Tasani Monika, Tong Steven Y C, Andrews Ross M, Holt Deborah C, Currie Bart J, Carapetis Jonathan R, Bowen Asha C
From the *Royal Children's Hospital Melbourne, Melbourne, Australia; †Royal Darwin Hospital, Darwin, Australia; ‡Menzies School of Health Research, Charles Darwin University, Darwin, Australia; §Telethon Kids Institute, University of Western Australia, Perth, Australia; and ¶Princess Margaret Hospital for Children, Perth, Australia.
Pediatr Infect Dis J. 2016 Apr;35(4):374-8. doi: 10.1097/INF.0000000000001013.
Skin infections account for a high disease burden in indigenous children living in northern Australia. Although the relationship between impetigo and scabies is recognized, the prevalence of scabies in children with impetigo is not well reported. We report the prevalence, demographics and treatment success outcomes of impetigo and scabies coinfection in indigenous children who were participants in a randomized controlled trial of impetigo treatment conducted in remote communities of the Northern Territory, Australia.
Of 1715 screening episodes for impetigo, 508 children were randomized to receive intramuscular benzathine benzylpenicillin (BPG), twice daily co-trimoxazole (SXT) for 3 days (4 mg/kg trimethoprim plus 20 mg/kg sulfamethoxazole per dose) or once daily SXT for 5 days (8 mg/kg trimethoprim plus 40 mg/kg sulfamethoxazole per dose). A clinical diagnosis of scabies; tinea of the skin, scalp or nail; and head lice was made on all children. Scabies presence was not confirmed using diagnostic scrapings. In a post-hoc analysis, we determined whether coinfection with scabies had an impact on treatment success for impetigo.
Of children randomized to receive treatment for impetigo, 84 of 508 (16.5%) had scabies. The presence of scabies ranged from 14.3% to 20.0% in the 3 treatment groups. Treatment success for impetigo with and without scabies coinfection, independent of the treatment groups, was 75.9% and 86.6%, respectively, absolute difference 10.7% [95% confidence interval (CI): +1% to +21%]. Treatment success for impetigo with and without scabies coinfection in the BPG group was 69.6% and 88.0%, respectively, absolute difference 18.4% (95% CI: -1% to +38%). In the pooled SXT groups, the treatment success for impetigo with and without scabies coinfection was 78.6% and 86.0%, respectively, with absolute difference 7.4% (95% CI: -4% to +18%). Treatment success in the pooled SXT group with scabies (78.6%) was higher than in the BPG group (69.6%) with scabies, absolute difference 9.0% (95% CI: +0.1% to +18%). Prediction of treatment success for impetigo is dependent on the presence or absence of scabies and for scabies coinfected impetigo it was higher in the group treated with SXT.
The burden of scabies in an impetigo trial for Indigenous children was high. Treatment success for scabies coinfection was lower than for impetigo overall, with a higher success seen in the SXT group than the BPG group.
皮肤感染给居住在澳大利亚北部的原住民儿童带来了沉重的疾病负担。尽管脓疱病和疥疮之间的关系已为人所知，但脓疱病患儿中疥疮的患病率尚无详尽报道。我们报告了参与澳大利亚北领地偏远社区脓疱病治疗随机对照试验的原住民儿童中脓疱病与疥疮合并感染的患病率、人口统计学特征及治疗成功结果。
在1715次脓疱病筛查病例中，508名儿童被随机分组，分别接受肌内注射苄星青霉素（BPG）、每日两次复方新诺明（SXT）共3天（每剂含4mg/kg甲氧苄啶加20mg/kg磺胺甲恶唑）或每日一次SXT共5天（每剂含8mg/kg甲氧苄啶加40mg/kg磺胺甲恶唑）。对所有儿童进行了疥疮、皮肤癣菌病（皮肤、头皮或指甲）及头虱的临床诊断。疥疮的存在未通过诊断性刮片进行确认。在一项事后分析中，我们确定疥疮合并感染是否对脓疱病的治疗成功有影响。
在随机接受脓疱病治疗的儿童中，508名中有84名（16.5%）患有疥疮。在3个治疗组中，疥疮的患病率在14.3%至20.0%之间。无论是否合并疥疮感染，脓疱病的治疗成功率分别为75.9%和86.6%，绝对差异为10.7%[95%置信区间（CI）：+1%至+21%]。在BPG组中，合并疥疮感染和未合并疥疮感染的脓疱病治疗成功率分别为69.6%和88.0%，绝对差异为18.4%（95%CI：-1%至+38%）。在合并的SXT组中，合并疥疮感染和未合并疥疮感染的脓疱病治疗成功率分别为78.6%和86.0%，绝对差异为7.4%（95%CI：-4%至+18%）。合并疥疮感染的SXT组治疗成功率（78.6%）高于合并疥疮感染的BPG组（69.6%），绝对差异为9.0%（95%CI：+0.1%至+18%）。脓疱病治疗成功的预测取决于是否存在疥疮，对于合并疥疮感染的脓疱病，SXT治疗组的成功率更高。
在一项针对原住民儿童的脓疱病试验中，疥疮负担较重。合并疥疮感染的治疗成功率低于脓疱病总体治疗成功率，SXT组的成功率高于BPG组。
