Infestations and Bites - Patel Flashcards
who does scabies affect? who does it more commonly affect?
Sarcoptes scabiei (scabies) affects patients of all ages and all scoioeconomic classes, although it is more common in women and children
How does one contract a scabies infection?
most infections occur from direct contact w/ an infected individual; fomites can transmit infection
Who is at especially increased risk of contracting a Scabies infection?
those in group settings (nursing homes) or in an immunocompromised state
in Scabies, what is the time from initial infestation to symptoms
3-4 weeks once sensitizied to the mite, re-infestation results in symptoms within 1-2 days
Where do papules commonly occur on the body in Scabies?
axillae, breasts, umbilicus, penis, scrotum, finger webs and wrists
Scalp and head scabies infection is more common in what subset of patients?
Infants, elderly, and immunosuppressed
what is the hallmark clinical feature, symptom, seen in Scabies (not sign)
itching at night
what is pathognomonic for scabies - this is $$$
Burrows - linear markings in the skin due to the mvmt of the mite, they are 1-10 mm in length
where do you most commonly find the burrows seen in scabies
interdigitial spaces, wrists, and elbows
what do you do in a patient that you suspect has scabies - be specific
skin scraping - mineral oil preparation use a 15-blade scalpel and scrape a burrow on the skin - scraped material is then placed on a slide and a drop of mineral oil is added - a cover slip is placed on top and you look through a microscope - look for the scabies mite, eggs, or scybala (feces)
what is crusted scabies also called and who is most at risk of developing
hyperkeratotic (thickening of epidermis) scabies. hence the term “crusted”
immunosuppressed or neurologically impaired individuals are at increased risk
what is the presentation of crusted scabies
thick, scaly, white-gray plaques with minimal pruritis
where on the body does crusted scabies often present
scalp, face, back, buttocks, feet
what is the importance of fissures in crusted scabies
provide an entry for bacteria leading to increased risk of sepsis and death
what happens to immunocompetent individuals who come in contact w/ crusted scabies
they develop typical scabies
what is a good differential finding in crusted scabies to help you diff from typical scabies - this is symptom of pt
pts do not complain of itching
In general, what is the treatment strategy for scabies
two pronged approach both the pt and the environment must be treated
what is the specific treatment strategy for the patient in treating scabies (the first prong)
two topical treatments separated one week apart with a prescription anti-scabietic medication
what is “post-scabietic” pruritis or dermatitis and the significance?
itch and lesions can persisit for 2-4 weeks after successful tx - this is not tx failure, rather it represents the body’s response to dead mites
what is the specific 2nd prong of treatment for scabies, how you treat the env
washing all clothing and linens within the last week in hot water and drying on high heat. items that cannot be washed, seal items in bags for 3 days alternatively, just burn it all. burn it all to the fucking ground
for scabies treatment, is isolation from other ppl necessary or not? why or why not?
isolation is unnecessary - the scabies mites cannot jump or fly, and can survive for only approx 72 hours away from skin
what is the first line tx medication for scabies? what pt populations can you use this in?
5% permethrin cream pts older than 2 mos age DO NOT use in pregnancy
what is treatment for crusted scabies?
combination therapy multiple doses of oral ivermectin topical permethrin - freq more than 2 treatments are required
do crusted scabies pts need to be isolated?
yes - due to the high mite burden
