Can scabies, tuberculosis (TB) really scare us today in the 21st century? Some cry, "give it to the antore!" as Don Lisander wrote with concealed irony in the early decades of the nineteenth century, recalling an era long gone and gone for good even for him. Can scabies be scary then? And do I run the risk of contracting it nowadays, me, a citizen of the Italian Republic? And TB, is it really a bogeyman, or merely a disease that if recognized and isolated I can cure and eradicate, and above all is it so difficult to avoid being infected? But for scabies I would say, continuing to quote (plunder) great literature, "Much ado about Nothing." Transmission occurs by sufficiently prolonged and effective close direct contact of the recipient's skin with that of the diseased or by the use of lettered effects. For contact to be efficient, it must consist precisely of special conditions of contiguity and adhesion between skin surfaces: in sexual intercourse, nursing children, sleeping in dormitories under precarious hygienic conditions, etc. Nowadays it is a health problem only in elderly nursing homes, prisons, even kindergartens or schools in some cases, and of course in concentrations of recruits. One category at high risk of contracting it in a severe form, such as to endanger existence, is that of AIDS patients: the so-called Norwegian or hyper disseminated scabies. Today's combination therapies for HIV, however, have all but eliminated these cases, which have become truly exceptional. Treatment involves the use for two to three days of creams based on anti-parasitic substances such as permethrin, benzyl benzoate, malathion. In some cases, oral ivernectin can also be administered. However, timely notification and intervention by the relevant health authorities has always made it possible to easily contain outbreaks and subject cases to appropriate treatment. This has also always been the case in the event of people with scabies from landings.
Scabies is NOT an emerging health problem and is an easily recognized and readily treatable disease.
There is no doubt, there can be no denying, however, that TB is a major health problem for the immigrant population, especially if it is uncontrolled; it is a major problem of public concern for our country as for others of low incidence. The growing trend of cases, the severity of the disease often associated with HIV infection, and especially the increasing drug resistance, makes it take on dramatic connotations. However, we should not forget that TB is primarily a social disease, unfairly affecting mostly the poor. In fact, poverty-related factors hand in hand with worsening living conditions and consequent nutritional status increase the likelihood of infection and also the subsequent progression to active disease. The current epidemiological situation of tuberculosis in Italia is characterized, however, by a low incidence in the general population, and cases are mostly concentrated in a few risk groups. From 2004 to 2014, about 4300 cases/year of TB were reported; 52% occurred in foreign individuals with a fixed-basis increase, parallel to the increase in the number of immigrants in Italy, in the percentage of cases reported among "non-Italian citizens." Hence, it rose from 44% in 2005 to 66% in 2014. The presence of immigrants from highly endemic areas is considered by many authors to be the most important co-factor, along with HIV infection, of the recent resurgence of tubercolosis reported in Italy
https://www.infezmed.it/media/journal/Vol_25_3_2017_1.pdf
Improving living conditions and freely offering specific drugs and good care to anyone with it would certainly reduce the incidence of TB and even more reduce to zero a risk that for the citizen is almost zero anyway. It is therefore a matter of appropriate health care organization, capable of delivering prompt surveillance and isolation of cases, in the context of efficient reception of immigrants. It is a matter of allowing easy and immediate access, not only to specific treatment, but also to complete and safe care, up to the sterilization of cases and possible outbreaks. After all, one of the goals of the WHO-WHO is precisely to act actively also on the determinants of health, poverty in the first place, and in a broader sense social protection to reduce the financial and human burden involved in the spread of TB cases and/or other dreaded diseases.
