Group A Streptococcal Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
Centre for International Child Health, Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.
PLoS Negl Trop Dis. 2018 May 24;12(5):e0006549. doi: 10.1371/journal.pntd.0006549. eCollection 2018 May.
Scabies was added to the WHO Neglected Tropical Diseases portfolio in 2017, and further understanding of the disease burden is now required. There are no uniformly accepted test methods or examination procedures for diagnosis, which limits the interpretation of research and epidemiological findings. The International Alliance for the Control of Scabies (IACS) designated harmonization of diagnostic procedures as a priority for the development of a global control strategy. Therefore, we aimed to develop consensus criteria for the diagnosis of scabies.
METHODOLOGY / PRINCIPAL FINDINGS: We conducted an iterative, consensus (Delphi) study involving international experts in the diagnosis of scabies. Panel members were recruited through expression of interest and targeted invitation of experts. The Delphi study consisted of four rounds of anonymous surveys. Rounds 1 and 2 involved generation and ranking an extensive list of possible features. In Rounds 3 and 4, participants were presented results from previous rounds and indicated agreement with a series of draft criteria. Panel participants (n = 34, range per Round 28-30) were predominantly highly experienced clinicians, representing a range of clinical expertise and all inhabited continents. Based on initial rounds, a draft set of criteria were developed, incorporating three levels of diagnostic certainty-Confirmed Scabies, Clinical Scabies and Suspected Scabies. Consensus was reached in Round 4, with a very high level of agreement (> 89%) for all levels of criteria and subcategories. Adoption of the criteria was supported by 96% of panel members.
CONCLUSIONS / SIGNIFICANCE: Consensus criteria for scabies diagnosis were established with very high agreement. The 2018 IACS Criteria for the Diagnosis of Scabies can be implemented for scabies research and mapping projects, and for surveillance after control interventions. Validation of the criteria is required.
疥疮于 2017 年被世界卫生组织（WHO）列入被忽视的热带病清单，现在需要进一步了解疾病负担。由于目前没有统一接受的诊断测试方法或检查程序，这限制了对研究和流行病学发现的解释。国际疥疮控制联盟（IACS）将诊断程序的协调一致指定为制定全球控制战略的优先事项。因此，我们旨在制定疥疮诊断的共识标准。
方法/主要发现：我们进行了一项迭代的、有共识的（德尔菲）研究，涉及疥疮诊断方面的国际专家。小组成员是通过表达兴趣和有针对性地邀请专家招募的。德尔菲研究由四轮匿名调查组成。第 1 轮和第 2 轮涉及生成和排列广泛的可能特征列表。在第 3 轮和第 4 轮中，参与者收到了前几轮的结果，并对一系列草案标准表示同意。小组成员（n=34，第 2 轮至第 4 轮的范围分别为 28-30）主要是经验丰富的临床医生，代表了各种临床专业知识，分布在各大洲。根据最初的几轮，制定了一套草案标准，纳入了三种诊断确定性级别-确诊疥疮、临床疥疮和疑似疥疮。在第 4 轮达成共识，所有标准和子类别都达到了非常高的一致性（>89%）。96%的小组成员支持采用这些标准。
结论/意义：建立了非常高一致性的疥疮诊断共识标准。2018 年 IACS 疥疮诊断标准可用于疥疮研究和绘图项目，以及控制干预后的监测。需要对这些标准进行验证。
