Investigating Skin Lesions Outbreak in a National Youth Service Camp South-Eastern Nigeria.

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Ezeoma Princewill Ikwunze, Walong Clement Emmanuel, Bello Isah Umar, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6548315/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Introduction Paederus dermatitis is an acute form of dermatitis triggered by the inadvertent crushing of insects from the Paederus genus, which releases the vesicant toxin pederin. This condition is particularly prevalent during the rainy season and is commonly observed in tropical regions. Methods The objective of this study was to investigate the potential causes, mode of transmission, and effective interventions for a sudden outbreak of skin lesions, identified as Paederus dermatitis, among Batch C, Stream 1 National Youth Service Corps (NYSC) members at the Umunna, Bende orientation camp in Abia State. A total of 157 corps members, who developed skin lesions between October and November 2021, were included in the study. Data were gathered through structured, interviewer-administered questionnaires, which documented participants' demographic information, medical history, and potential exposure factors. The collected data were analyzed using SPSS. All affected individuals received appropriate treatment, and preventive measures were recommended to reduce the risk of further outbreaks. Participants were monitored for two weeks until complete resolution of the lesions. Results The majority of participants were aged between 20 and 25 years, with a female-to-male ratio of 2:1. Seventy-two percent of respondents reported developing the rash, although the statistical analysis revealed no significant association between human-to-human contact and rash transmission (p-value > 0.05). In contrast, 67.9% of participants reported using tap water for bathing, which was significantly associated with the occurrence of skin lesions (p-value < 0.05). Additionally, 90% of those affected had been bitten by an insect, with this exposure showing a strong correlation with the development of the rash (p-value < 0.05). The insect responsible was identified as the "electric ant," which closely resembles the Paederus species. When crushed, the insect releases a coelomic fluid containing pederin, resulting in a linear erythematous rash accompanied by a burning sensation and pain. The typical attire of the corps members, consisting of white T-shirts and shorts, increased their vulnerability to insect contact. Regarding treatment efficacy, 37.8% of respondents rated the treatment as very effective, 36.9% as moderately effective, 16.2% as less effective, and 8.1% felt it had no effect. The treatment regimen consisted of topical steroids (hydrocortisone cream) and antibiotics (penicillin and gentamicin creams) to address the inflammation and prevent secondary bacterial infections. Conclusion The outbreak was chiefly attributed to exposure to the Paederus insect. While Paederus dermatitis is commonly observed in tropical regions such as Nigeria, its diverse clinical presentation often leads to misdiagnosis. Enhancing awareness of the condition can facilitate accurate diagnoses and streamline treatment approaches, thereby minimizing patient confusion. Additionally, effective preventive strategies and treatment options were identified during the course of the study. Burning sensation skin lesions electric ant paederus dermatitis irritant contact dermatitis (icd) NYSC Batch C Stream 1 2021 covid-19 vaccine Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Introduction Paederus insects, which belong to the order Coleoptera (beetles) and the family Staphylinidae (rove beetles), include over 600 species distributed across all continents, except Antarctica. [ 1 ] Outbreaks of dermatitis caused by Paederus beetles have been reported globally, including in South America, [ 2 ] Turkey, [ 3 ] Central Africa, [ 4 ] Okinawa, [ 5 ] and India. [ 6 ] Adult Paederus beetles typically measure between 7 and 10 mm in length and 0.5 to 1 mm in width, exhibiting a characteristic black head, lower abdomen, and elytra (wing coverings), alongside a red thorax and upper abdomen (Fig. 3 ). These beetles thrive in moist habitats and are beneficial to agriculture, as they feed on crop pests. They are particularly attracted to incandescent and fluorescent lights, which can lead to inadvertent human contact, especially if windows or doors are left open. [ 1 ] Although Paederus beetles do not bite or sting, accidental contact, such as brushing against or crushing the insect on the skin, causes the release of a coelomic fluid containing pederin, a potent blistering agent. [ 7 ] Pederin is primarily produced by female beetles and is synthesized with the help of an endosymbiotic Pseudomonas species within the insect. Upon contact, pederin induces a delayed skin reaction, typically within 24 hours. The severity of the dermatitis varies, ranging from mild erythema to more severe vesicular and bullous lesions, often in a linear pattern due to smearing the crushed insect. Severe cases may also present with additional systemic symptoms, such as fever, neuralgia, and vomiting. [ 8 , 9 ] While mild-to-moderate cases are generally not painful unless complicated by secondary infections, severe exposures can result in significant discomfort. Treatment involves removing the irritant, washing the affected area, and applying topical steroids. In some cases, oral antibiotics may be necessary to address concurrent bacterial infections. [ 9 ] Preventing Paederus dermatitis hinges on avoiding contact with the beetles. Measures include identifying and avoiding handling the insects, washing affected areas promptly, If a beetle lands on the skin, it should be blown off or encouraged to walk onto a piece of paper and then removed. The area in contact should be immediately washed with soap and water, and any clothes in contact with the beetle should be washed as well and also ensuring that buildings are adequately sealed to prevent entry. Since Paederus beetles are drawn to light, minimizing light exposure near sleeping areas can also reduce the risk of contact. [ 1 ] An outbreak of Paederus dermatitis among the 2021 Batch C, Stream 1 National Youth Service Corps (NYSC) members in Umunna, South-Eastern Nigeria, underscored the need to investigate the causes, transmission routes, and preventive strategies for this condition. The present study seeks to explore the factors contributing to this outbreak and provide recommendations for its prevention and management. Methods This study aimed to investigate the potential causes, mode of transmission, and effective interventions for a sudden outbreak of skin lesions among National Youth Service Corps (NYSC) members of Batch C, Stream 1, at the Umunna, Bende orientation camp in Abia State. The findings were intended to inform public health strategies and prevent future occurrences of similar outbreaks. A cross-sectional descriptive study design was employed, with participants randomly selected from the camp's registration management system. This approach was selected to ensure a comprehensive understanding of the sociodemographic profile and detailed medical history of the participants. Key variables included age, gender, platoon, hall of residence, prior awareness of insect contact, onset of lesions following exposure to camp water, lesion sites, and associated symptoms such as burning, itching, pain, blistering, and scarring. All data were documented on a case study sheet for analysis. Data were analyzed using SPSS software (version 19), and statistical significance was determined with a p-value of less than 0.05. Descriptive statistics were used to present the findings as frequencies and percentages. The research team comprised five members: the lead researcher, who represented the State Ministry of Health/National Center for Disease Control (SMOH/NCDC) at the NYSC orientation camp; a pediatric research expert from the United States; and three additional on-site researchers based at the camp. Study Setting and Participants The study was conducted at the National Youth Service Corps (NYSC) Orientation Camp in Umunna, Abia State, South-Eastern Nigeria, which had a population of approximately 2,000 corps members. A total of 157 adult participants, both male and female, aged 18 years and older, were randomly selected using a stratified random sampling technique. All participants were graduates from various higher learning institutions, assigned to the NYSC camp for the mandatory one-year orientation program. A cross-sectional descriptive study design was utilized to specifically target corps members presenting with skin lesions. The inclusion criteria for participation were as follows: (i) NYSC 2021 Batch C, Stream 1 corps members present at the NYSC Permanent Orientation Camp, who consented to participate, and (ii) participants must be adults aged 18 years or older. Individuals who did not meet these criteria were excluded from the study. Participants were selected from Platoons 1 to 10. Recruitment was facilitated by the Camp Commandant, who made an announcement via the Orientation Broadcasting System (OBS). Approval for the study was obtained from both the Camp Coordinator and the steering committee of the Umunna NYSC Orientation Camp. The Camp Commandant then contacted interested participants who had consented to participate. The lead researcher, who has been involved with the camp's activities for three years, coordinated the recruitment and meetings with participants. These were arranged at the camp clinic for their convenience. The study was supported by five research assistants from the 2021 Batch C, who were fluent in Igbo, Hausa, Yoruba, and English. They were recruited and trained for two days on how to administer the structured questionnaires. Prior to the interviews, participants were fully briefed about the study, and verbal consent was obtained. To maintain confidentiality, participant identities were anonymized in the study reports. Corps members with skin lesions were referred to the camp clinic for appropriate treatment. Data Collection Data collection for this study was conducted in October 2021. A structured, interviewer-administered interview guide was used as the primary data collection instrument. The guide was developed based on existing literature on Paederus dermatitis, with key questions and probing inquiries designed to capture relevant information. [ 10 , 11 , 12 ] The interview guide included questions such as: (a) "Have you developed a rash during your stay at the camp?" (b) "Do you bath or drink water from the camp's tap?" (c) "Have you been bitten by an insect in the camp?" The guide was structured to gather a comprehensive sociodemographic profile and detailed medical history, including variables such as age, gender, platoon, hall of residence, awareness of insect contact, onset of skin lesions after bathing with camp water, lesion site, and symptoms such as burning, itching, pain, blistering, or scarring. The interview guide was developed in English, and all participants provided verbal consent prior to their inclusion in the study. Data Analysis The data collected were analyzed using the Statistical Package for Social Sciences (SPSS), version 19. Categorical variables were summarized using percentages and proportions, while continuous variables were summarized using means and standard deviations. The association between categorical variables was assessed using the Chi-square test (or Fisher’s exact test, where applicable), with a p-value of < 0.05 and a 95% confidence interval considered statistically significant. The prevalence of the rash was classified based on clinical presentations, with allergic rashes caused by hypersensitivity reaction to normal agent of the environment characterized by redness and itching, and infective rashes caused by either bacteria, virus or fungi identified by pustular discharge. Among the cases, 68.4% presented with allergic rashes, 8.2% with infective rashes, and 23.5% exhibited both allergic and infective symptoms. Rigour and Trustworthiness To enhance the credibility of the study, we engaged in repeated readings and thoroughly immersed ourselves in the narratives provided by the participants. [ 13 ] In addition, the involvement of a pediatric expert researcher strengthened the study’s validity. Feedbacks from participants were used to ensure authenticity and accurately reflect their viewpoints. Transferability was ensured by providing a detailed description of our research methodology and the specific geographical context of the study. [ 14 ] This approach allows other researchers working in similar settings to reference our methodology for guidance and potential replication. During data collection, regular debriefing sessions with research assistants were conducted to address any potential inconsistencies and prevent the introduction of bias. This contributed to the study’s conformability, transferability, authenticity, and dependability. Furthermore, all interview guide transcripts were meticulously maintained to support the conformability of the research process. Ethical approval for the study was granted by the Camp Coordinator and the steering committee of the NYSC Orientation Camp in Umunna, Bende, Abia State. Both oral and written informed consent were obtained from all participants. Participants were assured of confidentiality, data protection, anonymity, and their right to withdraw from the study at any point without consequence, including cessation of treatment if desired. The study adhered to the ethical standards outlined in the 1964 Declaration of Helsinki and its subsequent amendments, or comparable ethical guidelines. Results In our study, 161 cases were initially identified, with 157 participants consenting to participate. The gender distribution consisted of 51 male and 106 female patients, yielding a female-to-male ratio of 2:1 [See Fig. 1 ]. The majority of participants 56.2% were aged between 20 and 25 years [See Table 1 – 2 ]. Clinical presentations of the rash were categorized into allergic rashes caused by hypersensitivity reaction to normal agent of the environment characterized by redness and itching, and infective rashes caused by either bacteria, virus or fungi identified by pustular discharge. Based on these presentations, 68.4% of the rashes were classified as allergic, 8.2% as infective, and 23.5% exhibited both allergic and infective symptoms. Eighty-four out of the 157 participants reported prior awareness of insect contact before the onset of the lesions, which typically appeared suddenly overnight or early the following morning [See Fig. 2 ]. The insects described by patients were small (< 2 cm), reddish-brown, with wings and a colored abdomen, consistent with characteristics of rove beetles, though the insects were not physically collected for identification. The most common complaints included itching and a burning sensation at the site of contact. The duration of the lesions ranged from two to 10 days in all patients. Lesions were confined to exposed areas of the body, with the face and neck being the most common sites, followed by the forearms. [See Fig. 4 – 8 ] Severe, wincing pain upon touch was reported by 156 patients, while one patient remained asymptomatic, presenting with acute dermatitis. Table 1 Shows the consolidated table with Frequency, Percent, Valid Percent, and Cumulative Percent for each Category. Category Frequency Percent (%) Valid Percent (%) Cumulative Percent (%) Sex of Respondents Male 51 31.7 32.5 32.5 Female 106 65.8 67.5 100 Missing System 4 2.5 Total 161 100 100 Age of Respondents < 20 5 3.1 3.2 3.2 20–25 90 56.2 57.3 60.5 26–30 62 38.5 39.5 100 Missing System 4 2.5 Total 157 9.5 100 Have you developed a rash in camp? Yes 156 96.9 99.4 99.4 No 1 0.6 0.6 100 Missing System 4 2.5 Total 161 100 100 Respondent Resumption Date into NYSC Camp Before 24th 51 31.7 32.1 32.1 24th-25th 102 63.5 64.2 96.3 After 25th 6 3.7 3.8 100 Missing System 2 1.2 Total 159 98.8 100 Table 2 Combined Cross-Tabulation of Factors (Tap Water Usage, Insect Bites, Contact with Individuals Having a Rash) and Rash Development among Participants in the Camp Factor Rash Development Yes No Total Bath with Tap Water Yes 112 39 151 No 1 3 4 Total (Bath with Tap Water) 113 42 155 Drink Tap Water Yes 13 6 19 No 98 35 133 Total (Drink Tap Water) 111 41 152 Insect Bites Yes 84 9 93 No 29 32 61 Total (Insect Bites) 113 41 154 Contact with Rash Yes 86 33 119 No 25 10 35 Total (Contact with Rash) 111 43 154 Table 3 Combined Table: Treatment, Effectiveness, and Symptoms Associated with Rash Development. Factor Frequency Percent Valid Percent Cumulative Percent Treatment Administered for Rash Conventional 76 47.2 67.9 67.9 Unconventional 14 8.7 12.5 80.4 Both 22 13.7 19.6 100 Total (Valid) 112 69.6 100 Missing System 49 30.4 Total (Valid) 161 100 Assessment of Treatment Effectiveness 0 (No Effect) 1 0.6 0.9 0.9 Very Effective 42 26.1 37.8 38.7 Moderately Effective 41 25.5 36.9 75.7 Less Effective 18 11.2 16.2 91.9 No Effect 9 5.6 8.1 100 Total (Valid) 111 68.9 100 Missing System 50 31.1 Total (Valid) 161 100 Symptoms Associated with Rash Allergic 67 41.6 68.4 68.4 Infective 8 5 8.2 76.5 Both 23 14.3 23.5 100 Total (Valid) 98 60.9 100 Missing System 63 39.1 Total (Valid) 161 100 Discussion This study highlights the significant prevalence of allergic skin reactions among National Youth Service Corps (NYSC) members, likely triggered by an insect, with findings consistent with other studies conducted in tropical regions. These outbreaks are commonly associated with insects like Paederus , which possess chemical defense mechanisms capable of causing skin irritation in humans, a condition often referred to as Paederus dermatitis [3]. Accidental contact with these insects, through brushing against or crushing them on the skin, leads to the release of coelomic fluid containing paederin, a potent blistering agent [3] [See Figure]. The findings from this study provide important insights into the relationship between various factors (such as water usage, insect bites, and contact with individuals with a rash) and the development of rashes among participants in the camp [See Table 2 ]. The study also highlights the types of treatments administered and their effectiveness in managing rashes, such like conventional method which consisted of topical treatments, such as hydrocortisone cream and antibiotics ( penicillin and gentamicin ), and unconventional method notably the application of toothpaste to the affected areas in managing these rashes [See Table 3 ]. This underscores the importance of preventive measures, including fumigation and the use of insect repellents, to reduce the risk of future outbreaks. Further research is needed to explore long-term strategies for prevention and to assess the influence of environmental factors on such incidents. The key results of the study are discussed below, considering their public health and clinical implications. The study indicates that the majority of participants 96.9% developed a rash in the camp, which is a striking finding that emphasizes the prevalence of this issue in this population. A range of environmental and behavioral factors were found to be associated with rash development. These included bathing with tap water, drinking tap water, insect bites, and contact with individuals having a rash. The findings indicate a potentially significant association between bath water from the tap and rash development, with 112 participants 67.9% of those who bathed with tap water developing a rash. This suggests that the tap water might be contaminated or contain irritants, which could be contributing to the skin reactions. However, drinking tap water did not show a strong correlation with rash development, as only 13 participants who drank tap water reported a rash (13 out of 19, or 68.4%). This finding warrants further investigation into the water quality in the camp and its potential role as a vector for skin irritation or other dermatological conditions. A significant portion of the participants (84 individuals, or 90.3%) who reported insect bites also developed a rash. This strong association suggests that insect bites may be a key factor in triggering rashes, possibly due to allergic reactions to bites or infection of the skin. Insects in the camp may need to be controlled more effectively to reduce these skin-related symptoms. Similarly, contact with individuals who had a rash was linked to an increased likelihood of developing a rash, with 86 individuals 72.3% who had such contact also reporting a rash. This supports the hypothesis that rashes in the camp may be contagious or transmitted through close personal contact, possibly due to skin-to-skin contact or shared items like clothing or bedding [See Fig. 1 ]. Regarding the treatment of rashes, the majority of participants (67.9%) who developed rashes reported receiving conventional treatments, which primarily included topical steroids (such as hydrocortisone cream) and antibiotics (including penicillin and gentamicin creams). These treatments were intended to address inflammation and prevent secondary bacterial infections, which are common complications of dermatological conditions. A smaller proportion of participants 19.6% reported receiving a combination of both conventional treatments (topical steroids and antibiotics) and unconventional treatments, notably the application of toothpaste to the affected areas. Only 12.5% of participants used unconventional treatments alone, with toothpaste being the primary remedy [See Table 3 ]. These findings suggest that the majority of participants opted for medically recognized interventions to manage their rashes, indicating a strong desire for effective symptom management. The reliance on conventional treatments aligns with medical recommendations for managing skin inflammation and preventing infections. However, the use of unconventional treatments, particularly toothpaste, could reflect a lack of access to, or trust in, conventional medical services. It may also signal a preference for alternative medicine among some participants, possibly due to cultural beliefs, perceived efficacy, or economic barriers to accessing professional healthcare. The assessment of treatment effectiveness shows that most participants felt their treatment was moderately effective or very effective, with 64.7% reporting positive outcomes 37.8% very effective, 36.9% moderately effective. A small portion of participants 5.6% indicated that the treatment had no effect, which could point to either the severity of the rash or a mismatch between the type of treatment and the specific cause of the rash [See Table 3 ]. This approach is consistent with a study conducted in Sierra Leone, where half of the patients with Paederus dermatitis received oral ciprofloxacin alongside topical steroids, resulting in faster healing times compared to those who did not receive the oral antibiotic [5]. The study suggests that while treatments generally had a positive effect, there may be room for improvement in ensuring the timely and appropriate administration of treatments. The categorization of symptoms linked to rash development reveals that allergic reactions were the most common symptom 68.4%, followed by infective causes 8.2% and a combination of both 23.5%. This suggests that allergic reactions might be the predominant cause of rashes in the camp. The allergic responses could be triggered by factors like insect bites, contact with irritants in the water, or environmental allergens, such as dust or plants. Infective causes were less common, which may indicate that the rashes were largely non-infectious, though it is still important to consider the possibility of viral, bacterial, or fungal infections in the camp population. Demographic analysis of the respondents reveals a predominantly female population 65.8%, which could reflect the gender distribution in the camp. Age distribution showed that most participants were between 20 and 25 years old 56.2%, followed by those aged 26 to 30 years 38.5%. The majority of respondents had arrived at the camp between the 24th and 25th 63.5%, with a small proportion having arrived before or after this period. These demographic factors may influence the generalizability of the results, and future studies should consider exploring gender and age-related differences in rash development and treatment responses. Public Health Implications The high incidence of rash development, coupled with the reported environmental and behavioral factors, suggests the need for a comprehensive public health intervention in the camp. Measures such as improving the quality of tap water, controlling insect populations, and educating camp participants about hygiene and the risks of skin contact with infected individuals could significantly reduce the prevalence of rashes. Moreover, medical personnel should be equipped to provide appropriate treatments, and more resources could be allocated to ensure timely intervention, especially for those whose rash is persistent or worsening. Limitations and Future Research While the findings of this study are informative, there are several limitations. First, the cross-sectional design of the study prevents the establishment of causal relationships between the factors and rash development. Longitudinal studies would be valuable in understanding the long-term effects of exposure to camp conditions on dermatological health. Additionally, further research into the water quality, insect species, and potential contagiousness of the rashes could help elucidate the underlying causes of rash development. Second, is the lack species identification of the Paederus beetles, which would have been important for distinguishing between species-specific variations in toxicity. Third, the absence of histopathological examination restricted our reliability to fully characterize the tissue damage and underlying mechanisms of injury. These factors may limit the broader applicability and depth of the findings. Finally, qualitative studies exploring participants' experiences with conventional and unconventional treatments could provide a deeper understanding of treatment preferences and the barriers to effective care in such settings. Conclusion In conclusion, the study provides valuable data on the high prevalence of rashes in a camp setting, the factors contributing to rash development, the types of treatments administered, and the effectiveness of these treatments. The findings underscore the need for targeted public health interventions and further research into the causes and management of skin conditions in camp populations. In addition to addressing medical concerns, the study aims to alleviate fear, anxiety, and misinformation related to COVID-19 vaccinations and other health issues, which were prevalent during the study period. Given the findings, future research should focus on long-term prevention measures, including the impact of environmental factors, and explore more effective strategies to mitigate such outbreaks. Recommendation/Public Health Implications The high incidence of rash development, coupled with the reported environmental and behavioral factors, suggests the need for a comprehensive public health intervention in the camp. Measures such as improving the quality of tap water, controlling insect populations, and educating camp participants about hygiene and the risks of skin contact with infected individuals could significantly reduce the prevalence of rashes. Moreover, medical personnel should be equipped to provide appropriate treatments, and more resources could be allocated to ensure timely intervention, especially for those whose rash is persistent or worsening. Based on these findings, the following recommendations were made: Implement regular fumigation of orientation camps with eco-friendly, odourless fumigants. Install insect-repellent lighting in common areas. Encourage Corps members to wear protective clothing, such as long trousers and socks, especially at nights. Use of insecticide-treated nets should be made compulsory for all corps members in the orientation camp as this would not only drastically reduce spread of disease such as malaria but would greatly minimize contact between corps members and other insects with the potential of causing harm. Mandate use of insecticide-treated nets in orientation camps. Include insect repellents in the list of recommended items for corps members. Utilize the study’s findings to address misinformation about the COVID-19 vaccine and other health concerns. Promote research among Corps members to enhance evidence-based practices in public health. Declarations Acknowledgement We would like to express our sincere gratitude to all the study participants for their willingness to participate and provide valuable insights for this research. Our appreciation extends to the past and present State Coordinators of Abia State National Youth Service Corps (NYSC), as well as the Camp Commandants and Heads of Assignments, for their support and for granting the necessary ethical clearance for the study. We would also like to acknowledge and extend our profound thanks to Dr. Chibuzor Nwakasi, Ph.D., MSPH, Assistant Professor in the Department of Human Development and Family Sciences at the University of Connecticut, USA, and Dr. Onyeka Chukwudalu Ekwebene, Department of Paediatrics, Infectious Disease, and Global Health, Indiana University School of Medicine, Indianapolis, USA, for their invaluable guidance, expertise, and unwavering support throughout the development of this manuscript. Financial support and sponsorship This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. The study was conducted and funded by the authors personally. Ethical considerations The study was approved by the Abia State Coordinator National Youth Service Corp (NYSC) Ethics committee. Written and verbal consent was sought prior to administration of the questionnaire. The study is in compliance with the principle of the declaration of Helsinki. The confidentiality of information was maintained by excluding personal identifiers. Declaration of consent The authors affirm that all necessary consent forms have been obtained, duly signed by the participants. In these forms, participants have provided their consent for the inclusion of images and other clinical information in the study. Participants were assured that their names and initials will not be disclosed in any published materials, and efforts will be made to maintain their anonymity. However, while every precaution will be taken to protect their identity, complete anonymity cannot be guaranteed. Authors’ contributions This work was carried out in collaboration amongst all authors. All authors read and approved the final manuscript. Disclosure The authors report no conflicts of interest in this work. Competing Interest The authors declare that they have no competing interests related to this work. Data Availability Statement All data generated or analysed during this study are included in the submitted manuscript and will be made available upon publication. Clinical Trial Number This study does not involve a clinical trial; therefore, registration was not required. References Frank JH, Kanamitsu K. Paederus, Sensu Lato (Coleoptera: Staphylinidae): natural history and medical importance. J Med Entomol. 1987; 24:155–191. Mullen G, Durden L. Beetles (Cloeoptera). In: Medical and Veterinary Entomology. 2nd ed. London, UK: Academic Press; 2009:102. Uslular C, Kavukcu H. An epidemicity of Paederus species in the Cukurova region. Cutis. 2002; 69:277–279. Penchenier L, Mouchet J, Cros B, et al. Invasions de Paederus sabaeus (Coleoptera : Staphylinidae) en Afrique Centrale. I. Aspects entomologiques et épidémiologiques. Bull Soc Path Ex. 1994; 87:45–48. Armstrong RK, Winfield JL. Paederus fuscipes dermatitis: an epidemic on Okinawa. The American Journal of Tropical Medicine and Hygiene. 1969; 18:147–150. Srichandan M. Skinpossible photo blog. 2011. www.flickr.com/ photos/skinpossible. Piel J. A polyketide synthase-peptide synthetase gene cluster from an uncultured bacterial symbiont of Paederus beetles. PNAS. 2002; 99:14002–14007. Borroni G, Brazzelli V, Rosso R, M Pavan. Paederus fuscipes dermatitis: a histopathological study. The American Journal of Dermatopathology. 1991; 13:467–474. Rahman S. Paederus dermatitis In Sierra Leone. Dermatol Online J. 2006; 12:9. Karthikeyan K, Kumar A: Paederus dermatitis. Indian J Dermatol Venereol Leprol. 2017, 83:424-31. 10.4103/0378-6323.198441. Srihari S, Kombettu AP, Rudrappa KG, Betkerur J: Paederus dermatitis: a case series. Indian Dermatol Online J. 2017, 8:361-4. 10.4103/idoj.IDOJ_238_16. Capinera JL: Encyclopedia of entomology. Springer Science and Business Media, Florida (USA); 2008. 10.1007/978-1-4020-6359-6. Todd RE, Guthridge SL, Montgomery BL: Evacuation of an Aboriginal community in response to an outbreak of blistering dermatitis induced by a beetle (Paederus australis). Med J Aust. 1996, 164:238-40. 10.5694/j.1326-5377.1996.tb94150.x. Taneja A, Nayak UK S, Shenoi SD: Clinical and epidemiological study of Paederus dermatitis in Manipal, India. J Pak Assoc Dermatol. 2016, 23:133-8. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6548315","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":464748840,"identity":"60adab82-262e-4c11-9888-e3375e0efae4","order_by":0,"name":"Ezeoma Princewill Ikwunze","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA9klEQVRIiWNgGAWjYBACNh5Uvg0QMzYeIEVLGkhLA14tDGhaDoNJvFr4eM6YSRf8sZGTb28+uuHnjvN2a9sPA22psYnG6TDeHjPpGTxpxow9x9Ju9p65nbztTCJQy7G03AZcWvh5t0nzSBxObJbIMbvB23Y72ewAUAtjw2ECWgz+17fJvzG7+bftXLLZ+YcEtPD2ArUkHEjgkeAxu83bdsDO7AYhW3jOf7bmOZBsCPRP2m3ZM8kJZjeAtiTg8Yt8T1ribZ4/dvLy7YeP3Xy7w87e7Hz6wwcfamxwakEFjA0MiWCVCUQph2qxJ1rxKBgFo2AUjBgAANWWXyw3PansAAAAAElFTkSuQmCC","orcid":"","institution":"Department of Public Health and Disease Control, Epidemiology Unit, Abia State Ministry of Health, Umuahia, Abia State","correspondingAuthor":true,"prefix":"","firstName":"Ezeoma","middleName":"Princewill","lastName":"Ikwunze","suffix":""},{"id":464748841,"identity":"8a21354f-f32d-4d1d-9225-9191d876d638","order_by":1,"name":"Walong Clement Emmanuel","email":"","orcid":"","institution":"National Youth Service Corps (NYSC) Member, Batch C Stream 1, 2021, Abia State Secretariat, Umuahia, Abia State","correspondingAuthor":false,"prefix":"","firstName":"Walong","middleName":"Clement","lastName":"Emmanuel","suffix":""},{"id":464748842,"identity":"bcae9f45-6776-4599-9812-aaa98ee7e3da","order_by":2,"name":"Bello Isah Umar","email":"","orcid":"","institution":"National Youth Service Corps (NYSC) Member, Batch C Stream 1, 2021, Abia State Secretariat, Umuahia, Abia State","correspondingAuthor":false,"prefix":"","firstName":"Bello","middleName":"Isah","lastName":"Umar","suffix":""},{"id":464748843,"identity":"e7e6fdb6-97cd-49e7-b3af-dc9568abf7d7","order_by":3,"name":"Osadolor Benedo Uyioghosa","email":"","orcid":"","institution":"National Youth Service Corps (NYSC) Member, Batch C Stream 1, 2021, Abia State Secretariat, Umuahia, Abia State","correspondingAuthor":false,"prefix":"","firstName":"Osadolor","middleName":"Benedo","lastName":"Uyioghosa","suffix":""},{"id":464748844,"identity":"44464311-125e-41ab-8136-e008a3449851","order_by":4,"name":"Obaseki Sandra Oghomwen","email":"","orcid":"","institution":"National Youth Service Corps (NYSC) Member, Batch C Stream 1, 2021, Abia State Secretariat, Umuahia, Abia State","correspondingAuthor":false,"prefix":"","firstName":"Obaseki","middleName":"Sandra","lastName":"Oghomwen","suffix":""},{"id":464748845,"identity":"aaaa6e65-9f9d-43fb-ac6a-a667eb9f544d","order_by":5,"name":"Akinola Tolulope Peace","email":"","orcid":"","institution":"National Youth Service Corps (NYSC) Member, Batch C Stream 1, 2021, Abia State Secretariat, Umuahia, Abia State","correspondingAuthor":false,"prefix":"","firstName":"Akinola","middleName":"Tolulope","lastName":"Peace","suffix":""},{"id":464748846,"identity":"79e355df-07e4-4f09-8ae8-843ed7813c52","order_by":6,"name":"Omofurieme Annette Fejiro","email":"","orcid":"","institution":"National Youth Service Corps (NYSC) Member, Batch C Stream 1, 2021, Abia State Secretariat, Umuahia, Abia State","correspondingAuthor":false,"prefix":"","firstName":"Omofurieme","middleName":"Annette","lastName":"Fejiro","suffix":""},{"id":464748847,"identity":"1e9af354-40cf-4763-b08f-2a90dda1b2e0","order_by":7,"name":"Chukwudalu Onyeka Ekwebene","email":"","orcid":"","institution":"Indiana University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Chukwudalu","middleName":"Onyeka","lastName":"Ekwebene","suffix":""},{"id":464748848,"identity":"864d6599-9cd4-4533-88a1-a6bfa45dc715","order_by":8,"name":"Emmanuel Edison Emmanuel","email":"","orcid":"","institution":"National Youth Service Corps (NYSC) Member, Batch C Stream 1, 2021, Abia State Secretariat, Umuahia, Abia State","correspondingAuthor":false,"prefix":"","firstName":"Emmanuel","middleName":"Edison","lastName":"Emmanuel","suffix":""}],"badges":[],"createdAt":"2025-04-28 13:23:29","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6548315/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6548315/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":83816146,"identity":"7bafedfc-aac7-45e7-86f0-2179b3f61aab","added_by":"auto","created_at":"2025-06-03 07:47:13","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":45840,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eBar Chart Showing the Proportion of Participants Who Developed a Rash in the Camp\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6548315/v1/98d164021badd3414a0bd4af.png"},{"id":83816150,"identity":"3aa376ec-2789-4012-980c-85c1852bc0a4","added_by":"auto","created_at":"2025-06-03 07:47:13","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":36900,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eBar Chart Depicting the Proportion of Participants Bitten by Insects in the Camp\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6548315/v1/2f400bdd25eea61d1f11f9ac.png"},{"id":83816153,"identity":"d2e15ac6-428b-48fd-9ed7-27fa31e936d3","added_by":"auto","created_at":"2025-06-03 07:47:13","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":329391,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ePaederus beetle (photo courtesy of www.entomart.be)\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-6548315/v1/6ece07acf06edddd3be32c8f.png"},{"id":83817325,"identity":"09026e01-f350-4da0-a4c7-f50dfb8633d6","added_by":"auto","created_at":"2025-06-03 07:55:13","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":376566,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ePaederus dermatitis lesion on the left cheek near the ear.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-6548315/v1/336c9e7273ec77112ae2d9bd.png"},{"id":83816152,"identity":"8d386dde-a03a-41bb-b49c-b6931661a9c3","added_by":"auto","created_at":"2025-06-03 07:47:13","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":311942,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ePaederus dermatitis lesion at the back of the neck near the clothing label region.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-6548315/v1/6db882f8f86efdcda80c838a.png"},{"id":83816157,"identity":"2ad522d2-61e0-4c2c-a581-e9a58c7772f7","added_by":"auto","created_at":"2025-06-03 07:47:13","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":375731,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ePaederus dermatitis lesion at the nape of the neck.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"6.png","url":"https://assets-eu.researchsquare.com/files/rs-6548315/v1/0bb0118dffda100dd1baba81.png"},{"id":83816155,"identity":"36c8e421-3302-4e3c-8b2e-76a060c6a175","added_by":"auto","created_at":"2025-06-03 07:47:13","extension":"png","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":373252,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ePaederus dermatitis lesion over the right cubital flexural area\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"7.png","url":"https://assets-eu.researchsquare.com/files/rs-6548315/v1/f405d9fdada54a4f6d047f99.png"},{"id":83817324,"identity":"ad9ea2ae-6893-4808-9355-8f6853a37fec","added_by":"auto","created_at":"2025-06-03 07:55:13","extension":"png","order_by":8,"title":"Figure 8","display":"","copyAsset":false,"role":"figure","size":289083,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ePaederus dermatitis lesion at the left neck region.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"8.png","url":"https://assets-eu.researchsquare.com/files/rs-6548315/v1/17944264dd9838b4e3ec1172.png"},{"id":98380725,"identity":"fe7e85fb-098d-4a30-a505-1d8b2ba7b5e1","added_by":"auto","created_at":"2025-12-17 07:40:37","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":4090325,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6548315/v1/f8468068-ff4d-4682-99eb-a61837a94189.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eInvestigating Skin Lesions Outbreak in a National Youth Service Camp South-Eastern Nigeria.\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003e \u003cem\u003ePaederus\u003c/em\u003e insects, which belong to the order Coleoptera (beetles) and the family Staphylinidae (rove beetles), include over 600 species distributed across all continents, except Antarctica. \u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e Outbreaks of dermatitis caused by \u003cem\u003ePaederus\u003c/em\u003e beetles have been reported globally, including in South America, \u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e Turkey, \u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e Central Africa, \u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e Okinawa, \u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e and India. \u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e Adult \u003cem\u003ePaederus\u003c/em\u003e beetles typically measure between 7 and 10 mm in length and 0.5 to 1 mm in width, exhibiting a characteristic black head, lower abdomen, and elytra (wing coverings), alongside a red thorax and upper abdomen (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). These beetles thrive in moist habitats and are beneficial to agriculture, as they feed on crop pests. They are particularly attracted to incandescent and fluorescent lights, which can lead to inadvertent human contact, especially if windows or doors are left open. \u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eAlthough \u003cem\u003ePaederus\u003c/em\u003e beetles do not bite or sting, accidental contact, such as brushing against or crushing the insect on the skin, causes the release of a coelomic fluid containing pederin, a potent blistering agent.\u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e Pederin is primarily produced by female beetles and is synthesized with the help of an endosymbiotic \u003cem\u003ePseudomonas\u003c/em\u003e species within the insect. Upon contact, pederin induces a delayed skin reaction, typically within 24 hours. The severity of the dermatitis varies, ranging from mild erythema to more severe vesicular and bullous lesions, often in a linear pattern due to smearing the crushed insect. Severe cases may also present with additional systemic symptoms, such as fever, neuralgia, and vomiting. \u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e While mild-to-moderate cases are generally not painful unless complicated by secondary infections, severe exposures can result in significant discomfort. Treatment involves removing the irritant, washing the affected area, and applying topical steroids. In some cases, oral antibiotics may be necessary to address concurrent bacterial infections. \u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e \u003cp\u003ePreventing \u003cem\u003ePaederus\u003c/em\u003e dermatitis hinges on avoiding contact with the beetles. Measures include identifying and avoiding handling the insects, washing affected areas promptly, If a beetle lands on the skin, it should be blown off or encouraged to walk onto a piece of paper and then removed. The area in contact should be immediately washed with soap and water, and any clothes in contact with the beetle should be washed as well and also ensuring that buildings are adequately sealed to prevent entry. Since \u003cem\u003ePaederus\u003c/em\u003e beetles are drawn to light, minimizing light exposure near sleeping areas can also reduce the risk of contact. \u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eAn outbreak of Paederus dermatitis among the 2021 Batch C, Stream 1 National Youth Service Corps (NYSC) members in Umunna, South-Eastern Nigeria, underscored the need to investigate the causes, transmission routes, and preventive strategies for this condition. The present study seeks to explore the factors contributing to this outbreak and provide recommendations for its prevention and management.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis study aimed to investigate the potential causes, mode of transmission, and effective interventions for a sudden outbreak of skin lesions among National Youth Service Corps (NYSC) members of Batch C, Stream 1, at the Umunna, Bende orientation camp in Abia State. The findings were intended to inform public health strategies and prevent future occurrences of similar outbreaks. A cross-sectional descriptive study design was employed, with participants randomly selected from the camp's registration management system. This approach was selected to ensure a comprehensive understanding of the sociodemographic profile and detailed medical history of the participants. Key variables included age, gender, platoon, hall of residence, prior awareness of insect contact, onset of lesions following exposure to camp water, lesion sites, and associated symptoms such as burning, itching, pain, blistering, and scarring. All data were documented on a case study sheet for analysis.\u003c/p\u003e \u003cp\u003eData were analyzed using SPSS software (version 19), and statistical significance was determined with a p-value of less than 0.05. Descriptive statistics were used to present the findings as frequencies and percentages. The research team comprised five members: the lead researcher, who represented the State Ministry of Health/National Center for Disease Control (SMOH/NCDC) at the NYSC orientation camp; a pediatric research expert from the United States; and three additional on-site researchers based at the camp.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Setting and Participants\u003c/h2\u003e \u003cp\u003eThe study was conducted at the National Youth Service Corps (NYSC) Orientation Camp in Umunna, Abia State, South-Eastern Nigeria, which had a population of approximately 2,000 corps members. A total of 157 adult participants, both male and female, aged 18 years and older, were randomly selected using a stratified random sampling technique. All participants were graduates from various higher learning institutions, assigned to the NYSC camp for the mandatory one-year orientation program. A cross-sectional descriptive study design was utilized to specifically target corps members presenting with skin lesions.\u003c/p\u003e \u003cp\u003eThe inclusion criteria for participation were as follows: (i) NYSC 2021 Batch C, Stream 1 corps members present at the NYSC Permanent Orientation Camp, who consented to participate, and (ii) participants must be adults aged 18 years or older. Individuals who did not meet these criteria were excluded from the study. Participants were selected from Platoons 1 to 10. Recruitment was facilitated by the Camp Commandant, who made an announcement via the Orientation Broadcasting System (OBS). Approval for the study was obtained from both the Camp Coordinator and the steering committee of the Umunna NYSC Orientation Camp. The Camp Commandant then contacted interested participants who had consented to participate.\u003c/p\u003e \u003cp\u003eThe lead researcher, who has been involved with the camp's activities for three years, coordinated the recruitment and meetings with participants. These were arranged at the camp clinic for their convenience. The study was supported by five research assistants from the 2021 Batch C, who were fluent in Igbo, Hausa, Yoruba, and English. They were recruited and trained for two days on how to administer the structured questionnaires. Prior to the interviews, participants were fully briefed about the study, and verbal consent was obtained. To maintain confidentiality, participant identities were anonymized in the study reports. Corps members with skin lesions were referred to the camp clinic for appropriate treatment.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eData Collection\u003c/h3\u003e\n\u003cp\u003eData collection for this study was conducted in October 2021. A structured, interviewer-administered interview guide was used as the primary data collection instrument. The guide was developed based on existing literature on Paederus dermatitis, with key questions and probing inquiries designed to capture relevant information. \u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e The interview guide included questions such as: (a) \"Have you developed a rash during your stay at the camp?\" (b) \"Do you bath or drink water from the camp's tap?\" (c) \"Have you been bitten by an insect in the camp?\"\u003c/p\u003e \u003cp\u003eThe guide was structured to gather a comprehensive sociodemographic profile and detailed medical history, including variables such as age, gender, platoon, hall of residence, awareness of insect contact, onset of skin lesions after bathing with camp water, lesion site, and symptoms such as burning, itching, pain, blistering, or scarring. The interview guide was developed in English, and all participants provided verbal consent prior to their inclusion in the study.\u003c/p\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eData Analysis\u003c/h2\u003e \u003cp\u003eThe data collected were analyzed using the Statistical Package for Social Sciences (SPSS), version 19. Categorical variables were summarized using percentages and proportions, while continuous variables were summarized using means and standard deviations. The association between categorical variables was assessed using the Chi-square test (or Fisher\u0026rsquo;s exact test, where applicable), with a p-value of \u0026lt;\u0026thinsp;0.05 and a 95% confidence interval considered statistically significant.\u003c/p\u003e \u003cp\u003eThe prevalence of the rash was classified based on clinical presentations, with allergic rashes caused by hypersensitivity reaction to normal agent of the environment characterized by redness and itching, and infective rashes caused by either bacteria, virus or fungi identified by pustular discharge. Among the cases, 68.4% presented with allergic rashes, 8.2% with infective rashes, and 23.5% exhibited both allergic and infective symptoms.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eRigour and Trustworthiness\u003c/h3\u003e\n\u003cp\u003eTo enhance the credibility of the study, we engaged in repeated readings and thoroughly immersed ourselves in the narratives provided by the participants. \u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e In addition, the involvement of a pediatric expert researcher strengthened the study\u0026rsquo;s validity. Feedbacks from participants were used to ensure authenticity and accurately reflect their viewpoints. Transferability was ensured by providing a detailed description of our research methodology and the specific geographical context of the study. \u003csup\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e This approach allows other researchers working in similar settings to reference our methodology for guidance and potential replication.\u003c/p\u003e \u003cp\u003eDuring data collection, regular debriefing sessions with research assistants were conducted to address any potential inconsistencies and prevent the introduction of bias. This contributed to the study\u0026rsquo;s conformability, transferability, authenticity, and dependability. Furthermore, all interview guide transcripts were meticulously maintained to support the conformability of the research process.\u003c/p\u003e \u003cp\u003eEthical approval for the study was granted by the Camp Coordinator and the steering committee of the NYSC Orientation Camp in Umunna, Bende, Abia State. Both oral and written informed consent were obtained from all participants. Participants were assured of confidentiality, data protection, anonymity, and their right to withdraw from the study at any point without consequence, including cessation of treatment if desired. The study adhered to the ethical standards outlined in the 1964 Declaration of Helsinki and its subsequent amendments, or comparable ethical guidelines.\u003c/p\u003e \u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eIn our study, 161 cases were initially identified, with 157 participants consenting to participate. The gender distribution consisted of 51 male and 106 female patients, yielding a female-to-male ratio of 2:1 [See Fig. \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e]. The majority of participants 56.2% were aged between 20 and 25 years [See Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e]. Clinical presentations of the rash were categorized into allergic rashes caused by hypersensitivity reaction to normal agent of the environment characterized by redness and itching, and infective rashes caused by either bacteria, virus or fungi identified by pustular discharge. Based on these presentations, 68.4% of the rashes were classified as allergic, 8.2% as infective, and 23.5% exhibited both allergic and infective symptoms.\u003c/p\u003e\n\u003cp\u003eEighty-four out of the 157 participants reported prior awareness of insect contact before the onset of the lesions, which typically appeared suddenly overnight or early the following morning [See Fig. \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e]. The insects described by patients were small (\u0026lt;\u0026thinsp;2 cm), reddish-brown, with wings and a colored abdomen, consistent with characteristics of rove beetles, though the insects were not physically collected for identification. The most common complaints included itching and a burning sensation at the site of contact. The duration of the lesions ranged from two to 10 days in all patients.\u003c/p\u003e\n\u003cp\u003eLesions were confined to exposed areas of the body, with the face and neck being the most common sites, followed by the forearms. [See Fig. \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan class=\"InternalRef\"\u003e8\u003c/span\u003e] Severe, wincing pain upon touch was reported by 156 patients, while one patient remained asymptomatic, presenting with acute dermatitis.\u0026nbsp;\u003c/p\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eShows the consolidated table with Frequency, Percent, Valid Percent, and Cumulative Percent for each Category.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCategory\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eFrequency\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePercent (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eValid Percent (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCumulative Percent (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSex of Respondents\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e31.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e32.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e32.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e106\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e65.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e67.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMissing System\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e161\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge of Respondents\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20\u0026ndash;25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e56.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e57.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e60.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26\u0026ndash;30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e38.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e39.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMissing System\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e157\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eHave you developed a rash in camp?\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e156\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e96.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e99.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e99.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMissing System\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e161\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eRespondent Resumption Date into NYSC Camp\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBefore 24th\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e31.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e32.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e32.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24th-25th\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e102\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e63.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e64.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e96.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAfter 25th\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMissing System\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e159\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e98.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eCombined Cross-Tabulation of Factors (Tap Water Usage, Insect Bites, Contact with Individuals Having a Rash) and Rash Development among Participants in the Camp\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eFactor\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eRash Development\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eBath with Tap Water\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e112\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e151\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal (Bath with Tap Water)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e113\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e155\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eDrink Tap Water\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e133\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal (Drink Tap Water)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e111\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e152\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eInsect Bites\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e93\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e61\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal (Insect Bites)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e113\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e154\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eContact with Rash\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e119\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal (Contact with Rash)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e111\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e154\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n \u003cdiv id=\"Sec9\" class=\"Section3\"\u003e\u0026nbsp;\u003ctable id=\"Tab3\" border=\"1\" class=\"fr-table-selection-hover\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eCombined Table: Treatment, Effectiveness, and Symptoms Associated with Rash Development.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eFactor\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eFrequency\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePercent\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eValid Percent\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCumulative Percent\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTreatment Administered for Rash\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eConventional\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e47.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e67.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e67.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnconventional\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e80.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBoth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTotal (Valid)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e112\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e69.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMissing System\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTotal (Valid)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e161\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eAssessment of Treatment Effectiveness\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (No Effect)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVery Effective\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e37.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e38.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eModerately Effective\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e36.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e75.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLess Effective\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e91.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo Effect\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTotal (Valid)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e111\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e68.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMissing System\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e31.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTotal (Valid)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e161\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eSymptoms Associated with Rash\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAllergic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e41.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e68.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e68.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInfective\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e76.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBoth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTotal (Valid)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e60.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMissing System\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e39.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTotal (Valid)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e161\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study highlights the significant prevalence of allergic skin reactions among National Youth Service Corps (NYSC) members, likely triggered by an insect, with findings consistent with other studies conducted in tropical regions. These outbreaks are commonly associated with insects like \u003cem\u003ePaederus\u003c/em\u003e, which possess chemical defense mechanisms capable of causing skin irritation in humans, a condition often referred to as \u003cem\u003ePaederus dermatitis\u003c/em\u003e [3]. Accidental contact with these insects, through brushing against or crushing them on the skin, leads to the release of coelomic fluid containing paederin, a potent blistering agent [3] [See Figure]. The findings from this study provide important insights into the relationship between various factors (such as water usage, insect bites, and contact with individuals with a rash) and the development of rashes among participants in the camp [See Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe study also highlights the types of treatments administered and their effectiveness in managing rashes, such like conventional method which consisted of topical treatments, such as \u003cb\u003ehydrocortisone cream\u003c/b\u003e and antibiotics (\u003cb\u003epenicillin and gentamicin\u003c/b\u003e), and unconventional method notably the application of \u003cb\u003etoothpaste\u003c/b\u003e to the affected areas in managing these rashes [See Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e]. This underscores the importance of preventive measures, including fumigation and the use of insect repellents, to reduce the risk of future outbreaks. Further research is needed to explore long-term strategies for prevention and to assess the influence of environmental factors on such incidents. The key results of the study are discussed below, considering their public health and clinical implications.\u003c/p\u003e \u003cp\u003eThe study indicates that the majority of participants 96.9% developed a rash in the camp, which is a striking finding that emphasizes the prevalence of this issue in this population. A range of environmental and behavioral factors were found to be associated with rash development. These included bathing with tap water, drinking tap water, insect bites, and contact with individuals having a rash.\u003c/p\u003e\u003cp\u003eThe findings indicate a potentially significant association between bath water from the tap and rash development, with 112 participants 67.9% of those who bathed with tap water developing a rash. This suggests that the tap water might be contaminated or contain irritants, which could be contributing to the skin reactions. However, drinking tap water did not show a strong correlation with rash development, as only 13 participants who drank tap water reported a rash (13 out of 19, or 68.4%). This finding warrants further investigation into the water quality in the camp and its potential role as a vector for skin irritation or other dermatological conditions.\u003c/p\u003e\u003cp\u003eA significant portion of the participants (84 individuals, or 90.3%) who reported insect bites also developed a rash. This strong association suggests that insect bites may be a key factor in triggering rashes, possibly due to allergic reactions to bites or infection of the skin. Insects in the camp may need to be controlled more effectively to reduce these skin-related symptoms.\u003c/p\u003e\u003cp\u003eSimilarly, contact with individuals who had a rash was linked to an increased likelihood of developing a rash, with 86 individuals 72.3% who had such contact also reporting a rash. This supports the hypothesis that rashes in the camp may be contagious or transmitted through close personal contact, possibly due to skin-to-skin contact or shared items like clothing or bedding [See Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eRegarding the treatment of rashes, the majority of participants (67.9%) who developed rashes reported receiving conventional treatments, which primarily included topical steroids (such as hydrocortisone cream) and antibiotics (including penicillin and gentamicin creams). These treatments were intended to address inflammation and prevent secondary bacterial infections, which are common complications of dermatological conditions. A smaller proportion of participants 19.6% reported receiving a combination of both conventional treatments (topical steroids and antibiotics) and unconventional treatments, notably the application of toothpaste to the affected areas. Only 12.5% of participants used unconventional treatments alone, with toothpaste being the primary remedy [See Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThese findings suggest that the majority of participants opted for medically recognized interventions to manage their rashes, indicating a strong desire for effective symptom management. The reliance on conventional treatments aligns with medical recommendations for managing skin inflammation and preventing infections. However, the use of unconventional treatments, particularly toothpaste, could reflect a lack of access to, or trust in, conventional medical services. It may also signal a preference for alternative medicine among some participants, possibly due to cultural beliefs, perceived efficacy, or economic barriers to accessing professional healthcare.\u003c/p\u003e \u003cp\u003eThe assessment of treatment effectiveness shows that most participants felt their treatment was moderately effective or very effective, with 64.7% reporting positive outcomes 37.8% very effective, 36.9% moderately effective. A small portion of participants 5.6% indicated that the treatment had no effect, which could point to either the severity of the rash or a mismatch between the type of treatment and the specific cause of the rash [See Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e]. This approach is consistent with a study conducted in Sierra Leone, where half of the patients with \u003cem\u003ePaederus dermatitis\u003c/em\u003e received oral ciprofloxacin alongside topical steroids, resulting in faster healing times compared to those who did not receive the oral antibiotic [5].\u003c/p\u003e \u003cp\u003eThe study suggests that while treatments generally had a positive effect, there may be room for improvement in ensuring the timely and appropriate administration of treatments.\u003c/p\u003e \u003cp\u003eThe categorization of symptoms linked to rash development reveals that allergic reactions were the most common symptom 68.4%, followed by infective causes 8.2% and a combination of both 23.5%. This suggests that allergic reactions might be the predominant cause of rashes in the camp. The allergic responses could be triggered by factors like insect bites, contact with irritants in the water, or environmental allergens, such as dust or plants. Infective causes were less common, which may indicate that the rashes were largely non-infectious, though it is still important to consider the possibility of viral, bacterial, or fungal infections in the camp population.\u003c/p\u003e \u003cp\u003eDemographic analysis of the respondents reveals a predominantly female population 65.8%, which could reflect the gender distribution in the camp. Age distribution showed that most participants were between 20 and 25 years old 56.2%, followed by those aged 26 to 30 years 38.5%. The majority of respondents had arrived at the camp between the 24th and 25th 63.5%, with a small proportion having arrived before or after this period. These demographic factors may influence the generalizability of the results, and future studies should consider exploring gender and age-related differences in rash development and treatment responses.\u003c/p\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003ePublic Health Implications\u003c/h2\u003e \u003cp\u003eThe high incidence of rash development, coupled with the reported environmental and behavioral factors, suggests the need for a comprehensive public health intervention in the camp. Measures such as improving the quality of tap water, controlling insect populations, and educating camp participants about hygiene and the risks of skin contact with infected individuals could significantly reduce the prevalence of rashes. Moreover, medical personnel should be equipped to provide appropriate treatments, and more resources could be allocated to ensure timely intervention, especially for those whose rash is persistent or worsening.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eLimitations and Future Research\u003c/h2\u003e \u003cp\u003eWhile the findings of this study are informative, there are several limitations. First, the cross-sectional design of the study prevents the establishment of causal relationships between the factors and rash development. Longitudinal studies would be valuable in understanding the long-term effects of exposure to camp conditions on dermatological health. Additionally, further research into the water quality, insect species, and potential contagiousness of the rashes could help elucidate the underlying causes of rash development. Second, is the lack species identification of the \u003cem\u003ePaederus\u003c/em\u003e beetles, which would have been important for distinguishing between species-specific variations in toxicity. Third, the absence of histopathological examination restricted our reliability to fully characterize the tissue damage and underlying mechanisms of injury. These factors may limit the broader applicability and depth of the findings. Finally, qualitative studies exploring participants' experiences with conventional and unconventional treatments could provide a deeper understanding of treatment preferences and the barriers to effective care in such settings.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn conclusion, the study provides valuable data on the high prevalence of rashes in a camp setting, the factors contributing to rash development, the types of treatments administered, and the effectiveness of these treatments. The findings underscore the need for targeted public health interventions and further research into the causes and management of skin conditions in camp populations. In addition to addressing medical concerns, the study aims to alleviate fear, anxiety, and misinformation related to COVID-19 vaccinations and other health issues, which were prevalent during the study period. Given the findings, future research should focus on long-term prevention measures, including the impact of environmental factors, and explore more effective strategies to mitigate such outbreaks.\u003c/p\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eRecommendation/Public Health Implications\u003c/h2\u003e \u003cp\u003eThe high incidence of rash development, coupled with the reported environmental and behavioral factors, suggests the need for a comprehensive public health intervention in the camp. Measures such as improving the quality of tap water, controlling insect populations, and educating camp participants about hygiene and the risks of skin contact with infected individuals could significantly reduce the prevalence of rashes. Moreover, medical personnel should be equipped to provide appropriate treatments, and more resources could be allocated to ensure timely intervention, especially for those whose rash is persistent or worsening.\u003c/p\u003e \u003cp\u003eBased on these findings, the following recommendations were made:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eImplement regular fumigation of orientation camps with eco-friendly, odourless fumigants.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eInstall insect-repellent lighting in common areas.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eEncourage Corps members to wear protective clothing, such as long trousers and socks, especially at nights.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eUse of insecticide-treated nets should be made compulsory for all corps members in the orientation camp as this would not only drastically reduce spread of disease such as malaria but would greatly minimize contact between corps members and other insects with the potential of causing harm.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eMandate use of insecticide-treated nets in orientation camps.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eInclude insect repellents in the list of recommended items for corps members.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eUtilize the study\u0026rsquo;s findings to address misinformation about the COVID-19 vaccine and other health concerns.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003ePromote research among Corps members to enhance evidence-based practices in public health.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to express our sincere gratitude to all the study participants for their willingness to participate and provide valuable insights for this research. Our appreciation extends to the past and present State Coordinators of Abia State National Youth Service Corps (NYSC), as well as the Camp Commandants and Heads of Assignments, for their support and for granting the necessary ethical clearance for the study.\u003c/p\u003e\n\u003cp\u003eWe would also like to acknowledge and extend our profound thanks to Dr. Chibuzor Nwakasi, Ph.D., MSPH, Assistant Professor in the Department of Human Development and Family Sciences at the University of Connecticut, USA, and Dr. Onyeka Chukwudalu Ekwebene, Department of Paediatrics, Infectious Disease, and Global Health, Indiana University School of Medicine, Indianapolis, USA, for their invaluable guidance, expertise, and unwavering support throughout the development of this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFinancial support and sponsorship\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. The study was conducted and funded by the authors personally.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical considerations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by the Abia State Coordinator National Youth Service Corp (NYSC) Ethics committee. Written and verbal consent was sought prior to administration of the questionnaire. The study is in compliance with the principle of the declaration of Helsinki. The confidentiality of information was maintained by excluding personal identifiers.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclaration of consent\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe authors affirm that all necessary consent forms have been obtained, duly signed by the participants. In these forms, participants have provided their consent for the inclusion of images and other clinical information in the study. Participants were assured that their names and initials will not be disclosed in any published materials, and efforts will be made to maintain their anonymity. However, while every precaution will be taken to protect their identity, complete anonymity cannot be guaranteed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was carried out in collaboration amongst all authors. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDisclosure\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors report no conflicts of interest in this work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests related to this work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data generated or analysed during this study are included in the submitted manuscript and will be made available upon publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Trial Number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study does not involve a clinical trial; therefore, registration was not required.\u003c/p\u003e"},{"header":"References","content":"\u003col start=\"1\" type=\"1\"\u003e\n\u003cli\u003eFrank JH, Kanamitsu K. Paederus, Sensu Lato (Coleoptera: Staphylinidae): natural history and medical importance. J Med Entomol. 1987; 24:155\u0026ndash;191.\u003c/li\u003e\n\u003cli\u003eMullen G, Durden L. Beetles (Cloeoptera). In: Medical and Veterinary Entomology. 2nd ed. London, UK: Academic Press; 2009:102.\u003c/li\u003e\n\u003cli\u003eUslular C, Kavukcu H. An epidemicity of Paederus species in the Cukurova region. Cutis. 2002; 69:277\u0026ndash;279.\u003c/li\u003e\n\u003cli\u003ePenchenier L, Mouchet J, Cros B, et al. Invasions de Paederus sabaeus (Coleoptera : Staphylinidae) en Afrique Centrale. I. Aspects entomologiques et \u0026eacute;pid\u0026eacute;miologiques. Bull Soc Path Ex. 1994; 87:45\u0026ndash;48.\u003c/li\u003e\n\u003cli\u003eArmstrong RK, Winfield JL. Paederus fuscipes dermatitis: an epidemic on Okinawa. The American Journal of Tropical Medicine and Hygiene. 1969; 18:147\u0026ndash;150.\u003c/li\u003e\n\u003cli\u003eSrichandan M. Skinpossible photo blog. 2011. www.flickr.com/ photos/skinpossible.\u003c/li\u003e\n\u003cli\u003ePiel J. A polyketide synthase-peptide synthetase gene cluster from an uncultured bacterial symbiont of Paederus beetles. PNAS. 2002; 99:14002\u0026ndash;14007.\u003c/li\u003e\n\u003cli\u003eBorroni G, Brazzelli V, Rosso R, M Pavan. Paederus fuscipes dermatitis: a histopathological study. The American Journal of Dermatopathology. 1991; 13:467\u0026ndash;474.\u003c/li\u003e\n\u003cli\u003eRahman S. Paederus dermatitis In Sierra Leone. Dermatol Online J. 2006; 12:9.\u003c/li\u003e\n\u003cli\u003eKarthikeyan K, Kumar A: Paederus dermatitis. Indian J Dermatol Venereol Leprol. 2017, 83:424-31. 10.4103/0378-6323.198441.\u003c/li\u003e\n\u003cli\u003eSrihari S, Kombettu AP, Rudrappa KG, Betkerur J: Paederus dermatitis: a case series. Indian Dermatol Online J. 2017, 8:361-4. 10.4103/idoj.IDOJ_238_16.\u003c/li\u003e\n\u003cli\u003eCapinera JL: Encyclopedia of entomology. Springer Science and Business Media, Florida (USA); 2008. 10.1007/978-1-4020-6359-6.\u003c/li\u003e\n\u003cli\u003eTodd RE, Guthridge SL, Montgomery BL: Evacuation of an Aboriginal community in response to an outbreak of blistering dermatitis induced by a beetle (Paederus australis). Med J Aust. 1996, 164:238-40. 10.5694/j.1326-5377.1996.tb94150.x.\u003c/li\u003e\n\u003cli\u003eTaneja A, Nayak UK S, Shenoi SD: Clinical and epidemiological study of Paederus dermatitis in Manipal, India. J Pak Assoc Dermatol. 2016, 23:133-8.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Burning sensation, skin lesions, electric ant, paederus dermatitis, irritant contact dermatitis (icd), NYSC Batch C Stream 1, 2021, covid-19 vaccine","lastPublishedDoi":"10.21203/rs.3.rs-6548315/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6548315/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eIntroduction\u003c/h2\u003e \u003cp\u003ePaederus dermatitis is an acute form of dermatitis triggered by the inadvertent crushing of insects from the \u003cem\u003ePaederus\u003c/em\u003e genus, which releases the vesicant toxin pederin. This condition is particularly prevalent during the rainy season and is commonly observed in tropical regions.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThe objective of this study was to investigate the potential causes, mode of transmission, and effective interventions for a sudden outbreak of skin lesions, identified as Paederus dermatitis, among Batch C, Stream 1 National Youth Service Corps (NYSC) members at the Umunna, Bende orientation camp in Abia State. A total of 157 corps members, who developed skin lesions between October and November 2021, were included in the study. Data were gathered through structured, interviewer-administered questionnaires, which documented participants' demographic information, medical history, and potential exposure factors. The collected data were analyzed using SPSS. All affected individuals received appropriate treatment, and preventive measures were recommended to reduce the risk of further outbreaks. Participants were monitored for two weeks until complete resolution of the lesions.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe majority of participants were aged between 20 and 25 years, with a female-to-male ratio of 2:1. Seventy-two percent of respondents reported developing the rash, although the statistical analysis revealed no significant association between human-to-human contact and rash transmission (p-value\u0026thinsp;\u0026gt;\u0026thinsp;0.05). In contrast, 67.9% of participants reported using tap water for bathing, which was significantly associated with the occurrence of skin lesions (p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Additionally, 90% of those affected had been bitten by an insect, with this exposure showing a strong correlation with the development of the rash (p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The insect responsible was identified as the \"electric ant,\" which closely resembles the \u003cem\u003ePaederus\u003c/em\u003e species. When crushed, the insect releases a coelomic fluid containing pederin, resulting in a linear erythematous rash accompanied by a burning sensation and pain. The typical attire of the corps members, consisting of white T-shirts and shorts, increased their vulnerability to insect contact. Regarding treatment efficacy, 37.8% of respondents rated the treatment as very effective, 36.9% as moderately effective, 16.2% as less effective, and 8.1% felt it had no effect. The treatment regimen consisted of topical steroids (hydrocortisone cream) and antibiotics (penicillin and gentamicin creams) to address the inflammation and prevent secondary bacterial infections.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe outbreak was chiefly attributed to exposure to the \u003cem\u003ePaederus\u003c/em\u003e insect. While Paederus dermatitis is commonly observed in tropical regions such as Nigeria, its diverse clinical presentation often leads to misdiagnosis. Enhancing awareness of the condition can facilitate accurate diagnoses and streamline treatment approaches, thereby minimizing patient confusion. Additionally, effective preventive strategies and treatment options were identified during the course of the study.\u003c/p\u003e","manuscriptTitle":"Investigating Skin Lesions Outbreak in a National Youth Service Camp South-Eastern Nigeria.","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-03 07:47:08","doi":"10.21203/rs.3.rs-6548315/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"3094ee62-1ff6-46eb-b885-50576209e29a","owner":[],"postedDate":"June 3rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-12-17T07:39:24+00:00","versionOfRecord":[],"versionCreatedAt":"2025-06-03 07:47:08","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6548315","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6548315","identity":"rs-6548315","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}