{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,28]],"date-time":"2026-02-28T04:24:08Z","timestamp":1772252648756,"version":"3.50.1"},"reference-count":33,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2022,1,17]],"date-time":"2022-01-17T00:00:00Z","timestamp":1642377600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Scabies is a skin infestation from the Sarcoptes scabiei. It is considered a public health issue causing concern in developing countries and is considered a \u201cneglected tropical disease\u201d by the World Health Organization (WHO). Scabies skin lesions may cause severe itching and can be the portal of entry for opportunistic and pathogenic bacteria, which can cause serious systemic infections. We report the case of a 3-year-old boy with recurrent scabies infections who presented to the emergency department because of a fever and refusal to walk. Blood tests showed neutrophilic leukocytosis and significantly increased C reactive protein (CRP) and procalcitonin. Upon medical examination, his right thigh was extremely painful upon palpation, knee flexion was lost and he was unable to stand, so magnetic resonance imaging (MRI) was performed. MRI showed osteomyelitis of metaphysis and distal diaphysis of the right femur with associated subperiosteal purulent collection and concomitant pyomyositis and fasciitis of the distal right thigh. Blood cultures were positive for methicillin-resistant Staphylococcus aureus (MRSA). The patient received a long course of intravenous antibiotic therapy and his condition slowly improved. Follow-up femur X-ray showed a mixed pattern of erosion and sclerosis at the meta-diaphyseal region and periosteal reaction at the diaphyseal region. This case highlights the importance of early scabies diagnosis even in Western countries where poverty and household overcrowding are uncommon. Early diagnosis, timely initiation of proper treatment and evidence of clinical resolution are important elements to prevent recurrence of infection and serious systemic superinfections even from multi-drug resistant bacteria. Clinical consequences from unrecognized disease or inadequate eradication are preventable.<\/jats:p>","DOI":"10.3390\/ijerph19021007","type":"journal-article","created":{"date-parts":[[2022,1,17]],"date-time":"2022-01-17T08:20:42Z","timestamp":1642407642000},"page":"1007","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["MRSA Femoral Osteomyelitis from Superinfected Scabies Lesions: A Pediatric Case Report"],"prefix":"10.3390","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5942-0729","authenticated-orcid":false,"given":"Marco Ugo Andrea","family":"Sartorio","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Vittore Buzzi Children\u2019s Hospital, University of Milan, Via Castelvetro 32, 20154 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5117-6530","authenticated-orcid":false,"given":"Alice Marianna","family":"Munari","sequence":"additional","affiliation":[{"name":"Pediatric Radiology and Neuroradiology, Vittore Buzzi Children\u2019s Hospital, 20154 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patrizia","family":"Carlucci","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Vittore Buzzi Children\u2019s Hospital, University of Milan, Via Castelvetro 32, 20154 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paola","family":"Erba","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Vittore Buzzi Children\u2019s Hospital, University of Milan, Via Castelvetro 32, 20154 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2137-5974","authenticated-orcid":false,"given":"Valeria","family":"Calcaterra","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Vittore Buzzi Children\u2019s Hospital, University of Milan, Via Castelvetro 32, 20154 Milan, Italy"},{"name":"Pediatrics and Adolescentology Unit, Department of Internal Medicine and Therapeutics, University of Pavia, 27100 Pavia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6449-1724","authenticated-orcid":false,"given":"Valentina","family":"Fabiano","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Vittore Buzzi Children\u2019s Hospital, University of Milan, Via Castelvetro 32, 20154 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,1,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1111\/j.1469-0691.2012.03798.x","article-title":"Scabies in the developing world--its prevalence, complications, and management","volume":"18","author":"Hay","year":"2012","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_2","unstructured":"(2021, November 19). Scabies and Other Ectoparasites. Available online: https:\/\/www.who.int\/neglected_diseases\/diseases\/scabies-and-other-ectoparasites\/en\/."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1097\/QCO.0b013e32835e847b","article-title":"Impact of scabies in resource-poor communities","volume":"26","author":"Heukelbach","year":"2013","journal-title":"Curr. Opin. Infect. Dis."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"619","DOI":"10.1136\/bmj.331.7517.619","article-title":"Scabies: Diagnosis and treatment","volume":"331","author":"Johnston","year":"2005","journal-title":"BMJ (Clin. Res. Ed.)"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1","DOI":"10.7573\/dic.2020-12-3","article-title":"Paediatrics: How to manage scabies","volume":"10","author":"Thompson","year":"2021","journal-title":"Drugs Context"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"ep65","DOI":"10.1136\/adc.2005.073825","article-title":"Scabies in children","volume":"92","author":"Karthikeyan","year":"2007","journal-title":"Arch. Dis. Child. Educ. Pract. Ed."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1128\/CMR.00042-06","article-title":"Problems in diagnosing scabies, a global disease in human and animal populations","volume":"20","author":"Walton","year":"2007","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1718","DOI":"10.1056\/NEJMcp052784","article-title":"Clinical practices. Scabies","volume":"354","author":"Chosidow","year":"2006","journal-title":"N. Engl. J. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1186\/s13071-017-2234-1","article-title":"A review of Sarcoptes scabiei: Past, present and future","volume":"10","author":"Arlian","year":"2017","journal-title":"Parasites Vectors"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"S61","DOI":"10.1016\/j.jinf.2016.04.024","article-title":"Impetigo and scabies\u2014Disease burden and modern treatment strategies","volume":"72","author":"Yeoh","year":"2016","journal-title":"J. Infect."},{"key":"ref_11","first-page":"33","article-title":"Scabies: A Neglected Global Disease","volume":"16","author":"Leung","year":"2020","journal-title":"Curr. Pediatric Rev."},{"key":"ref_12","first-page":"251","article-title":"Annales De Dermatologie Et De Venereologie","volume":"143","author":"Jouret","year":"2016","journal-title":"Elsevier Mass"},{"key":"ref_13","first-page":"75","article-title":"Comparing the diagnostic properties of skin scraping, adhesive tape, and dermoscopy in diagnosing scabies","volume":"27","author":"Elshahed","year":"2018","journal-title":"Acta Dermatovenerol. Alp. Pannonica Adriat."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"410","DOI":"10.1097\/MOP.0000000000001031","article-title":"Common pediatric infestations: Update on diagnosis and treatment of scabies, head lice, and bed bugs","volume":"33","author":"Ogbuefi","year":"2021","journal-title":"Curr. Opin. Pediatrics"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Rosumeck, S., Nast, A., and Dressler, C. (2018). Ivermectin and permethrin for treating scabies. Cochrane Database Syst. Rev., 4.","DOI":"10.1002\/14651858.CD012994"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1003","DOI":"10.1111\/bjd.18369","article-title":"Ivermectin safety in infants and children under 15 kg treated for scabies: A multicentric observational study","volume":"182","author":"Levy","year":"2020","journal-title":"Br. J. Dermatol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"adv00112","DOI":"10.2340\/00015555-3468","article-title":"The Management of Scabies in the 21st Century: Past, Advances and Potentials","volume":"100","author":"Bernigaud","year":"2020","journal-title":"Acta Derm.-Venereol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"960","DOI":"10.1016\/S1473-3099(15)00132-2","article-title":"Prevalence of scabies and impetigo worldwide: A systematic review","volume":"15","author":"Romani","year":"2015","journal-title":"Lancet. Infect. Dis."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Steer, A.C., Jenney, A.W., Kado, J., Batzloff, M.R., La Vincente, S., Waqatakirewa, L., Mulholland, E.K., and Carapetis, J.R. (2009). High burden of impetigo and scabies in a tropical country. PLoS Negl. Trop. Dis., 3.","DOI":"10.1371\/journal.pntd.0000467"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1159\/000495290","article-title":"A Review of Scabies: An Infestation More than Skin Deep","volume":"235","author":"Chandler","year":"2019","journal-title":"Dermatology"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1767","DOI":"10.1016\/S0140-6736(06)68772-2","article-title":"Scabies","volume":"367","author":"Heukelbach","year":"2006","journal-title":"Lancet"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1218","DOI":"10.1111\/ijd.14123","article-title":"Skin bacterial colonizations and superinfections in immunocompetent patients with scabies","volume":"57","author":"Esposito","year":"2018","journal-title":"Int. J. Dermatol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"520","DOI":"10.1056\/NEJM199808203390806","article-title":"Staphylococcus aureus infections","volume":"339","author":"Lowy","year":"1998","journal-title":"N. Engl. J. Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1016\/S0001-7310(08)74711-2","article-title":"Staphylococcus aureus sepsis as a complication of scabies","volume":"99","year":"2008","journal-title":"Actas Dermo-Sifiliogr."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1055\/s-2008-1034027","article-title":"Acute hematogenic osteomyelitis after impetiginized scabies","volume":"197","author":"Gaida","year":"1985","journal-title":"Klin. Padiatr."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1016\/j.tim.2019.01.008","article-title":"Commensal Staphylococci Influence Staphylococcus aureus Skin Colonization and Disease","volume":"27","author":"Parlet","year":"2019","journal-title":"Trends Microbiol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1248","DOI":"10.1111\/jdv.14351","article-title":"European guideline for the management of scabies","volume":"31","author":"Salavastru","year":"2017","journal-title":"J. Eur. Acad. Dermatol. Venereol. JEADV"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1258\/ijsa.2011.011112","article-title":"European guideline for the management of scabies, 2010","volume":"22","author":"Scott","year":"2011","journal-title":"Int. J. STD AIDS"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1267","DOI":"10.15537\/smj.2019.12.24773","article-title":"Recurrence rate of scabies in patients 14 years or older in Saudi Arabia","volume":"40","author":"Ahmed","year":"2019","journal-title":"Saudi Med. J."},{"key":"ref_30","first-page":"874","article-title":"Risk factors for recurrence of scabies: A retrospective study of scabies patients in a long-term care hospital","volume":"38","author":"Makigami","year":"2011","journal-title":"J. Dermatol."},{"key":"ref_31","first-page":"89","article-title":"Diagnosis and treatment of scabies by general practitioners: A survey of practices in France","volume":"145","author":"Aubin","year":"2018","journal-title":"Ann. Dermatol. Venereol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1111\/j.1529-8019.2009.01243.x","article-title":"Scabies","volume":"22","author":"Hicks","year":"2009","journal-title":"Dermatol. Ther."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1001\/archfami.9.5.473","article-title":"Treating asymptomatic bodily contacts of patients with scabies","volume":"9","author":"Chambliss","year":"2000","journal-title":"Arch. Fam. Med."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/2\/1007\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:02:44Z","timestamp":1760133764000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/2\/1007"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,1,17]]},"references-count":33,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2022,1]]}},"alternative-id":["ijerph19021007"],"URL":"https:\/\/doi.org\/10.3390\/ijerph19021007","relation":{"has-preprint":[{"id-type":"doi","id":"10.21203\/rs.3.rs-923860\/v1","asserted-by":"object"}]},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,1,17]]}}}