Demographics and comorbidities.

a<p>Median [IQR].</p

A Novel Clinical Grading Scale to Guide the Management of Crusted Scabies

<div><p>Background</p><p>Crusted scabies, or hyperinfestation with <i>Sarcoptes scabiei</i>, occurs in people with an inadequate immune response to the mite. In recent decades, data have emerged suggesting that treatment of crusted scabies with oral ivermectin combined with topical agents leads to lower mortality, but there are no generally accepted tools for describing disease severity. Here, we describe a clinical grading scale for crusted scabies and its utility in real world practice.</p><p>Methodology/Principal Findings</p><p>In 2002, Royal Darwin Hospital (RDH), a hospital in tropical Australia developed and began using a clinical grading scale to guide the treatment of crusted scabies. We conducted a retrospective observational study including all episodes of admission to RDH for crusted scabies during the period October 2002–December 2010 inclusive. Patients who were managed according to the grading scale were compared with those in whom the scale was not used at the time of admission but was calculated retrospectively. There were 49 admissions in 30 patients during the study period, of which 49 (100%) were in Indigenous Australians, 29 (59%) were male and the median age was 44.1 years. According to the grading scale, 8 (16%) episodes were mild, 24 (49%) were moderate, and 17 (35%) were severe. Readmission within the study period was significantly more likely with increasing disease severity, with an odds ratio (95% CI) of 12.8 (1.3–130) for severe disease compared with mild. The patients managed according to the grading scale (29 episodes) did not differ from those who were not (20 episodes), but they received fewer doses of ivermectin and had a shorter length of stay (11 vs. 16 days, p = 0.02). Despite this the outcomes were no different, with no deaths in either group and a similar readmission rate.</p><p>Conclusions/Significance</p><p>Our grading scale is a useful tool for the assessment and management of crusted scabies.</p></div

Grading scale, disease severity, and outcomes.

a<p>n(%).</p>b<p>Highest plasma C-reactive protein during the hospital admission (median [IQR]).</p>c<p>Lowest serum albumin value during the hospital admission (median [IQR]).</p>d<p>P value for moderate and severe combined, compared with mild, except where indicated.</p>e<p>Median [IQR].</p>f<p>P value based on Kruskall Wallis test comparing the three groups.</p

Severity grading scale for crusted scabies.

<p>Severity grading scale for crusted scabies.</p

Examples of melting curves for each target region

<p>. For some target regions not all melting curves were represented among the isolates analysed in this study, therefore not all theoretically possible curves are depicted in the figure. <b>A</b>) Target region <i>infB</i>729, showing two (12, 13) of two predicted melting curves. <b>B</b>) Target region <i>mdh</i>1197, showing two (9, 10) of three predicted melting curves. <b>C</b>) Target region <i>pho</i>E2013, showing four (18, 19, 20, 21) of four predicted melting curves. <b>D</b>) Target region <i>rpoB</i>2227, showing six (41, 42 43, 44, 45, 46) of seven predicted melting curves. <b>E</b>) Target region <i>tonB</i>2693, showing three (39, 40, 41) of seven predicted melting curves. <b>F</b>) Target region <i>tonB</i>2886, showing three (54, 55, 56) of eight predicted melting curves.</p

Power of Minim typing to identify and discriminate <i>K. pneumoniae</i> STs of particular significance.

<p>*SLV = single locus variant, DLV = double locus variant, TLV = triple locus variant, QLV = quadruple locus variant.</p

Discriminatory power from different combinations of markers, calculated against all STs (863 STs, <i>D</i> = 1).

<p>Discriminatory power from different combinations of markers, calculated against all STs (863 STs, <i>D</i> = 1).</p

Indices of association for combinations of MLST alleles with and without <i>tonB</i>, and measurements of diversity conferred by individual loci indicate that <i>tonB</i> is highly diverse and likely subjected to horizontal gene transfer.

<p>Indices of association for combinations of MLST alleles with and without <i>tonB</i>, and measurements of diversity conferred by individual loci indicate that <i>tonB</i> is highly diverse and likely subjected to horizontal gene transfer.</p

Supplementary appendices and figures from Implications of asymptomatic carriers for infectious disease transmission and control

A. Details of the literature review; B--D. Additional calculations; E. List of parameter values used for plots in each figure; Supplementary figures S1--S4

Le Cri du peuple : journal politique quotidien

15 décembre 18871887/12/15 (A4,N1508)-1887/12/15