Infection Control among Healthcare Workers and Management of a Scabies Outbreak in a Large Italian University Hospital.

This retrospective observational study describes the results of an ad-hoc designated prevention protocol aimed at containing the spread of the scabies infestation among healthcare workers (HCWs) of a large University Hospital in Italy. The outbreak started on October 2022 and a preventive protocol was set up thanks to a multidisciplinary approach. HCWs at high scabies risk were defined as subjects working in Operative Units with a scabies prevalence higher than 2%, close contacts of a confirmed case of scabies, or HCWs with signs and symptoms of the disease. All cases at high scabies risk underwent a dermatological examination, and the infested HCWs were suspended from work until definitive healing. Mass drug administration was established for all HCWs working in Operative Units with a scabies prevalence higher than 2%. Until March 2023, out of 183 screening dermatological examinations, 21 (11.5%) were diagnostic for scabies. Between 11 October 2022 (date of the first diagnosed scabies case) and 6 March 2023 (the end of incubation period related to the last case detected), the frequency of scabies was 0.35% (21 scabies cases/6000 HCWs). The duration of the outbreak in our hospital was 14.7 weeks. Statistical analysis shows a significant association between scabies and being a nurse and having an allergy to dust mites. We obtained a low frequency of scabies infection, limiting the duration of the outbreak and the related economic burden.

Changing patterns in the distribution of skin lesions of scabies during the COVID-19 pandemic - a cross-sectional observational study

BACKGROUND: An ectoparasitic disease, scabies, caused by the mite Sarcoptes scabiei var hominis. Some of the predisposing factors are overcrowding, unhygienic surroundings, immunocompromised status, dementia, homelessness, and sexual contact. In this study, we wanted to evaluate the changed distribution of lesions of scabies during pandemic. METHODS: A cross sectional study was performed on 600 patients attending the skin department of our tertiary care hospital over a period of 6 months. The sites of the scabies lesions were noted along with types of lesions. Demographic data and history of regular hand washing and sanitization were also documented. RESULTS: Our study revealed an important correlation between change in pattern of distribution of scabies lesions from being less frequent on finger webs (19%) to being more frequent on abdomen (periumbilical area) (73%) and groins (67%) due to regular hand washing and frequent sanitization, in this pandemic era. CONCLUSIONS: A significant change in distribution of skin lesions in scabies can be noticed during this COVID-19 pandemic.

An inaugural survey of cereal, oilseed and vegetable crop diseases in the Yukon Territory in 2020

Various kinds of field crops growing on two commercial farms in the Whitehorse area of the southern Yukon Territory were surveyed for diseases in summer 2020 by staff of the Agriculture Branch of the Government of Yukon. They included barley, wheat, canola, beets, broccoli, cabbage, carrots, potatoes and turnips. Fields were visited one or more times during July and August. The incidence and severity of diseases were visually assessed on a crop-by-crop basis and samples were collected for laboratory analysis of the pathogens present, if any. Both infectious and non-infectious diseases were present on most crops. The infectious diseases were caused by various species of plant pathogenic bacteria and fungi that were common on these crops growing in other areas of Canada. INTRODUCTION AND METHODS: The 2020 field crop disease survey is believed to be the first organized study of its kind on agricultural crops in the Territory. In his book, "An Annotated Index of Plant Diseases in Canada . . . ", I.L. Conners lists over 300 records of plant diseases on trees, shrubs, herbs and grasses in the Yukon that were published by individuals who were surveying forests and native vegetation mainly for federal government departments, universities and other agencies (Conners 1967). The objectives of the 2020 survey were: (1) to determine the kinds and levels of diseases on selected Yukon crops, (2) to identify the major pathogen species attacking Yukon crops, and (3) to use the results to plan future surveillance activities aimed at helping producers to improve their current disease management programs. All of the fields included in the 2020 survey were situated on two commercial farms, which were designated as Farm #1 and #2, in the Whitehorse area in the southern Yukon (Fig. 1). The crops surveyed included cereals (barley and wheat), oilseeds (canola) and vegetables (beets, broccoli, cabbage, carrots, potatoes and turnips). Fields were visited one or more times in the mid- to late growing season (July/August) at a time when damage from diseases was most noticeable. Symptoms were visually assessed on a crop-by-crop basis by determining their incidence and severity. Incidence was represented by the percentage of plants, leaves, heads, kernels, etc., damaged in the target crop, while severity was estimated to be the proportion of the leaf, fruit, head, root/canopy area, etc., affected by a specific disease as follows: Proportion of the canopy affected based on a 0-4 rating scale, where: 0 = no disease symptoms, 1 = 1-10% of the crop canopy showing symptoms;2 = 11-25% showing symptoms, 3 = 26- 50% showing symptoms, and 4 = > 50% showing symptoms. Photographs of affected plants were taken and sent to plant pathologists across Western Canada for their opinions on causation. Where possible, representative samples of plants with disease symptoms were packaged and sent to the Alberta Plant Health Lab (APHL) in Edmonton, AB for diagnostic analyses. Background information, such as the general cultural practices and cropping history, was obtained from the producers wherever possible. GPS coordinates were obtained for each field to enable future mapping Cereals: Individual fields of barley (11 ha) and wheat (30 ha) located at Farm #1 were surveyed. The barley was a two-row forage cultivar 'CDC Maverick', while the wheat was an unspecified cultivar of Canada Prairie Spring (CPS) Wheat. Plant samples were taken along a W-shaped transect for a total of five sampling points for the barley field (< 20 ha) and ten sampling points for the wheat field (> 20 ha). The first visit, which occurred on July 30, involved visual inspection and destructive sampling wherein plants were collected and removed from the field for a detailed disease assessment at a lab space in Whitehorse. There, the roots were rinsed off and the plants were examined for disease symptoms. The second visit to these fields, which occurred on August 27, only involved visual examination of the standing crop. Oilseeds: A single 40 ha field of Polish canola (cv. 'Synergy') was examined o

Topical steroid menace: A case series of severe debilitating infections during the COVID-19 pandemic

Background: Topical corticosteroids is a boon and also a bane in treating chronic skin conditions. The risk of cutaneous infections due to topical steroids increases with their potency, dose, and duration of treatment. Herein, we present a case series of severe debilitating infections secondary to topical steroid abuse. Materials and Methods: We came across five cases of severe skin infection following the prolonged application of topical steroids. These cases gave a history of the use of steroid creams for persistent skin conditions and the inability to visit the hospital due to the prevailing COVID-19 pandemic. Observations: We came across two cases of crusted scabies, two cases of Fournier's gangrene, and a case of erosio interdigitalis blastomycetica. These cases had been using topical steroids for a prolonged period for other dermatological conditions. Conclusion: We propose that, as crusted scabies and erosio interdigitalis blastomycetica mimic various other papulosquamous disorders, a KOH examination is a diagnostic tool. Topical steroid abuse is one of the predisposing factors for Fournier's gangrene. [ FROM AUTHOR]

Increased Scabies Incidence at the Beginning of the 21st Century: What Do Reports from Europe and the World Show?

Reports from various countries have described increasing numbers of scabies cases, especially in the past two decades. The epidemiological data for various world regions showed prevalence estimates ranging from 0.2% to 71%, with the highest prevalence in the Pacific region and Latin America. Therefore, geographically, scabies occurs more commonly in the developing world, tropical climates, and in areas with a lack of access to water. According to results from specific regions of the world, the greatest burdens from scabies were recorded for East Asia, Southeast Asia, Oceania, tropical Latin America, and South Asia. Among countries with the highest rates, the top 10 were Indonesia, China, Timor-Leste, Vanuatu, Fiji, Cambodia, Laos, Myanmar, Vietnam, and the Seychelles. From Europe, available data shows an increasing trend in scabies infestation, particularly evident among populations with associated contributing factors, such as those who travel frequently, refugees, asylum seekers, those who regularly lack drinking water and appropriate hygiene and are of a younger age, etc. This increase in observed cases in the last 10-20 years has been evidenced by research conducted in Germany, France, Norway, and Croatia, among other countries. In addition, increased scabies transmission was also recorded during the COVID-19 pandemic and may have been the result of increased sexual intercourse during that time. Despite all the available treatment options, scabies commonly goes unrecognized and is therefore not treated accordingly. This trend calls for a prompt and synergistic reaction from all healthcare professionals, governmental institutions, and non-governmental organizations, especially in settings where population migration is common and where living standards are low. Furthermore, the proper education of whole populations and accessible healthcare are cornerstones of outbreak prevention. Accurate national data and proper disease reporting should be a goal for every country worldwide when developing strategic plans for preventing and controlling the community spread of scabies.

Decreases in scabies and lice cases among the pediatric and adult populations during COVID-19.

The influence of the nationwide lockdown orders during the COVID-19 pandemic on the transmission of scabies and lice remains unknown. We conducted a cross-sectional study utilizing UNC patient registry i2b2 to investigate monthly cases and prescriptions for scabies and lice in adult and pediatric patients in North Carolina. There were significant decreases in the cases and prescriptions for scabies and lice in the pediatric and adult populations. These results provide early insights on how COVID-19 pandemic lockdown orders affected the prevalence of these two conditions and suggest that physical distancing measures reduce transmission of these parasitic conditions.

Prevalence of Scabies in the Covid-19 Pandemic Period and Determination of Risk Factors for Scabies: a Hospital-Based Cross-Sectional Study in Northeast Turkey.

BACKGROUND: There is an increase in the incidence of scabies in Turkey, which started before the Covid-19 pandemic, and this situation is considered as an epidemic. With this study, we aimed to reveal the prevalence of scabies during the pandemic period and the risk factors that are effective in the transmission of scabies. METHODS: Our study was performed as a cross-sectional study in 376 patients who applied to our dermatology outpatient clinic between 1st and 30th April 2021. Sociodemographic and socioeconomic characteristics, living space, health behavior, and health care utilization of the patients were questioned. RESULTS: The prevalence of scabies was determined as 10.9%. Features such as sex, area of residence, age, formal education status, employment status, total income, number of shower, number of people per room, water source, and heating method, which were found to be significant as a result of the double test, were included in the logistic regression analysis. Scabies was found 2.728 times (CI 1.325-5.557) more in those who live in rural areas than those who live in urban areas, 2.714 times (CI 1.365-5.451) more in men than women, 2.707 times (CI 1.256-5.833) more in nonworking than working, 2.354 times (CI 1.057-5.243) more in those with less than 9 showers per month than those with 9 or more showers per month. CONCLUSION: During the Covid-19 pandemic period, the prevalence of scabies in Turkey is increasing and it is becoming a serious health problem. Our study emphasizes this increase and determines the risk factors for transmission.

Impact of coronavirus in a dermatology outpatient clinic: a single-center retrospective study

Objective: Increased anxiety among individuals following the declaration of the coronavirus disease (COVID-19) pandemic, changes in social life, and dermatological eruptions caused or triggered by the COVID-19 infection have altered the incidence of dermatological diseases. To determine the impact of the pandemic, this study evaluated changes in the frequency, profile, and diagnostic spectrum of dermatology patients during the pandemic compared to the previous year. Materials and Methods: This study compared a 6-month period from March 2020, when the first COVID-19 case was reported in Turkey, to September 2020, with the same period in 2019. Age, sex, diagnosis groups, and diagnoses were recorded and compared with the previous year.

Change in dermatology practice during crisis and normalization periods after the COVID-19 pandemic and potential problems awaiting us

Background and Design: This study aimed to reveal the effects of the crisis period and normalization process after the Coronavirus disease-2019 (COVID-19) pandemic on dermatology practice to anticipate future health problems. Materials and Methods: All patients were enrolled from the dermatology outpatient clinics between February and July 2020 (pre-COVID-19 period, crisis period, and normalization period). Data such as age, sex, application dates, diagnoses, and treatment methods were received from the electronic registration database. Results: The number of patients in the normalization period (32.3%) increased relative to that in the crisis period (11.5%), and it was significantly lower than that before the pandemic (56.2%). Remarkably, the change in the distribution of stress-related diseases, such as idiopathic generalized pruritus, alopecia areata, and herpes zoster, stably paralleled each other and the increase and decrease trends during the crisis and normalization periods, respectively. The increase in the frequency of contact dermatitis, which was not reflected in the crisis period, became evident in the normalization period (p<0.001). No significant change was found in the rate of scabies (p=0.276). However, the number of patients with scabies was remarkably decreased. Conclusion: The decrease in stress-related diseases indicates that social stress started to decrease with normalization. Scabies and venereal diseases, which concern public health, should not be neglected. Disease rates and the number of patients provide an idea about potential problems after the pandemic. Understanding the trends in dermatological diseases and the changing health system during the pandemic will aid in future problems.

Dermatology on the global stage: The role of dermatologists in international health advocacy and COVID-19 research.

BACKGROUND: Over the last decade, there has been a surge in interest and funding for global health dermatology. Skin conditions are now recognized as the fourth leading cause of nonfatal disease burden worldwide in disability-adjusted life years. Dermatologists are uniquely positioned within global health because skin conditions are often the presenting sign of severe illnesses, such as neglected tropical diseases and COVID-19. METHODS: We review four major areas of work by dermatologists within global health: i) characterization of global burden of skin disease, ii) advocacy for dermatologic therapies on the World Health Organization's Model List of Essential Medicines, iii) advancements in global programming for skin-related tropical diseases, and iv) the role of dermatologists during the COVID-19 pandemic. For each area of work, the significance and impact on the health of women and girls is briefly highlighted. RESULTS: Dermatologists have led the efforts to quantify and evaluate the global burden of skin disease, the burden of which is disproportionately shared by women. The dermatology community has also championed global efforts to eliminate skin-related neglected tropical diseases, such as scabies. Through national and international policy advocacy, dermatologists have pushed for more dermatologic therapies in the World Health Organization's Model List of Essential Medicines, helping to secure better care for patients with skin disease throughout the world. Since 2020, the dermatology community has worked collaboratively in the fight against COVID-19, establishing a worldwide registry for cutaneous manifestations of SARS-CoV-2 and pursuing research that has allowed colleagues in the house of medicine to better understand this landmark disease. CONCLUSION: Through the study and promotion of global health, dermatologists have an important role in the house of medicine.

Impact of Pandemic in the Frequency of Scabies: Possible Scabies Outbreak Scenario Aftermath COVID-19

Objective: This study aimed to evaluate the post-pandemic changes in the frequency of scabies and determined the clues that may indicate a possible outbreak of scabies in the future. Methods: All patients diagnosed with scabies in the University of Health Sciences Turkey, Erzurum Regional Training and Research Hospital and Palandöken State Hospital between January 2019 and September 2020 were evaluated. Results: The frequency of scabies of 1.87% was remarkable in the first quarter of 2020, which corresponds to the pre-pandemic, and >50% (n=442) of all patients with scabies in 2019 (n=769) were encountered only in the first 3 months. The frequency of scabies seen in the first 3 quarters of 2020 was significantly higher than in 2019 (p<0.001). Significant decreases were found in the 0-14 years age groups (infant, preschool and school period) compared to 2019 (p<0.001, p<0.001 and p=0.015, respectively). No significant increase or decrease was determined in the frequency of scabies in 2020 (p=0.205). In addition, an increase in the number and rates of scabies patients are observed after the first month of normalisation period followed by the increase in the number of Coronavirus disease-2019 (COVID-19) daily cases. Conclusion: Applications for scabies to polyclinics after the pandemic were determined to be too low compared to previous periods, especially in school-age children, and showed an increasing trend over time. Patients with scabies that reach treatment late or not due to the pandemic may cause outbreak aftermath COVID-19.

Current Use of Ivermectin in Dermatology, Tropical Medicine, and COVID-19: An Update on Pharmacology, Uses, Proven and Varied Proposed Mechanistic Action.

Ivermectin is a broad-spectrum antiparasitic drug with anti-inflammatory, anti-viral, anti-bacterial, and anti-tumor effects. In this review, we discuss the history, pharmacology, multimodal actions, indications in dermatology and tropical medicine, therapeutic and prophylactic use of ivermectin in COVID-19, safety, adverse effects, special considerations, and drug interactions of ivermectin.