Lice, Scabies, Spider Bites Flashcards
Medical Term for Lice
Pediculosis
Define Pediculosis
Ectoparasites that live on the body & feed on human blood after piercing the skin
Clinical Presentation
Pururitis Secondary cellulitis Pubic lice: eval for other STIs Pink eye Swollen lymph nodes
Diagnosis of Pediculosis
Eggs (nits) Nymphs Mature lice Found behind ears & back of neck Wood lamp of area
Focus of Treatment of Pediculosis
Neurotoxicity
Suffocation via “coating”
Hyper-excitation & death by paralysis
Treatment of Pediculosis
Permethrin 1% lotion (Nix)
Benzyl alcohol 5% lotion (Ulesfia)
Spinosad 0.9% (Natroba)
Environmental control
Medical Term for Scabies
Sarcoptes Scabiei
What is scabies?
Parasite that burrows under the host’s skin causing intense itching
Transmission of Scabies
Objects
Direct skin to skin contact
Crowded conditions
How long until patient’s become symptomatic?
2-6 weeks
What causes the itching?
Allergic reaction to the mites
Worse with warmth
Usually worse at night
Watch for excoriation
Diagnosis of Scabies
Scraping of skin
View under microscope
Treatment for Scabies
Permethrin Cream 5%
Lindane Lotion 1%
Oral Ivermectin
SE of Permethrin Cream 5%
Mild to moderate burning & stinging
Itching
Rash
Redness
Education for Permethrin Cream 5%
Apply head to toe
Leave on 8-14 hours then wash with soap & water
Repeat in 7 days
Treat family members & sexual partners
Other Treatment for Scabies
Wash clothing, bedding, towels in hot water & dry with hot temp
Pruritis: atarax (hydroxyzine), benadryl
Steroid cream
Lindane Lotion 1% for Scabies
More neurotoxic
Head to toe
Oral Ivermectin
More effective than Lindane
Less effective permethrin
Oral medication
2 Spiders That are a Threat to Humans
Black widow
Brown recluse
Insect Bites that Mimic Spider Bites
Ant bites Bedbug bites Flea bites Fly bites Reduviid bug bites Mite bites Tick bites
Skin Disorders that Mimic Spider Bites
Erythema chronic migrans Erythema nudism Leukocytosclastic vasculitis Sporotrichosis Toxic epidermal necrolysis
Infections that Mimic Spider Bites
Chronic herpes simplex Cutaneous anthrax Disseminated gonococcal infection MRSA Septic emboli in endocarditis or IVDU
Trauma that Mimics Spider Bites
Self-inflicted injuries
Subcutaneous drug injection
Location of Black Widow Spiders
Worldwide
Location of Recluse Spiders
North & South America
Acute Presentation of Spider Bites
Appears within minutes
Papule
Pustule
Wheal
Recent History with Black Widow Spider Bites
Recent
Symptoms of Black Widow Spider Bites
Muscle pain Mild pain at site Tremor Weakness Shaking of the extremity Distressed & inconsolable (infants & children) Refusing food & drink (infants & children) Generalized erythema
Physical Findings of Black Widow Spiders
VS normal (70%) Intermittent muscle rigidity & tenderness adjacent to the bit Weakness Tremor Myoclonus Diaphoresis Blanched circular patch Surrounding red perimeter Central puncture Appears "target" lesions
Diagnosis of Black Widow Spider Bite
S/S with Hx Leukocytosis Elevated creatinine, liver enzymes EKGs (cardiac risk) Cardiac enzymes (cardiac risk)
PE Findings of Mild Envenomation from Black Widow Bites
Localized pain at bit
Normal VS
PE Findings of Moderate Envenomation from Black Widow Bites
Muscular pain in area
Extension of muscular pain to chest or abdomen
Local diaphoresis at bite
Normal VS
PE Findings of Severe Envenomation from Black Widow Bites
Generalized muscular pain in back, abdomen, & chest Diffuse diaphoresis ABnormal VS: tachycardia, tachypnea N/V Headache
Treatment of Mild Envenomation of Black Widow Bites
Local: clean bite
Analgesia: acetaminophen, ibuprofen, oxycodone or hydrocodone
Muscle relaxers: Valium, methocarbamol (Robaxin)
Tetanus prophylaxis
Treatment of Moderate to Severe Envenomation of Black Widow Spiders
Local wound care Tetanus prophylaxis Parenteral opioids, benzodiazepines Antiemetic therapy Antivenom administration
Risk of Antivenom Administration
Anaphylactic reactions
Pregnancy Category of Antivenom Administration
Category C
Where are brown recluse bites normally?
Upper extremities
Thorax
Inner thigh
Areas Where Brown Recluse Spiders are Located
South
West
Midwest
Local Symptoms of a Brown Recluse Bite
Develop 2-8 hours after a bite
Painless initially
Minor burning
Severe pain at site after 4 hours
Systemic Symptoms of a Brown Recluse Bite
Malaise
N/V
Fever
Myalgia
Physical Findings of a Brown Recluse Bite
Initially: bite site mildly red May reveal fang marks Blistering Necrosis of skin & subcutaneous fat Severe destructive necrotic lesions with deep wide borders
Diagnosis of a Brown Recluse Bite
History
Clinical Presentation
Definitive: spider seen, recovered, collected & identified
Conditions Mistaken for a Brown Recluse Spider Bite
Bacterial Deep fungal Pseudomonas aeruginosa Parasitic Viral Topical & exogenous causes Venous Neoplastic disease Necrotizing vasculitis Diabetic ulcers
Treatment of Brown Recluse Bite
Local wound care
Pain management: NSAIDs or opioids
Tetanus prophylaxis
Dapsone to prevent progression to necrosis & reduce pain
Local Wound Care of Brown Recluse Bites
Clean with mild soap & water
Apply cold packs
Maintain affected part in elevated or neutral position
