Hospital admissions for skin and soft tissue infections in a population with endemic scabies: A prospective study in Fiji, 2018-2019

PLoS Negl Trop Dis. 2020 Dec 9;14(12):e0008887. doi: 10.1371/journal.pntd.0008887. eCollection 2020 Dec.

Abstract

Scabies is an important predisposing factor for impetigo but its role in more serious skin and soft tissue infections (SSTIs) is not well understood. Information is limited on incidence of SSTIs in the presence of endemic scabies. We conducted a prospective study of hospital admissions for SSTIs in the Northern Division of Fiji (population: 131,914). Prospective surveillance for admissions with impetigo, abscess, cellulitis, wound infection, pyomyositis, necrotizing fasciitis, infected scabies, and crusted scabies was conducted at the Division's referral hospital between 2018 to 2019. Information was collected on demographic characteristics, clinical features, microbiology, treatment and outcomes. Over the study period, 788 SSTI admissions were recorded corresponding to a population incidence 647 per 100,000 person-years (95%CI 571-660). Incidence was highest at the extremes of age with peak incidence in children aged <5 years (908 per 100,000) and those aged ≥65 years (1127 per 100,000). Incidence was 1.7 times higher among the Indigenous Fijian population (753 per 100,000) compared to other ethnicities (442 per 100,000). Overall case fatality rate was 3.3%, and 10.8% for those aged ≥65 years. Scabies was diagnosed concurrently in 7.6% of all patients and in 24.6% of admitted children <5 years. There is a very high burden of hospital admissions for SSTIs in Fiji compared to high-income settings especially among the youngest, oldest and indigenous population which is concordant with scabies and impetigo distribution in this population. Our findings highlight the need for strategies to reduce the burden of SSTIs in Fiji and similar settings.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Child
  • Child, Preschool
  • Endemic Diseases
  • Female
  • Fiji / epidemiology
  • Hospitalization
  • Humans
  • Incidence
  • Infant
  • Male
  • Middle Aged
  • Prospective Studies
  • Scabies / epidemiology*
  • Skin Diseases, Bacterial / complications*
  • Skin Diseases, Bacterial / microbiology
  • Soft Tissue Infections / complications*
  • Soft Tissue Infections / microbiology
  • Young Adult

Grants and funding

Funding for this study was from the National Health and Medical Research Council (NHMRC) of Australia, awarded as a project grant (Grant number: APP1127300) to Andrew Steer (Principal Investigator), Margot Whitfeld, Handan Wand, Mike Kama, Joseph Kado, Lucia Romani and Natalie Carvalho. The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.