Special Issue "Skin-Related Neglected Tropical Diseases (Skin-NTDs)—A New Challenge"

A special issue of Tropical Medicine and Infectious Disease (ISSN 2414-6366).

Deadline for manuscript submissions: closed (31 July 2018)

Special Issue Editors

Guest Editor
Prof. Roderick J. Hay

International Foundation for Dermatology, UK
E-Mail
Interests: infections of the skin; tropical dermatology; medical mycology
Guest Editor
Dr. Kingsley Asiedu

Department of Control of Neglected Tropical Diseases, WHO
Website | E-Mail
Interests: Buruli ulcer; yaws

Special Issue Information

Dear Colleagues,

The skin of the patient is the first and most visible structure of the body that any health care worker encounters in the course of an examination. To the patient and relatives, it is also highly visible and any disease that affects the skin is both noticeable and will have an impact on personal and social wellbeing. It is therefore an important entry point for diagnosis, surveillance, disease mapping and integrated management. Many of the major neglected tropical diseases produce changes in the skin, often the first indicator of illness that patients will notice. Changes to the skin often reinforce the feelings of isolation and stigma experienced by patients with Neglected Tropical Diseases (NTDs), but they also provide opportunities for simplifying diagnosis and developing an integrated and strategic approach to control and care

A key challenge in taking the common feature of skin involvement in NTDs to this higher level is that skin disease in general is very common, particularly in resource-poor settings and seeking solutions to the identification and management of skin NTDs without addressing the commonality of skin disease is not an option.

This Special Issue will explore the range of clinical manifestations and epidemiology of both skin NTDs and common skin disease in endemic regions, the use of common diagnostic and management pathways, the different technologies that play a role in diagnosis and training, and the role of patient and family involvement at the community level, as well as the assessment of the results of different studies or programmes in this field.

Prof. Roderick J. Hay
Dr. Kingsley Asiedu
Guest Editors

Manuscript Submission Information

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Keywords

  • Skin disease
  • Neglected tropical diseases (NTDs)
  • Diagnosis
  • Integrated care
  • Disease mapping
  • Community participation
  • Training
  • Technology

Published Papers (18 papers)

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Editorial

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Open AccessEditorial
Skin-Related Neglected Tropical Diseases (Skin NTDs)—A New Challenge
Trop. Med. Infect. Dis. 2019, 4(1), 4; https://doi.org/10.3390/tropicalmed4010004
Received: 21 December 2018 / Accepted: 22 December 2018 / Published: 25 December 2018
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Abstract
Medical teaching has emphasised over many years the uniqueness of disease states, valuing the rare skills on which the art of diagnosis is based and the intricacies of individual patient-centred management. [...] Full article

Research

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Open AccessArticle
Diagnosis and Management of Fungal Neglected Tropical Diseases In Community Settings—Mycetoma and Sporotrichosis
Trop. Med. Infect. Dis. 2019, 4(2), 81; https://doi.org/10.3390/tropicalmed4020081
Received: 19 March 2019 / Revised: 26 April 2019 / Accepted: 26 April 2019 / Published: 16 May 2019
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Abstract
Background: This is a retrospective, analytic observational study where we describe cases of sporotrichosis and mycetoma from Acapulco General Hospital and Community Dermatology Mexico C.A. over 25 years. Analysis of environmental features that favour the development of such diseases has been made, as [...] Read more.
Background: This is a retrospective, analytic observational study where we describe cases of sporotrichosis and mycetoma from Acapulco General Hospital and Community Dermatology Mexico C.A. over 25 years. Analysis of environmental features that favour the development of such diseases has been made, as well as the limitations in the study and treatment of such diseases in resource poor settings. Methods: We reviewed the information on 76 sporotrichosis and 113 mycetoma patients out of a total of 14,000 consultations at Acapulco General Hospital and from Community Dermatology clinics. We analysed the epidemiological and mycological characteristics and the investigations used for diagnosis such as direct examination, culture, intradermal test reactions, and biopsy. Results: In total 91 confirmed cases of actinomycetoma, 22 of eumycetoma and 76 of sporotrichosis have been identified including diagnostic studies for both diseases and their treatment. Discussion: The results obtained have been analysed and interpreted in patients with mycetoma and sporotrichosis in the state of Guerrero, México, along with limitations in their management in areas with limited economic and logistical resources. The prevalence of mycetoma in our setting is compared with other centres where patients from all over the country are seen. The possible causes for variations in prevalence in specific areas has been looked for, in one of the poorest states of the Mexican Republic. Full article
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Open AccessArticle
The Mite-Gallery Unit: A New Concept for Describing Scabies through Entodermoscopy
Trop. Med. Infect. Dis. 2019, 4(1), 48; https://doi.org/10.3390/tropicalmed4010048
Received: 16 January 2019 / Revised: 12 February 2019 / Accepted: 11 March 2019 / Published: 16 March 2019
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Abstract
Scabies has always represented a diagnostic challenge for dermatologists, especially in subclinical cases or in atypical ones due to the coexistence of other diseases. Fortunately, dermatoscopy has enabled easier and faster in situ diagnosis. The aim of this study is to examine old [...] Read more.
Scabies has always represented a diagnostic challenge for dermatologists, especially in subclinical cases or in atypical ones due to the coexistence of other diseases. Fortunately, dermatoscopy has enabled easier and faster in situ diagnosis. The aim of this study is to examine old and new dermatoscopic signs that Sarcoptes scabiei produces on the skin during its whole life cycle through entodermoscopy (dermatoscopy with an entomological focus) which, unlike traditional optical microscope examination, allows the local micro-environment to be preserved intact. Patients were enrolled during outbreaks of scabies from hospitals or nursing homes for the elderly in Bari (Italy). The study was performed applying both immersion and polarized dry dermatoscopy. The systematic use of dermatoscopy highlighted the morphological complexity of the Sarcoptes tunnel that had been described previously as a simple unitary structure. On the contrary, it is possible to distinguish three separate segments of the burrow that introduce a new anatomo-functional concept called the Mite-Gallery Unit (MGU). This approach, based on the mite life cycle and local skin turnover (the latter usually being ignored), allows the dermatologist to recognize not only Sarcoptes using the gallery, but also new descriptors including tunnels without Sarcoptes, those with acari alone, and those with associated signs of inflammation. The diagnosis of scabies using optical microscopy until recently has always involved demonstrating the mite and its products outside the human body (on a glass slide) without taking into account exactly what happens within the epidermis. Entodermoscopy is a term used to encapsulate both the presence of the parasite, the usual target of microscopy, and the changes produced in the superficial layers of the epidermis in situ. Thus, the scabies tunnel or burrow can be shown to be composed of three parts, the Head, Body, and Tail, in which different events affecting both mite and host develop. The Mite-Gallery Unit provides a new anatomical and functional explanation of scabies because it provides a more comprehensive in vivo and in situ dermatoscopic diagnosis. In this respect, dermatoscopy takes into account the behavior of the mite in addition to its interaction with its habitat, the human skin. Full article
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Open AccessArticle
In Situ Diagnosis of Scabies Using a Handheld Digital Microscope in Resource-Poor Settings—A Proof-of-Principle Study in the Amazon Lowland of Colombia
Trop. Med. Infect. Dis. 2018, 3(4), 116; https://doi.org/10.3390/tropicalmed3040116
Received: 31 July 2018 / Revised: 24 October 2018 / Accepted: 24 October 2018 / Published: 2 November 2018
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Abstract
Scabies is a neglected tropical disease associated with important morbidity. The disease occurs worldwide and is particularly common in resource-poor communities in the Global South. A validated technique for the diagnosis of scabies in resource-poor settings does not exist. The objective of the [...] Read more.
Scabies is a neglected tropical disease associated with important morbidity. The disease occurs worldwide and is particularly common in resource-poor communities in the Global South. A validated technique for the diagnosis of scabies in resource-poor settings does not exist. The objective of the study was to determine the practicability and accuracy of handheld digital microscopy in three indigenous communities in the Amazon lowland of Colombia, where scabies is the most common parasitic skin disease. One-hundred-and-eleven children and adults from three indigenous communities with a presumptive diagnosis of scabies were examined clinically by using a handheld digital microscope placed directly on the skin. The microscopical identification of a mite was verified by an “experienced mother”, a woman who had acquired the skills to diagnose scabies as part of traditional Amerindian medicine. The “experienced mother” removed the parasite with a fine needle and placed it on a flat surface in order to enable its direct examination with the digital microscope. Using digital microscopy, scabies was diagnosed in 24 out of 111 participants and confirmed by the extraction of a Sarcoptes mites from the acarine eminence. A characteristic tunnel (burrow) with or without mite could be clearly identified irrespective of the degree of pigmentation of the skin. Besides, digital microscopy revealed pathological characteristics of scabies hitherto unknown and impossible to be seen in dermoscopy, such as partially or totally obliterated tunnels, tunnels with multiple entry or exit points, circumscribed hyperpigmentation around obliterated tunnels and mites secluded in a nodule. This proof-of-principle study demonstrated the accurate diagnosis of scabies by handheld digital microscopy in patients with pigmented skin and the feasibility of this technique in resource-poor settings. Full article
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Open AccessArticle
Investigation of a Scabies Outbreak in Drought-Affected Areas in Ethiopia
Trop. Med. Infect. Dis. 2018, 3(4), 114; https://doi.org/10.3390/tropicalmed3040114
Received: 10 September 2018 / Revised: 23 October 2018 / Accepted: 25 October 2018 / Published: 29 October 2018
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Abstract
The impact of the severe drought in Ethiopia, attributed to El Niño weather conditions, has led to high levels of malnutrition that have, in turn, increased the potential for disease outbreaks. In 2015, Ethiopia faced a scabies outbreak in drought-affected areas where there [...] Read more.
The impact of the severe drought in Ethiopia, attributed to El Niño weather conditions, has led to high levels of malnutrition that have, in turn, increased the potential for disease outbreaks. In 2015, Ethiopia faced a scabies outbreak in drought-affected areas where there was a shortage of safe water for drinking and personal hygiene. Following a house-to-house census to assess the prevalence of scabies, a detailed study was conducted looking at the disease burden. Following the outbreak report, training was provided on scabies identification and management for zonal and district health officials from administrative districts affected by the drought (nutritional hot-spot woredas). The training was cascaded down to the health extension workers in the affected areas. Screening and management guidelines and protocols were also distributed. House-to-house data collection was undertaken by 450 health extension workers (HEWs) to assess the prevalence of scabies. The HEWs used a simplified reporting tool. Subsequently, data were collected and validated in two zones and six woredas from 474 participants who had been diagnosed with scabies using a standardized questionnaire. This was designed to look at the specificity of the diagnosis of scabies, age distribution, severity, duration of illness, secondary infection and other sociodemographic variables as preparation for mass drug administration (MDA). The HEWs screened 1,125,770 people in the 68 districts in Amhara Region and a total of 379,000 confirmed cases of scabies was identified. The prevalence in the different districts ranged from 2% to 67% and the median was 33.5% [interquartile range (IQR) 19–48%]. 49% of cases were school-aged children. The detailed study of 474 individuals who were recorded as scabies cases revealed that the specificity of the diagnosis of scabies by the HEWs was 98.3%. The mean duration of illness was 5 months (SD of ± 2.8). One third of patients were recorded as having severe illness, 75.1% of cases had affected family members, and 30% of affected children were noted to have secondary bacterial infection. Eleven percent of the students had discontinued school due to scabies or/and drought and 85% of these had secondary bacterial infection. These community-based data serve as reliable proxy indicators for community-based burden assessment of the scabies epidemic. This study will also provide a good basis for advocating the use of a community-level clinical diagnostic scheme for scabies using an algorithm with a simple combination of signs and symptoms in resource-poor settings. Full article
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Open AccessCommunication
The Development of a Mobile Application to Support Peripheral Health Workers to Diagnose and Treat People with Skin Diseases in Resource-Poor Settings
Trop. Med. Infect. Dis. 2018, 3(3), 102; https://doi.org/10.3390/tropicalmed3030102
Received: 27 July 2018 / Revised: 7 September 2018 / Accepted: 10 September 2018 / Published: 15 September 2018
Cited by 1 | PDF Full-text (205 KB) | HTML Full-text | XML Full-text
Abstract
The high prevalence of skin diseases in resource-poor settings, where health workers with sufficient knowledge of skin diseases are scarce, calls for innovative measures. Timely diagnosis and treatment of skin diseases, especially neglected tropical diseases (NTDs) that manifest with skin lesions, such as [...] Read more.
The high prevalence of skin diseases in resource-poor settings, where health workers with sufficient knowledge of skin diseases are scarce, calls for innovative measures. Timely diagnosis and treatment of skin diseases, especially neglected tropical diseases (NTDs) that manifest with skin lesions, such as leprosy, is crucial to prevent disabilities as well as psychological and socioeconomic problems. Innovative technological methods like telemedicine and mobile health (mHealth) can help to bridge the gap between the burden of skin diseases and the lack of capable staff in resource-poor settings by bringing essential health services from central level closer to peripheral levels. Netherlands Leprosy Relief (NLR) has developed a mobile phone application called the ‘SkinApp’, which aims to support peripheral health workers to recognize the early signs and symptoms of skin diseases, including skin NTDs, and to start treatment promptly or refer for more advanced diagnostic testing or disease management when needed. Further research is needed to determine how greatly mHealth in general and the SkinApp in particular can contribute to improved health outcomes, efficiency, and cost-effectiveness. Full article
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Graphical abstract

Open AccessArticle
A Teledermatology Pilot Programme for the Management of Skin Diseases in Primary Health Care Centres: Experiences from a Resource-Limited Country (Mali, West Africa)
Trop. Med. Infect. Dis. 2018, 3(3), 88; https://doi.org/10.3390/tropicalmed3030088
Received: 24 July 2018 / Revised: 4 August 2018 / Accepted: 6 August 2018 / Published: 17 August 2018
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Abstract
In sub-Saharan Africa, in particular in rural areas, patients have limited access to doctors with specialist skills in skin diseases. To address this issue, a teledermatology pilot programme focused on primary health centres was set up in Mali. This study was aimed at [...] Read more.
In sub-Saharan Africa, in particular in rural areas, patients have limited access to doctors with specialist skills in skin diseases. To address this issue, a teledermatology pilot programme focused on primary health centres was set up in Mali. This study was aimed at investigating the feasibility of this programme and its impact on the management of skin diseases. The programme was based on the store-and-forward model. Health care providers from 10 primary centres were trained to manage common skin diseases, to capture images of skin lesions, and to use an e-platform to post all cases beyond their expertise for dermatologists in order to obtain diagnosis and treatment recommendations. After training, the cases of 180 patients were posted by trained health workers on the platform. Ninety-six per cent of these patients were properly managed via the responses given by dermatologists. The mean time to receive the expert’s response was 32 h (range: 13 min to 20 days). Analysis of all diseases diagnosed via the platform revealed a wide range of skin disorders. Our initiative hugely improved the management of all skin diseases in the targeted health centres. In developing countries, Internet accessibility and connection quality represent the main challenges when conducting teledermatology programmes. Full article
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Open AccessArticle
Long-Range Diagnosis of and Support for Skin Conditions in Field Settings
Trop. Med. Infect. Dis. 2018, 3(3), 84; https://doi.org/10.3390/tropicalmed3030084
Received: 9 July 2018 / Revised: 6 August 2018 / Accepted: 7 August 2018 / Published: 13 August 2018
Cited by 1 | PDF Full-text (866 KB) | HTML Full-text | XML Full-text
Abstract
Skin diseases are a significant cause of morbidity and mortality worldwide; however, access to dermatology services are critically limited, particularly in low- to middle-income countries (LMIC), where there is an overall shortage of physicians. Implementation of long-range technological support tools has been growing [...] Read more.
Skin diseases are a significant cause of morbidity and mortality worldwide; however, access to dermatology services are critically limited, particularly in low- to middle-income countries (LMIC), where there is an overall shortage of physicians. Implementation of long-range technological support tools has been growing in an effort to provide quality dermatology care to even the most remote settings globally. eHealth strategies can provide realistic healthcare solutions if implemented in a feasible and sensitive way, customizing tools to address the unique needs and resource limitations of the local setting. This article summarizes the various types of telemedicine and mobile health (mHealth) tools and their practical applications and benefits for patient care. The challenges and barriers of teledermatology are discussed, as well as steps to consider when implementing a new teledermatology initiative. eHealth arguably offers one of the most flexible and realistic tools for providing critically needed access to dermatology skills in underserved LMICs. Full article
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Review

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Open AccessReview
Integrated Management of Skin NTDs—Lessons Learned from Existing Practice and Field Research
Trop. Med. Infect. Dis. 2018, 3(4), 120; https://doi.org/10.3390/tropicalmed3040120
Received: 26 September 2018 / Revised: 10 November 2018 / Accepted: 11 November 2018 / Published: 14 November 2018
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Abstract
Integration of neglected tropical diseases (NTDs) into the public health agenda has been a priority in global health for the last decade. Because a number of these diseases share not only the geographical distribution, but also a common feature which is skin involvement, [...] Read more.
Integration of neglected tropical diseases (NTDs) into the public health agenda has been a priority in global health for the last decade. Because a number of these diseases share not only the geographical distribution, but also a common feature which is skin involvement, bringing together a sub-group of ‘skin NTDs’ is one way forward to promote further integration among NTDs. With these diseases, which include leprosy, Buruli ulcer, yaws, mycetoma, lymphatic filariasis, and leishmaniasis, patients may be left with life-long deformities and disabilities when diagnosis and treatment are delayed. Stigma is another serious consequence of skin NTDs as it places a large barrier on the economic activities and social life of a patient. As a result, this creates a vicious cycle and obstructs a key goal of society, the elimination of poverty. Enhancement in surveillance systems as well as the further development of diagnostic methods, improvement in treatment and management, and identification of preventative measures for skin NTDs are therefore urgently needed. This article summarizes the existing practices and field research on skin NTDs and identifies potential synergies that could be achieved by adopting this integrated approach. Full article
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Open AccessReview
Polymerase Chain Reaction (PCR) as a Potential Point of Care Laboratory Test for Leprosy Diagnosis—A Systematic Review
Trop. Med. Infect. Dis. 2018, 3(4), 107; https://doi.org/10.3390/tropicalmed3040107
Received: 20 July 2018 / Revised: 19 September 2018 / Accepted: 23 September 2018 / Published: 1 October 2018
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Abstract
Leprosy is an infectious disease caused by Mycobacterium leprae and mainly affects skin, peripheral nerves, and eyes. Suitable tools for providing bacteriological evidence of leprosy are needed for early case detection and appropriate therapeutic management. Ideally these tools are applicable at all health [...] Read more.
Leprosy is an infectious disease caused by Mycobacterium leprae and mainly affects skin, peripheral nerves, and eyes. Suitable tools for providing bacteriological evidence of leprosy are needed for early case detection and appropriate therapeutic management. Ideally these tools are applicable at all health care levels for the effective control of leprosy. This paper presents a systematic review analysis in order to investigate the performance of polymerase chain reaction (PCR) vis-à-vis slit skin smears (SSS) in various clinical settings and its potential usefulness as a routine lab test for leprosy diagnosis. Records of published journal articles were identified through PubMed database search. Twenty-seven articles were included for the analysis. The evidence from this review analysis suggests that PCR on skin biopsy is the ideal diagnostic test. Nevertheless, PCR on SSS samples also seems to be useful with its practical value for application, even at primary care levels. The review findings also indicated the necessity for improving the sensitivity of PCR and further research on specificity in ruling out other clinical conditions that may mimic leprosy. The M. leprae-specific repetitive element (RLEP) was the most frequently-used marker although its variable performance across the clinical sites and samples are a matter of concern. Undertaking further research studies with large sample numbers and uniform protocols studied simultaneously across multiple clinical sites is recommended to address these issues. Full article
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Open AccessReview
The Skin—A Common Pathway for Integrating Diagnosis and Management of NTDs
Trop. Med. Infect. Dis. 2018, 3(3), 101; https://doi.org/10.3390/tropicalmed3030101
Received: 9 August 2018 / Revised: 4 September 2018 / Accepted: 5 September 2018 / Published: 10 September 2018
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Abstract
Many of the neglected tropical diseases (NTDs) have major skin manifestations. These skin-related NTDs or ‘skin NTDs’ cause significant morbidity and economic hardship in some of the poorest communities worldwide. We draw attention to the collective burden of skin disease and suggest that [...] Read more.
Many of the neglected tropical diseases (NTDs) have major skin manifestations. These skin-related NTDs or ‘skin NTDs’ cause significant morbidity and economic hardship in some of the poorest communities worldwide. We draw attention to the collective burden of skin disease and suggest that the skin be used as a platform for the integration of control activities for NTDs. The opportunities for integration are numerous, ranging from diagnosis and disease mapping to mass drug administration and morbidity management. The dermatology community has an important role to play, and will be expected to support research and control activities globally. Full article
Open AccessReview
Control Strategies for Scabies
Trop. Med. Infect. Dis. 2018, 3(3), 98; https://doi.org/10.3390/tropicalmed3030098
Received: 12 August 2018 / Revised: 3 September 2018 / Accepted: 3 September 2018 / Published: 5 September 2018
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Abstract
Scabies is a neglected tropical disease of the skin, causing severe itching and stigmatizing skin lesions. Further, scabies leads to impetigo, severe bacterial infections, and post-infectious complications. Around 200 million people are affected, particularly among disadvantaged populations living in crowded conditions in tropical [...] Read more.
Scabies is a neglected tropical disease of the skin, causing severe itching and stigmatizing skin lesions. Further, scabies leads to impetigo, severe bacterial infections, and post-infectious complications. Around 200 million people are affected, particularly among disadvantaged populations living in crowded conditions in tropical areas. After almost 50 years, research into scabies control has shown great promise, particularly in highly-endemic island settings, but these findings have not been widely adopted. Newer approaches, utilizing ivermectin-based mass drug administration, appear feasible and highly effective. Inclusion of scabies in the WHO portfolio of neglected tropical diseases in 2017 may facilitate renewed opportunities and momentum toward global control. However, further operational research is needed to develop evidence-based strategies for control in a range of settings, and monitor their impact. Several enabling factors are required for successful implementation, including availability of affordable drug supply. Integration with existing health programs may provide a cost-effective approach to control. Full article
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Open AccessReview
Mycetoma: The Spectrum of Clinical Presentation
Trop. Med. Infect. Dis. 2018, 3(3), 97; https://doi.org/10.3390/tropicalmed3030097
Received: 4 August 2018 / Revised: 22 August 2018 / Accepted: 30 August 2018 / Published: 4 September 2018
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Abstract
Mycetoma is a chronic infection, newly designated by the World Health Organization (WHO) as a neglected tropical disease, which is endemic in tropical and subtropical regions. It follows implantation of infectious organisms, either fungi (eumycetomas) or filamentous bacteria (actinomycetomas) into subcutaneous tissue, from [...] Read more.
Mycetoma is a chronic infection, newly designated by the World Health Organization (WHO) as a neglected tropical disease, which is endemic in tropical and subtropical regions. It follows implantation of infectious organisms, either fungi (eumycetomas) or filamentous bacteria (actinomycetomas) into subcutaneous tissue, from where infection spreads to involve skin, bone and subcutaneous sites, leading to both health related and socioeconomic problems. In common with other NTDs, mycetoma is most often seen in rural areas amongst the poorest of people who have less access to health care. The organisms form small microcolonies that are discharged onto the skin surface via sinus tracts, or that can burrow into other adjacent tissues including bone. This paper describes the clinical features of mycetoma, as early recognition is a key to early diagnosis and the institution of appropriate treatment including surgery. Because these lesions are mostly painless and the majority of infected individuals present late and with advanced disease, simplifying early recognition is an important public health goal. Full article
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Open AccessReview
Onchodermatitis: Where Are We Now?
Trop. Med. Infect. Dis. 2018, 3(3), 94; https://doi.org/10.3390/tropicalmed3030094
Received: 30 July 2018 / Revised: 27 August 2018 / Accepted: 28 August 2018 / Published: 1 September 2018
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Abstract
Onchocerciasis causes debilitating pruritus and rashes as well as visual impairment and blindness. Prior to control measures, eye disease was particularly prominent in savanna areas of sub-Saharan Africa whilst skin disease was more common across rainforest regions of tropical Africa. Mass drug distribution [...] Read more.
Onchocerciasis causes debilitating pruritus and rashes as well as visual impairment and blindness. Prior to control measures, eye disease was particularly prominent in savanna areas of sub-Saharan Africa whilst skin disease was more common across rainforest regions of tropical Africa. Mass drug distribution with ivermectin is changing the global scene of onchocerciasis. There has been successful progressive elimination in Central and Southern American countries and the World Health Organization has set a target for elimination in Africa of 2025. This literature review was conducted to examine progress regarding onchocercal skin disease. PubMed searches were performed using keywords ‘onchocerciasis’, ‘onchodermatitis’ and ‘onchocercal skin disease’ over the past eight years. Articles in English, or with an English abstract, were assessed for relevance, including any pertinent references within the articles. Recent progress in awareness of, understanding and treatment of onchocercal skin disease is reviewed with particular emphasis on publications within the past five years. The global burden of onchodermatitis is progressively reducing and is no longer seen in children in many formerly endemic foci. Full article
Open AccessReview
Advances in the Treatment of Yaws
Trop. Med. Infect. Dis. 2018, 3(3), 92; https://doi.org/10.3390/tropicalmed3030092
Received: 31 July 2018 / Revised: 27 August 2018 / Accepted: 27 August 2018 / Published: 29 August 2018
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Abstract
Yaws is one of the three endemic treponematoses and is recognised by the World Health Organization as a neglected tropical disease. Yaws is currently reported in 15 countries in the Pacific, South-East Asia, West and Central Africa, predominantly affects children, and results in [...] Read more.
Yaws is one of the three endemic treponematoses and is recognised by the World Health Organization as a neglected tropical disease. Yaws is currently reported in 15 countries in the Pacific, South-East Asia, West and Central Africa, predominantly affects children, and results in destructive lesions of the skin and soft tissues. For most of the twentieth century penicillin-based treatment was the standard of care and resistance to penicillin has still not been described. Recently, oral azithromycin has been shown to be an effective treatment for yaws, facilitating renewed yaws eradication efforts. Resistance to azithromycin is an emerging threat and close surveillance will be required as yaws eradication efforts are scaled up globally. Full article
Open AccessReview
Community Involvement in the Care of Persons Affected by Podoconiosis—A Lesson for Other Skin NTDs
Trop. Med. Infect. Dis. 2018, 3(3), 87; https://doi.org/10.3390/tropicalmed3030087
Received: 20 July 2018 / Revised: 8 August 2018 / Accepted: 11 August 2018 / Published: 16 August 2018
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Abstract
Podoconiosis is a neglected tropical disease (NTD) characterized by lower-leg swelling (lymphedema), which is caused by long-term exposure to irritant red-clay soils found within tropical volcanic high-altitude environments with heavy rainfall. The condition places a substantial burden on affected people, their families and [...] Read more.
Podoconiosis is a neglected tropical disease (NTD) characterized by lower-leg swelling (lymphedema), which is caused by long-term exposure to irritant red-clay soils found within tropical volcanic high-altitude environments with heavy rainfall. The condition places a substantial burden on affected people, their families and communities, including disability, economic consequences, social exclusion, and stigma; mental disorders and distress are also common. This paper focuses on community-based care of podoconiosis, and, in particular, the role that community involvement can have in the reduction of stigma against people affected by podoconiosis. We first draw on research conducted in Ethiopia for this, which has included community-based provision of care and treatment, education, and awareness-raising, and socioeconomic rehabilitation to reduce stigma. Since people affected by podoconiosis and other skin NTDs often suffer the double burden of mental-health illness, which is similarly stigmatized, we then point to examples from the mental-health field in low-resource community settings to suggest avenues for stigma reduction and increased patient engagement that may be relevant across a range of skin NTDs, though further research is needed on this. Full article
Open AccessReview
Potential Animal Reservoir of Mycobacterium ulcerans: A Systematic Review
Trop. Med. Infect. Dis. 2018, 3(2), 56; https://doi.org/10.3390/tropicalmed3020056
Received: 11 April 2018 / Revised: 10 May 2018 / Accepted: 24 May 2018 / Published: 30 May 2018
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Abstract
Mycobacterium ulcerans is the causative agent of Buruli ulcer, also known in Australia as Daintree ulcer or Bairnsdale ulcer. This destructive skin disease is characterized by extensive and painless necrosis of the skin and soft tissue with the formation of large ulcers, commonly [...] Read more.
Mycobacterium ulcerans is the causative agent of Buruli ulcer, also known in Australia as Daintree ulcer or Bairnsdale ulcer. This destructive skin disease is characterized by extensive and painless necrosis of the skin and soft tissue with the formation of large ulcers, commonly on the leg or arm. To date, 33 countries with tropical, subtropical and temperate climates in Africa, the Americas, Asia and the Western Pacific have reported cases of Buruli ulcer. The disease is rarely fatal, although it may lead to permanent disability and/or disfigurement if not treated appropriately or in time. It is the third most common mycobacterial infection in the world after tuberculosis and leprosy. The precise mode of transmission of M. ulcerans is yet to be elucidated. Nevertheless, it is possible that the mode of transmission varies with different geographical areas and epidemiological settings. The knowledge about the possible routes of transmission and potential animal reservoirs of M. ulcerans is poorly understood and still remains patchy. Infectious diseases arise from the interaction of agent, host and environment. The majority of emerging or remerging infectious disease in human populations is spread by animals: either wildlife, livestock or pets. Animals may act as hosts or reservoirs and subsequently spread the organism to the environment or directly to the human population. The reservoirs may or may not be the direct source of infection for the hosts; however, they play a major role in maintenance of the organism in the environment, and in the mode of transmission. This remains valid for M. ulcerans. Possums have been suggested as one of the reservoir of M. ulcerans in south-eastern Australia, where possums ingest M. ulcerans from the environment, amplify them and shed the organism through their faeces. We conducted a systematic review with selected key words on PubMed and INFORMIT databases to aggregate available published data on animal reservoirs of M. ulcerans around the world. After certain inclusion and exclusion criteria were implemented, a total of 17 studies was included in the review. A variety of animals around the world e.g., rodents, shrews, possums (ringtail and brushtail), horses, dogs, alpacas, koalas and Indian flap-shelled turtles have been recorded as being infected with M. ulcerans. The majority of studies included in this review identified animal reservoirs as predisposing to the emergence and reemergence of M. ulcerans infection. Taken together, from the selected studies in this systematic review, it is clear that exotic wildlife and native mammals play a significant role as reservoirs for M. ulcerans. Full article
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Open AccessCase Report
Cushing Syndrome due to Inappropriate Corticosteroid Topical Treatment of Undiagnosed Scabies
Trop. Med. Infect. Dis. 2018, 3(3), 82; https://doi.org/10.3390/tropicalmed3030082
Received: 26 June 2018 / Revised: 23 July 2018 / Accepted: 24 July 2018 / Published: 3 August 2018
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Abstract
The uncontrolled sale of topical corticosteroids has become an important risk factor for the development of iatrogenic Cushing syndrome in children, especially in countries where medications are sold over the counter. This is exacerbated by the lack of information for both the patients [...] Read more.
The uncontrolled sale of topical corticosteroids has become an important risk factor for the development of iatrogenic Cushing syndrome in children, especially in countries where medications are sold over the counter. This is exacerbated by the lack of information for both the patients and pharmacists. This report documents a series of eight cases of iatrogenic Cushing syndrome secondary to an inappropriate use of topical steroids, due to a misdiagnosis of scabies. Full article
Trop. Med. Infect. Dis. EISSN 2414-6366 Published by MDPI AG, Basel, Switzerland RSS E-Mail Table of Contents Alert
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