Does immunodepression induced by TNF antagonists promote atypical scabies?

Boureau, Anne Sophie; Cozic, Céline; Poiraud, C.; Varin, Stéphane; Chaillous, Benoît; Cormier, Grégoire

doi:10.1016/j.jbspin.2013.06.009

Cited by 6 publications

(9 citation statements)

References 8 publications

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“…In addition, outbreaks readily occur in the community in schools, hospitals (including intensive care units), and other institutions (5-10). Among immunocompromised patients, such as HIV-infected individuals, organ transplant recipients, and patients on biologics or other immunosuppressive therapies, scabies can occur as an unrecognized complication with considerable delays in diagnosis and treatment or as a manifestation of the immune reconstitution inflammatory syndrome (11)(12)(13)(14)(15).Scabies is a contagious skin infection characterized by intense itching due to a delayed type IV hypersensitivity reaction toward Sarcoptes scabiei antigens; some of these antigens also modulate the skin immune response to mites (16). Transmission is predominately person to person through close and prolonged contact, but fomites may also play a role in heavily infected patients, as in the case of crusted scabies (17).…”

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Development of Conventional and Real-Time Quantitative PCR Assays for Diagnosis and Monitoring of Scabies

et al. 2015

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c Scabies remains the most prevalent, endemic, and neglected ectoparasitic infestation globally and can cause institutional outbreaks. The sensitivity of routine microscopy for demonstration of Sarcoptes scabiei mites or eggs in skin scrapings is only about 50%. Except for three studies using conventional or two-tube nested PCR on a small number of cases, no systematic study has been performed to improve the laboratory diagnosis of this important infection. We developed a conventional and a real-time quantitative PCR (qPCR) assay based on the mitochondrial cytochrome c oxidase subunit 1 (cox1) gene of S. scabiei. The cox1 gene is relatively well conserved, with its sequence having no high levels of similarity to the sequences of other human skin mites, pathogenic zoonotic mites, or common house dust mite species. This mitochondrial gene is also present in large quantities in arthropod cells, potentially improving the sensitivity of a PCR-based assay. In our study, both assays were specific and were more sensitive than microscopy in diagnosing scabies, with positive and negative predictive values of 100%. The S. scabiei DNA copy number in the microscopy-positive specimens was significantly higher than that in the microscopy-negative specimens (median S. scabiei DNA copy number, 3.604 versus 2.457 log 10 copies per reaction; P ‫؍‬ 0.0213). In the patient with crusted scabies, the qPCR assay performed on lesional skin swabs instead of scrapings revealed that the parasite DNA load took about 2 weeks to become negative after treatment. The utility of using lesional skin swabs as an alternative sample for diagnosis of scabies by PCR should be further evaluated. Scabies remains a significant infectious problem worldwide and is a problem not merely in developing countries but also in the developed world. An estimated 300 million cases of scabies occur globally every year, with scabies having a particular association with young children, poor hygiene, homelessness, crowdedness, and poverty in the tropical and subtropical regions (1). The prevalence of scabies in some populations, such as Australian aborigines, can be as high as 25 to 50%, and the burden of disease and morbidity are further aggravated by complications with bacterial pyoderma, including that caused by methicillin-resistant Staphylococcus aureus (2, 3). In developed countries, scabies causes significant public health issues in vulnerable individuals, such as individuals at the extremes of ages and immunocompromised hosts. For example, an estimated incidence of 233 to 470 per 100,000 person-years was reported in a national study conducted from 1994 to 2003 in England (4). In addition, outbreaks readily occur in the community in schools, hospitals (including intensive care units), and other institutions (5-10). Among immunocompromised patients, such as HIV-infected individuals, organ transplant recipients, and patients on biologics or other immunosuppressive therapies, scabies can occur as an unrecognized complication with considerable delays in diagnosis and...

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Development of Conventional and Real-Time Quantitative PCR Assays for Diagnosis and Monitoring of Scabies

et al. 2015

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“…More recently, a dozen cases of CS have been described in Fig. 3 Aspect of the face (a), hands (b) and lower limbs (c) 1 month after hospitalization patients using anti-tumor necrosis factor alpha therapies; including etanercept [11], adalimumab [6,12] and infliximab [13]. One case was described in a patient on ipilimumab, an anti-T-cell CTLA-4 antibody, for the treatment of melanoma [14].…”

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Risankizumab-Aggravated Crusted Scabies in a Patient with Down Syndrome

Senterre

Jouret

Collins

et al. 2020

Dermatol Ther (Heidelb)

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Risankizumab, an interleukin (IL)-23 antagonist, is a highly effective treatment for moderate to severe psoriasis. Crusted scabies (CS) is a rare and severe form of scabies, occurring mainly in immunosuppressed patients and/or neurologically or mentally ill patients. A young girl with Down syndrome was diagnosed with a hyperkeratotic form of psoriasis. As treatment with topical dermocorticosteroids, UVB-phototherapy and acitretin for 6 weeks did not improve the lesions, two injections of risankizumab were administered. Following these injections, the lesions became rapidly even more severely crusted, and new lesions appeared on the extremities and the face of the patient. There was histological evidence of a high charge of scabies, leading to a diagnosis of CS. The patient was hospitalized and successfully treated by local permethrine and systemic ivermectine. This case suggests that even though anti-IL23 antagonists display an excellent overall safety profile, a particular caution for infections should still be respected in patients with underlying risk factors.

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“…Making an early diagnosis can be more difficult in immunosuppressed and elderly patients because they present with atypical symptoms (3), such as hyperkeratotic lesions on the fingertips and nails (13), microvesicular rash and generalized pruritus and hyperkeratosis (14), and hyperpigmented crusted plaques with hemorrhagic fissures (15). Late diagnosis, misdiagnosis or a misleading diagnosis are thought to occur frequently even if dermatologist recommendations are followed, which can lead to outbreaks in medical institutions (16).…”

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A scabies outbreak in a diabetic and collagen disease ward: Management and prevention

Furuya

Nakajima

Sasaki

et al. 2016

Experimental and Therapeutic Medicine

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Abstract. Scabies is an infection caused by Sarcoptes scabiei.In developed countries, scabies remains an important public health problem in hospitals and care facilities among elderly or immunocompromised patients. There are a number of medical providers who have not experienced scabies and there has been confusion surrounding its management and prevention. Therefore, the aim of the present study was to identify the optimal approach for the management and prevention of scabies. A scabies outbreak occurred between June 2014 and October 2014 in the Toho University School of Medicine, Omori Hospital (Tokyo, Japan), and the current study investigates factors concerning the outbreak, such as disease recognition, diagnostic strategy, medical staff experience and correspondence after the outbreak occurred. Six patients were newly diagnosed with scabies including patients, medical staff and family of the medical staff. An infection control committee was implemented and required a follow-up survey of 181 people (144 patients and 37 medical staff). It took ~4 months to resolve the outbreak. Scabies is highly infectious, and sufficient knowledge is required to care for the patients and prevent the infection of healthy people. In this example, the spread of infection was controlled by prompt action.

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Does immunodepression induced by TNF antagonists promote atypical scabies?

Cited by 6 publications

References 8 publications

Development of Conventional and Real-Time Quantitative PCR Assays for Diagnosis and Monitoring of Scabies

Development of Conventional and Real-Time Quantitative PCR Assays for Diagnosis and Monitoring of Scabies

Risankizumab-Aggravated Crusted Scabies in a Patient with Down Syndrome

A scabies outbreak in a diabetic and collagen disease ward: Management and prevention

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