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High burden and seasonal variation of paediatric scabies and pyoderma prevalence in The Gambia: A cross-sectional
Edwin P Armitage1, Elina Senghore1, Saffiatou Darboe1
1Medical Research Council Unit The Gambia at The London School of Hygiene & Tropical Medicine, Banjul, The Gambia.
Insights
High rates of scabies and pyoderma were found in Gambian children under five. Pyoderma, a bacterial skin infection, increased during the rainy season, highlighting the need for further research into its complications like rheumatic heart disease.
Area of Science:
- Global Health
- Infectious Diseases
- Dermatology
Background:
- Scabies is a neglected tropical disease prevalent in low- and middle-income countries, particularly affecting children.
- Secondary bacterial skin infections, such as pyoderma caused by Staphylococcus aureus and Streptococcus pyogenes (group A streptococcus, GAS), frequently develop from excoriated scabies lesions.
- GAS pyoderma is linked to serious health issues including acute post-streptococcal glomerulonephritis (APSGN) and potentially rheumatic heart disease (RHD), yet data from Africa is scarce.
Purpose of the Study:
- To determine the prevalence of common skin infections, including scabies and pyoderma, in children under five years old in Sukuta, a peri-urban settlement in western Gambia.
- To investigate the bacterial etiology of pyoderma, specifically the presence of S. aureus and GAS.
- To explore the association between scabies and pyoderma, and the impact of seasons on infection prevalence.
Main Methods:
- A cross-sectional study was conducted over four months, encompassing both dry and rainy seasons, in children under five years old.
- Prevalence of scabies, pyoderma, and fungal infections was assessed through clinical examination.
- Swabs from pyoderma lesions were cultured to identify S. aureus and GAS, with statistical analyses performed to determine associations and seasonal effects.
Main Results:
- The study found a prevalence of 15.9% for scabies, 17.4% for pyoderma, and 9.7% for fungal infections among 1441 children examined.
- Scabies was significantly associated with pyoderma (aOR 2.74).
- Culture results showed high rates of S. aureus (80.8%) and GAS (50.8%) in pyoderma swabs. Pyoderma prevalence was significantly higher after the first rains (aRR 2.42), while scabies prevalence remained unaffected by season.
Conclusions:
- High prevalence of scabies and pyoderma necessitates attention in this population.
- The significant increase in pyoderma during the rainy season, coupled with high GAS prevalence, warrants further investigation into its link with rheumatic heart disease in West Africa.
Background:
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.
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