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Journal of Cutaneous Medicine and... May 2024Rosacea is a chronic inflammatory skin condition affecting approximately 5.5% of the global population. Patients present heterogeneously with a mix of features in the...
INTRODUCTION
Rosacea is a chronic inflammatory skin condition affecting approximately 5.5% of the global population. Patients present heterogeneously with a mix of features in the central facial region, of which papules and pustules are considered to be a major feature. The identification of effective treatments for reducing inflammatory lesions in rosacea can alleviate the psychosocial burden that many rosacea patients experience, including reduced self-esteem, anxiety, and social withdrawal. The objective of this systematic review is to determine the effectiveness of topical and systemic therapies in reducing lesion count in rosacea patients.
METHODS/RESULTS
Medline, Embase, and Cochrane CENTRAL databases were searched, resulting in the inclusion of 43 clinical trials reporting on a total of 18,347 rosacea patients. The most well-studied treatments include ivermectin, metronidazole, azelaic acid, minocycline, and doxycycline. Oral isotretinoin was the most effective treatment in reducing inflammatory lesions and may be recommended for severe recalcitrant cases of rosacea.
CONCLUSIONS
Several topical and systemic therapies have demonstrated efficacy in reducing inflammatory lesion count in rosacea patients, with mechanisms of action centred around suppressing inflammation and killing mites. Additional research is required to determine effective combination therapies in rosacea.
PubMed: 38807451
DOI: 10.1177/12034754241253195 -
Journal of Vector Borne Diseases Jan 2024Rickettsial infections are emerging and/or re-emerging disease that poses a serious global threat to humans and animals. Transmission to humans and animals is through...
Rickettsial infections are emerging and/or re-emerging disease that poses a serious global threat to humans and animals. Transmission to humans and animals is through the bite of the ectoparasites including ticks, fleas and chigger mites. Most of the rickettsial diseases are endemic in India, but underdiagnosed. This review is aimed at analyzing the prevalence of rickettsiosis in India and the advancement of rickettsial diagnosis. We have conducted a systematic review on the prevalence of rickettsial disease in India ranging from 1.3% to 46.6% for spotted fever, 2.4% to 77.8% for scrub typhus and 1% to 46.4% for Q fever, based on the literature published with the evidence of isolation, serological, and molecular diagnostics. Search engines Medline/PubMed, Science Direct, ProQuest, and EBSCO were used to retrieve the articles from electronic databases by using appropriate keywords to track the emergence of these rickettsial diseases in India for the period of 1865 to till date. We retrieved 153 published rickettsial articles on hospital-based studies from India that were purely made on the basis of prevalence and the laboratory parameters viz., Weil-Felix test (WF) and Rapid Immunochromatographic tests (RICT) with reference to the gold standard IFA and ELISA. More epidemiological studies are required for epidemic typhus to know the exact prevalence status of this louse-borne rickettsiosis in India. Currently, there is no confirmed specific inflammatory marker for rickettsial diseases. Moreover, serological cross-reactivity is an important aspect, and it should be investigated in endemic areas, there is also a need to include molecular diagnostic techniques for further confirmation in healthcare settings.
Topics: Animals; Humans; India; Prevalence; Rickettsia; Rickettsia Infections; Scrub Typhus; Ticks
PubMed: 38648402
DOI: 10.4103/0972-9062.392255 -
International Journal of Infectious... Jun 2024Crusted scabies (CS, Norwegian scabies) is a severe form of scabies, characterized by hyper-infestation of Sarcoptes scabiei mites. CS is commonly associated with... (Review)
Review
OBJECTIVES
Crusted scabies (CS, Norwegian scabies) is a severe form of scabies, characterized by hyper-infestation of Sarcoptes scabiei mites. CS is commonly associated with immunosuppression but is also reported in overtly immunocompetent individuals. We reviewed immunosuppressive risk factors and comorbidities associated with CS.
METHODS
The National Library of Medicine (PubMed) database was reviewed for patient case reports of CS from January 1998 to July 2023. Two authors screened records for eligibility, extracted data, and one critically appraised the quality of the studies.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO CRD42023466126.
RESULTS
A total of 436 records were identified, of which 204 were included for systematic review. From these, 683 CS patients were included. CS impacted both genders equally. Adults (21-59 years) were more commonly affected (45.5%) compared to children (0-20 years, 21%). Corticosteroid use was the most prevalent immunosuppressive risk factor identified (27.7% of all cases). About 10.2% of reports were associated with HIV/AIDS, and 8.5% with HTLV-1 infection. 10.5% of patients were overtly immunocompetent with no known risk factors. Overall, 41 (6.0%) died, many subsequent to secondary bacteremia.
CONCLUSION
This study represents the first systematic review undertaken on immunosuppressive risk factors associated with CS. This provides insights into trends of immunosuppression and mechanisms of CS development.
Topics: Scabies; Humans; Risk Factors; Comorbidity; Female; Male; Adult; Immunocompromised Host; Middle Aged; Young Adult; Adolescent; Child; Animals; Infant; Sarcoptes scabiei; HIV Infections; Child, Preschool; HTLV-I Infections; Immunosuppression Therapy; Infant, Newborn
PubMed: 38570134
DOI: 10.1016/j.ijid.2024.107036 -
American Journal of Ophthalmology Mar 2024Several treatments have been in use for Demodex blepharitis, before the discovery of lotilaner, like tea tree oil and antibiotics; however, they either have irritable... (Review)
Review
Efficacy and Safety of Lotilaner Ophthalmic Solution (0.25%) for the Treatment of Demodex Blepharitis: A GRADE Assessed Systematic Review and Meta-Analysis of Observational & Experimental Studies.
PURPOSE
Several treatments have been in use for Demodex blepharitis, before the discovery of lotilaner, like tea tree oil and antibiotics; however, they either have irritable effects or systemic adverse effects, respectively. Lotilaner, a novel ectoparasiticide, has been proposed as a treatment for patients grappling with Demodex blepharitis. This review aims to assess the safety and efficacy of lotilaner in the treatment of Demodex blepharitis.
DESIGN
Systematic review and meta-analysis.
METHODS
An extensive search was conducted on PubMed, Cochrane Library, Scopus, and Google Scholar to find relevant literature till July 31, 2023 following the PRISMA guidelines. A total of 143 articles were retrieved by database searching, out of which 6 studies met the inclusion criteria and were included in the review. Four randomized controlled trials were included in the meta-analysis of mite eradication incidence. The review is registered with PROSPERO: CRD42023459997.
RESULTS
Lotilaner is effective in eradicating Demodex mites in individuals suffering from Demodex blepharitis according to RR for the intervention versus the control group of 3.55 (95% confidence interval [CI]: 2.87-4.40, P < .00001, I = 0%). The meta-analysis of clinically meaningful collarette score revealed the summary RR for the intervention versus the control group was 3.15 (95% CI: 2.56-3.89, P < 0.00001, I = 27%). In conclusion, the results of the included studies were comparable and consistent.
CONCLUSIONS
Our results indicated that lotilaner is an effective, well-tolerated, and promising drug in treating patients with Demodex blepharitis. Lotilaner administration and cost-effectiveness should now be contemplated for the study population as these constituents have a vital impact on its treatment success.
PubMed: 38513948
DOI: 10.1016/j.ajo.2024.03.019 -
Parasites & Vectors Mar 2024The study of parasites provides insight into intricate ecological relationships in ecosystem dynamics, food web structures, and evolution on multiple scales. Hepatozoon... (Review)
Review
BACKGROUND
The study of parasites provides insight into intricate ecological relationships in ecosystem dynamics, food web structures, and evolution on multiple scales. Hepatozoon Eucoccidiorida: Hepatozoidae) is a genus of protozoan hemoparasites with heteroxenous life cycles that switch infections between vertebrates and blood-feeding invertebrates. The most comprehensive review of the genus was published 26 years ago, and currently there are no harmonized data on the epizootiology, diagnostics, genotyping methods, evolutionary relationships, and genetic diversity of Hepatozoon in the Americas.
METHODS
Here, we provide a comprehensive review based on the PRISMA method regarding Hepatozoon in wild mammals within the American continent, in order to generate a framework for future research.
RESULTS
11 out of the 35 countries of the Americas (31.4%) had data on Hepatozoon, with Carnivora and Rodentia orders having the most characterizations. Bats, ungulates, and shrews were the least affected groups. While Hepatozoon americanum, H. americanum-like, H. canis, H. didelphydis, H. felis, H. milleri, H. griseisciuri, and H. procyonis correspond to the identified species, a plethora of genospecies is pending for a formal description combining morphology and genetics. Most of the vectors of Hepatozoon in the Americas are unknown, but some flea, mite, and tick species have been confirmed. The detection of Hepatozoon has relied mostly on conventional polymerase chain reaction (PCR), and the implementation of specific real time PCR for the genus needs to be employed to improve its diagnosis in wild animals in the future. From a genetic perspective, the V4 region of the 18S rRNA gene has been widely sequenced for the identification of Hepatozoon in wild animals. However, mitochondrial and apicoplast markers should also be targeted to truly determine different species in the genus. A phylogenetic analysis of herein retrieved 18S ribosomal DNA (rDNA) sequences showed two main clades of Hepatozoon: Clade I associated with small mammals, birds, and herpetozoa, and Clade II associated with Carnivora. The topology of the tree is also reflected in the haplotype network.
CONCLUSIONS
Finally, our review emphasizes Hepatozoon as a potential disease agent in threatened wild mammals and the role of wild canids as spreaders of Hepatozoon infections in the Americas.
Topics: Animals; Cats; Ecosystem; Phylogeny; Chiroptera; Eucoccidiida; Shrews; Animals, Wild; Canidae
PubMed: 38444020
DOI: 10.1186/s13071-024-06154-3 -
Cureus Jan 2024Demodex blepharitis is marked by an excessive presence of Demodex mites on the eyelids, particularly in the lash follicles. While these microscopic mites are a natural... (Review)
Review
Demodex blepharitis is marked by an excessive presence of Demodex mites on the eyelids, particularly in the lash follicles. While these microscopic mites are a natural component of the skin microbiota, their overabundance can lead to ocular complications. Symptoms associated with Demodex blepharitis include eyelid itching, inflammation, and ocular irritation. Our objective is to investigate Lotilaner as a potential treatment for Demodex blepharitis, assessing both the safety and efficacy of the ophthalmic formula in managing this disease. We conducted research in Web of Science, PubMed, Cochrane Library, and Scopus up to November 2023. The quality of studies was evaluated using the Cochrane Risk of Bias tool, and it was employed to evaluate the quality of evidence. Our meta-analysis was executed using Review Manager 5.4. We evaluated the safety and efficacy of Lotilaner ophthalmic solution with a concentration of 0.25%. The following outcomes were assessed: clinically meaningful reduction in collarette, collarette cure, composite cure, drop comfort, erythema cure, mite density, and mite eradication. In the case of dichotomous data, we used the risk ratio (RR) with a 95% confidence interval (CI). In our analysis, all included studies, comprising a total of 891 participants, consistently reported clinically meaningful reductions in collarettes. The findings were statistically significant, with Lotilaner demonstrating a substantially higher reduction compared to the vehicle group (RR = 3.09, 95% CI [2.65-3.60]; -value < 0.0001). Notably, results for Drop Comfort outcomes were nonsignificant, indicating no discernible differences compared to the group that used the vehicle (RR = 1.03, 95% CI [0.98-1.07]; -value = 0.26). However, both mite density and mite eradication outcomes exhibited significant improvements with Lotilaner in comparison to the vehicle (RR = 2.58, 95% CI [2.25-2.95]; -value < 0.0001) and (RR = 3.80, 95% CI [2.88-5.01]; -value < 0.0001). The Lotilaner ophthalmic solution at 0.25% showed superior efficacy over the vehicle in reducing collarettes, achieving complete mite eradication within six weeks, and significantly decreasing erythema in Demodex blepharitis. It demonstrated safety with no reported side effects compared to the vehicle. Direct comparative studies with alternative treatments are recommended for a comprehensive assessment of efficacy and safety.
PubMed: 38380217
DOI: 10.7759/cureus.52664 -
The Journal of Allergy and Clinical... May 2024Although randomized controlled trials (RCT) are the reference standard of evidence in allergen immunotherapy (AIT), nonrandomized studies (NRS) are needed to confirm...
IR (index of reactivity)-house dust mite sublingual immunotherapy liquid formulation for allergic rhinoconjunctivitis: Systematic review and meta-analysis of randomized and nonrandomized studies.
BACKGROUND
Although randomized controlled trials (RCT) are the reference standard of evidence in allergen immunotherapy (AIT), nonrandomized studies (NRS) are needed to confirm their results in more representative populations, particularly for treatment duration and persistence. However, when discrepancies are observed between RCT and NRS, NRS reliability decreases because these discrepant results are generally attributed to the methodologic flaws of NRS.
OBJECTIVE
We compared the benefit of sublingual AIT (SLIT) for allergic rhinoconjunctivitis in NRS versus RCT focusing on a single product/allergen to reduce heterogeneity.
METHODS
For meta-analysis, house dust mite (HDM) SLIT liquid formulation studies were sourced from computerized (Medline, Web of Science, and LILACS databases, to January 2023) and manual literature searches. Populations, treatments, and outcome data were combined (DerSimonian-Laird method). Noncomparative NRS were compared to RCT' SLIT arm before and after treatment. Efficacy was determined as the standardized mean difference (SMD) in symptom score (SS) and medication score (MS).
RESULTS
Data from 12 NRS (682 patients) and 8 RCT (176 patients) were analyzed. The benefit with index of reactivity (IR)-HDM SLIT liquid formulation was found significant for, first, SS in both NRS (SMD = -1.27; 95% confidence interval [CI], -1.64, -0.90) and RCT (SMD = -0.56; 95% CI, -0.90, -0.21), and second, MS with SMD equal to -1.35 (95% CI, -1.77, -0.93) and -0.46 (95% CI, -0.67, -0.25), respectively. Metaregression showed that symptom improvement was correlated with treatment duration with consistent results in NRS and RCT with 12-month SS data: -0.87 (interquartile range, -1.02, -0.77) and -0.75 (interquartile range, -0.93, -0.41), respectively.
CONCLUSION
This meta-analysis showed comparable clinical benefit of IR-HDM SLIT liquid formulation increasing over time in both NRS and RCT, suggesting that NRS may reliably integrate RCT results and be considered for guidelines.
PubMed: 38328804
DOI: 10.1016/j.jacig.2024.100208 -
Frontiers in Immunology 2023To systematically compare the efficacy and safety of subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT) in children with allergic rhinitis (AR). (Meta-Analysis)
Meta-Analysis
AIM
To systematically compare the efficacy and safety of subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT) in children with allergic rhinitis (AR).
METHODS
PubMed, Embase, Cochrane Library, and Web of Science were searched from inception to March 2, 2023. Outcomes included symptom scores (SSs), medication scores (MSs), symptom and medication scores (SMSs), new sensitizations, development of asthma, improvement, and treatment-related adverse events (TRAEs). The quality of the included studies was assessed by the modified Jadad scale and Newcastle-Ottawa scale (NOS). Meta-regression was carried out to explore the source of heterogeneity. Subgroup analysis was further conducted in terms of study design [randomized controlled trials (RCTs), cohort studies], allergen [house dust mites (HDMs), grass pollen], treatment duration (≥ 24, 12-23 or < 12 months), allergen immunotherapy (AIT) modality (drops or tablets), and AIT protocol [continuous, pre-seasonal, co-seasonal, or after the grass pollen season (GPS)]. Sensitivity analysis was conducted for all outcomes. A Bayesian framework and a Monte Carlo Markov Chain (MCMC) model were developed for indirect comparison.
RESULTS
Totally 50 studies with 10813 AR children were included, with 4122 treated with SLIT, 1852 treated with SCIT, and 4839 treated with non-SLIT or non-SCIT therapy. For direct comparison, the SLIT group had a similar SS to the SCIT group [pooled standardized mean difference (SMD): 0.41, 95% confidence interval (CI): -0.46, 1.28, = 0.353]. Comparable MSs were observed in the SLIT and SCIT groups (pooled SMD: 0.82, 95%CI: -0.88, 2.53, = 0.344). For indirect comparison, no significant differences were found in SSs (pooled SMD: 1.20, 95% credibility interval (CrI): -1.70, 4.10), MSs (pooled SMD: 0.57, 95%CrI: -1.20, 2.30), SMSs (pooled SMD: 1.80, 95%CrI: -0.005, 3.60), new sensitizations [pooled relative risk (RR): 0.34, 95%CrI: 0.03, 3.58], and development of asthma (pooled RR: 0.68, 95%CrI: 0.01, 26.33) between the SLIT and SCIT groups; the SLIT group illustrated a significantly lower incidence of TRAEs than the SCIT group (pooled RR: 0.17, 95%CrI: 0.11, 0.26).
CONCLUSION
Considering both efficacy and safety, SLIT might be a more favorable AIT than SCIT in the treatment of pediatric AR, which may serve as a decision-making reference for clinicians.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO (CRD42023460693).
Topics: Child; Humans; Allergens; Asthma; Desensitization, Immunologic; Pollen; Rhinitis, Allergic; Immunotherapy; Sublingual Immunotherapy
PubMed: 38162647
DOI: 10.3389/fimmu.2023.1274241 -
BMC Infectious Diseases Dec 2023Scrub typhus is a bacterial mite-borne disease associated with poor clinical outcomes if not treated adequately. The study aimed to compare the time to defervescence,... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Scrub typhus is a bacterial mite-borne disease associated with poor clinical outcomes if not treated adequately. The study aimed to compare the time to defervescence, clinical failure, mortality and treatment-related adverse effects of two common drugs (doxycycline and azithromycin) used for its treatment.
METHODOLOGY
This was a systematic review and meta-analysis. All studies up to 20.03.2023 were screened for eligibility in Pubmed and Embase using a search string containing terms related to scrub typhus, doxycycline and azithromycin. After two phases of screening, all comparative studies where doxycycline and azithromycin were used to treat scrub typhus were included. The studies were critically appraised using standardised tools, and a meta-analysis was performed for time to defervescence (primary outcome), clinical failure, mortality and treatment-related adverse effects.
RESULTS
Of 744 articles from two databases, ten were included in the meta-analysis. All but two studies had a high risk of bias. The meta-analysis for time to defervescence had a high heterogeneity and did not show any significant difference between doxycycline and azithromycin arms [Mean difference of -3.37 hours (95%CI: -10.31 to 3.57), p=0.34]. When the analysis was restricted to studies that included only severe scrub typhus, doxycycline was found to have a shorter time to defervescence [mean difference of -10.15 (95%CI: -19.83 to -0.46) hours, p=0.04]. Additionally, there was no difference between the two arms concerning clinical failure, mortality and treatment-related adverse effects.
CONCLUSION
The current data from studies with a high risk of bias did not find statistically significant differences in clinical outcomes between doxycycline and azithromycin for scrub typhus.
Topics: Humans; Azithromycin; Doxycycline; Anti-Bacterial Agents; Scrub Typhus; Patients; Drug-Related Side Effects and Adverse Reactions
PubMed: 38110855
DOI: 10.1186/s12879-023-08893-7 -
International Journal For Parasitology.... Dec 2023Sarcoptic mange, caused by , is a disease that affects many species of mammals, including several wild ungulate species in the region of the European Alps, especially... (Review)
Review
Sarcoptic mange, caused by , is a disease that affects many species of mammals, including several wild ungulate species in the region of the European Alps, especially the Alpine chamois and the Alpine ibex, which act as parasite reservoirs. Here records of mange in alpine wild ungulates and its spread over time across the eastern parts of the European Alps are reviewed. First cases were recorded from Austria in 1824, and epizootic outbreaks have been described since then from the mountainous regions of Austria (mostly Tyrol, Carinthia, and Styria), Germany (Bavaria), Italy (Udine and Trentino) and Slovenia. Switzerland, by contrast, has so far been free of mange except for cases in wild boar, indicating that this species is not a reservoir host of sarcoptic mites for other ungulate species in the European Alps, and that, so far, the disease in ruminant ungulates is restricted to the eastern and central parts of the Alps. Mutual transmission among wild and domestic ruminants is possible and, together with the protection of vulnerable wildlife, is also a reason for monitoring and, if necessary, intervention to contain mange outbreaks.
PubMed: 37854272
DOI: 10.1016/j.ijppaw.2023.10.003