13 - Bites, Stings, Infestations Flashcards by michael english

What is human scabies?

Highly contagious dz caused by sarcoptes scabiei mite

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S/s of human scabies?

Bruising/excoriations from itching/scratching

Kids - vesicles

Secondary staph impetigo

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Human scabies may be mistaken for?

May be mistaken for atopic dermatitis

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Etiology of human scabies?

Mite
Skin to skin contact
Crowded living conditions
Can live for several days outside skin

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Who doesnt get scabies?

DPP rarely acquire it

We dont know why

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Common locations of scabies infection?

Slide 5

Arm pits
Belt line
Groin
Wrist 
Finger webbing
Anus 
Knees
Heels of Feet

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Morphology of scabies?

Create a burrow (tunnel)
- best seen where they cant scratch 
Itching (at night)
1st lesion is usually destroyed by scratching
Secondary lesions 
- pinpoint erosions (from scratching)

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Describe human scabies lesions?

Burrows 2-15mm long
Pink/white
Slightly elevated
Mite - black dot

MC location

finger webws
writs
sides of hands/feet
penis
buttocks
scrotum
palms/soles (infants)

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Diagnosis of scabies?

Clinical

Touch the burrow w a felt tipped pen and it will suck up ink

Deroof burrow #15 blade and transfer to slide w immersion oil
- mites, eggs, feces

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Tx for scabies?

Permethrin 5%
Lindane (1% kwell)
Ivermectin

Treat family members

HC in Eucerin for inflammation

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How long does itching last w scabies?

Continues until mite, eggs, and stool are expholiated

Tx w antihistamine prn

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Lindane 1% (kwell) rundown

Chemical pesticide
Toxic
NOT FOR KIDS <2
NOT FOR PREGGO
Pretreat w steroids
Apply to dry skin
Sleep nude (occlusion)
Only for confirmed infestation

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Ivermectin (stromectrol) basics?

Vet medicine

Human dose 12mg PO on day 1 and 8

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What types of scabies get ivermectin?

Norwegian scabies
HIV
Institutionalized
Nursing home
Tx failure

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Whats the deal with crusted Norwegian scabies?

HIV pts

Its a variant of scabies but

w 1000’s of mites
not much itch
highly contageous
scaly
significant crusts

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Where does crusted norwegian scabies like to go?

Primarily hands and face

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Pediculosis is aka?

Lice

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Clinical manifestations of pediculosis?

Pediculosis capitis - hairPediculosis corpis - body
Pediculosis pubis (crabs)

How to ID lice?

See them in seams of clothes

Woods lights - yellow-green to blue-green

Pediculosis etiology

Skin to skin contact
Formite to skin
Sex
Head like rare in DPP

Pediculosis management?

Clean/burn clothes

Clotes/formites bugs may survive 10 days - 3 weeks off a host

Body lice concerns?

Can carry typhus and trench fever

Pediculosis txt?

Body lice

permethrin (elimite)
(head to toe, leave on 10 min)

Head lice

permetherin shampoo
(10 min)
coat eyelashes w vaseline
wash w body shampoo TID x 5 days

Crabs (P. Pubis)

permethrin shampoo (for body)
comb/shave pubic hair
check for STI

All types of pediculosis need?

Tx close contacts
Retreat q 7-10 days
Wash/burn everything
- may be able to use dyer on high

MC skin disease among travelers to tropical countries?

Cutaneous larva migrans | Aka creeping eruption

Cutaneous larva migrans are commonly seen?

Back buttocks, foot/hand In the SE Us

Etiology of cutaneous larva migrans?

Accidental invasion of hookworms - burrows 1-2mm qd - long serpiginous lesions - larva eventually dies

Cutaneous larva migrans management?

Topical - steroid to decrease inflammation Oral (sever cases) - ivermectin repeat in 1-2 wks - albendazole x 3-7 days Its self limiting though so dont go crazy

Management of fleas?

``` Symptomatic tx - antihistamine - topical abx - topical steroids Get rid of fleas - treat pets - bedding ```

Presentation of bed bugs

On exposed skin Rows of 3-5 bites Adenopathy and fever (numerous bites) Look for bugs at night

Etiology of bed bugs?

Cimex lectularius

Management of bed bugs?

Get rid of bugs Symptomatic tx - antihistamines - topical preps PRN

What are chiggers?

Mite that attaches to human from tall grass

Presentation of chiggers?

Legs and belt line (or other ares of constriction) Intense itch FB reaction Persisten

Management of chiggers?

OTC chigger meds Nail polish Chig-a-way Treat symptoms

Unlike the previous stuff., fire ants?

Sting (not a bite) W immediate pain Also prone to anaphylaxis - wasps and bees are their cousins

Presentation of fire ant sting?

Wheal -> vesicle -> pustule

Tx for fire ant sting?

Symptomatic - cool compress - sarna lotion (OTC anti-itch) - antihistamine - steroids (if severe)

Presentation of cat scratch fever?

``` Exposure to cats - scratch or bite - fleas (may spread it) Malaise Low grade fever Ocular manifestations ``` More common in kids/teens

Morphology of cat scratch fever?

``` Single red papule (non-pruritic) Evolve to vesicle filled w sterile fluid Spread to node-enlarged Tender and firm May suppurate ```

Distribution of cat scratch disease?

Usually extremities but anywhere you got scratched/bit

Cat scratch fever diagnosis

Primary lesion - papule/pustule site in the presence of LAD and H/O cats Causative agent - bartonella henselas Lymph node biopsy - small plepmorphic bacilli - via warthin-starry silver strain

Tx for cat scratch disease?

Mild - spontaneous resolution in 4-6 wks Severe - Antibiotic therapy - azithromycin (z pack) - erythromycin - doxy Suppurative node can be drained - needle aspiration

What sound do porcupines make when they kiss?

ouch!