Botryomycosis is a rare pyogenic disease that presents with chronic suppurative and granulomatous skin lesions, commonly caused by Staphylococcus aureus. We report a case of botryomycosis presenting similarly to mycetoma, secondary to the emerging cutaneous pathogen Staphylococcus simulans. A 46-year-old female who previously worked in a wet market presented with a 13-year history of suppurative papules on a gradually enlarging right foot, and pain on ambulation. She had no systemic symptoms or co-morbidities, and does not recall preceding trauma. Physical examination showed brawny edema of the right foot with multiple sinus tracts draining purulent discharge. The clinical diagnosis at presentation was mycetoma. Magnetic resonance imaging showed a soft tissue mass involving the right foot and ankle with osseous destruction. Biopsy revealed suppurative granulomatous dermatitis; staining with Grocott methenamine silver did not highlight fungal elements. Potassium hydroxide mount of the purulent discharge did not show grains or hyphal elements. Tissue cultures showed growth of co-trimoxazole-susceptible Staphylococcus simulans. The patient was managed as a case of botryomycosis and treated with co-trimoxazole for 12 months. There was a significant decrease in right foot circumference along with scarring and resolution of associated pain. Repeat biopsy showed no evidence of infection. This is the first reported case of botryomycosis in the Philippines as well as the first report citing Staphyloccocus simulans as a causative agent. Botryomycosis is an important differential in patients clinically presenting as mycetoma. Animal pathogens may need to be considered as etiologic agents in at-risk patients with chronic subcutaneous infections.

Human ; Female ; Middle Aged: 45-64 Yrs Old ; Mycetoma

BACKGROUND AND OBJECTIVE

Scabies is the second most common cause of disability due to skin disease in the Philippines. However, there were no cited studies in Global Burden of Disease 2019 and the disability-adjusted life years (DALY) computations were most likely based on statistical modelling. The Philippine Department of Health has embarked on a program to estimate the disease burden of priority diseases in the country, which include scabies. The last nationwide prevalence survey was 23 years ago. This systematic review aimed to estimate the prevalence or incidence of scabies in the Philippines.

METHODS

We searched PubMed, Scopus, Herdin, and Philippine Health Research Registry (search date October 2022) for studies on prevalence/incidence (including systematic reviews, cross-sectional studies, cohort studies, case series, registry or census studies) of patients diagnosed with scabies in the Philippines. We excluded narrative reviews, commentaries, and conference proceedings or abstracts. Two reviewers independently screened titles and abstracts, assessed full text reports for eligibility, appraised the quality of included studies, and collected data using a pretested data extraction form. We did not pool studies due to clinical heterogeneity but plotted the individual studies in a forest plot with prevalence estimates and confidence intervals. We reported the median and interquartile range for entire group or relevant subgroups (age, setting) of studies. We used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to assess the certainty of evidence.

RESULTS

We included nine studies (N=79,065). Most were clinic-based prevalence studies, retrospective chart reviews, conducted in dermatology outpatient clinics, Metro Manila area, and on pediatric populations. Prevalence of scabies was moderate (i.e., between 2 and 10%), ranging from 2.75% (national prevalence survey) to 6.8% (communitybased review), to high (> 10%) among pediatric patients in clinic-based retrospective chart reviews (29 to 36%) and institution-based surveys (39.0% to 45%), and a tertiary government university training hospital dermatology clinic (22.9%). The most affected age group was from 0 to 14 y/o, while males tended to have a higher prevalence than females. The cooler month of January had higher prevalence than the hotter month of June in one study.

CONCLUSION

Scabies is common in the Philippines, especially among children and elderly in institutional settings, and during the month of January. There is a need to do a national prevalence survey to identify high-risk areas and to monitor the prevalence of scabies, especially in crowded settings and vulnerable populations. This information can be used for estimating the burden of disease for scabies and guide appropriate health resource allocation.

Human ; Scabies ; Philippines ; Epidemiology ; Prevalence ; Incidence

Background and Objective: Scabies is the second most common cause of disability due to skin disease in the Philippines. However, there were no cited studies in Global Burden of Disease 2019 and the disability-adjusted life years (DALY) computations were most likely based on statistical modelling. The Philippine Department of Health has embarked on a program to estimate the disease burden of priority diseases in the country, which include scabies. The last nationwide prevalence survey was 23 years ago. This systematic review aimed to estimate the prevalence or incidence of scabies in the Philippines. Methods: We searched PubMed, Scopus, Herdin, and Philippine Health Research Registry (search date October 2022) for studies on prevalence/incidence (including systematic reviews, cross-sectional studies, cohort studies, case series, registry or census studies) of patients diagnosed with scabies in the Philippines. We excluded narrative reviews, commentaries, and conference proceedings or abstracts. Two reviewers independently screened titles and abstracts, assessed full text reports for eligibility, appraised the quality of included studies, and collected data using a pretested data extraction form. We did not pool studies due to clinical heterogeneity but plotted the individual studies in a forest plot with prevalence estimates and confidence intervals. We reported the median and interquartile range for entire group or relevant subgroups (age, setting) of studies. We used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to assess the certainty of evidence. Results: We included nine studies (N=79,065). Most were clinic-based prevalence studies, retrospective chart reviews, conducted in dermatology outpatient clinics, Metro Manila area, and on pediatric populations. Prevalence of scabies was moderate (i.e., between 2 and 10%), ranging from 2.75% (national prevalence survey) to 6.8% (communitybased review), to high (> 10%) among pediatric patients in clinic-based retrospective chart reviews (29 to 36%) and institution-based surveys (39.0% to 45%), and a tertiary government university training hospital dermatology clinic (22.9%). The most affected age group was from 0 to 14 y/o, while males tended to have a higher prevalence than females. The cooler month of January had higher prevalence than the hotter month of June in one study. Conclusion Scabies is common in the Philippines, especially among children and elderly in institutional settings, and during the month of January. There is a need to do a national prevalence survey to identify high-risk areas and to monitor the prevalence of scabies, especially in crowded settings and vulnerable populations. This information can be used for estimating the burden of disease for scabies and guide appropriate health resource allocation.
Scabies ; Philippines ; Epidemiology ; Prevalence ; Incidence

BACKGROUND

The Philippines has the highest number of new leprosy cases in the Western Pacific Region, with 1,000 to 2,000+ cases detected annually over the past decade. Out of 46 filariasis-endemic provinces in the country, 43 have eliminated lymphatic filariasis. However, many grade 2 disabilities acquired from these neglected tropical diseases (NTDs) remain undetected due to inadequate monitoring during and after treatment. This was further exacerbated by the detrimental impact of COVID-19 on healthcare access. The pandemic prompted initial adoption of teletraining, making a feasibility study necessary.

OBJECTIVE

This study aimed to determine the feasibility of using telehealth and distance learning to train healthcare workers and patients in the integrated rehabilitation and prevention of impairments and disabilities from leprosy, lymphatic filariasis, mycetoma, diabetes, pressure ulcers, and other chronic wounds.

METHODS

Selected rural health units, patients with disabilities, and their caregivers in a leprosy- and lymphatic filariasis-endemic region were recruited. Municipal health officers and leprosy coordinators helped in the conceptualization, planning, implementation, and evaluation of the teletraining program to ensure its acceptability and utilization. Asynchronous and synchronous methods were used. The main reference was the "Ten Steps" guide. Training materials were shared via Google Drive and flash drives sent to each study site. One-day didactics and skills trainings were conducted through live-interactive sessions using online platforms (Zoom or Google Meet). Topics focused on nerve function assessment (for leprosy and diabetes), problems of mobility, lymphedema, wound care, and self-care. Participants practiced and demonstrated their skills on local patients, with mentoring through Messenger chats. Knowledge and performance assessments were conducted.

RESULTS

The study was conducted from 2021 to 2022 and the actual training implemented within four months of 2022. Two municipalities of Sultan Kudarat province, Mindanao Island group with one rural health unit (RHU) each had participated. All participants (N=16; eight RHU personnel and eight village health workers) attended the synchronous skills training, 12 (75%) submitted return demo videos, and 13 (81.25%) had practicum patients. All participants rated the training as successfully attaining objectives and activities. All were generally satisfied with the teletraining because of improved knowledge and skills gained and were willing to continue it. Efficiency, speed, quality of training, and trainers had high ratings. Teletraining was considered effective in improving the wound care of their patients. Patients were also satisfied with the home care. However, the unreliable internet service in the study sites created difficulties during synchronous sessions and negatively affected appropriateness of teletraining. Finding patients for practicum was challenging. Some supplies were not available in local drugstores and had to be shipped from Manila, raising costs. Overall, the rating of the teletraining was good.

CONCLUSION

Teletraining of health workers from distant health units on integrated disability prevention and care is feasible in terms of implementation, acceptability, and practicality if stable internet connectivity is available. Larger studies are recommended.

Human ; Telehealth ; Telemedicine ; Leprosy ; Lymphatic Filariasis ; Elephantiasis, Filarial ; Pressure Ulcer