Insect and parasite disorders Flashcards
Lice presentation
occurs worldwide, lice are gray-white, 2-3 mm in length, eggs are called nits, feed on scalp, face and neck
Lice diagnosis
need visualization of lice, wet combing is preferred method, can also use UV light (lice glow light blue), nits alone do not mean active infestation
Lice treatment
1st: topical pediculicides (permethrin) if older than 2 months old. If younger then must remove manually. Oral ivermectin if topical fails
scabies presentation
caused by sarcopetes scabiei, not visible with eye, ,4-6 week incubation period, pruritus caused by feces and eggs in epidermis
scabies treatment
topical permethrin, treat household items as well. massage into skin and remove by shower 8-14 later. In nursing homes ivermectin is 1 st line. Decontaminate clothes by placing in plastic bag for 3 days, can return to school day after treatment
Hymenoptera presentation
history of sting or bite, patient can usually identify what stung them
Hymenoptera localized symptoms
pain, erythema, edema, pruritus; fire ants cause sterile pustules
Hymenoptera systemic reactions
urticaria, angioedema, anaphylaxis
massive envenomation symptoms
vomiting, diarrhea, rhabdomyolysis, myocardial injury, renal/hepatic failure
Hymenoptera treatment
single sting: discharge if symptoms are minor, prescribe H1 blocker for symptoms
>100 stings, extreme age/comorbidities/systemic manifestations: admit
if <100 stings/asymptomatic: discharge after 6 hours
any person with systemic reaction should be prescribed epipen and referred to allergist.
brown recluse signs and symptoms
two puncture marks, erythema, red plaques, vesiculation, pain, necrosis, systemic illness (only in South America)
brown recluse diagnosis
usually not definitive b/c patient does not see bite happen, if symptoms are systemic run diagnostics to check for hemolysis, rhabdomyolysis, and AKI (CBC w/ differential, type/screen and coombs test, lactate dehydrogenase, serum uric acid, UA, PT/INRA, D-dimer, fibrinogen, EKG)
Brown recluse treatment
local: clean, analgesia as needed, tetanus prophylaxis
necrosis: no proven care, surgery for lesions >2 cm 2-3 weeks after bite, antivenom is available in South America
Black Widow Symptoms
asymptomatic initially, erythema at site in 1 hr with target lesion, generalized symptoms in 30-120 minutes like abdominal rigidity, severe pain (lower–> abdomen, upper–> chest)
Black widow treatment
mild: local wound care, tetanus, oral analgesics, oral benzodiazepines and discharge. moderate: local wound care, tetanus, IV opioids, IV benzodiazepines, antiemetic therapy, admit if IV is needed. Use antivenom only if severe symptoms because could cause adverse reaction.
