Infestations Flashcards
Which infestation is characterized by intractable pruritus at night?
Scabies
Which infestation is characterized by itching, burrows and leaves a linear rash?
Scabies
What is the first line treatment for scabies?
Permethrin 5% cream at bedtime to entire body except the head. Prescribe 1 tube for each application.
Apply to folds. Wash off in the am.
Repeat in one week.
Oral ivermectin for crusted scabies
Wt based.
Repeat in one week
Not for PG, lactating or kids <15g
How is scabies transmitted?
Direct skin to skin contact through sexual contact or sharing a bed with an infected individual.
What are the common infestation sites for scabies?
interdigital spaces, flexures of the wrists and arms, genitals, feet, buttocks and axillae.
Name 3 diagnostic criteria for scabies.
Dermoscopy - make burrows more visible
Adhesive tape test
Scabies prep - a drop of mineral oil is placed on a burrow and the lesion is scraped or shaved then viewed under a microscope.
What are some preventative measures for scabies?
Cut nails to prevent scratching.
Wash everything in hot water
Use hottest setting in the dryer
Seal bedding in a plastic bag for 2 weeks
Vacuum stuffed sofas and chairs
Treat family members and sexual partners.
How long does it take itching to resolve for scabies?
Up to 4 weeks after eradication due to the hypersensitivity of the rash that this still active.
Name two supportive treatment measures for scabies.
Oral antihistamines
Emollients
How long is the life span of lice?
30 days
Which infestation is most common in school aged children?
Pediculosis (head lice)
How long can lice survive off the scalp?
4 days
Nits - 10 days
How is lice diagnosed?
Diagnosis is confirmed by detection of lice. Nits alone are not dx or active infestation.
What is the first line treatment for head lice?
Permethrin 1% cream (OTC >1mo old)
Apply to damp hair and rinse after 10 minutes.
Don’t wash hair for 48 hrs.
Repeat in 7 days if >1mo old
Spinosad (>6 mo) Ivermectin topical (>6mo)
What is a complication of lice?
Impetigo may occur as a secondary infection.
What are some preventative measures for lice?
Discard infested clothing or linens.
Soak personal grooming items in hot water for 15-30 minutes.
Wash clothing/bedding in hot water.
What are the common areas to find lice?
Behind the ears and occipital region.
What are symptoms of lice?
Asymptomatic
Pruritis after 4-6 weeks
How is lice transmitted?
Physical contact, sharing hats, pillows, brushes etc.
What is first line treatment for pubic lice?
Oral ivermectin due to migration
Repeat at day 8 and 15
Treat sexual partners
When should kids return to school after having head lice?
Children should not be excluded from school due to head lice.
The provider is prescribing 5% permethrin cream for an adolescent patient who has scabies. What will the provider include in education for this patient?
a. All household contacts will be treated only if symptomatic.
b. Itching 2 weeks after treatment indicates treatment failure.
c. Stuffed animals and pillows should be placed in plastic bags for 1 week.
d. The adolescent’s school friends should be treated.
ANS: C
Bedding and clothing of persons with scabies should be washed in hot water and dried on hot dryer settings. Items that cannot be washed should be put in plastic bags for 1 week. All household contacts should be treated. Itching may persist as a result of the secondary dermatitis for up to 2 weeks and does not represent treatment failure. Casual contacts do not require treatment.
A patient has a pruritic eczematous dermatitis which has been present for one week and reports similar symptoms in other family members. What will the practitioner look for to help determine a diagnosis of scabies?
a. Bullous lesions on the soles of the feet and palms of the hands
b. Intra-epidermal burrows on the interdigital spaces of the hands
c. Nits and small bugs along the scalp line at the back of the neck
d. Pustular lesions in clusters on the trunk and extremities
ANS: B
The scabies mite typically burrows no deeper than the stratus corneum and burrows may be found in the interdigital spaces of the hands, among other places. Bullous lesions may occur with impetigo. Nits and small bugs are characteristic findings with pediculosis. Pustular lesions represent superficial skin infections.
What instructions will the primary care provider give to parents of a child who has scabies who is ordered to use 5% permethrin cream?
Select all that apply:
a. Appy the cream at bedtime and rinse off in the am.
b. it is not necessary to wash bedding or clothing when using this cream.
c. Massage the cream into the skin from head to toe
d. The rash should disappear within a day or two after using the cream.
e. use once now and repeat the treatment in 1-2 weeks.
ANS: A, E
Permethrin cream should be applied from the neck down in children and rinsed off in 8-12 hours. the treatment should be done once and then repeated in 1-2 wks. bedding and clothing should be washed thoroughly. Adults should apply from head to toe, since the scabies can infest the hairline of adults. the rash may still be present for several weeks after treatment.
