Bites, insects and skin trauma

Question 1

Lice tx

Answer 1

Permetherin cream
- everyone in family needs treatment
wash all bedding

Question 2

Scabies Tx

Answer 2

Permetherin - apply from neck down and wash off 8-12 hrs later
- entire household must be treated
- clean all beddings and towels and no sharing

Question 3

Lyme disease symptoms

Answer 3

Fever
Headache
Fatigue
Myalgias
Athralagias
TARGET / BULLS EYE RASH
lymphadenopathy

Question 4

Complications of lyme disease

Answer 4

Bell’s palsy
Palpitations
3rd degree AV block
Aseptic meningitis
Polyarticular athralgias / joint effusions

Question 5

Cause of lyme disease

Answer 5

Bacteria - borrelia burgodorferi
MAY BE transmitted via infected deer tick bit

Question 6

Lyme disease Dx and Tx

Answer 6

Dx
- Lyme ELISA
- western blot

Tx
- remove carefully by twisting and pulling (body poisonous so shouldnt break off)
- Doxycycline (tetracycline contraindicated in pregnancy and children under 12)
- Amoxcillin instead if pregnant or under 12 yrs
- azithromycin if allergic to penicillin and pregnant or under 12
- refer if neuro involvement

Question 7

Management of animal bite

Answer 7

Control bleeding
Irrigate with germicidal
Consider tetanus
Consider rabies prophylaxis
Prophylactic Abx if cat bite as more likely to become infected - co-amoiclav (doxy + metronidazole if allergic)
- Refer to A+E if bit to hands/feet/face or if bite involves bones/tendons/arteries/nerves (likely with dog bite)

Question 8

Considerations with doxycycline and metronidazole

Answer 8

Doxycycline - photosensitivty - stay out of sun, stay covered and use suncream
Metronidazole - no alcohol

Question 9

Ix for human bites

Answer 9

Serology for blood borne viruses esp if skin is broken - HBV, HCV, HIV
Consider prophylaxis - HBV immunisation and antivirals for HIV esp if immunocompromised
Antibiotics - coamoxiclav 1st line (doxycycline and metronidazole if allergic)