Medical Research Council Unit The Gambia at The London School of Hygiene & Tropical Medicine, Banjul, The Gambia.
Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom.
PLoS Negl Trop Dis. 2019 Oct 14;13(10):e0007801. doi: 10.1371/journal.pntd.0007801. eCollection 2019 Oct.
Scabies is a WHO neglected tropical disease common in children in low- and middle-income countries. Excoriation of scabies lesions can lead to secondary pyoderma infection, most commonly by Staphyloccocus aureus and Streptococcus pyogenes (group A streptococcus, GAS), with the latter linked to acute post-streptococcal glomerulonephritis (APSGN) and potentially rheumatic heart disease (RHD). There is a paucity of data on the prevalence of these skin infections and their bacterial aetiology from Africa.
METHODOLOGY/PRINCIPAL FINDINGS: A cross-sectional study, conducted over a four-month period that included the dry and rainy season, was conducted to determine the prevalence of common skin infections in Sukuta, a peri-urban settlement in western Gambia, in children <5 years. Swabs from pyoderma lesions were cultured for S. aureus and GAS. Of 1441 children examined, 15.9% had scabies (95% CI 12.2-20.4), 17.4% had pyoderma (95% CI 10.4-27.7) and 9.7% had fungal infections (95% CI 6.6-14.0). Scabies was significantly associated with pyoderma (aOR 2.74, 95% CI 1.61-4.67). Of 250 pyoderma swabs, 80.8% were culture-positive for S. aureus, and 50.8% for GAS. Participants examined after the first rains were significantly more likely to have pyoderma than those examined before (aRR 2.42, 95% CI 1.38-4.23), whereas no difference in scabies prevalence was seen (aRR 1.08, 95% CI 0.70-1.67). Swab positivity was not affected by the season.
CONCLUSIONS/SIGNIFICANCE: High prevalence of scabies and pyoderma were observed. Pyoderma increased significantly during the rainy season. Given the high prevalence of GAS pyoderma among children, further research on the association with RHD in West Africa is warranted.
疥疮是一种被世界卫生组织忽视的热带病，在中低收入国家的儿童中很常见。疥疮病变的搔抓会导致继发性脓疱疮感染，最常见的病原体是金黄色葡萄球菌和化脓性链球菌（A 组链球菌，GAS），后者与急性链球菌后肾小球肾炎（APSGN）和潜在的风湿性心脏病（RHD）有关。非洲关于这些皮肤感染及其细菌病因的患病率数据很少。
方法/主要发现：在冈比亚西部的一个城市边缘定居点 Sukuta 进行了一项为期四个月的横断面研究，包括旱季和雨季，以确定 5 岁以下儿童中常见皮肤感染的患病率。脓疱病变的拭子进行了金黄色葡萄球菌和 GAS 的培养。在检查的 1441 名儿童中，15.9%患有疥疮（95%CI12.2-20.4），17.4%患有脓疱病（95%CI10.4-27.7），9.7%患有真菌感染（95%CI6.6-14.0）。疥疮与脓疱病显著相关（优势比 2.74，95%CI1.61-4.67）。在 250 份脓疱病拭子中，80.8%培养出金黄色葡萄球菌，50.8%培养出 GAS。在第一次降雨后接受检查的参与者患脓疱病的可能性明显高于降雨前（RRR2.42，95%CI1.38-4.23），而疥疮的患病率没有差异（RR1.08，95%CI0.70-1.67）。季节对拭子阳性率没有影响。
结论/意义：观察到疥疮和脓疱病的高患病率。雨季期间脓疱病显著增加。鉴于儿童中 GAS 脓疱病的高患病率，有必要在西非进一步研究其与 RHD 的关系。
