Exploration of a simplified clinical examination for scabies to support public health decision-making.

Authors:
Michael Marks
Michael Marks
University of Colorado
United States
Daniel Engelman
Daniel Engelman
University of Melbourne
Pasig | Philippines
Lucia Romani
Lucia Romani
University of Sydney
Australia
Daniel Mason
Daniel Mason
California Institute of Technology
United States
Oliver Sokana
Oliver Sokana
London School of Hygiene and Tropical Medicine
United Kingdom
Mike Kama
Mike Kama
Ministry of Health
Margot Whitfeld
Margot Whitfeld
St Vincent's Hospital
Australia
Andrew C Steer
Andrew C Steer
University of Melbourne
Australia

PLoS Negl Trop Dis 2018 12 27;12(12):e0006996. Epub 2018 Dec 27.

The Kirby Institute, University of New South Wales, Sydney, Australia.

Introduction: In most settings, the diagnosis of scabies is reliant on time-consuming and potentially intrusive clinical examination of all accesible regions of skin. With the recent recognition of scabies as a neglected tropical disease by the World Health Organization there is a need for standardised approaches to disease mapping to define populations likely to benefit from intervention, and to measure the impact of interventions. Development and validation of simplified approaches to diagnose scabies would facilitate these efforts.

Methods: We utilised data from three population-based surveys of scabies. We classified each individual as having scabies absent or present overall, based on whole body assessment, and in each of 9 regions of the body. We calculated the sensitivity of diagnosing the presence of scabies based on each individual body region compared to the reference standard based on whole body examination and identified combinations of regions which provided greater than 90% sensitivity. We assessed the sensitivity according to gender, age group, severity of scabies and the presence or absence of impetigo.

Results: We included 1,373 individuals with scabies. The body regions with highest yield were the hands (sensitivity compared to whole body examination 51.2%), feet (49.7%), and lower legs (48.3%). Examination of the exposed components of both limbs provided a sensitivity of 93.2% (95% CI 91.2-94.4%). The sensitivity of this more limited examination was greater than 90% regardless of scabies severity or the presence or absence of secondary impetigo.

Discussion: We found that examination limited to hands, feet and lower legs was close to 90% for detecting scabies compared to a full body examination. A simplified and less intrusive diagnostic process for scabies will allow expansion of mapping and improved decision-making about public health interventions. Further studies in other settings are needed to prospectively validate this simplified approach.

Download full-text PDF

Source
http://dx.doi.org/10.1371/journal.pntd.0006996DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6307692PMC
December 2018
4 Reads

Publication Analysis

Top Keywords

scabies
12
body examination
12
presence absence
8
based body
8
lower legs
8
public health
8
greater 90%
8
clinical examination
8
examination
8
body
7
sensitivity
6
sensitivity gender
4
90% detecting
4
legs close
4
standard based
4
detecting scabies
4
scabies compared
4
compared reference
4
examination identified
4
reference standard
4

References

(Supplied by CrossRef)
Scabies
J Heukelbach et al.
The Lancet 2006
Scabies in the developing world—its prevalence, complications, and management
RJ Hay et al.
Clin Microbiol Infect Off Publ Eur Soc Clin Microbiol Infect Dis 2012
Control of scabies, skin sores and haematuria in children in the Solomon Islands: another role for ivermectin
G Lawrence et al.
Bull World Health Organ 2005
A simple system for the assessment of trachoma and its complications
B Thylefors et al.
Bull World Health Organ 1987

Similar Publications