Bugs & Bites

Question 1

What is Scabies?
Where is it m/c located?

Answer 1

• An intensely pruritic, contagious disease caused by Sarcoptes scabei transmitted by direct contact
• M/C in web spaces, body folds, wrists, between fingers & toes

Question 2

Itch that’s worse at night, other family members have similar sx

Answer 2

Scabies

Question 3

What skin manifestations are seen with Scabies?

Answer 3

• “Burrows”
• 1-2mm pustules (infants)
• Nodules/papules –> nodules on scrotum = scabies until proven otherwise!
• Eczematous reaction pattern with excoriation

Question 4

What labs should you order for Scabies?

Answer 4

• Skin Biopsy
• Mineral oil/KOH

Question 5

How do you treat Scabies?

Answer 5

• Permetherin topical cream
• Wash sheets in hot water
• Ivermectin
• Precipitated sulfur 6% if <2 mo old

Question 6

Head lice is m/c in?
Body lice is associated with?
Pubic lice is also known as?

Answer 6

• School-age kids
• Poor hygiene
• “Crabs” (STD)

Question 7

What skin findings to you see with lice?

Answer 7

• Live lice
• Pruritic papules
• “White dots” (nits) on hair shaft

Question 8

How is lice treated?

Answer 8

• Permetherin rinse (NIX/Elimite)
• Ivermectin
• Lindane
• Shaving to remove nits

Question 9

Linear distribution of bites

Answer 9

Bed Bugs

Question 10

How do you treat bed bugs?

Answer 10

• Topical steroids
• Antihistamines
• Extermination

Question 11

What’s the causative agent for Rocky Mountain Spotted Fever (RMSF)?

Answer 11

Rickettsia ricketsii

Question 12

RMSF is characterized by acute onset of?

Answer 12

• Fever
• Severe H/A
• Myalgia
• Vomiting
• Petechial rash (day 3-5, but not all develop a rash)

Question 13

What skin manifestations are seen with RMSF?
What’s the distribution?

Answer 13

• Discrete pink/purple macules that BLANCH with pressure then becomes petechial
• Diffuse vasculitis
• Starts on wrists & ankles –> palms/soles –> generalized

Question 14

Complication of RMSF rash?

Answer 14

Post-inflammatory hyperpigmentation

Question 15

T/F Labs are helpful for RMSF?

Answer 15

FALSE they’re rarely helpful

Question 16

How is RMSF treated?

Answer 16

Doxycycline

Question 17

What’s the causative agent for Lyme Disease?
What’s the vector/carrier?

Answer 17

• Borrelia Burgdorferi (spirochete)
• Ixodes scapularis (deer tick)

Question 18

When is Lyme Disease m/c?

Answer 18

Late spring early summer (endemic in NE & MW)

Question 19

When are sx typically seen with Lyme Disease?

Answer 19

3-21 days after bite

Question 20

What are S&S of Lyme Disease?

Answer 20

• Erythema migrans (round expanding target rash that blanches)
• Fever/Malaise
• H/A, Neck stiffness
• Mylagia/Arthralgia
• Cardiac complications

Question 21

How do you treat Lyme Disease?

Answer 21

Doxy or Amoxicillin

Question 22

What do you see with a Brown Recluse Spider bite?

Answer 22

Rash starts as painless red papules/plaques that develop central pallor (can get necrosis, toxin destroys tissue)

Question 23

How do you treat a Brown Recluse bite?

Answer 23

Supportive care (rest, ice, analgesic):
- Local wound care
- Abx/tetanus
- Oral steroids
- Hyperbaric chamber w/i 24 hrs to prevent necrosis