda, que fueron tratadas. La sarna costrosa fue tratada con ivermectina oral con dosis de 15 mg (200 ug/kilo de peso ideal según la talla), los días 1, 2, 7, 8 y 15, obteniendo una excelente respuesta terapéutica.

We present the case of an immunosuppressed obese patient who presented with crusted scabies. After clinical suspicion, the diagnosis was confirmed with skin scraping for the diagnosis of scabies. The patient presented some complications associated with her baseline condition, such as superinfection of her skin lesions, epistaxis and acute renal failure, which were treated. Crusted scabies was treated with oral ivermectin with a dose of 15 mg (200 ug/kg of ideal weight according to height), on days 1,2,7,8 and 15, obtaining an excellent therapeutic response.

Brote de escabiosis en el Hospital Víctor Lazarte Echegaray, Trujillo, 2017 / Scabies outbreak at the Hospital Víctor Lazarte Echegaray, Trujillo, 2017

Objetivo: Describir las características de un brote de escabiosis y evaluar el impacto de las medidas de control.Materiales y métodos: Estudio epidemiológico descriptivo y prospectivo, realizado en un hospital de referencia, con 220 camas de hospitalización. Los datos se recolectaron a través de visitas diarias al Servicio de Medicina, entrevistas al personal asistencial y revisión de las historias clínicas. En la descripción del brote se consideran las variables epidemiológicas de persona, lugar y tiempo. Se aplicó estadística descriptiva, y se determinaron las frecuencias absolutas y relativas y la tasa de ataque. Se solicitó consentimiento informado a los pacientes y al personal asistencial, se les explicó sobre el beneficio de la investigación. La intervención consistió en medidas de aislamiento y precauciones de transmisión por contacto, se enfatizó el uso de guantes no estériles.Resultados: El brote ocurrió desde la semana epidemiológica 29 hasta la 37 del 2017. El caso primario fue un paciente varón de 93 años de edad con sarna noruega, hospitalizado por demencia de Alzheimer. El cuadro se presentó en 9 enfermeras, 7 médicos residentes, 6 técnicos de enfermería, 1 interno de medicina y 5 pacientes hospitalizados. Conclusiones: El brote fue de fuente propagada, con duración de 9 semanas epidemiológicas; y afectó enfermeras, médicos residentes, internos de medicina y a pacientes hospitalizados. La tasa de ataque fue del 40 %. Las medidas de prevención y control fueron aislamiento del caso primario y de los pacientes, higiene de manos antes y después de la atención, uso de guantes no estériles, uso de bata, artículos de uso clínico exclusivos para cada paciente, la ropa de los pacientes con sarna fue manipulada con guantes y en bolsas cerradas, limpieza de superficies, exclusión de la atención clínica de los trabajadores de la salud con sarna hasta las 24 horas de iniciado el tratamiento, y la vigilancia epidemiológica. El tratamiento médico consistió en loción de permetrina al 5 % por tres días. Se recomienda aplicar normas de bioseguridad en la atención de todos los pacientes, sobre todo cuando se hospitalizan con lesiones dermatológicas. Las medidas que se implementaron deben tenerse en cuenta en la prevención y control de este tipo de brote.

Objective: To describe the characteristics of a scabies outbreak and assess the effect of the control measures.Materials and methods: A descriptive and prospective epidemiological study was conducted at a reference hospital with 220 inpatient beds. Data was collected by visiting the Medicine Service on a daily basis, interviewing the healthcare personnel and examining the medical records. The description of the outbreak includes epidemiological variables such as subject, place and time. Descriptive statistics was used to determine the absolute and relative frequencies, as well as the attack rate. Patients and healthcare personnel were requested to sign an informed consent and received information about the benefits of the research. The intervention consisted of isolation measures and contact transmission-based precautions. The use of non-sterile gloves was emphasized.Results: The outbreak took place between the epidemiological weeks 29 and 37 in the year 2017. The index case was a 93-year-old male patient who had Norwegian scabies and was admitted to the hospital due to Alzheimer's disease. The scabies occurred in nine female nurses, seven residents, six nurse technicians, one intern y five inpatients. Conclusions: This propagated-source outbreak lasted nine epidemiological weeks; and affected nurses, residents, interns and inpatients. The attack rate was 40 %. The prevention and control measures were isolation of the index case and patients, hand hygiene before and after patient care, use of non-sterile gloves, use of scrubs, use of individual medical supplies for each patient, handling of clothing from scabies-infected patients in sealed bags and using gloves, surface cleaning, withdrawal of scabies-infected health workers from their duties until 24 hours of treatment onset, and epidemiological surveillance. Medical treatment was 5 % permethrin lotion for three days. Use of biosafety standards is recommended for patient care, especially when patients are admitted to the hospital with skin lesions. The implemented measures must be considered to prevent and control this type of outbreak.

Sarna costrosa en un paciente diabético / Crusted scabies in a diabetic patient

La sarna costrosa corresponde a una variedad muy rara y poco frecuente de escabiosis; una parasitosis humana causada por el ácaro Sarcoptes Scabiei (var. Hominis); se produce principalmente en pacientes inmunodreprimidos y se caracteriza por lesiones atípicas y extensas, sumamente contagiosas debido al compromiso inmunitario. Se presenta el caso clínico de un paciente de 68 años de edad con antecedentes de hipertensión arterial y diabetes mellitus tipo 2 con un mal control glucémico, que es atendido por el servicio de dermatología. Las lesiones se presentan como placas extensas pruriginosas, queratósicas, eritemato-escamosas de escamas gruesas y adherentes de seis meses de evolución en tronco, muslos y pliegues axilares, inguinales e interdigitales. La sospecha clínica de sarna costrosa fue confirmada por biopsia; el tratamiento se realizó con ivermectina con mejoría del cuadro clínico.

Crusted scabies corresponds to a very rare variety and little common scabies; a human parasitic disease caused by an acarid in this case Sarcoptes Scabiei (var. Hominis); it observed mainly among inmunosupressed patients and is characterized by atypical and extensive lesions, highly contagious due to their immune compromise. A case of a patient of 68 years old is described with a history of hypertension and diabetes mellitus type 2 with poor glycemic control, which is assist by the dermatology service. Lesions included extensive and pruritic badges, quetatotic, erythematous-squamous of thick and adherent scales of six months evolution in trunk, thighs and axillary, inguinal and interdigital folds. The clinical suspicion of crusted scabies was confirmed by biopsy; the treatment was performed with ivermectin with improvement of the clinical picture.

Alternativas diagnósticas de escabiose felina / Diagnostic alternatives of feline scabies

A sarna notoédrica é uma doença altamente pruriginosa, causada pelo ácaro Notoedres cati. O diagnóstico consiste na observação do ácaro no material analisado, sendo o raspado cutâneo o método mais utilizado. Outras técnicas têm surgido como alternativas menos invasivas no diagnóstico de sarnas, sobretudo para demodicose em cães, como a de fita de acetato e o arrancamento de pelos, que vêm se mostrando tão sensíveis quanto o raspado cutâneo no diagnóstico de tal dermatopatia. Desse modo, o objetivo deste estudo foi comparar o raspado cutâneo com dois métodos alternativos para diagnóstico de sarna notoédrica em gatos: fita de acetato e arrancamento de pelo, sendo possível concluir que o método da fita é tão sensível quanto o raspado cutâneo, ambos apresentando 100% de sensibilidade. A técnica de arrancamento de pelo apresentou sensibilidade significativamente menor para o diagnóstico de Notoedres cati, resultado esperado, uma vez que esse parasita habita principalmente porções superficiais da derme. Assim, o método da fita de acetato pode ser utilizado de forma eficaz e segura para o diagnóstico de sarna notoédrica em gatos, além de ser menos estressante aos animais, mais rápido e simples do que o raspado cutâneo.(AU)

Notoedric mange is a highly pruritic disease caused by the Notoedres cati mite. The diagnosis consists of the observation of the mite in the material analyzed, skin scrapings is the most used method. Other techniques have emerged as less invasive alternatives in the diagnosis of mange, especially for demodicosis in dogs, such as acetate tape and hair removal, which have shown to be as sensitive as skin scrapings in the diagnosis of such dermatopathy. Thus, the objective of this study was to compare skin scaling with two alternative methods for the diagnosis of notohedral scabies in cats: acetate tape and hair collection, and it is possible to conclude that the acetate tape method is as sensitive as skin scraping, both presenting 100% sensitivity. The hair pulling technique showed significantly lower sensitivity for the diagnosis of Notoedres cati, an expected result, since this parasite inhabits mainly superficial portions of the dermis. Thus, the tape method can be used effectively and safely for the diagnosis of notodroid mange in cats, as well as being less stressful to animals, faster and simpler than skin scraping.(AU)

Escabiasis costrosa imitando una acrodermatitis continua de Hallopeau / Crusted scabies mimicking an acrodermatitis continua of Hallopeau

Resumen Introducción: La escabiasis costrosa (EC) es una variante poco común de sarcoptiosis clásica, altamente contagiosa. Las lesiones poseen una elevada concentración del ácaro Sarcoptes scabiei var hominis, lo que conlleva a un cuadro clínico más extenso que en la escabiasis clásica. Se observa principalmente en pacientes con algún tipo de inmunocompromiso y se relaciona con el síndrome de Down. Caso clínico: Se describe una paciente pediátrica con síndrome de Down quien presentó placas escamosas que afectaron la porción distal de los dedos, asociadas con distrofia ungueal e hiperqueratosis subungueal, por lo que se consideró acrodermatitis continua de Hallopeau como diagnóstico diferencial. Se realizó una biopsia tipo punch con lo que se llegó al diagnóstico de EC. La paciente recibió tratamiento sistémico con ivermectina vía oral y tratamiento tópico con crema hidratante y desonida al 0.1%. Mostró mejoría clínica notoria dos semanas después de finalizar el tratamiento. Conclusiones: La EC es una variante prevalente en pacientes inmunocomprometidos y con síndrome de Down que fácilmente puede confundirse con patologías inflamatorias con alteración de la queratinización epidérmica. Este caso se considera una presentación atípica debido a la afección localizada en los dedos de las manos asociada con distrofia ungueal. El estudio histopatológico fue necesario para realizar el diagnóstico y descartar diagnósticos diferenciales.

Abstract Background: Crusted scabies (CS) is an uncommon, highly contagious, variant of classic scabies. Elevated concentrations of the mite Sarcoptes scabiei var. hominis are found in the skin lesions, which lead to a more exaggerated clinical picture than in classic scabies. This disease is mainly observed in patients with any kind of immunosuppression and relates to Down syndrome. Case report: A pediatric female patient with Down syndrome, who presented a crusty white plaque associated with nail dystrophy and subungual hyperkeratosis affecting the distal portion of the fingers is described. Because of these findings, the diagnosis of acrodermatitis continua of Hallopeau was considered. A punch biopsy was performed, attaining the diagnosis of CS. She received systemic treatment with oral ivermectin, topical treatment with emollient cream and desonide 0.1%. Notorious clinical improvement was observed two weeks after finalizing treatment. Conclusions: CS is variant of scabies prevalent in immunocompromised patients and Down syndrome that can be easily confused with inflammatory pathologies with abnormal epidermal keratinization. This case is considered as an atypical presentation of the disease because of local affection of the fingers and nail dystrophy. The histopathological study was necessary to obtain the diagnosis and rule out differential diagnosis.