11. Skin Disease in Aboriginal and Torres Strait Islander Peoples Flashcards
Which of the following statements is true?
Which of the following statements is true?
Which of the following statements is true?
Definition of:
- Indigenous people?
- Aboriginal?
Definition of:
- Torres Strait Islander people?
Systemic Lupus Erythematosus in Aboriginal and Torres Strait Islander Peoples.
- Prevalance?
- Causes of higher prevalence?
- Clinical features?
- Main differential?
Main differential diagnosis = tinea faciei - very common in Aboriginals in remote communities.
Systemic Lupus Erythematosus in Aboriginal and Torres Strait Islander Peoples.
- Management?
What is Neonatal Lupus Erythematosus?
Diabetes in Aboriginal and Torres Strait Islander Peoples.
- Background?
- Clinical features?
- Management?
Management - The dermatologist mainly helps in diagnosis. Management is usually carried out by the general practitioner in consultation with cardiology, endocrinology, other specialists, and allied health.
Streoptococcal Pyoderma, Rheumatic Fever, and Glomerulonephritis
- Background: 4 Risk factors for Pyoderma?
- Clinical features?
Streoptococcal Pyoderma, Rheumatic Fever, and Glomerulonephritis
- Background: 4 Risk factors for Pyoderma?
- Clinical features?
Community Acquired MRSA
- Background?
- Clinical features?
Tinea
- Background?
- Tinea Corporis: Clinical features?
Tinea
- Tinea Capitis: Clinical features?
- Differentials?
- Diagnosis?
Management of:
- Tinea corporis?
- Tinea capitis?
- Tinea unguium?
Which investigations will you order?
4 Differentials?
Differential Diagnoses
1. Tinea Corporis
2. Subacute SLE
3. Psoriasis
4. Paraneoplastic Erythema Gyratum Repens
Management?
Pityriasis Versicolor
- Background?
- Clinical features?
Pityriasis Versicolor
- Diagnosis?
- Management: Topical treatments?
- Management: Oral treatments?
What investigations should be performed?
A skin scraping for direct microscopy to look for the “spaghetti and meatballs” pattern of yeasts and mycelium of pityriasis versicolor.
However, due to the remote location, you do not have access to a microscope to conduct a KOH examination. The scrapings will have to be sent to a laboratory in a major centre.
Scabies in Aboriginal and Torres Strait Islander Peoples
- Background: Prevalence? Transmission?
- Clinical features?
Scabies in Aboriginal and Torres Strait Islander Peoples
- What is crusted scabies?
Scabies in Aboriginal and Torres Strait Islander Peoples
- Diagnosis: Which test?
- Management: Topical treatment?
Scabies in Aboriginal and Torres Strait Islander Peoples
- Management: Preventing recurrence?
- Management: Crusted scabies?
Which investigations would you perform for this man and how would you manage him?
Give a clinical summary of Leprosy in Australia.
- Where is it found?
- Lesions?
- Treatments?
- Transmission?
- Organism?
- Classification?
Leprosy in Australia.
- History? (8)
- Examination: Skin? Nerves? Eyes?
Leprosy - Clinical Features
- Tuberculoid leprosy?
- Lepromatous leprosy?
Leprosy
- Diagnosis?
- 7 Pre-treatment investigations?
- Management?
Pre-treatment investigations should include:
1. CBE
2. EUC
3. LFT
4. HIV Ab
5. Glucose-6-phosphate dehydrogenase levels
6. CXR
7. Mantoux or QuantiFERON gold
Melioidosis
- Organism?
- Transmission?
- Epidemiology?
Transmission of Melioidosis
- Infection is commonly acquired through the skin, usually via an abraison, cut or ulcer which comes into contact with contaminated vegetable material, soil or water.
- The other common route of infection is via inhalation.
- Rarely the transmission may be human-to-human, nosocomial (from bronchoscopes and surgical equipment), animal-to-human, sexual, vertical, and laboratory-associated infection in microbiology staff.
Melioidosis
- Risk Factors?
Melioidosis
- Clinical Manifestations?
- Skin?
- Systemic?
Clinical Manifestations
1. Disease may be acute, subacute, or chronic. Incubation time may range from a few days to over 20 years.
2. Subclinical infection is relatively common. In Northern Australia, 10% of Aboriginal people are seropositive for past exposure. Of Vietnamese refugees, 29% are seropositive. In Thailand, 15% of the population is seropositive.
3. The organism can remain latent in the body and later reactivate. It may be found in the lungs of people with chronic lung disease and may possible be found in the bowel.
4. Disease may involve one or more organ systems.
Melioidosis
- History? (2)
- Examination? (4)
- Investigations? (6)
Melioidosis - Diagnosis & Treatment
- What will it show in staining?
- Which medium should be used?
- 2 Patterns of histology?
- Antibiotic Susceptibility?
- Treatment? (6 points)
The organism of often susceptible to:
1. Ceftazidime
2. Piperacillan/Tazobactam
3. Ticarcillin/Clavulanate
4. Amoxicillin/Clavulanate
5. Meropenem
6. Trimethoprim/Sulfamethoxazole
7. Doxycycline
8. Chloramphenicol
What further information would you like to know on history?
- Where has he been?
- What has he been doing?
- Detailed history of what has happened to his leg?
What examination assessment should you perform?
- What is the clinical differential diagnosis for the clinical findings at the right leg? (This question is NOT asking for a microbiological diagnosis). (2)
- What specimens do you wish to collect for microbiology prior to commencing antibiotics? (6)
Differentials for right leg:
1. Bullous cellulitis
2. Necrotizing fasciitis/myonecrosis
Micro Specimens:
1. Blood cultures
2. Aspirate of the bulla
3. Sputum sample
4. Urine sample
5. A skin biopsy in an area of cellulitis
6. A swab of inoculation site on the lower leg.
= Aboriginal lupus patients in the Northern Territory can develop disseminated strongyloidiasis.
= Aboriginal patients with diabetes die at a significantly younger age than Causasian patients.
= Scabies can predispose to pyoderma.
= Scabies in babies involved the head and neck in tropical areas.
