Bites & Infestations Dan Flashcards
T/F
Scabies is acquired from domestic dosg
False
dogs have different species
human scabies lives whole life in the epidermis
dog scabies cause itch in humans but do not establish infection
T/F
scabies is due to sarcoptes scabeii var hominis
True
How long do scabies mite survive off a human host?
ABTSI module says 56 hrs
Rook says 24-36
both agree depends on temp and humidity
T/F
scabies mites have 4 pairs of legs
True
T/F
The male scabies mite is larger than the female
False
female is larger and may see eggs and feaces associated with female mite
females rear 2 sets of legs are closer to the middle of the body, males are closer to the rear of the body
T/F
It takes 2-6 weeks after infestation for symptoms of scabies to appear
True
when symptomatic it is said the pt is sensitized - they are mounting a low level immune response against the mites resulting in the itch - immediate and delayed type hypersensitivity
Pts who develop crusted scabies are often not completely sensitized
T/F
A scabies mite lives for 2-3 months
False
4-6 weeks
T/F
A person will become itchy within 1-2 days of reinfested with scabies after previous sensitization
True
T/F
The scalp and face are commonly involved in scabies infestation
False
usually spared in adults but involved in children, elderly or immuncompromised
T/F
secondary staph infection is common in crusted scabies
True
T/F
KOH is helpful for identifying scabies on slides
False
mineral oil should be used
T/F
Pink pigtail like structures are a clue to the diagnosis of scabies on histology
True
thought to be empty egg shell cases or perhaps adult mite exoskeleton
What are Scybala?
scabies feaces pellets - round amorphous structures on histo
T/F
a pt with scabies infestation typically has hundreds of adult mites on them at any time
False
usually not many mites
hundreds present in crusted scabies
How is scabies treated in adults and children
Adults, kids over 2 months and preg and breastfeeding women should all be treated with lyclear 2 treatments
Kids under 2 months can be treated with 5% precipitated sulphur in WSP
In kids, elderly and immune suppressed must apply topicals to face and scalp, not just neck down
T/F
Nits and head lice are the same thing
False
although ‘Nits’ is often used to refer to head lice the nits are actually the eggs attached to the hairshaft
white nits are hatched eggs, brown nits are viable eggs
What is the organism responsible for head lice
Pediculus capitis
Infestation is called pediculois capitis
T/F
head lice have 8 legs
False
6 legs
T/F
girls get head lice more than boys
True
T/F
head lice are common amongst afro-caribbean kids
False
rare as dont like coarse curly hair
How are head lice identified?
Wet hair and apply conditioner to stun lice and allow comb to pass easily
comb hair with fine nit comb and wipe off on paper towel to look for lice and nits
What measures should be taken if head lice are suspected?
Make diagnosis
check all household members and close contacts
Notify school so other kids can be assessed
treat case and family members
hot wash pillow cases, wash or discard hair brushes etc
child can go to school if treatment started
Permethrin or malathion are Rx of choice + repeated combing
some lice are resistant to permethrin and even malathion
Ivermectin can be used in resistant cases - single dose usually works well
T/F
Body lice may be found in large numbers on human skin
False
usually live mainly in clothing esp in seams
esp affect homeless and people unable to wash or change their clothes for a long period
T/F
Body lice may transmit endemic typhus
True
also trench fever and relapsing fever
What is the organism responsible for body lice
Pediculus humanis var corporis
pediculus corporis
T/F
body lice are smaller than head lice
False
larger
otherwise look the same
what are the features of body lice infestation
pediculosis corporis
Very itchy papules or pinpoint red lesions esp on neck, shoulders, back and waist
may have LNs
may skin sores/ impetigo
see stains on clothes and sheets from blood and foeacal pellets
How is body lice managed?
incinerate clothes, sheets and towels
if not possible hot wash and machine dry then hot iron seams or leave in sealed plastic bag for 2 weeks before wearing again
alternative is to fumigate clothes with DDT, permethrin or malathion
good wash of body repeated regularly is usually sufficient
sometimes topical pediculicide is used in same way as for head lice but usually not necessary
what is the organism responsible for pubic lice?
pthirus pubis
(crab louse)
shorter, wider body than head/body lice, with 6 legs with hooks on ends of 4 of them - resemble crabs
about 1mm long
T/F
pubic lice usually affect at least 2 hairy regions and not always pubic area
True
can be perianal hair, beard, eyelashes or axillae
T/F
pubic lice are always spread by sexual contact
False
can be just close contact or from contaminated clothing or linen
T/F
women are affected by pubic lice less often than men
True
? due to less body hair
T/F
Lice usually cannot survive more than 36 hrs off a human host
True
T/F
pubic lice present with itch and both lice and nits may be seen on hair shafts typically near the base
True
can be erythema around follicles
rare blue-grey macules on trunk and thighs in chronic cases due to bites - macula cerulea
T/F
Pts with pubic lice should be treated with topical insecticide such as permethrin but pt with body lice usually only need treatment of their clothes and basic hygeine measures
True
T/F
Tungiasis occurs in C America, africa and asia due to jumping flea called Tunga penetrans
True
burrows into dermis then releases eggs then dies
presents with small black lesion which enlarges into nodule
can get secondary infection including tetanus and gangrene
self resolves or Rx w/ curette or topical ivermectin. Oral ivermectin not effective
T/F
Botfly infection is synonymous with cutaneous myiasis
True
is infestation of the skin by the larvae (maggots) of one of several species of fly in the family Diptera
e.g. human botfly (dermatobia hominis), Tumbu fly
T/F
botfly larvae infecting a wound is known as wound myiasis, and when the larvae invades intact skin causing a boil-like lesion it is called furuncular myiasis
True
T/F
botfly infestation is self limiting
True
but can be serious if close to nose, eyes, sinuses or on scalp
can treat with oral or topical ivermectin or suffocate larva with vaseline occlusion of air hole and remove with forceps when it emerges
T/F
Botfly larvae are easily removed when in the skin
False
have barbs and tapered body to prevent extraction
need to kill then remove or suffocate so it exits the burrow
e.g. LN2, curettage
or vaseline or steak occlusion
What is creeping myiasis?
Due to cattle or horse fly larvae in skin
like larva migrans but moves more slowly and persists longer
what disease are transmitted by mosquitos?
malaria filariasis yellow fever West Nile virus dengue fever
T/F
exagerrated bite reaction with bullae or necrosis are associated with chronic EBV infection
True
Asian or Hispanic children and adolescents with chronic EBV infection and proliferation of EBV-carrying NK cells
In widespread or severe rcns consider HIV or CLL (eosinophilic dermatosis of haematological malignancy)
T/F
Animal fleas rarely bite humans
false
commonly do bite but dont cause established infestations
esp bite lower legs and feet/ankles
human fleas are very rare and most flea bites in humans are from domestic animal fleas
T/F
The human flea is called pulex irritans
true
occurs in high density low hygeine groups
what are the organisms known as bed bugs?
Cimex lectularius or C. hemipterus