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Ophthalmic & Physiological Optics : the... Jul 2020There is increasing clinical and research interest in the potential contribution of Demodex to ocular surface disease. The aim of this systematic review was to summarise...
PURPOSE
There is increasing clinical and research interest in the potential contribution of Demodex to ocular surface disease. The aim of this systematic review was to summarise and synthesise current clinical evidence relating to the aetiology, diagnosis and treatment of ocular Demodex.
RECENT FINDINGS
A comprehensive literature search was performed in OVID Medline, OVID Embase, and clinical trial registries, for studies published between 1990 and August 2019, examining Demodex on the ocular surface. The review included primary clinical research studies and systematic reviews of primary clinical research studies, where Demodex was considered in the context of the ocular surface and/or adnexa. Studies were categorised using the National Health and Medical Research Council evidence hierarchy. Risk of bias assessment was performed using validated tools for studies categorised as providing Level I or II evidence. A total of 87 studies were eligible for inclusion, including two systematic reviews. Most studies (60%) were observational, describing the prevalence of ocular Demodex in different clinical populations. There was a high degree of variability in the epidemiological data derived from cross-sectional aetiology studies. There was mostly consistent evidence to support an association between ocular Demodex and chronic blepharitis. Seven diagnostic test-accuracy studies were identified, which considered a range of techniques, including slit lamp examination for cylindrical eyelash collarettes and/or eyelash manipulation techniques, light microscopic evaluation of epilated eyelashes and in vivo confocal microscopy. There is currently no accepted gold-standard diagnostic method for ocular Demodex. For intervention studies, there was one systematic review, 11 published randomised trials, six trial registry entries, and nine case series. Despite a number of recent trials, the appropriate treatment regimen for ocular Demodex (including the optimal criteria and timing of an intervention) is not clearly established.
CONCLUSIONS
This comprehensive narrative synthesis has captured the landscape of clinical evidence relating to the prevalence, aetiology, diagnosis and treatment of ocular Demodex. There remain opportunities to enhance understanding of its role in ocular surface disease, best diagnostic approaches and optimal treatment protocols.
Topics: Animals; Blepharitis; Eye Infections, Parasitic; Eyelashes; Humans; Microscopy, Confocal; Mite Infestations
PubMed: 32691894
DOI: 10.1111/opo.12691 -
The Cochrane Database of Systematic... Jun 2020Demodex blepharitis is a chronic condition commonly associated with recalcitrant dry eye symptoms though many people with Demodex mites are asymptomatic. The primary... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Demodex blepharitis is a chronic condition commonly associated with recalcitrant dry eye symptoms though many people with Demodex mites are asymptomatic. The primary cause of this condition in humans is two types of Demodex mites: Demodex folliculorum and Demodex brevis. There are varying reports of the prevalence of Demodex blepharitis among adults, and it affects both men and women equally. While Demodex mites are commonly treated with tea tree oil, the effectiveness of tea tree oil for treating Demodex blepharitis is not well documented.
OBJECTIVES
To evaluate the effects of tea tree oil on ocular Demodex infestation in people with Demodex blepharitis.
SEARCH METHODS
We searched CENTRAL (which contains the Cochrane Eyes and Vision Trials Register) (2019, Issue 6); Ovid MEDLINE; Embase.com; PubMed; LILACS; ClinicalTrials.gov; and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP). We used no date or language restrictions in the electronic search for trials. We last searched the databases on 18 June 2019.
SELECTION CRITERIA
We included randomized controlled trials (RCTs) that compared treatment with tea tree oil (or its components) versus another treatment or no treatment for people with Demodex blepharitis.
DATA COLLECTION AND ANALYSIS
Two review authors independently screened the titles and abstracts and then full text of records to determine their eligibility. The review authors independently extracted data and assessed risk of bias using Covidence. A third review author resolved any conflicts at all stages.
MAIN RESULTS
We included six RCTs (1124 eyes of 562 participants; 17 to 281 participants per study) from the US, Korea, China, Australia, Ireland, and Turkey. The RCTs compared some formulation of tea tree oil to another treatment or no treatment. Included participants were both men and women, ranging from 39 to 55 years of age. All RCTs were assessed at unclear or high risk of bias in one or more domains. We also identified two RCTs that are ongoing or awaiting publications. Data from three RCTs that reported a short-term mean change in the number of Demodex mites per eight eyelashes contributed to a meta-analysis. We are uncertain about the mean reduction for the groups that received the tea tree oil intervention (mean difference [MD] 0.70, 95% confidence interval [CI] 0.24 to 1.16) at four to six weeks as compared to other interventions. Only one RCT reported data for long-term changes, which found that the group that received intense pulse light as the treatment had complete eradication of Demodex mites at three months. We graded the certainty of the evidence for this outcome as very low. Three RCTs reported no evidence of a difference for participant reported symptoms measured on the Ocular Surface Disease Index (OSDI) between the tea tree oil group and the group receiving other forms of intervention. Mean differences in these studies ranged from -10.54 (95% CI - 24.19, 3.11) to 3.40 (95% CI -0.70 7.50). We did not conduct a meta-analysis for this outcome given substantial statistical heterogeneity and graded the certainty of the evidence as low. One RCT provided information concerning visual acuity but did not provide sufficient data for between-group comparisons. The authors noted that mean habitual LogMAR visual acuity for all study participants improved post-treatment (mean LogMAR 1.16, standard deviation 0.26 at 4 weeks). We graded the certainty of evidence for this outcome as low. No RCTs provided data on mean change in number of cylindrical dandruff or the proportion of participants experiencing conjunctival injection or experiencing meibomian gland dysfunction. Three RCTs provided information on adverse events. One reported no adverse events. The other two described a total of six participants randomized to treatment with tea tree oil who experienced ocular irritation or discomfort that resolved with re-educating the patient on application techniques and continuing use of the tea tree oil. We graded the certainty of the evidence for this outcome as very low.
AUTHORS' CONCLUSIONS
The current review suggests that there is uncertainty related to the effectiveness of 5% to 50% tea tree oil for the short-term treatment of Demodex blepharitis; however, if used, lower concentrations may be preferable in the eye care arena to avoid induced ocular irritation. Future studies should be better controlled, assess outcomes at long term (e.g. 10 to 12 weeks or beyond), account for patient compliance, and study the effects of different tea tree oil concentrations.
Topics: Adult; Anti-Infective Agents, Local; Blepharitis; Female; Humans; Male; Middle Aged; Mite Infestations; Randomized Controlled Trials as Topic; Tea Tree Oil
PubMed: 32589270
DOI: 10.1002/14651858.CD013333.pub2 -
BMC Infectious Diseases May 2020Scabies is an infectious disease that affects the skin caused by the mite Sarcoptes scabiei and it transmitted through close personal contact. Even though it is easily... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Scabies is an infectious disease that affects the skin caused by the mite Sarcoptes scabiei and it transmitted through close personal contact. Even though it is easily treatable disease, its prevalence is high and continuous as neglected tropical disease of resource-poor settings, and particularly affects young age groups. Despite of these facts, studies conducted in Ethiopia regarding to the prevalence and associated factors for scabies infestation have been highly variable and didn't well compiled. Due to that, the aim of this systematic review and meta-analysis was to estimates the overall prevalence of scabies and associated factors in all age groups in Ethiopia.
METHODS
International databases (PubMed/PMC/Midline, EMBASE, CINAHL, Web of Science, Google Scholar, Google and Science Direct) were systematically searched from December 1, 2019, to January 18, 2020. All observational studies noted the prevalence of human scabies and associated factors in Ethiopia were included. Two authors (AG and G.T) independently extracted all necessary data using a standardized data extraction format. The data which is extracted each study were analyzed using STATA Version 14.1. Heterogeneity among the included studies was assessed through the Cochrane Q test statistics and I test. Lastly, a random effects meta-analysis model was computed to fix overall prevalence and associated factors of scabies.
RESULTS
Twelve studies were included in this meta-analysis after 410 articles retrieved. Of these, eight studies were analyzed for prevalence estimation. The overall prevalence of scabies infestation was 14.5% (95%CI: 1.5, 27.6%) in Ethiopia. Furthermore, the subgroup analysis revealed the highest prevalence was 19.6% in Amhara region. A person from a large family size (OR: 3.1, 95% CI: 1.76, 5.67), and sharing a bed (OR: 3.59, 95%CI: 2.88, 4.47) were significantly associated with scabies.
CONCLUSION
This study revealed the prevalence of scabies infestation was 14.5% in Ethiopia which was high. Persons from high family size and any contact with scabies case were factors associated with scabies.
Topics: Animals; Ethiopia; Family Characteristics; Humans; Prevalence; Risk Factors; Sarcoptes scabiei; Scabies; Skin
PubMed: 32460770
DOI: 10.1186/s12879-020-05106-3 -
International Journal For Parasitology Jun 2020The ectoparasitic mite Varroa destructor is the most significant pathological threat to the western honey bee, Apis mellifera, leading to the death of most colonies if... (Review)
Review
The ectoparasitic mite Varroa destructor is the most significant pathological threat to the western honey bee, Apis mellifera, leading to the death of most colonies if left untreated. An alternative approach to chemical treatments is to selectively enhance heritable honey bee traits of resistance or tolerance to the mite through breeding programs, or select for naturally surviving untreated colonies. We conducted a literature review of all studies documenting traits of A. mellifera populations either selectively bred or naturally selected for resistance and tolerance to mite parasitism. This allowed us to conduct an analysis of the diversity, distribution and importance of the traits in different honey bee populations that can survive V. destructor globally. In a second analysis, we investigated the genetic bases of these different phenotypes by comparing 'omics studies (genomics, transcriptomics, and proteomics) of A. mellifera resistance and tolerance to the parasite. Altogether, this review provides a detailed overview of the current state of the research projects and breeding efforts against the most devastating parasite of A. mellifera. By highlighting the most promising traits of Varroa-surviving bees and our current knowledge on their genetic bases, this work will help direct future research efforts and selection programs to control this pest. Additionally, by comparing the diverse populations of honey bees that exhibit those traits, this review highlights the consequences of anthropogenic and natural selection in the interactions between hosts and parasites.
Topics: Animals; Bees; Genomics; Host-Parasite Interactions; Phenotype; Varroidae
PubMed: 32380096
DOI: 10.1016/j.ijpara.2020.03.005 -
PloS One 2020Existing evidence on the relationship between childhood lower respiratory tract infections (LRTI) and the subsequent atopy development is controversial. We aimed to... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Existing evidence on the relationship between childhood lower respiratory tract infections (LRTI) and the subsequent atopy development is controversial. We aimed to investigate an association between viral LRTI at <5 years and the development of atopy at > 2 years.
METHODS
We conducted a search at Embase, Pubmed, Web of Science, and Global Index Medicus. We collected data from the included articles. We estimated the odds ratio and the 95% confidence intervals with a random effect model. We determined factors associated with atopy development after childhood LRTI using univariate and multivariate meta-regression analyses. We recorded this systematic review at PROSPERO with the number CRD42018116955.
RESULTS
We included 24 studies. There was no relationship between viral LRTI at <5 years and skin prick test-diagnosed-atopy (OR = 1.2, [95% CI = 0.7-2.0]), unknown diagnosed-atopy (OR = 0.7, [95% CI = 0.4-1.3]), atopic dermatitis (OR = 1.2, [95% CI = 0.9-1.6]), hyperreactivity to pollen (OR = 0.8, [95% CI = 0.3-2.7]), food (OR = 0.8, [95% CI = 0.3-2.5]), or house dust mite (OR = 1.1, [95% CI = 0.6-2.2]). Although not confirmed in all studies with a symmetric distribution of the 23 confounding factors investigated, the overall analyses showed that there was a relationship between childhood viral LRTI at < 5 years and serum test diagnosed-atopy (OR = 2.0, [95% CI = 1.0-4.1]), allergic rhinoconjunctivitis (OR = 1.7, [95% CI = 1.1-2.9]), hyperreactivity diagnosed by serum tests with food (OR = 5.3, [1.7-16.7]) or inhaled allergens (OR = 4.2, [95% CI = 2.1-8.5]), or furred animals (OR = 0.6, [95% CI = 0.5-0.9]).
CONCLUSION
These results suggest that there is no association between viral LRTI at < 5 years and the majority of categories of atopy studied during this work. These results, however, are not confirmed for the remaining categories of atopy and more particularly those diagnosed by serum tests. There is a real need to develop more accurate atopy diagnostic tools.
Topics: Allergens; Animals; Asthma; Child; Conjunctivitis, Allergic; Dermatitis, Atopic; Dermatophagoides pteronyssinus; Humans; Pollen; Respiratory Tract Infections; Rhinitis, Allergic; Skin Tests; Time Factors
PubMed: 32330171
DOI: 10.1371/journal.pone.0231816 -
International Forum of Allergy &... Nov 2020Allergic rhinitis (AR) is a major public health problem and is increasing worldwide. AR affects children's learning efficiency, sleep quality, and other major aspects of... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Allergic rhinitis (AR) is a major public health problem and is increasing worldwide. AR affects children's learning efficiency, sleep quality, and other major aspects of life. Sublingual immunotherapy (SLIT) is effective and safe for children with seasonal AR, but for children with perennial allergic rhinitis (PAR) caused by house dust mites (HDM), its effectiveness and safety is less convincing.
METHODS
Medical literature databases up to 2019 were searched for published and unpublished pieces of evidence. Studies were individually screened by 2 reviewers against the eligibility criteria. Primary outcomes were total nasal symptoms scores (TNSS) and total medication scores (TMS). The secondary outcomes were total ocular symptoms scores and adverse events (AEs). Random effect models and fixed-effect models were used to calculate the standard mean difference (SMD) and risk ratio (RR), respectively.
RESULTS
We identified 3772 abstracts, of which only 16 studies met our established criteria. SLIT significantly reduced TNSS (SMD -1.73; 95% CI, -2.62 to -0.84; p = 0.0001) and TMS (SMD -1.21; 95% CI, -1.75 to -0.67; p < 0.00001). Compared with children taking placebo, children taking SLIT were 1.08 (95% CI, 1 to 1.17; p = 0.05), 1.15 (95% CI, 0.87 to 1.51; p = 0.32), and 1.68 (95% CI, 0.68 to 4.11; p = 0.26) times more likely to develop mild, moderate, and severe AEs, respectively.
CONCLUSION
HDM SLIT can effectively alleviate TNSS and TMS in children with PAR, but care should be taken to avoid harm due to possible adverse drug reactions.
Topics: Allergens; Animals; Antigens, Dermatophagoides; Child; Humans; Pyroglyphidae; Rhinitis; Rhinitis, Allergic; Rhinitis, Allergic, Perennial; Rhinitis, Allergic, Seasonal; Sublingual Immunotherapy; Treatment Outcome
PubMed: 32329187
DOI: 10.1002/alr.22589 -
Expert Opinion on Therapeutic Patents Mar 2020: Allergic illnesses are one of the most prevalent immunological disorders worldwide and house dust mites are important triggers of these diseases. Allergen-specific...
: Allergic illnesses are one of the most prevalent immunological disorders worldwide and house dust mites are important triggers of these diseases. Allergen-specific immunotherapy (AIT) is an alternative treatment to pharmacotherapy and among its technologies, recombinant hypoallergenic derivatives have shown promising features, turn them into safer and more efficient allergy vaccines.: Patents and scientific publications referring to advances in the design of spp. hypoallergenic molecules. Data were obtained from the Espacenet® and PubMed websites, using different key terms, advanced tools and Boolean operators for searches. The retrieved data were then descriptively analyzed, taking into consideration clinical targets, geographical, temporal, collaborative, and different classification aspects of the productions.: Joint advances of molecular biology, genetic engineering, and bioinformatics technologies led to progresses in the design of spp. hypoallergenic derivatives. Collaborative networks seem to be an interesting way not only to improve technologies in AIT but also to boost the number of patents, publications, and grants for researchers. The observed trend for the use of hypoallergenic hybrid molecules was a fundamental AIT advance and this type of molecule appears to be a more attractive product for companies and more convenient, efficient, and safer allergy immunotherapy for patients.
Topics: Allergens; Animals; Desensitization, Immunologic; Humans; Hypersensitivity; Patents as Topic; Pyroglyphidae
PubMed: 31913726
DOI: 10.1080/13543776.2020.1712360 -
Parasites & Vectors Nov 2019Scrub typhus, caused by Orientia tsutsugamushi, is an important and neglected vector-borne zoonotic disease with an expanding known distribution. The ecology of the...
Scrub typhus, caused by Orientia tsutsugamushi, is an important and neglected vector-borne zoonotic disease with an expanding known distribution. The ecology of the disease is complex and poorly understood, impairing discussion of public health interventions. To highlight what we know and the themes of our ignorance, we conducted a systematic review of all studies investigating the pathogen in vectors and non-human hosts. A total of 276 articles in 7 languages were included, with 793 study sites across 30 countries. There was no time restriction for article inclusion, with the oldest published in 1924. Seventy-six potential vector species and 234 vertebrate host species were tested, accounting for over one million trombiculid mites ('chiggers') and 83,000 vertebrates. The proportion of O. tsutsugamushi positivity was recorded for different categories of laboratory test and host species. Vector and host collection sites were geocoded and mapped. Ecological data associated with these sites were summarised. A further 145 articles encompassing general themes of scrub typhus ecology were reviewed. These topics range from the life-cycle to transmission, habitats, seasonality and human risks. Important gaps in our understanding are highlighted together with possible tools to begin to unravel these. Many of the data reported are highly variable and inconsistent and minimum data reporting standards are proposed. With more recent reports of human Orientia sp. infection in the Middle East and South America and enormous advances in research technology over recent decades, this comprehensive review provides a detailed summary of work investigating this pathogen in vectors and non-human hosts and updates current understanding of the complex ecology of scrub typhus. A better understanding of scrub typhus ecology has important relevance to ongoing research into improving diagnostics, developing vaccines and identifying useful public health interventions to reduce the burden of the disease.
Topics: Animals; Arachnid Vectors; Geographic Mapping; Humans; Orientia tsutsugamushi; Scrub Typhus; Trombiculidae; Vertebrates; Zoonoses
PubMed: 31685019
DOI: 10.1186/s13071-019-3751-x -
Dermatologic Therapy Nov 2019Bacterial folliculitis, rosacea, and other common skin conditions have been linked to infestation by Demodex mites (human demodicosis). Currently, there is little...
Bacterial folliculitis, rosacea, and other common skin conditions have been linked to infestation by Demodex mites (human demodicosis). Currently, there is little guidance for treatment of inflammatory conditions associated with demodicosis. Thus, the objective of this review is to evaluate the efficacy and safety of treatments utilized for Demodex infestation. PubMed (1946 to January 2019) and Embase (1947 to January 2019) were searched with the following term combinations: Demodex mites, Demodex folliculitis, demodicosis, Demodex folliculorum, or Demodex brevis and articles evaluating treatment of body surface colonization with Demodex mites were included. Common interventions used for Demodex infestation include metronidazole-based therapies, permethrin, benzoyl benzoate, crotamiton, lindane, and sulfur. Short courses of metronidazole taken orally have shown efficacy in reducing Demodex density. Additionally, topical administration of permethrin daily or twice daily was shown to be efficacious across multiple studies. Crotamiton and benzyl benzoate were also efficacious treatments. Several therapies were associated with mild-to-moderate skin irritation. Due to limited data, no standard of care can be identified at this time. Efficacious treatment options may include permethrin, crotamiton, benzyl benzoate, and oral metronidazole; however, long-term efficacy has not been established.
Topics: Administration, Topical; Benzoates; Folliculitis; Humans; Metronidazole; Mite Infestations; Permethrin; Rosacea; Toluidines
PubMed: 31583801
DOI: 10.1111/dth.13103 -
Allergologia Et Immunopathologia 2019Undesirable immunological responses to alimentary allergens are one of the hallmarks of atopic diseases. The prevalence of common food allergens is dissimilar among... (Meta-Analysis)
Meta-Analysis Review
Are the most common food allergens in an Iranian atopic population compatible with worldwide reports? A systemic review and meta-analysis with molecular classification of frequent allergens.
BACKGROUND
Undesirable immunological responses to alimentary allergens are one of the hallmarks of atopic diseases. The prevalence of common food allergens is dissimilar among different communities with distinct nutritional habits and genetic characteristics.
AIM
To assess the prevalence of the most common food allergens in Iran, using different reliable studies.
METHODS
All studies determining sensitization to common food allergens that were indexed in PubMed, Web of Science, Google Scholar, ProQuest, Scopus, Iran Medex, and Magiran were included in this review. To perform a meta-analysis, STATA 14 and metaprop command was applied. A logistic-normal random-effects model with Freeman-Tukey double arcsin transformation was applied to combine the findings of different studies and evaluate their heterogeneity. Random pooled estimate (ES) (pooled prevalence), 95% confidence interval (95% CI) and p-value were determined.
RESULTS
A total of 23 studies with data from a total of 6126 children and adults met the inclusion criteria for entering this meta-analysis. The respective pooled prevalence of a positive family history of allergy and positive specific IgE to at least one food allergen was 72% (95% CI: 66-77%) and 41% (95% CI: 33-49%), respectively. Our results in the total population revealed that allergic sensitization to egg yolk, cow's milk (CM), egg white, and wheat were 25% (95% CI: 16%-35%), 24% (95% CI: 19-29%), 23% (95% CI: 18%-28%), and 9% (95% CI: 6%-14%), respectively. Walnut, peanut, and soybean sensitization was detected in 23% (95% CI: 17%-31%), 23% (95% CI: 13%-33%), and 20% (95% CI: 12%-28%) of patients, respectively. Random pooled ES for sensitization to shrimp and fish was 32% (95% CI: 21-45%) and 12% (95% CI: 6-20%), respectively. The result of analysis in different age groups revealed that allergic sensitization to milk, egg white, and egg yolk declines in higher age groups; while shrimp sensitization increases in older patients. In patients with atopic dermatitis, egg white was the most frequent food allergen 29% (95% CI = 18-42%); while wheat was the least frequent 8% (95% CI = 4-14%).
CONCLUSIONS
Considering the prevalence of different food allergens, the results of the current meta-analysis revealed that egg yolk and cow's milk had the second and third rate after shrimp, respectively. The high prevalence of sensitization to shrimp may be attributed to its high consumption in coastal areas and/or cross-reactivity of shrimp with some aeroallergens such as mites.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Allergens; Child; Child, Preschool; Cross Reactions; Egg Proteins; Female; Food Hypersensitivity; Humans; Infant; Iran; Male; Middle Aged; Milk Proteins; Prevalence; Triticum; Young Adult
PubMed: 31353064
DOI: 10.1016/j.aller.2019.04.005