A case report of medical laboratory confirmation of suspected scabies outbreak at Daara Madina Suwaneh, a quranic school located in Brufut Heights, The Gambia, 2025

TL;DR

This case report confirms a scabies outbreak in a Gambian Quranic school using a simple lab test, highlighting challenges in diagnosis and the need for better diagnostic tools in low-resource areas.

Contribution

The study provides a real-world example of scabies outbreak confirmation in a resource-limited setting using a low-cost diagnostic method.

Findings

Only one out of 13 cases tested positive for scabies using the saline mount technique.

The most common affected body sites were hands and knees in 38.5% of cases.

Treatment with 10% Benzyl Benzoate lotion led to full recovery in all cases.

Abstract

Scabies is a high-burden neglected tropical disease, particularly in crowded, resource-limited settings, where children are disproportionately affected. Confirmation of scabies includes the use of clinical diagnosis supported by laboratory confirmation. This study was conducted to provide a laboratory confirmation for a clinically suspected scabies outbreak.

Skin scrapings were collected from 13 clinically suspected cases and transported to the National Public Health Laboratories. Samples were processed using the simple saline mount technique. A case was considered positive when a mite, egg, or fecal pellet was identified with microscopy.

A suspected scabies outbreak was reported from Daara Madina Suwaneh, a quranic boarding school located in Brufut Heights in the West Coast Region. A team from the Ministry of Health was deployed to confirm the scabies outbreak. A total of 13 male children were screened, with a mean age of 11.6 years (SD = 1.94) and an average symptom duration of 4.3 weeks (SD = 0.48). The hands and knees were the most frequently affected sites, observed in 38.5% of cases. Laboratory analysis found mite eggs in only one child, and no mites were detected in any of the samples, resulting in a positivity rate of 7.7%. All the cases were treated with 10% Benzyl Benzoate lotion, as it is the recommended medication for the treatment of children by the World Health Organization, and they fully recovered. This report highlights the important role of a simple saline mount, a low-cost routine parasitological technique, in supporting clinical suspicion of a scabies outbreak.

This laboratory confirmation has provided supportive evidence for clinical diagnosis of scabies at a quranic school in The Gambia. The low laboratory positivity likely reflects challenges associated with the use of the normal saline method for sample processing, instead of potassium hydroxide, the most reliable method. These findings highlight the importance of timely sampling and improved diagnostic capacity for disease outbreak confirmation in resource-limited settings.

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