Clinical Research Department, Faculty of Infectious & Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom.
Hospital for Tropical Diseases, London, United Kingdom.
PLoS Negl Trop Dis. 2018 Dec 27;12(12):e0006996. doi: 10.1371/journal.pntd.0006996. eCollection 2018 Dec.
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.
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.
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.
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.
在大多数情况下，疥疮的诊断依赖于对所有可触及皮肤区域进行耗时且可能具有侵入性的临床检查。随着世界卫生组织最近将疥疮确认为被忽视的热带病，需要采用标准化方法进行疾病绘图，以确定可能受益于干预的人群，并衡量干预措施的影响。开发和验证简化的疥疮诊断方法将有助于这些努力。
我们利用了三项疥疮人群调查的数据。我们根据全身评估以及身体的 9 个区域将每个个体分为整体无疥疮或有疥疮，并计算了根据每个个体的身体区域诊断疥疮存在的敏感性，与基于全身检查的参考标准进行比较，并确定了提供大于 90%敏感性的区域组合。我们根据性别、年龄组、疥疮严重程度以及是否存在脓疱病评估了敏感性。
我们纳入了 1373 名患有疥疮的个体。手部（与全身检查相比敏感性为 51.2%）、脚部（49.7%）和小腿（48.3%）是收益最高的身体区域。检查四肢暴露的部分提供了 93.2%（95%CI 91.2-94.4%）的敏感性。无论疥疮严重程度或是否存在继发脓疱病，这种更有限的检查的敏感性均大于 90%。
我们发现，与全身检查相比，仅检查手、脚和小腿即可接近 90%地检测到疥疮。一种简化且侵入性较小的疥疮诊断过程将允许扩大绘图，并改善公共卫生干预措施的决策。需要在其他环境中进行进一步的研究来前瞻性验证这种简化方法。
