Micro- Lice and Scabies Flashcards

1
Q

What are the 2 chilopods?
Describe their structure. How do they differ?
Where are they usually located?

A

Millipedes and centipedes

  • both are elongated, multi-segmented
  • centipedes have poison claws, millipedes do not

They are found in leaf litter [usually in the tropics]
Bites are accidental or occupational and rarely fatal

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2
Q

What species is the tongue worm?
Describe the structure.
What syndrome do they cause?

A

Pentastomid [not insect or worm]

  • blood sucking endoparasite of reptiles, birds, mammals
  • 2 body segments [cephalothorax, abdomen]

Halzoun syndrome [essentially a hypersensitivity]

  • cough
  • sneeze
  • nasopharyngeal discomfort
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3
Q

What are the 2 types of crustacea?

What is each an intermediate host for?

A
  1. Copepod [water flea] is intermediate host for diphyllobothrium latum [tapeworm]
  2. Decapod [prawn, shrimp, lobster, crab] is the intermediate host for the flatworm Paragonimus westermani
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4
Q

Describe the structure of Arachnids.

What are the 2 major type?

A

Spiders and scorpions are arachnids.

They have 8 legs [4 pairs]
NO antennae
NO wings
2 body regions {cephalothorax, unsegmented abdomen]

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5
Q

Where do loxosceles reclusa live?

What do they cause?

A

Brown recluse spiders live in dark, cool places.

If they bite, they cause local necrosis that may sometimes need debridement.

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6
Q

What area of the body do the following mites infect?

  1. demodex folliculorum
  2. demodex brevis

Where do they live their entire life cycle?
How does rate of infection with these mites increase with age?
What percent are infected as adults?

A
Folliculorum = hair follicles on the face
Brevis = sebaceous glands on body and head 

Entire life cycle is in the follicle/gland

Rates are rare in childhood, increase at puberty and by adulthood 98-100% are infested

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7
Q

What family does the chigger/house mite belong to?
What is their regional distribution?
Describe how they elicit response from hosts?
How is the host treated?

A

They are trombiculidae which have a worldwide distribution as ALLERGENS.

The larvae feed on blood and then drop off. There is NO infestation.

Host has hypersensitivity rxn whh is treated with antihistamines, topical corticosteroids

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8
Q

What skin disease is caused by the “itch mite”?
What is the mite species? [RED]
How large are they?
What is their body structure?

A

Itch mites cause scabies.
- sarcoptes scabiei [RED]

They are 300-400nm long with sac-like bodies and 8 pairs of legs.

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9
Q

Describe the scabies life cycle.

A
  1. female mite burrows into the epidermis
  2. she lays 2 to 3 eggs daily
  3. Larvae hatch in 3-4 days
  4. 17 days later, the larvae are adults where they mate.
  5. male dies after mating, female lives for a month or 2 living in the burrow and continuing to lay eggs
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10
Q

What is the distribution of scabies?

A

You see linear red streaks:

  1. fingers and toes
  2. behind the knees
  3. intertriginous areas [groin, below breast]
  4. wrists
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11
Q

What is the primary symptom of scabies?

A

Itching - occurs at burrows in the “characteristic locations”

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12
Q

What causes the hypersensitivity reaction to scabies?

A

Hypersensitivity is to the mite and the egg

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13
Q

Who does Norwegian Crusted Scabies usually occur in?

What 2 things characterize Norwegian Scabies from classic scabies?

A

It usually occurs in immunocompromised patients:

  1. HIV
  2. HTLV-1

It is characterized by:

  1. severe scaling - cm to inches thick
  2. tremendous number of mites- 100s to 1000s
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14
Q

How is scabies diagnosed?

A
  1. Clinical
    - pruritic patient
    - typical distribution and appearance of lesions
  2. Scraping and microscopy
  3. biopsy
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15
Q

What is treatment for scabies?

Which is usually reserved for norwegian crusted scabies?

A
  1. permethrin
  2. hexachloroyclohexane
  3. Ivermectin - RESERVED FOR NORWEGIAN
  4. wash clothing in boiling water, bath, treat contacts
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16
Q

What is the body structure of lice?

A

Insects so:

  1. 3 body segments [head, thorax, segmented abdomen]
  2. six legs
  3. antennae
17
Q

What are the 3 types of lice?

A
  1. pediculosis humanis corporis
    - human body louse
  2. pediculosis humanis capitis
    - human head lice
  3. phthirus pubis
    - crab louse
18
Q

Describe the life cycle of lice.

A
  1. eggs are laid on human hair follicles or on clothing [contained in a nit]
  2. one week : eggs–> nymph
  3. 3 nymph stages–> mature adults
  4. Lay 200-300 eggs during the lifetime before dying
19
Q

What 2 types of lice complete their life cycle on the human body?
Which type lays eggs on the fibers of clothing and feed periodically on humans for blood meal?

A

Head lice and crabs = human body

Clothing = body louse

20
Q

What is the regional distribution of lice?

What 2 things does incidence of lice correlate with?

A

It is cosmopolitan [worldwide, no class differences]

Incidence correlates with:

  1. crowded environment
    - prison
    - schools
  2. poor personal hygienge
21
Q

How is lice transmitted?

A
  1. Person -to-person

2. Fomites - clothing, towels, bedding

22
Q

How long can lice survive in the environment without a blood meal? [RED]
What does this mean for treatment? [RED]

A

2 weeks

Treatment must often be repeated

23
Q

What are common symptoms of lice?

A
  1. pruritis [primary symptom]
  2. excoriations from scratching–> secondary infections/impetigo
  3. macules and papules
24
Q

How is lice diagnosed?

A
  1. examine hair for nits

2. examine skin for adults

25
Q

What is treatment for lice and scabies?

A

Permethrin [DRUG OF CHOICE FOR EACH]

  • hexachlorocyclohexane
  • malathion

Disinfect environment, bedding, clothing
Treat contacts.

MAY NEED TO REPEAT [RED]

26
Q

What is the mechanism of action of permethrin?

A

Is is a semisynthetic pyrethrin that is used as:

  1. insecticide
  2. neurotoxin

It prolongs activation of Na channels which kills adults [not eggs]

27
Q

How is permethrin delivered for scabies and lice?
What is the 1st course efficacy? Second course?

What are the 3 benefits that make it 1st choice for scabies/lice?

A

Scabies- 5% shampoo/lotion given overnight
Lice- 1% shampoo/lotion given 10min

Efficacy for 1 treatment =70%, 2 =95%

Benefits

  1. neurotoxin has lowest toxicity
  2. not absorbed well across skin
  3. easily biodegradable
28
Q

What is the mechanism of action of hexachlorocyclohexane?
What is the major benefit?
What is the major drawback/who is this contraindicated in?

A

It acts on GABA Cl channels at the NMJ of arthropods

Pro:
Highly specific for insects

Cons:

  1. Absorbed through skin with highest in : neonates, kids, elderly [thin skin] so it is contraindicated for these populations as well as pregnant/breast-feeding women
  2. tics, seizures, permanent damage
29
Q

What is the mechanism of action for ivermectin to treat scabies?
What are pros?
What are cons?

A

It acts on GABA -gated Cl channels at arthropod NMJ

Pros:

  1. specific for insects causing paralysis
  2. very little neurotoxicity
  3. doesnt cross BBB

Cons:
Reserved for Norwegian scabies

30
Q

What is the mechanism of action of malathion?

Why is is not used very often?

A

ACHEI at the neuromuscular junction causing tonic paralysis of the lice.

*smells bad, oily, toxic