Search

Background Dermatological infections constitute the most common health problem in the homeless population. Objectives To estimate the prevalences of scabies and pediculosis corporis and to identify associated factors in the homeless population. Methods Two randomized cross-sectional surveys were performed, one on the homeless population sleeping in public places in Paris, and the other on the homeless population in various shelters in the Ile-de-France administrative region. Overall 341 and 667 people, respectively, were interviewed about sociodemographic characteristics, lifestyle and hygiene practices, and were examined by a nurse. Results In individuals sleeping in public places the prevalence of scabies was estimated at 6·5% [95% confidence interval (CI) 0·5-12·5] and for pediculosis corporis at 5·4% (95% CI 1·7-9·1). For those sleeping in shelters these values were 0·4% (95% CI 0·1-1·8) and 0·15% (95% CI 0·0-9·7), respectively ( P < 0·01 in both cases). In public places, after multivariate analysis, being a woman, citing squats among the three main types of accommodation and not possessing a sleeping bag were significantly associated with diagnosis of scabies. Likewise, begging, a history of pubic lice, and not taking showers in municipal baths were associated with pediculosis corporis in public places. Conclusions Firstly, this study highlights the real existence of two distinct subpopulations having different sociodemographic characteristics, with specific lifestyles and practices, and with different prevalences of ectoparasitism. Secondly, the results of the multivariate analyses will help the implementation of specific actions targeting the group of people who sleep in public places. [ABSTRACT FROM AUTHOR]

Background. Mucormycosis is a deadly invasive fungal infection whose characteristics are only partially understood. Methods. Data on mucormycosis obtained in France between 2005 and 2007 from 2 notification systems were merged. The 2008 European Organisation for Research and Treatment of Cancer/Mycoses Study Group definition criteria were applied and risk factors for death were analyzed by hazard ratios (HRs) calculated from the Cox proportional hazards regression model. Results. A total of 101 cases (60 proven, 41 probable), mostly in men (58%) .50 years (mean age, 50.7 ± 19.9) were recorded. Hematological malignancies represented 50% (median time for occurrence, 8.8 months after disease onset), diabetes 23%, and trauma 18% of cases. Sites of infection were lungs (28%; 79% in hematology patients), rhinocerebral (25%; 64% in diabetic patients), skin (20%), and disseminated (18%). Median time between first symptoms and diagnosis was 2 weeks. The main fungal species were Rhizopus oryzae (32%) and Lichtheimia species (29%). In cases where the causative species was identified, R. oryzae was present in 85% of rhinocerebral forms compared with only 17% of nonrhinocerebral forms (P <.001). Treatment consisted of surgery in 59% and antifungals in 87% of cases (liposomal amphotericin B in 61%). Ninety-day survival was 56%; it was reduced in cases of dissemination compared with rhinocerebral (HR, 5.38 [2.0-14.1]; P, .001), pulmonary (HR, 2.2 [1.0-4.7]; P = .04), or skin localization (HR, 5.73 [1.9-17.5]; P = .002); survival was reduced in cases of hematological malignancies compared with diabetes mellitus (HR, 2.3 [1.0-5.2]; P < .05) or trauma (HR, 6.9 [1.6-28.6], P =.008) and if &ges;2 underlying conditions (HR, 5.9 [1.8-19.0]; P = .004). Mucormycosis localization remained the only independent factor associated with survival. Conclusions. This 3-year study performed in one country shows the diverse clinical presentation of mucormycosis with a high prevalence of primary skin infection following trauma and a prognosis significantly influenced by localization. [ABSTRACT FROM AUTHOR]